bluuebunny/crossref_metadata_2025_split huggingface dataset:
The obesity challenge in joint replacement: a multifaceted analysis of self-reported health status and exercise capacity using NHANES data: a population-based study
Authors: Zhang Xianzuo , Shen Xianyue , Bai Jiaxiang , Zang Wanli , Chen Mo , Maimaitiabula Abasi , Zhu Chen 
Published: March 2024

Background:
Joint replacement is successful for end-stage oeteoarthritis, with obesity linked to elevated risk. But the impact of obesity on self-reported health and exercise capacity among joint replacement patients remains complex and requires investigation.

Methods:
This study utilizes data from the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between obesity severity, demographic factors, medical comorbidities, and self-reported health status. The relationship between general health status and BMI was analyzed using multivariable regression, and further illustrated using a restricted cubic spline. Additionally, a bibliometric analysis and systematic review was done to frame the research within the broader context of existing knowledge and demographic specifics.

Results:
Analysis of NHANES data involving 327 joint replacement patients yielded intriguing insights. The difference in self-reported health between BMI groups did not achieve conventional statistical significance (P=0.06), and multivariable analysis showed that even severely obese patients did not exhibit significantly elevated risk of poor/fair self-reported health compared to normal weight subjects. Among severely obese individuals (BMI>40), 40.63% still rated their health positively. However, stratified analyses indicated that obesity correlated with negative health reports across sex, age, and education strata. Notably, physical functioning emerged as a robust predictor of self-reported health, with those reporting no walking difficulties having significantly lower odds of poor/fair health (Odds ratio=0.37, P=0.01).

Conclusion:
The study highlights the need for healthcare providers to consider individual physical abilities and comorbidities alongside obesity severity when discussing treatment options with joint replacement patients. It supports tailored interventions and informed shared decision-making. Future research could explore effective weight management strategies for obese individuals undergoing joint replacement.
The anterior neck scar outcomes of conventional thyroidectomy using a wound protector: a multicenter double-blinded randomized controlled trial
Authors: Kim Woochul , Yu Hyeong Won , Kim Su-jin , Chai Young Jun , Choi June Young , Lee Kyu Eun 
Published: March 2024

Purpose:
This study aimed to investigate the effectiveness of a novel wound protector in enhancing the cosmetic outcomes of thyroidectomy.

Material and methods:
This multicenter, double-blinded randomized controlled trial enrolled 129 patients undergoing open thyroidectomy. The patients were divided into a wound protector group and a control group. Subjective patient assessments were conducted, measuring wound satisfaction, pain, and itchiness. Additionally, blinded observers evaluated scars using the Vancouver Scar Scale.

Results:
The Vancouver Scar Scale revealed significant advantages for the wound protector group, demonstrating improvements in pigmentation (P=0.002), vascularity (P=0.014), pliability (P=0.001), and height (P=0.001).

Conclusion:
The thyroid wound protector offers a potential to improve postoperative cosmetic outcomes. Further research is warranted to explore patient experiences and optimize the application of this innovative wound protector across diverse surgical contexts.
Combined simultaneous transsphenoidal and transcranial regimen improves surgical outcomes in complex giant pituitary adenomas: a longitudinal retrospective cohort study
Authors: Qiao Nidan , Gao Wei , Deng Xingli , Xin Tao , Zhang Gangli , Wu Nan , Wang Pan , Bi Yunke , Cong Zixiang , Zhou Zhiyi , Li Junjun , Sun Shengyu , Li Meng , Tang Wenlong , Yan Xiaorong , Wang Wenxiong , Qiu Wenjin , Yao Shun , Ye Zhao , Ma Zengyi , Zhou Xiang , Cao Xiaoyun , Shen Ming , Shou Xuefei , Zhang Zhaoyun , Wu Zhenyu , Chu Liangzhao , Qiu Yongming , Ma Hui , Wu Anhua , Ma Chiyuan , Lou Meiqing , Jiang Changzhen , Wang Yongfei , Zhao Yao 
Published: March 2024

Background:
Surgical treatment of complex giant pituitary adenomas (GPAs) presents significant challenges. The efficacy and safety of combining transsphenoidal and transcranial approaches for these tumors remain controversial. In this largest cohort of patients with complex GPAs, we compared the surgical outcomes between those undergoing a combined regimen and a non-combined regimen. We also examined the differences in risks of complications, costs, and logistics between the two groups, which might offer valuable information for the appropriate management of these patients.

