bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis
Authors: Wang Jian-Peng , Li Da-Peng , Liu Yu-Chen , Zhang Lei , Fu Zi-Yue , Liang Bing-Yu , Yin Si-Yue , Yang Yi-Pin , Fan Min , Ding Zhao , Chen Shan-Wen , Zhang Liang , Wu Kai-Le , Liu Ye-Hai , Cao Fan , Pan Hai-Feng , Han Yan-Xun 
Published: June 2024

Background:
Endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) yield similar perioperative outcomes. This study investigated how the learning curve (LC) affects perioperative outcomes between ET and RT, identifying factors that influence the LC.

Materials and methods:
Two researchers individually searched PubMed, EMBASE, Web of Science, and Cochrane Library for relevant studies published until February 2024. The Newcastle–Ottawa Scale assessed study quality. A random-effects model was used to compute the odds ratio and weighted mean difference (WMD). Poisson regression comparison of the number of surgeries (NLC) was required for ET and RT to reach the stable stage of the LC. Heterogeneity was measured using Cochran’s Q. Publication bias was tested using funnel plots, and sensitivity analysis assessed findings robustness. Subgroup analysis was done by operation type and patient characteristics.

Results:
This meta-analysis involved 33 studies. The drainage volume of ET was higher than that of RT (WMD=−17.56 [30.22, −4.49]). After reaching the NLC, the operation time of ET and RT was shortened (ET: WMD=28.15 [18.04–38.26]; RT: WMD=38.53 [29.20–47.86]). Other perioperative outcomes also improved to varying degrees. Notably, RT showed more refined central lymph node resection (5.67 vs. 4.71), less intraoperative bleeding (16.56 ml vs. 42.30 ml), and incidence of transient recurrent laryngeal nerve injury (24.59 vs. 26.77). The NLC of RT was smaller than that of ET (incidence-rate ratios [IRR]=0.64 [0.57–0.72]). CUSUM analysis (ET: IRR=0.84 [0.72–0.99]; RT: IRR=0.55 [0.44–0.69]) or a smaller number of respondents (ET: IRR=0.26 [0.15–0.46]; RT: IRR=0.51 [0.41–0.63]) was associated with smaller NLC. In RT, transoral approach (IRR=2.73 [1.96–4.50]; IRR=2.48 [1.61–3.84]) and retroauricular approach (RAA) (IRR=2.13 [1.26–3.60]; IRR=1.78 [1.04–3.05]) had smaller NLC compared to bilateral axillo-breast and transaxillary approach (TAA). In ET, the NLC of RAA was smaller than that of TAA (IRR=1.61 [1.04–2.51]), breast approach (IRR=1.67 [1.06–2.64]), and subclavian approach (IRR=1.80 [1.03–3.14]).

Conclusions:
Rich surgical experience can improve surgical results of ET and RT. After reaching the NLC, the perioperative outcomes of RT are better than those of ET. Study subjects, surgical approaches, and analysis methods can affect NLC.
Pure 46, XY gonadal dysgenesis and 46, XY complete androgen insensitivity syndrome: A case report
Authors: Yu Tengge , Liu Li 
Published: June 2024

Background:
Disorders of sex development (DSD) are congenital conditions characterized by atypical development of chromosomal, gonadal, and phenotypic sex. 46, XY DSD can result from disorders of testicular development or androgen synthesis.

Methods:
We present 2 rare cases of 46, XY DSD, specifically XY pure gonadal dysgenesis and complete androgen insensitivity syndrome.

Results:
Both cases underwent prophylactic gonadectomy due to the elevated risk of gonadal malignancy. Bilateral gonadoblastoma and dysgerminoma were diagnosed on one side, while Leydig cell hyperplasia and only Sertoli cells were diagnosed in the seminiferous tubules on both sides. The normal menstruation for the pure gonadal dysgenesis patient only as CAIS patients never menstruate. Estrogen replacement therapy was administered periodically to promote the development of secondary sexual characteristics and menstruation in pure gonadal dysgenesis case, as well as to prevent osteoporosis. Follow-up examinations revealed no tumor recurrence, and the patient with Swyer syndrome had regular menstrual cycles.

