bluuebunny/crossref_metadata_2025_split huggingface dataset:
The therapeutic effect of alcoholic extract of Fumaria parviflora on high-fat diet-induced nonalcoholic fatty liver in rats: an animal experiment
Authors: Eghdami Shayan , Afrashteh Fatemeh , Shojaii Asie , Abolhasani Maryam , Motevalian Manijeh 
Published: March 2024

Background and purpose:
Nonalcoholic fatty liver disease (NAFLD) is a growing problem with a significant burden. Lifestyle modification is the recommended treatment, but researchers are exploring other options. This study focused on the effects of Fumaria parviflora (FP) extracts on NAFLD induced by a high-fat diet in rats.

Experimental approach:
Thirty-five 10-week-old male Wister-Albino rats were divided into seven groups: normal diet control, high fat diet control, high fat diet with oral normal saline gavage, high fat diet with oral Atorvastatin gavage, and three groups receiving high fat diet with FP extract in 200 mg/kg, 400 mg/kg, and 700 mg/kg.
Blood samples of rats were used for the measurement of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP).
1×1 cm Liver biopsies were taken, stained with Trichrome Stain (Masson) and Hematoxylin and eosin (H&E) stain for evaluation by a pathologist.

Findings/results:
Lab results showed that FP extract inhibits weight gain, has positive effects on triglyceride and alkaline phosphatase levels, and reduces hepatocyte ballooning and inflammation in rats.

Conclusion:
FP extract may lower liver enzymes and have a positive impact on triglyceride, LDL, and HDL levels in rats with NAFLD.
Pancytopenia as a first presentation of late-onset systemic lupus erythematosus: a case report
Authors: Haidar Ghina , Khalayli Naram , Drie Tasneem , Safiah Mhd Homam , Kudsi Maysoun 
Published: March 2024

Introduction:
Systemic lupus erythematosus (SLE) is a systemic immune disease that classically occurs in young to middle-aged women and may present with cutaneous, renal, haematologic, neurological, and/or other symptoms at the time of diagnosis. Late-onset SLE or SLE in the elderly is a subtype that differs from classic SLE in terms of age group, clinical symptoms, organ involvement and severity.

Case presentation:
A 63-year-old female noted to have pancytopenia. The patient was diagnosed with lupus upon obtaining clinical presentations and serological marker, along with high titres of the antinuclear antibody and/or anti-double-stranded DNA antibody. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid response.

Discussion:
Late-onset SLE accounts for 2–12% of SLE patients with a minimum age of onset of 50 years and older, leading to significant delays in diagnosis. Late-onset SLE differs from early-onset SLE in terms of sex and ethnicity prevalence, clinical symptoms and signs, development of organ damage, disease activity and severity, and prognosis. Some studies have also shown that late-stage SLE patients have higher rates of RF and anti-Ro/anti-La antibody positivity, lower complement titre, and higher incidence of elevated creatinine and decreased creatinine clearance. First-line treatment of pancytopenia is glucocorticoid. In refractory cases, rituximab and immunosuppressants can be used.

Conclusion:
It is important to assess any unusual presentation of SLEs when clinical suspicion remains high and conducting further laboratory and imaging investigation.
Ventricular tachycardia storm after accidental poisoning of delphinium species: a rare case report
Authors: Shrestha Swikriti , Thapa Shovit , Hussain Asraf , Lamichhane Sandesh , Subedi Subash , KC Sujata , Kandel Narayan , Pant Kailash 
Published: March 2024

Introduction:

Delphinium species are commonly used as medicinal herbs, with a wide range of implications for medical conditions. The injudicious use of this plant has been known to cause devastating side effects, including cardiac arrhythmias.

Case presentation:
Here, the authors present an 80-year-old male with incessant ventricular tachycardia after ingestion of this herb. The sinus rhythm was restored after electrical cardioversion and aggressive intravenous antiarrhythmics.

Clinical discussion:
To the best knowledge of the authors, no case of a ventricular storm following ingestion of Delphinium has been reported till now, probably rendering this case the first one.