Patients and Methods:
This was a multicenter retrospective cohort study conducted at 13 neurosurgical centers. Consecutive patients who received a combined or non-combined regimen for complex GPAs were enrolled. The primary outcome was gross total resection, while secondary outcomes included complications, surgical duration, and relapse. A propensity score-based weighting method was used to account for differences between the groups.

Results:
Out of 647 patients [298 (46.1%) women, mean age: 48.5 ± 14.0 years] with complex GPAs, 91 were in the combined group and 556 were in the noncombined group. Compared with the noncombined regimen, the combined regimen was associated with a higher probability of gross total resection [50.5% vs. 40.6%, odds ratio (OR): 2.18, 95% confidence interval (CI): 1.30–3.63, P = 0.003]. The proportion of patients with life-threatening complications was lower in the combined group than in the non-combined group (4.4% vs. 11.2%, OR: 0.25, 95% CI: 0.08–0.78, P = 0.017). No marked differences were found between the groups in terms of other surgical or endocrine-related complications. However, the combined regimen exhibited a longer average surgery duration of 1.3 h (P < 0.001) and higher surgical costs of 22,000 CNY (~ 3,000 USD, P = 0.022) compared with the noncombined approach.

Conclusions:
The combined regimen offered increased rates of total resection and decreased incidence of life-threatening complications, which might be recommended as the first-line choice for these patients.
Step into the era of large multimodal models: a pilot study on ChatGPT-4V(ision)’s ability to interpret radiological images
Authors: Zhu Lingxuan , Mou Weiming , Lai Yancheng , Chen Jinghong , Lin Shujia , Xu Liling , Lin Junda , Guo Zeji , Yang Tao , Lin Anqi , Qi Chang , Gan Ling , Zhang Jian , Luo Peng 
Published: March 2024

Background:
The introduction of ChatGPT-4V’s ‘Chat with images’ feature represents the beginning of the era of large multimodal models (LMMs), which allows ChatGPT to process and answer questions based on uploaded images. This advancement has the potential to transform how surgical teams utilize radiographic data, as radiological interpretation is crucial for surgical planning and postoperative care. However, a comprehensive evaluation of ChatGPT-4V’s capabilities in interpret radiological images and formulating treatment plans remains to be explored.

Patients and methods:
Three types of questions were collected: (1) 87 USMLE-style questions, submitting only the question stems and images without providing options to assess ChatGPT’s diagnostic capability. For questions involving treatment plan formulations, a five-point Likert scale was used to assess ChatGPT’s proposed treatment plan. The 87 questions were then adapted by removing detailed patient history to assess its contribution to diagnosis. The diagnostic performance of ChatGPT-4V was also tested when only medical history was provided. (2) We randomly selected 100 chest radiography from the ChestX-ray8 database to test the ability of ChatGPT-4V to identify abnormal chest radiography. (3) Cases from the ‘Diagnose Please’ section in the Radiology journal were collected to evaluate the performance of ChatGPT-4V in diagnosing complex cases. Three responses were collected for each question.

Results:
ChatGPT-4V achieved a diagnostic accuracy of 77.01% for USMLE-style questions. The average score of ChatGPT-4V’s treatment plans was 3.97 (Interquartile Range: 3.33–4.67). Removing detailed patient history dropped the diagnostic accuracy to 19.54% (P<0.0001). ChatGPT-4V achieved an AUC of 0.768 (95% CI: 0.684–0.851) in detecting abnormalities in chest radiography, but could not specify the exact disease due to the lack of detailed patient history. For cases from ‘Diagnose Please’ ChatGPT provided diagnoses consistent with or very similar to the reference answers.

