bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Practical Dosing Algorithm for Deep Neuromuscular Blockade during Total Intravenous Anesthesia: ROCURITHM
Authors: Albers-Warlé Kim I. , Reijnders-Boerboom Gabby T. J. A. , Bijkerk Veerle , Torensma Bart , Panhuizen Ivo F. , Snoeck Marc M. J. , Fuchs-Buder Thomas , Keijzer Christiaan , Dahan Albert , Warlé Michiel C. 
Published: May 2024

Background
The number of trials investigating the effects of deep neuromuscular blockade (NMB) on surgical conditions and patient outcomes is steadily increasing. Consensus on which surgical procedures benefit from deep NMB (a posttetanic count [PTC] of 1 to 2) and how to implement it has not been reached. The European Society of Anaesthesiology and Intensive Care does not advise routine application but recommends use of deep NMB to improve surgical conditions on indication. This study investigates the optimal dosing strategy to reach and maintain adequate deep NMB during total intravenous anesthesia.

Methods
Data from three trials investigating deep NMB during laparoscopic surgery with total intravenous anesthesia (n = 424) were pooled to analyze the required rocuronium dose, when to start continuous infusion, and how to adjust. The resulting algorithm was validated (n = 32) and compared to the success rate in ongoing studies in which the algorithm was not used (n = 180).

Results
The mean rocuronium dose based on actual bodyweight for PTC 1 to 2 was (mean ± SD) 1.0 ± 0.27 mg · kg−1 ·h−1 in the trials, in which mean duration of surgery was 116 min. An induction dose of 0.6 mg ·kg−1 led to a PTC of 1 to 5 in a quarter of patients after a mean of 11 min. The remaining patients were equally divided over too shallow (additional bolus and direct start of continuous infusion) or too deep; a 15-min wait after PTC of 0 for return of PTC to 1 or higher. Using the proposed algorithm, a mean 76% of all 5-min measurements throughout surgery were on target PTC 1 to 2 in the validation cohort. The algorithm performed significantly better than anesthesiology residents without the algorithm, even after a learning curve from 0 to 20 patients (42% on target, P ≤ 0.001, Cohen’s d = 1.4 [95% CI, 0.9 to 1.8]) to 81 to 100 patients (61% on target, P ≤ 0.05, Cohen’s d = 0.7 [95% CI, 0.1 to 1.2]).

Conclusions
This study proposes a dosing algorithm for deep NMB with rocuronium in patients receiving total intravenous anesthesia.

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Monitoring advanced gastrointestinal stromal tumor with circulating tumor DNA
Authors: Gómez-Peregrina David , Cicala Carlo Maria , Serrano César 
Published: May 2024

Purpose of review
This review explores the role of circulating tumor (ct)DNA as a biomarker for clinical decision-making and monitoring purposes in metastatic gastrointestinal stromal tumor (GIST) patients. We discuss key insights from recent clinical trials and anticipate the future perspectives of ctDNA profiling within the clinical landscape of GIST.

Recent findings
The identification and molecular characterization of KIT/platelet-derived growth factor receptor alpha (PDGFRA) mutations from ctDNA in metastatic GIST is feasible and reliable. Such identification through ctDNA serves as a predictor of clinical outcomes to tyrosine-kinase inhibitors (TKIs) in metastatic patients. Additionally, conjoined ctDNA analysis from clinical trials reveal the evolving mutational landscapes and increase in intratumoral heterogeneity across treatment lines. Together, this data positions ctDNA determination as a valuable tool for monitoring disease progression and guiding therapy in metastatic patients. These collective efforts culminated in the initiation of a ctDNA-based randomized clinical trial in GIST, marking a significant milestone in integrating ctDNA testing into the clinical care of GIST patients.

Summary
The dynamic field of ctDNA technologies is rapidly evolving and holds significant promise for research. Several trials have successfully validated the clinical utility of ctDNA in metastatic GIST, laying the foundations for its prospective integration into the routine clinical management of GIST patients.
State of the art and upcoming trends in claudin-directed therapies in gastrointestinal malignancies
Authors: Rogers Jane E. , Ajani Jaffer A. 
Published: May 2024

Purpose of review
Claudins, components of tight cell junctions in epithelial and endothelial cells, have emerged as a therapeutic target in gastrointestinal (GI) malignancies, particularly claudin 18.2 (CLDN18.2).