Conclusion:
Laparoscopic bilateral prophylactic gonadectomy and long-term hormone therapy with patient counseling and support are recommended.
From seizures to cognitive dysfunction: A case report of Fahr syndrome in an Afghan patient
Authors: Madadi Shekiba , Alami Kawsar , Kaneda Yudai , Sediqi Pazhman 
Published: June 2024

Rationale:
Fahr syndrome is a rare, degenerative neurological condition characterized by bilateral idiopathic calcification of the periventricular region, especially the basal ganglia. This condition is often misdiagnosed as other neurological or psychiatric disorders due to its rarity and overlapping symptoms.

Patient concerns:
A 34-year-old man had been experiencing seizures and cognitive dysfunction for few years, which were further compounded by slurred speech and motor difficulties as acute conditions.

Diagnosis:
After investigations, severe hypocalcemia, and hypoparathyroidism were detected and his brain computed tomography showed extensive bilateral calcifications in basal ganglia, thalamus, dentate nuclei, and some parts of subcortical white matter, suggestive of Fahr syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease.

Intervention:
The patient was treated with intravenous calcium gluconate, vitamin D3, l-ornithine l-aspartate syrup, and levetiracetam, replacing carbamazepine.

Outcome:
His symptoms, including slurred speech, muscle pain, and stiffness improved, serum calcium normalized, and he was discharged with medications for memory deficit and depression.

Lessons:
This case underscores the importance of raising awareness among physicians, especially in areas with limited medical resources, about the significance of prompt diagnosis and appropriate symptomatic treatment in enhancing patient prognosis and quality of life.
Effects of video-assisted preanesthetic patient education on preanesthetic interview time; A prospective, single-blinded, randomized controlled trial
Authors: Park Heechan , Ko Eunji , Lim Choon Hak , Lee Jeonghoon , Kim Dongil , Yeom Gyeongmin , Lee Kyungmin 
Published: June 2024

Background:
A preanesthetic evaluation interview with an anesthesiologist is essential for patient safety, however, it is not performed adequately owing to the excessive workload of doctors. This study aimed to determine whether video-assisted preanesthetic patient education can reduce patient interview time and solve the problem of excessive labor at a relatively low cost.

Methods:
This study considered relatively healthy patients aged 19 to 65 years who were scheduled for elective surgery under general anesthesia. None of the patients had history of general anesthesia. Patients were randomly assigned 1:1 to Groups V and C. Group V watched the preanesthetic education video, while Group C did not. The duration of the preanesthetic evaluation interview was measured for all participants. The satisfaction of the anesthesiologist and patient with the preanesthetic evaluation procedure, anxiety of the patient, and vital signs during surgery were collected.

Results:
A total of 33 patients in Group V watched the preanesthetic education video, while 31 patients in Group C did not. Group V spent significantly less time on the preanesthetic evaluation interview with an anesthesiologist than that of Group C (172.42 vs 196.68 seconds; P = .005). There was no difference in patient and anesthesiologist satisfaction between the 2 groups (P = .861 and P = .849, respectively). Patients’ anxiety (P = .474), intraoperative mean blood pressure (P = .168), and heart rate (P = .934) did not differ between Groups V and C.

Conclusion:
Watching the informational video about anesthesia before preanesthetic evaluation could reduce the interview time by an average of 24 seconds, with no difference in patients’ or doctors’ satisfaction or anxiety compared to patients who did not watch it. Video-assisted preanesthetic patient education indicates that the load on anesthesiologists can be reduced.
Ulnar bone tuberculosis in children: Case report and literature review
Authors: Mo Qineng , Wei Xiaohua , Xia Xiansheng , Li Yunlong , Nan Guoxin , Ling Chunli 
Published: June 2024

Rationale:
Tuberculosis of the long tubular bones in children’s extremities is infrequent, particularly in the ulna. Early diagnosis poses significant challenges. This report presents a case involving a 2-year-old child with tuberculosis of the ulnar bone, accompanied by a comprehensive review of pertinent literature. The purpose of this study is to share diagnostic and therapeutic experiences and provide potentially valuable insights.