Conclusion:
This report aims to present the rare case using theoretical concepts from the discipline and to share our approach in the hope of achieving a better understanding of similar cases.
Diagnosis and management of intraspinal tuberculoma with osseous involvement: A case report
Authors: Wu Song , Hu Fei , Sun Bing , Yang Yuting , Zhang Wenxin , Ma Yuan , Ouyang Qing 
Published: March 2024

Introduction and Importance:
Intraspinal tuberculoma is rare and challenging situation, which results in serious neurological dysfunctions.

Case Presentation:
This case report shows an intraspinal tuberculoma with osseous involvement in a 31-year-old male patient with subacute progressing neurologic deficit. His medical history included tuberculosis of pulmonary and intestinal 8 years previously, at which time he had been treated with intestinal obstruction operation and antituberculosis treatment. A quadruple antituberculosis treatment was carried out after admission, however, his neurological condition was steadily worsening. He underwent debulking of mass for decompression and pathological analysis revealed intraspinal tuberculoma. The patient was prescribed a 12-month course of antituberculosis therapy, and a good clinical outcome was obtained subsequently.

Clinical Discussion:
This case was treated by microsurgical resection and antituberculosis therapy, and the outcome was favorable.

Conclusion:
Intraspinal tuberculoma should be considered when an intraspinal mass is found with a history of tuberculosis, it can be effectively diagnosed by MRI and treated by the combination of medical and surgical treatments.
Prevalence, types, and characteristics of headache in Behcets disease without involvement of the central nervous system in the Syrian population: a case-cohort study
Authors: Rabah Karam , Rabah Nour , Deeb Haya , Haidar Ghina , Kudsi Maysoun 
Published: March 2024

Introduction:
Oral ulcers, genital ulcers, and uveitis represent the typical trial of Behcet’s disease (BD). It is well common on the Old Silk Road. The mucocutaneous lesions are the hallmark of BD, but neurological involvement is one of the severe symptoms. Headaches may be an early sign of BD neurological involvement. This study aims to investigate the headache prevalence and its types, and characteristics in a Syrian sample of BD patients.

Methods:
BD patients were clinically interviewed and examined to collect their information, symptoms, and signs. the International Study Group for Behcet’s Disease diagnosis criteria was used to confirm the BD diagnosis. The International Classification of headaches was used when classifying the headaches.

Results:
One hundred twenty participants were included in the study. half of them were BD patients and the control group was also 60 participants. Among Syrian BD patients, 36.7% suffer from primary headaches and 36.7% suffer from secondary headaches. These findings were not significantly different between the BD patients and the healthy population. Our results showed that there was no statistically significant difference between the two groups.

Conclusion:
Headache should not be considered a predictor for neurological involvement among BD patients. Additional attention to BD patients or the specific treatment for headaches is not required and does not differ from the general population.
Paraneoplastic pemphigus in a patient with T-cell lymphoma, a case report
Authors: Molla Yohannis Derbew , Answar Isak Omer , Worku Biruk Mulat , Tadesse Amanuel Kassa , tefera Elias manaye , Alemu Bewketu Abebe , Legese Gebrehiwot Lema , Abera Samuel Addisu 
Published: March 2024

Introduction and importance:
Paraneoplastic pemphigus is an uncommon autoimmune mucocutaneous disease characterized by severe stomatitis, polymorphous skin eruptions, and the presence of underlying neoplasms. Unique histopathological features include suprabasal acantholysis and clefts with scattered necrotic keratinocytes.

Case presentation:
A 27-year-old female patient presented with a three-month history of a painless swelling, approximately the size of a pea, on the left lateral aspect of her neck and axillary area. This swelling progressively increased in size and number. Additionally, she had reddish, itchy, raised skin lesions over her elbows bilaterally, which gradually spread to involve most of her body, including her lips, tongue, and buccal mucosa. These skin lesions were associated with difficulty swallowing both liquid and solid foods. A diagnostic test, including a biopsy, confirmed the diagnosis of paraneoplastic pemphigus. Subsequently, the patient was managed with chemotherapy and other supportive measures, leading to improvement and eventual discharge.