Recent findings
Zolbetuximab, a chimeric anti-CLDN18.2 monoclonal antibody (mAb), is currently under FDA review and may emerge as the first claudin targeted therapy approved. Phase 3 trials show that zolbetuximab in combination with front-line fluoropyrimidine plus oxaliplatin improves survival in advanced CLDN18.2 positive (≥75% of tumor cells) gastric adenocarcinoma (GAC) patients. Many other therapies (mAbs; CART; bispecific; ADCs) are under investigation.

Summary
CLDN18.2 will be an important target in GAC. Early understanding of how to target CLDN18.2 based on the level of expression (high, moderate, low) will be the key to success in this area. Studying these as separate entities should be considered. Resistance patterns, loss of CLDN18.2 expression, role in the refractory setting, and if any role in localized disease are questions that remain. Other targets for claudin that target claudin six and four are under investigation. Their role in GI malignancies will soon be further clarified.
Active surveillance and emerging medical treatment options for desmoid: when and for whom?
Authors: Bonvalot Sylvie , Miah Aisha , Kasper Bernd 
Published: May 2024

Purpose of review
This article discusses the evolving approaches to desmoid tumors management, shedding light on recent developments.

Recent findings
Active surveillance has become the primary approach for managing primary peripheral desmoid tumors. This strategy was initially based on evidence from retrospective studies. Roughly 50% of cases managed with active surveillance show spontaneous stabilization or regression. Recent prospective trials conducted in Italy, The Netherlands, and France (2022–2023) confirm the efficacy of active surveillance, revealing 3-year progression-free survival rates ranging from 53.4 to 58%. For the patients under active surveillance, decisions regarding treatment are based on significant tumor growth or progressive symptoms. Moreover, three contemporary randomized trials investigated medical treatments for progressive or recurrent desmoid tumors. Sorafenib, pazopanib, and nirogacestat demonstrated clinical activity, as evidenced by favorable progression-free survival and objective response rates.

Summary
Active surveillance has solidified its position as the primary management approach for desmoid tumors, validated by three robust prospective studies. Three recent randomized trials explored medical treatment for progressive or recurrent desmoid tumors, revealing promising clinical activities.
Comparison of Partial Upper Sternotomy Versus Median Sternotomy for Total Arch Replacement in Patients With Type A Aortic Dissection
Authors: Li Dong , Chen Lei , Wu Yang , Jiang Wei , Ren Chonglei , Xiao Cangsong 
Published: May 2024

Objective:
Comparative studies of median sternotomy and partial upper sternotomy in total arch replacement for type A aortic dissection are rare, and the safety and benefits of partial upper sternotomy need further evaluation. This study aimed to explore the effectiveness and prognosis of partial upper sternotomy in total arch replacement among patients with type A aortic dissection.

Methods:
This is a retrospective study of patients who underwent total arch replacement for type A aortic dissection at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2016 and December 2019. They were grouped into the median sternotomy and partial upper sternotomy groups according to the different treatment methodologies. The intra-operative and prognostic indicators were compared between both groups.

Results:
Forty-nine patients were included: 31 in the median sternotomy group and 18 in the partial upper sternotomy group. The partial upper sternotomy group had a shorter incision ((9.0 ± 0.8) cm vs. (25.5 ± 1.3) cm, P = 0.02) and smaller postoperative total drainage volume (885 mL vs. 1,820 mL, P = 0.03) than the median sternotomy group. The differences between the 2 groups with respect to other intra-operative indicators such as operation duration, cardiopulmonary bypass duration, aortic occlusion duration, hypothermic circulatory arrest duration, and intra-operative blood loss, and prognostic indicators such as red blood cell infusion, ventilator aid duration, cardiac intensive care unit stay, postoperative hospital stay, and postoperative complications were not significantly different (all P > 0.05).