Patient concerns:
In this case, the patient exhibited complete destruction and expansion of the ulnar bone, resulting in a forearm size considerably greater than normal. Concerns were raised about the irreversible deformation of the ulna, the potential for a malignant bone tumor, and its impact on forearm function, potentially endangering the patient’s life.

Diagnoses:
The diagnosis was confirmed as tuberculosis of the ulnar bone.

Interventions:
The patient underwent surgery to remove the affected ulnar tissue and received anti-tuberculosis medication.

Outcomes:
Subsequent to treatment, the destruction and expansion of the ulnar bone resolved, with the return of normal ulnar morphology and bone structure.

Lessons:
Even in the absence of typical symptoms like fever, weight loss, and loss of appetite, extensive destruction and expansion of a long tubular bone should prompt vigilant consideration of bone tuberculosis.
A case of scrub typhus with meningitis as the onset: Case report and literature review
Authors: Zhang Bing-Can , Yang Zi-Bin , Liao Ren-Li , Ma Zhi-Qiang , Zhang Qiu-Juan , He Qian-Kun , Duan Xin-Ya , Liu Ming-Wei 
Published: June 2024

Rationale:
Scrub typhus is a naturally occurring acute febrile disease caused by Orientia tsutsugamushi. Although it can cause multiple organ dysfunction, central nervous system infections are uncommon.

Patient concerns:
A 17-year-old male presented with a 5-day history of fever and headaches. The MRI of the head revealed thickness and enhancement of the left temporal lobe and tentorium cerebelli, indicating potential inflammation.

Diagnoses:
The patient was diagnosed with a central nervous system infection.

Interventions:
Ceftriaxone and acyclovir were administered intravenously to treat the infection, reduce fever, restore acid-base balance, and manage electrolyte disorders.

Outcomes:
Despite receiving ceftriaxone and acyclovir as infection therapy, there was no improvement. Additional multipathogen metagenomic testing indicated the presence of O tsutsugamushi infection, and an eschar was identified in the left axilla. The diagnosis was changed to scrub typhus with meningitis and the therapy was modified to intravenous doxycycline. Following a 2-day therapy, the body temperature normalized, and the fever subsided.

Conclusions:
The patient was diagnosed with scrub typhus accompanied by meningitis, and doxycycline treatment was effective.

Lession:
Rarely reported cases of scrub typhus with meningitis and the lack of identifiable symptoms increase the chance of misdiagnosis or oversight. Patients with central nervous system infections presenting with fever and headache unresponsive to conventional antibacterial and antiviral treatment should be considered for scrub typhus with meningitis. Prompt multipathogen metagenomic testing is recommended to confirm the diagnosis and modify the treatment accordingly.
Challenges in cataract surgery after penetrating keratoplasty managed using femtosecond laser: A series of 3 case reports
Authors: Tang Qiaomei , Yao Ke 
Published: June 2024

Introduction:
Cataract surgery in patients after penetrating keratoplasty (PKP) is often challenging because of changes in corneal structure induced by PKP and primary corneal disease. Femtosecond laser-assisted cataract surgery offers several advantages over conventional phacoemulsification, and has been widely used in complicated cataract surgery.

Case report:
We report the use of femtosecond laser-assisted cataract surgery in 3 challenging cases after penetrating keratoplasty. Case 1 involved a patient with hard nuclear grade IV° cataract. After surgery, his corrected distance visual acuity (CDVA) improved from 20/400 to 20/25, and the endothelial cell loss (ECL) % was 12.05 % at 3 months postoperatively. The rotation of the toric IOL in Case 1 was 2°. Case 2 involved a patient with severe nuclear cataract and an endothelial cell density of 837 cells/mm2. After surgery, the CDVA improved from 20/100 to 20/40. The ECL% was 4.06% at 1 week postoperatively. Case 3 was a 91-year-old woman with a short axis length of 21.35 mm and an endothelial cell density number of 1238 cells/mm2. After surgery, the CDVA improved from light perception to 20/133, and the ECL% was 26.09% at 1 week postoperatively; ECL% was 2.67% at 1 month post-operation. The corneal grafts were transparent.