Conclusion:
ChatGPT-4V demonstrated an impressive ability to combine patient history with radiological images to make diagnoses and directly design treatment plans based on images, suggesting its potential for future application in clinical practice.
Concurrent ascending colon adenocarcinoma and colonic tuberculosis: a case report from Syria
Authors: Ahmad Basel , Durra Suzana , Tayfour Sabine , Habka Sandra , Albatal Bassel , Ahmad Mohamad 
Published: March 2024

Introduction and importance:
Tuberculosis (TB) has been one of the most devastating diseases to humanity in recent decades; although pulmonary infection is the most common, infection of any other organ is familiar as well. Colon cancer is another disease affecting the gastrointestinal (GI) system and mostly targets people over 50. Only a few studies mentioned the co-existence of cancer and TB occurring at the same place and time. Hence, the authors report a rare case of concurrent ascending colon adenocarcinoma and colonic TB.

Case presentation:
A 49 -year-old man presented to our clinic with constipation and abdominal pain. Two colonoscopies were performed, and two biopsies were taken; the first one showed granulomatous inflammation consistent with TB, and the second one showed low-grade adenocarcinoma. Computed tomography showed annular thickening of the ascending colon with infiltrates around the lesions. A right hemicolectomy was performed, and the final pathology confirmed adenocarcinoma grade II and extensive TB granulomas involving the colon into the serosa and the lymph nodes. Anti-TB medications were administered after surgery.

Clinical discussion:
Due to appropriate diagnostic methods, TB and cancer were detected at an early stage. In our treatment protocol, no adjuvant chemotherapy was applied after surgery due to the possibility of drug interaction with anti-TB medications.

Conclusion:
The two diseases may co-exist; thus, diagnosing them may not be the easiest, not to mention the lack of a clear treatment protocol in case of their accompany.
Bimaxillary fixed implant-supported zirconium oxide prosthesis therapy of an adolescent patient with non-syndromic oligodontia and two WNT10 variants: a case report
Authors: Grün Pascal , Pfaffeneder-Mantai Florian , Leunig Nikolai , Bytyqi Ditjon , Maier Cornelia , Gencik Martin , Bandura Patrick , Turhani Dritan 
Published: March 2024

Introduction and importance:
Oligodontia is a rare genetic condition characterized by more than six congenitally missing teeth, either as an isolated non-syndromic condition or in association with other genetic syndromes. The impact of WNT10A variants on dental development increases with the presence of the c.321C>A variant and the number of missing teeth.

Case presentation:
A 21-year-old man with non-syndromic oligodontia was diagnosed at 15 years of age with misaligned teeth, speech problems, and the absence of 24 permanent teeth. Interdisciplinary collaboration between specialists was initiated to enable comprehensive treatment. DNA analysis confirmed that the patient was a carrier of the known pathogenic WNT10A variant c321C>A and WNT10A variant c.113G>T of unknown clinical significance.

Clinical discussion:
Dental implants are a common treatment; however, bone development challenges in adolescent patients with non-syndromic oligodontia necessitate careful planning to ensure implant success. Many WNT variants play crucial roles in tooth development and are directly involved in non-syndromic oligodontia, especially the WNT10 variant c.321C>A.

Conclusion:
A full-arch implant-supported monolithic zirconia screw-retained fixed prosthesis is a viable treatment option for young adults with non-syndromic oligodontia. Further studies are needed to clarify the possible amplifying effect of the WNT10A variants c321C>A and c.113G>T on the pathogenic phenotype of non-syndromic oligodontia.
Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’
Authors: Aldiansyah Dudy , Halim Binarwan , Lumbanraja Sarma N. , Asroel Edwin M. , Fahdy M. , Hartono Hanudse , Thomson Thomson 
Published: March 2024

Introduction and importance:
The diagnostic criteria for Quintero staging in twin-to-twin transfusion syndrome (TTTS) are not applicable in all cases of TTTS, such as those in which the symptoms overlap with other monochorionic twin complications such as selective intrauterine growth restriction (sIUGR).