Conclusions:
The utilization of partial upper sternotomy in patients with type A aortic dissection resulted in a smaller incision and more aesthetically pleasing scar, along with reduced drainage volume compared to median sternotomy.
Early Experience with a Novel Treatment for Menière’s Disease: A Long Acting Dexamethasone Formulation for Precise Delivery to the Round Window Membrane
Authors: Kuthubutheen Jafri , Sharon Jeffrey D. , Jung Benson T. , Sepahdari Ali R. , Ng Jia Hui , Erickson Signe , Peris Hugo , De Juan Eugene , Limb Charles J. 
Published: May 2024

Objective
To investigate the safety and feasibility of precise delivery of a long-acting gel formulation containing 6% dexamethasone (SPT-2101) to the round window membrane for the treatment of Menière's disease

Study Design
Prospective, unblinded, cohort study

Setting
Tertiary care neurotology clinic

Patients
Adults 18 to 85 years with a diagnosis of unilateral definite Menière’s disease per Barany society criteria

Intervention(s)
A single injection of a long-acting gel formulation under direct visualization into the round window niche

Main Outcome Measure(s)
Procedure success rate, adverse events, and vertigo control. Vertigo control was measured with definitive vertigo days (DVDs), defined as any day with a vertigo attack lasting 20 minutes or longer.

Results
Ten subjects with unilateral Menière’s disease were enrolled. Precise placement of SPT-2101 at the round window was achieved in all subjects with in-office microendoscopy. Adverse events included one tympanic membrane perforation, which healed spontaneously after the study, and two instances of otitis media, which resolved with antibiotics. The average number of DVDs was 7.6 during the baseline month, decreasing to 3.3 by month 1, 3.7 by month 2, and 1.9 by month 3. Seventy percent of subjects had zero DVDs during the third month after treatment.

Conclusions
SPT-2101 delivery to the round window is safe and feasible, and controlled trials are warranted to formally assess efficacy
The Role of Trublue Laser in Cholesteatoma Surgery
Authors: Tam Ka Yue Aurora , Lui Kary Choi Mui , Cheng Horace , Tong Michael Chi Fai , Chang Wai Tsz 
Published: May 2024

Objective
The retrospective cohort study aimed to determine the safety and efficacy of TruBlue laser application in cholesteatoma surgeries.

Methods
All cholesteatoma surgeries conducted from January 2018 to January 2022 in two tertiary referral hospitals in Hong Kong, with and without use of TruBlue laser, were included. Pure tone audiogram was done pre- and post-operatively to assess hearing. Disease extent was graded with ChOLE score and ChOLE staging. Residual disease was determined clinically, radiologically, or surgically with second look operation.

Results
One hundred twenty cholesteatoma cases were identified. There are 39.2% (n = 47) of the cholesteatoma surgeries that utilized TruBlue laser, while 60.8% (n = 73) did not. Overall follow-up duration was 21 ± 12.4 months, ranging from 2 to 47 months. Both groups were similar in demographics, pre-operative hearing and ChOLE staging. The length of stay was comparable in both groups (2 ± 2 days in nonlaser, 1 ± 1 day in laser, p = 0.31). There was no facial nerve injury related to surgery in both groups, and overall complication rates were similar (4.1% in nonlaser, 4.3% in laser, p = 0.97). The postoperative hearing was comparable with good hearing preservation in both groups. Residual cholesteatoma occurred in 17.8% (n = 13) in nonlaser group, and 21.3% (n = 10) in laser group, which was not statistically significant (p = 0.64). Seventy percent of the cholesteatoma residual in laser group occurred at area that TruBlue LASER cannot be applied.

Conclusion
TruBlue LASER was safe in cholesteatoma surgeries, though no added benefits were shown in reducing cholesteatoma residual rate. A larger controlled study is warranted to discern the true effect of TruBlue LASER.

Level of evidence
Level 3
Epidemiology and Comorbidities of Vestibular Disorders: Preliminary Findings of the AVOCADO Study
Authors: Thorman Isaac B. , Schrack Jennifer A. , Schubert Michael C. 
Published: May 2024

Introduction
Studies on incidence and prevalence of vestibular disorders tend to focus on small pockets of patients recruited from specialized clinics and often exclude measures of vestibular function. The objectives of the study were to characterize patients with common vestibular disorders, estimate the prevalence of common vestibular disorders, and ascertain whether patients with vestibular disorders experience increased risks of falls and morbidity.

Materials and Methods
This retrospective cohort study includes both inpatient and outpatient routine clinical care data culled from a nationally representative, population-based sample. Patients were included if their record in the TriNetX Diamond Cohort comprised at least one vestibular function test or vestibular diagnosis. The main outcome measures were diagnosis with a vestibular disorder, a fall, or a common medical comorbidity (e.g., diabetes, cerebrovascular disease).