Conclusion:
Femtosecond laser-assisted cataract surgery seems to be an effective, predictable, and safe approach for challenging patients after PKP, and improves visual recovery and optimal refractive outcomes.
Hemophagocytic lymphohistiocytosis associated with acute otitis media: A case report
Authors: Chung Da Hyun , Lee Kyu-Yup , Kim Ji-Yoon , Jung Da Jung 
Published: June 2024

Introduction:
Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome for which early recognition and treatment are essential for improving outcomes. HLH is characterized by uncontrolled immune activation leading to fever, cytopenias, hepatosplenomegaly, coagulation abnormalities, and elevated typical markers. This condition can be genetic or secondary, with the latter often triggered by infections. Here, we present a unique case of HLH secondary to acute otitis media (AOM), a common ear infection.

Patient concerns:
We describe a 4-year-old boy who initially presented with a high fever and otalgia, later diagnosed with bilateral AOM. Despite antibiotic treatment, his condition deteriorated.

Diagnosis:
The patient fulfilled diagnostic criteria for HLH.

Interventions:
Aggressive treatment by using combination therapy with immunoglobulins, intravenous steroids (dexamethasone), cyclosporine, and etoposide was performed.

Outcomes:
After 1 month of treatment, improvement in the otologic symptoms was observed, and hematological findings gradually improved and normalized.

Lessions:
The link between AOM and HLH may be associated with inflammatory responses and immunological mechanisms, highlighting the importance of considering HLH in severe infection cases. This case emphasizes the need for prompt diagnosis and management, especially in secondary HLH scenarios, to improve patient outcomes. It is imperative to be aware of the potential correlation between these 2 conditions, and healthcare professionals should consider the likelihood of HLH.
Treatment of acute basilar artery occlusion by retrograde puncture via the vertebral artery approach: A care-compliant case report
Authors: Wang Zi Wen , Zhao Fang , Liu Jin Chao 
Published: June 2024

Background:
Vertebral artery stump syndrome (VASS) is a cause of acute stroke. Owing to the particularity of the pathogenesis of VASS, interventional treatment of VASS is difficult. Common mechanical thrombectomy approaches include femoral and radial artery approaches. However, conventional approaches may not be suitable for VASS. If effective measures are not taken to open offending vessels in time, this can lead to a high rate of disability. In recent years, no consensus has been reached regarding surgical methods for treating VASS.

Patient concerns:
The patient presented to the emergency department with a 2-hour history of disturbance of consciousness.

Diagnosis:
After neurological and magnetic resonance imaging examinations, the patient was diagnosed with acute large vessel occlusive posterior circulation cerebral infarction.

Methods:
The patient’s symptoms were not relieved after intravenous infusion of argatroban (10 mg) at a local hospital. We first attempted to open the occluded vertebral artery through normal approaches but failed. We then punctured the vertebral artery, successfully opened the occluded vertebral artery, and performed mechanical thrombectomy.

Results:
The patient underwent successful vertebral artery puncture and mechanical thrombectomy, with no evidence of postoperative bleeding or vascular injury at the puncture site. The patient regained consciousness the day after surgery but remained impaired in physical activity. After 4 months of rehabilitation, the patient recovered completely.

Conclusion:
When the conventional approach cannot meet the requirements of mechanical thrombectomy, reverse puncture of the vertebral artery is a feasible surgical method for patients with VASS. However, due to the small number of cases, a series of safety problems such as potential puncture failure, hemorrhage after puncture, and vascular occlusion still need to be further explored.
Difficult intubation in a patient with acute epiglottitis and abscess complicated with cervical necrotizing fasciitis: A case report
Authors: Fu Guanghua , Yang Luyao , Wu Guisheng 
Published: June 2024

Introduction:
Acute epiglottitis is not uncommon and it can cause high mortality due to airway obstruction. Acute epiglottitis complicated with cervical necrotizing fasciitis has rarely been reported, and it is also a life-threatening disease with a fatality rate of 7% to 50%.