Case presentation:
A 25-year-old woman, G1P0A0, at 22–24 weeks’ gestational age was diagnosed with TTTS, with no outstanding history of medication use during pregnancy, and no family history of genetic disorder or twin pregnancy. In the donor twin, persistently absent end-diastolic flow in the umbilical artery was observed using Doppler velocimetry. Polyhydramnios was observed in the recipient twins. The fetal weight discordance between the twins was 39%. After 2 weeks of follow-up, the authors performed fetoscopic laser photocoagulation and successfully ablated five vascular anastomoses and amnioreduction by 2.5 l. Five days after the laser surgery, the patient developed amniotic fluid leakage, and an amniopatch was performed. The authors did the caesarean section at 34 weeks because of severe preeclampsia, the donor and recipient birth weights were 1,120 g and 1,837 g, respectively (weight discordance 39%). The APGAR scores were 3/4 and 6/8, respectively. The donor twin died 6 days after delivery due to respiratory failure, and the recipient twin survived. Neonatal echocardiography of the surviving twin showed no tricuspid regurgitation. No long-term follow-up was performed.

Clinical discussion:
The traditional diagnostic criteria for TTTS stage 3 were not met and overlapped with the diagnostic criteria for sIUGR type 2. This is the first procedure reported in Indonesia for atypical TTTS with the outcome, one twin survived.

Conclusion:
Some TTTS cases do not meet traditional diagnostic criteria and overlap with other monochorionic twin complications.
The utilization of three-dimensional imaging and three-dimensional-printed model in autologous microtia reconstruction
Authors: Koento Trimartani , Damara Fachreza Aryo , Reksodiputro Mirta Hediyati , Safitri Eka Dian , Anatriera Raden Ayu , Widodo Dini Widiarni , Dewi Dwi Juliana 
Published: March 2024

Background:
The use of three-dimensional (3D) technology helps surgeons in performing autologous microtia reconstruction due to more accurate measurements and a better precision template model. However, the technical aspects of using a 3D imaging and 3D-printed model and the difference in outcomes postoperatively remain poorly reviewed.

Purpose:
This systematic review aimed to provide the current evidence of the benefit and technical aspects of using 3D technology in autologous microtia reconstruction.

Method:
A systematic literature search was conducted across multiple databases: Medline, Embase, Google Scholar, and Central until June 2022. Studies that evaluated the use of 3D imaging or 3D-printed models for autogenous microtia reconstruction were selected. The quality of the included studies was also assessed with respect to the study design.

Result:
A systematic literature search yielded 17 articles with a combination of observational and case report studies. Overall, 3D imaging showed a precise measurement for preoperative costal cartilage assessment. Compared to the 2D template, the utilization of a 3D-printed template provided a higher similarity rate relative to the unaffected ear, higher patient and surgeon satisfaction, and lower surgical time. Most 3D templates were fabricated using polylactic acid material on fused deposition modelling printers. The template costs were ranging from $1 to $4.5 depending on the material used.

Conclusion:
3D imaging and 3D-printed templates could improve the outcome of autologous microtia reconstruction. However, the quality of the existing evidence remains low due to the heterogeneity of the reported outcomes. Further studies with more adequate comparability and defined outcomes are still required.
Leiomyosarcoma of stomach extending to gastroesophageal junction and distal esophagus as a rare cause of dysphagia: a case report
Authors: Rajthala Lilamani , Gyawali Sagar , Banmala Sabin , Shah Surendra 
Published: March 2024

Introduction and importance:
Gastric leiomyosarcoma is a rare malignant tumor among the primary gastric carcinomas. Among the different common presentations, dysphagia is an uncommon presentation of gastric leiomyosarcoma.

Case presentation:
A 29-year-old female presented with complaints of progressive dysphagia for 1 year associated with vomiting, significant weight loss, and anorexia for 6 months. On blood investigations, she had anemia, hypokalemia, prerenal acute kidney injury, and unconjugated hyperbilirubinemia. Upper gastrointestinal endoscopy and contrast-enhanced computed tomography (CECT) were initially suggestive of carcinoma of stomach. Immunohistochemistry was diagnostic of leiomyosarcoma of stomach extending to the gastroesophageal junction and distal esophagus. She underwent total gastrectomy with distal esophagectomy with lateral segmentectomy of liver (nonanatomical) with Roux-en-Y esophago-jejunal anastomosis (end-to-side and retro-colic) through thoracoabdominal approach. After 6 weeks, she received four cycles of doxorubicin therapy. Follow-up at 18 months after surgery revealed no recurrence of malignancy.