Clinical discussion:
Paraneoplastic pemphigus is a rare blistering disorder associated with neoplasms, often presenting diagnostic and treatment challenges. Patients with PNP may develop a diverse range of lesions. It is crucial to promptly recognize and manage the underlying malignancy for improved patient outcomes.

Conclusion:
This case highlights the rare association between T-cell lymphoma and paraneoplastic pemphigus. Clinicians should also remain vigilant for the possibility of paraneoplastic pemphigus in lymphomas that are not of B-cell lineage.
Treatment of resistant paecilomyces lilacinus keratitis with topical voriconazole and oral itraconazole: A rare case report from somalia
Authors: Mohamed Hassan Muhumed , Hassan Ibrahim Ali , Yussuf Aisha Abdirahman , Nor Yahye Abshir , Ahmed Abdirisak Abdikarin , Roble Abdullahi Ali 
Published: March 2024

Introduction and importance:
Paecilomyces species are rare fungi that are resistant to standard treatment and have increasing clinical relevance. The Purpureocillium lilac-inum, formerly known as Paecilomyces lilacinus, has a unique sensitivity for the corneal surface. However, only a few cases have been documented globally. This case report presents the successful management of a patient with Paecilomyces lilacinus keratitis with topical voriconazole and oral itraconazole.

Case presentation:
A 40-year-old woman came to our ophthalmology clinic complaining of right eye pain due to a severe corneal infection in her right eye. Corneal scraping and identification of the cultured pathogen were performed, which revealed Paecilomyces lilacinus. The corneal infection improved after being treated with hourly topical voriconazole (10 mg/mL) and oral traconozole.

Clinical discussion:
Paecilomyces/Purpureocillium keratitis, which accounts for 5% of keratomycosis cases in tropical and subtropical areas, is extremely rare. It does not respond well to conventional antifungal treatment and frequently requires therapeutic surgery. Risk factors include wearing contact lenses, ocular trauma, ocular surgery, corticosteroids, and IOL implantation.

Conclusion:
For the treatment of Paecilomyces lilacinus keratitis that is unresponsive to conventional antifungal medications, voriconazole may be helpful. Early organism detection and the appropriate therapy are necessary for the management of keratitis.
Factors Related to Person-Centered Care for Older Patients With Cancer and Dementia in Designated Cancer Hospitals
Authors: Ikeda Setsuka , Aoyanagi Michiko , Nakaya Ryota , Yoshimura Mai , Sumi Naomi 
Published: March 2024

Background
Person-centered care (PCC) should be promoted for patients with cancer and dementia who are likely to be hindered from pursuing a meaningful life owing to their will not being reflected in the cancer treatment process.

Objective
This study aimed to clarify the factors related to nurses’ practice of PCC for older patients with cancer and dementia in designated cancer hospitals.

Methods
An online cross-sectional survey was administered to nurses working at designated cancer hospitals in Japan. The survey items included demographic data and factors assumed to be related to nursing practice and practice of PCC.

Results
A multiple regression analysis indicated that the factors related to the practice of PCC were attitude toward patients with dementia (β = 0.264, P < .001), holding conferences (β = 0.255, P < .001), knowledge about cancer nursing (β = 0.168, P < .001), knowledge about dementia (β = 0.128, P = .003), and participation in dementia care training (β = 0.088, P = .032).

Conclusions
Nurses’ practice of PCC may not be sufficient to provide personalized care tailored to patients’ cognitive function. The factors related to PCC are attitude toward patients with dementia, holding conferences, knowledge about cancer and dementia, and dementia care training.

Implications for Practice
To promote PCC for patients with cancer and dementia, nurses should learn about these conditions with an interest in patients and collaborate with other professionals. Future studies should use cluster sampling and focus on the extent of cancer or dementia symptoms.
Risk Factors for Tissue Expander–Related Infections in Pediatric Scar Reconstruction: A 10-Year Retrospective Study
Authors: Fan Chunjie , Li Peilong , Yan Ning , Huang Guobao 
Published: March 2024

Background:
Tissue expansion addresses limited soft-tissue availability and provides natural-looking skin for scar reconstruction. However, infection is a common complication in expander surgery. This 10-year retrospective cohort study was performed to investigate the infection risk factors in pediatric scar reconstruction.