Patient concerns:
A 64-year-old woman presented to our hospital with chief complaints of sore throat and cervical swelling, long with foreign body sensation and hoarseness. Endoscopic laryngoscopy showed erythematous and swollen epiglottis with purulent secretions on the surface. Computed tomography (CT) scan showed swollen epiglottis and swelling of the neck with air- and fluid-containing necrotizing tissue.

Diagnoses:
The diagnosis was acute epiglottitis and abscess complicated with cervical necrotizing fasciitis.

Interventions:
With the patient in awake condition, airway access was established by performing intubation with adjunctive use of gum elastic bougie, followed by surgical debridement under general anesthesia; a flap was used for skin coverage and intravenous piperacillin-tazobactam was administered.

Outcomes:
The patient was discharged without complications.

Conclusion:
Gum elastic bougie is a usable tool in difficult intubation. Adequate pre-anesthesia evaluation, patient sedation, and gentle manipulation assured the intubation success in this case.
Sexually transmitted infections and the vaginal microbiome after vaginoplasty
Authors: Werneburg Glenn T. , Fascelli Michele 
Published: June 2024

Purpose of review
Transgender and gender-diverse individuals (TGD) are at risk for sexually transmitted infections. Gender affirmation surgery is a cornerstone of care for many TGD individuals. For genital gender affirmation, the surgical creation of a vagina may be performed through a number of techniques. Those who have undergone vaginoplasty have unique anatomical and biopsychosocial considerations, which we discuss.

Recent findings
While sexually-transmitted infections including HPV, HSV, HIV, gonorrhea, and chlamydia, have been described in TGD individuals after vaginoplasty, the reports are very rare, and the provider should maintain an index of suspicion and maintain a broad differential for symptoms including neovaginal discharge. We discuss the association of the neovaginal microbiota composition with bacterial vaginosis, and how its modulation could potentially reduce bacterial vaginosis and sexually transmitted infection risk.

Summary
We examine the literature regarding sexually-transmitted infections following vaginoplasty, and the neovaginal microbiome and its similarities and differences relative to the natal vaginal microbiome.
Prevalence of mental health disorders in knee osteoarthritis patients: a systematic review and meta-analysis
Authors: Merry del Val Borja , Shukla Saurin R. , Oduoye Malik O. , Nsengiyumva Mugisha , Tesfaye Tadele , Glinkowski Wojciech M. 
Published: June 2024

Background:
Knee osteoarthritis (OA) is a prevalent degenerative disease affecting synovial joints, predominantly the knee, leading to various complications, including mental health conditions like depression and anxiety. This systematic review aimed to determine the prevalence of depression and anxiety in knee OA patients.

Methods:
A comprehensive literature search was conducted in various databases till September 15, 2023. Studies focusing on the prevalence of mental health issues in patients with knee OA were included, excluding narrative reviews, protocols, unpublished reports, editorials, case reports, abstracts, and commentaries. All statistical analyses were performed in R version 4.2.3.

Results:
This review included a total of 14 studies involving middle-aged to elderly adult patients with knee OA, with ages ranging from 45 to 75 years. Among these, 13 studies involving 3390 adult patients with an average age of 59.75 years reported a pooled prevalence of depression of 30% (95% confidence interval: 18–43), demonstrating a substantial heterogeneity (I
2=98%). Additionally, anxiety was identified with a combined prevalence of 27% (95% confidence interval: 24–30) based on three studies that included 1407 older adult patients with an average age of 62.1 years. These studies displayed minimal heterogeneity (I
2=7%).

Conclusion:
The findings show a significant prevalence of depression among adult patients with knee OA and anxiety among older adults with knee OA, emphasizing the need for integrated healthcare approaches that address both orthopedic and mental health conditions. More comprehensive research is essential to deepen our understanding of the connection between mental illnesses and knee OA and to develop effective preventive and treatment strategies.