Results
The cohort includes n = 4,575,724 patients, of which 55% (n = 2,497,136) had a minimum of one vestibular diagnosis. Patients with vestibular diagnoses were 61.3 ± 16.6 years old (mean ± standard deviation), 67% women, 28% White race (69% unknown race), and 30% of non-Hispanic or Latino ethnicity (66% unknown ethnicity). The prevalence of vestibular disorders was estimated at 2.98% (95% confidence interval [CI]: 2.98–2.98%). Patients with vestibular diagnoses experienced a significantly greater odds of falls (odds ratio [OR] = 1.04; 95% CI: 1.02–1.05), cerebrovascular disease (OR = 1.42; 95% CI: 1.40–1.43), ischemic heart disease (OR = 1.17; 95% CI: 1.16–1.19), and diabetes (OR = 1.14; 95% CI: 1.13–1.15), among others.

Discussion
Vestibular disorders affect an estimated 3% of the U.S. population, after weighting. Patients with these disorders are at greater risk for many common, consequential medical conditions.
Cochlear Implantation in Patients With Osteolytic Labyrinthitis: A Case Series
Authors: Thedinger William B. , Dornhoffer James R. , Merlino Dante J. , Lane John I. , Carlson Matthew L. , Kircher Matthew L. 
Published: May 2024

Objective
To describe the rare process of osteolytic labyrinthitis, previously referred to as labyrinthine sequestrum, which involves progressive obliteration of the bony and membranous labyrinth with eventual supplantation with soft tissue and, in some cases, bony sequestrum.

Patients
Three patients with diverse presentations of osteolytic labyrinthitis from two tertiary care academic medical centers.

Intervention(s)
Case series report analyzing the relevant clinical, radiologic, pathologic, and surgical data on our patients with osteolytic labyrinthitis and comparing these index cases to the existing literature.

Main Outcome Measure(s)
We describe the varying image findings seen in osteolytic labyrinthitis on computed tomography and magnetic resonance imaging. Also, we report successful surgical intervention and hearing rehabilitation with cochlear implantation in patients with osteolytic labyrinthitis.

Results
Our three patients presented with profound sudden sensorineural hearing loss and vertigo consistent with labyrinthitis. None of the three patients had a history of chronic otitis media. Imaging workup revealed varying degrees of erosion to the otic capsule bone demonstrating the spectrum of disease seen in osteolytic labyrinthitis. Although two cases showed osteolytic changes to the semicircular canals and vestibule, the first case revealed frank bony sequestrum within the obliterated labyrinth. The three cases were taken for surgical debridement and cochlear implantation.

Conclusions
We propose the new term, osteolytic labyrinthitis—previously referred to as labyrinthine sequestrum—to describe the rare spectrum of disease characterized by destruction of the osseous and membranous labyrinth and potential supplantation with bony sequestrum. Cochlear implantation is a viable option in selected patients with osteolytic labyrinthitis.
Impact of Migraine and Vestibular Migraine on Audiometric Profiles and Quality of Life in Patients With Tinnitus
Authors: Li Keng-Sheng , Liu Yu-Hsi 
Published: May 2024

Objective
To investigate the clinical manifestations and complete auditory function in primary tinnitus patients with and without migraine or vestibular migraine.

Design
Retrospective case-control study.

Setting
A tertiary referral center.

Participants
This study enrolled 298 patients from the Kaohsiung Veterans General Hospital. All patients were diagnosed with primary tinnitus by a neurotologist between April 2020 and August 2021. Patients were excluded if they had histories of chronic otitis media, idiopathic sudden sensorineural hearing loss, Ménière's disease, skull base neoplasm, or temporal bone trauma.

Interventions
Twenty-five-item Tinnitus Handicap Inventory (THI), speech audiometry including speech recognition threshold, most comfortable level, uncomfortable loudness levels, dynamic range, and pure-tone audiometry.

Main Outcomes Measures
Objective hearing loss is defined as a mean threshold greater than 25 dB. Extremely elevated THI is defined as a score greater than 1 standard deviation above the mean THI.