Clinical discussion:
Leiomyosarcoma, a rare malignant tumor arising from stomach involves commonly gastric body followed by antrum and fundus. Imaging including CECT and tissue diagnosis including immunohistochemistry (positive for α-SMA, desmin, calponin, h-caldesmon, or smoothelin) have been mainstay for definitive diagnosis. The standard treatment for leiomyosarcoma of stomach is complete surgical resection of tumor because it has malignant potential and does not respond to targeted treatment with a tyrosine kinase inhibitor. The type of surgery depends on the size and localization of the tumor.

Conclusions:
Early diagnosis with proper imaging, immunohistochemistry, and biopsy play important role in differentiating gastric leiomyosarcoma from gastrointestinal stromal tumor. Surgical resection is the mainstay of treatment.
The comparison of hot and cold executive functions in patients with bipolar II disorder, borderline personality disorder, and healthy individuals
Authors: Sabbah Ayyub , Mottaghi Shekoofeh , Ghaedi Parviz , Ghalandari Melika 
Published: March 2024

Background:
Differential diagnosis of bipolar II disorder (BD-II) and borderline personality disorder (BPD) has always been challenging for clinicians due to symptoms’ overlap. This study aimed to compare hot and cold executive functions (EFs) in BD-II patients, as well as BPD and healthy controls (HCs), in order to differentiate these two disorders.

Methods:
In the present study, 30 BD-II and 30 BPD patients undergoing the drug therapy with mood stabilizers, and 30 HC were examined using EFs evaluated tests. The data were then analyzed using ANOVA and Tukey post hoc test.

Results:
The BD-II Patients performed significantly less in all cold EFs than the HC. Also, BPD patients had meaningfully lesser performance compared to HC in all cold EFs except sustained attention. No significant difference was perceived between the two patient groups in the cold EFs. In BD-II patients, the risky decision-making as a hot EFs’ component was not significantly different from HC; nevertheless, its amount was significantly higher in BPD than in the HC and BD-II patients.

Conclusion:
These findings underline the differences between the two mentioned disorders based on the hot EFs, which may indicate further disorder in the emotional information processing system among the BPD patients.
Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration
Authors: Kim Eunjin , Lee Minjae , Park Inkyung 
Published: March 2024

Abstract

Background
Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness.

Objectives
The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration.

Methods
This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019–2021). Adults aged 40 years or older were included and divided into two groups using the STOP–Bang questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates.

Results
Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hr demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high-risk for OSA with a sleep duration of 5–9 hr.

Discussion
The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.
Brain Autopsy Findings in a Patient Who Received Lipid Emulsion Therapy for Suspected Drug Intoxication
Authors: Cutshall Hannah , Gokden Murat 
Published: March 2024

Abstract
Lipid emulsion therapy (LET) is the intravenous administration of lipid solution for parenteral alimentation, especially in preterm infants and adults with debilitating illnesses. It has also been used in attempts of detoxification in suspected cases of drug overdose. Whether this interferes with circulation and/or perfusion is debatable, and it is suggested that it may interfere with coagulation process. The emulsifying agent has been identified microscopically mainly in the lungs of these patients, with rare reports in adults and even more rare ones in the brain; however, although it is rarely reported in other organs, to our knowledge, no reports of gross autopsy findings in the brain are available in the English literature, nor are there reports of pathologic findings after lipid emulsion therapy administration for drug toxicity. Although it is also debated in the literature whether this material forms as an artifact or represents the actual agent, here we report the gross and microscopic autopsy findings in the brain of a patient who received LET for suspected beta-blocker intoxication. It will be beneficial for pathologists who perform autopsies in the forensic or medical settings to be aware of these findings, along with the uses and potential complications of LET.