Methods:
This single-center observational cohort study was conducted at the Central Hospital Affiliated with Shandong First Medical University, China, and analyzed data from pediatric patients undergoing tissue expander surgery for scar reconstruction from January of 2012 to June of 2022. Patients were selected, were divided into groups with or without infection, and their demographic and clinical data were analyzed. Propensity score matching ensured balanced comparisons, and logistic regression identified infection risk factors.

Results:
Among the 4539 patient records, 1756 eligible pediatric patients were included (142 with infections; 1614 without infections). Multivariate analysis revealed that factors increasing infection risk included having 3 or more expanders (OR, 2.39, P < 0.05), a total expander volume of 300 cc or more (OR, 2.33, P < 0.05), back or gluteal implants (OR, 1.33, P < 0.05), lack of antibiotic prophylaxis (OR, 0.65, P < 0.05), and absence of hematoma evacuation (OR, 3.29, P < 0.05). Microbiological analysis found no significant bacterial differences among antibiotic prophylaxis groups, with Staphylococcus aureus being the predominant bacterium in infections.

Conclusions:
Patients with multiple expanders, larger expander volumes, back or gluteal implants, lack of antibiotic prophylaxis, and hematoma evacuation absence have higher infection risks. Short-term (<24 hours) use of S. aureus–sensitive antibiotics after surgery may benefit pediatric infection risk reduction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Liver Imaging in Gastroenteropancreatic Neuroendocrine Neoplasms
Authors: Jeph Sunil , Gupta Shiva , Yedururi Sireesha , Daoud Taher E. , Stanietzky Nir , Morani Ajaykumar C. 
Published: March 2024

Abstract
The incidence of neuroendocrine neoplasms (NENs) has gradually increased over the past few decades with the majority of patients presenting with metastases on initial presentation. The liver is the most common site of initial metastatic disease, and the presence of liver metastasis is an independent prognostic factor associated with a negative outcome. Because NENs are heterogenous neoplasms with variable differentiation, grading, and risk of grade transformation over time, accurate diagnosis and management of neuroendocrine liver lesions are both important and challenging. This is particularly so with the multiple liver-directed treatment options available. In this review article, we discuss the diagnosis, treatment, and response evaluation of NEN liver metastases.
Prognostic Value of a Combined Nomogram Model Integrating 3-Dimensional Deep Learning and Radiomics for Head and Neck Cancer
Authors: Li Shuyan , Xie Jiayi , Liu Jinghua , Wu Yanjun , Wang Zhongxiao , Cao Zhendong , Wen Dong , Zhang Xiaolei , Wang Bingzhen , Yang Yifan , Lu Lijun , Dong Xianling 
Published: March 2024

Objective
The preoperative prediction of the overall survival (OS) status of patients with head and neck cancer (HNC) is significant value for their individualized treatment and prognosis. This study aims to evaluate the impact of adding 3D deep learning features to radiomics models for predicting 5-year OS status.

Methods
Two hundred twenty cases from The Cancer Imaging Archive public dataset were included in this study; 2212 radiomics features and 304 deep features were extracted from each case. The features were selected by univariate analysis and the least absolute shrinkage and selection operator, and then grouped into a radiomics model containing Positron Emission Tomography /Computed Tomography (PET/CT) radiomics features score, a deep model containing deep features score, and a combined model containing PET/CT radiomics features score +3D deep features score. TumorStage model was also constructed using initial patient tumor node metastasis stage to compare the performance of the combined model. A nomogram was constructed to analyze the influence of deep features on the performance of the model. The 10-fold cross-validation of the average area under the receiver operating characteristic curve and calibration curve were used to evaluate performance, and Shapley Additive exPlanations (SHAP) was developed for interpretation.