Results
Among the 298 patients with tinnitus, 149 were women and 149 were men, with a mean age of 57.06 (range, 19.22–94.58) years.
A total of 125 patients completed the THI questionnaire during their initial visit. The median THI score was 32 (95% confidence interval: 13.98–56.00), and the mean score was 34.99 with a standard deviation of 21.01. The sole contributing factor significantly associated with higher total THI score was the diagnosis of migraine or vestibular migraine (p < 0.001, odds ratio = 19.41).
Tinnitus patients with migraine or vestibular migraine exhibited significantly lower mean pure-tone auditory thresholds (right 22.2 versus 29.5, p = 0.002; left 22.5 versus 30.4, p < 0.001), speech recognition threshold (right 20.0 versus 25.2, p = 0.016; left 20.2 versus 25.5, p = 0.019), and most comfortable levels values (right 46.1 versus 51.4, p = 0.007; left 46.9 versus 51.4, p = 0.021) compared with the tinnitus patients without migraine.

Conclusions
In this population-based study, patients with primary tinnitus experienced significantly higher THI scores and exhibited concurrent symptoms, including dizziness/vertigo, cervicalgia, and migraine or vestibular migraine. Among these parameters, the diagnosis of migraine or vestibular migraine was the sole contributor to significant higher THI score.
Plasmapheresis combined with rituximab treatment of a case of thrombotic thrombocytopenic purpura with Sjögren syndrome and renal impairment: A case report
Authors: Zhang Yongqiang , Hu Shanshan , Deng Yiyao , Yang Zhi , Yuan Jing 
Published: May 2024

Rationale:
Thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy caused by reduced activity of the von Willebrand factor-cleaving protease (ADAMTS13), which can be life-threatening. The patient reported in this case study also had concurrent Sjögren syndrome and renal impairment, presenting multiple symptoms and posing a great challenge in treatment.

Patient concerns:
A 25-year-old woman in the postpartum period visited the hospital due to indifference in consciousness for more than 1 day following cesarean section 8 days prior.

Diagnosis:
Notable decreases were observed in platelets, hemoglobin, creatinine, and ADAMTS13 levels. After a consultative examination by an ophthalmologist, she was diagnosed with retinal hemorrhage in the right eye and dry eye syndrome in both eyes.

Interventions:
Having been diagnosed with TTP with Sjögren syndrome and renal impairment, she received repeated treatments with plasmapheresis combined with rituximab.

Outcomes:
Following treatment and during the follow-up period, the patient’s platelet counts and bleeding symptoms significantly improved.

Lessons:
TTP has a high mortality rate, and when combined with Sjögren syndrome and renal impairment, it poses an even greater challenge in treatment. However, after administering standard plasmapheresis combined with rituximab treatment, the treatment outcome is favorable.
Tocilizumab in the treatment of hyperferritinemic syndrome and capillary leak syndrome secondary to rheumatoid arthritis: Case report and literature review
Authors: He Zhendong , Mo Hanyou , Zheng Leting , Zeng Wen , Wen Jing , Chen Zhanrui , Qin Fang 
Published: May 2024

Introduction:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, which is mainly characterized by joint swelling, pressure pain and joint destruction. Some patients may suffer from a variety of serious complications, which require prompt diagnosis and treatment. Otherwise, the patient condition may deteriorate rapidly, leading to premature death.

Objective:
We reported a case of RA combined with hyperferritinemic syndrome and capillary leak syndrome (CLS) that was successfully treated with tocilizumab (TCZ), with the aim of improving diagnostic ideas for clinicians and consequently improving the diagnosis and treatment of the hyperferritinemic syndrome and CLS.

Case summary:
A 55-year-old female patient was admitted to the Department of Infectious Diseases of our hospital due to “recurrent fever for more than 1 month and aggravation for 3 days.” The patient was diagnosed with fever of unknown origin (lung infection?) and received anti-infective therapy with large encirclement of anti-bacterial, antifungal and empirical anti-tuberculosis successively during hospitalization in the Department of Infectious Diseases. Yet her condition continues to progress. The patient was eventually diagnosed with RA combined with hyperferritinemic syndrome and CLS. Then she received glucocorticoids (GC) (160 mg qd) combined with intravenous immunoglobulin (IVIG, 20 g/d, for 3 days). We considered that the patient also had an overwhelming proinflammatory cytokine storm, so she received a strong anti-inflammatory treatment with TCZ (400 mg qm). The patient symptoms and follow-up chest CT showed significant improvement following treatment.

Conclusion:
TCZ has good efficacy in the treatment of RA combined with hyperferritinemic syndrome and CLS and is expected to be a promising treatment.