Results
The TumorStage model, radiomics model, deep model, and the combined model achieved areas under the receiver operating characteristic curve of 0.604, 0.851, 0.840, and 0.895 on the train set and 0.571, 0.849, 0.832, and 0.900 on the test set. The combined model showed better performance of predicting the 5-year OS status of HNC patients than the radiomics model and deep model. The combined model was shown to provide a favorable fit in calibration curves and be clinically useful in decision curve analysis. SHAP summary plot and SHAP The SHAP summary plot and SHAP force plot visually interpreted the influence of deep features and radiomics features on the model results.

Conclusions
In predicting 5-year OS status in patients with HNC, 3D deep features could provide richer features for combined model, which showed outperformance compared with the radiomics model and deep model.
Estimating Body Weight From Measurements From Different Single-Slice Computed Tomography Levels: An Evaluation of Total Cross-Sectional Body Area Measurements and Deep Learning
Authors: Ichikawa Shota , Sugimori Hiroyuki 
Published: March 2024

Objective
This study aimed to evaluate the correlation between the estimated body weight obtained from 2 easy-to-perform methods and the actual body weight at different computed tomography (CT) levels and determine the best reference site for estimating body weight.

Methods
A total of 862 patients from a public database of whole-body positron emission tomography/CT studies were retrospectively analyzed. Two methods for estimating body weight at 10 single-slice CT levels were evaluated: a linear regression model using total cross-sectional body area and a deep learning–based model. The accuracy of body weight estimation was evaluated using the mean absolute error (MAE), root mean square error (RMSE), and Spearman rank correlation coefficient (ρ).

Results
In the linear regression models, the estimated body weight at the T5 level correlated best with the actual body weight (MAE, 5.39 kg; RMSE, 7.01 kg; ρ = 0.912). The deep learning–based models showed the best accuracy at the L5 level (MAE, 6.72 kg; RMSE, 8.82 kg; ρ = 0.865).

Conclusions
Although both methods were feasible for estimating body weight at different single-slice CT levels, the linear regression model using total cross-sectional body area at the T5 level as an input variable was the most favorable method for single-slice CT analysis for estimating body weight.
Coaching Program to Address Burnout, Well-being, and Professional Development in Pediatric Surgery Trainees
Authors: Huang Eunice Y. , Saberi Rebecca A. , Palamara Kerri , Katz Danielle , Chen Heidi , Neville Holly L. 
Published: March 2024

Objective:
To assess impact of participation in a positive psychology coaching program on trainee burnout and well-being.

Background:
Coaching using principles of positive psychology can improve well-being and reduce physician burnout. We hypothesized that participation in a coaching program would improve pediatric surgery trainee well-being.

Methods:
With IRB approval, a coaching program was implemented during the COVID-19 pandemic (September 2020 to July 2021) in the American Pediatric Surgical Association. Volunteer pediatric surgery trainees (n=43) were randomized to receive either one-on-one quarterly virtual coaching (n=22) from a pediatric surgeon trained in coaching skills or wellness reading materials (n=21). Participants completed prestudy and poststudy surveys containing validated measures, including positive emotion, engagement, relationships, meaning, accomplishment, professional fulfillment, burnout, self-valuation, gratitude, coping skills, and workplace experiences. Results were analyzed using the Wilcoxon rank sum test, Kruskal-Wallis test, or χ2 test.

Results:
Forty trainees (93%) completed both the baseline and year-end surveys and were included in the analysis. Twenty-five (64%) were female, mean age 35.7 (SD 2.3), and 65% were first-year fellows. Coached trainees showed an improved change in positive emotion, engagement, relationships, meaning, accomplishment (P=0.034), burnout (P=0.024), and gratitude (P=0.03) scores from precoaching to postcoaching compared with noncoached trainees. Coping skills also improved. More coaching sessions were associated with higher self-valuation scores (P=0.042), and more opportunities to reflect were associated with improved burnout and self-valuation.

Conclusions:
Despite the stress and challenges of medicine during COVID-19, a virtual positive psychology coaching program provided benefits in well-being and burnout to pediatric surgery trainees. Coaching should be integrated into existing wellness programs to support the acquisition of coping skills that help trainees cope with the stressors they will face during their careers.