bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Placenta Accreta Spectrum Disorder After Prior Non–Cesarean Delivery Uterine Surgery
Authors: Yang Ru , Zhang Lizi , Sun Lu , Wu Jianli , Bi Shilei , Hu Miao , Luo Shijun , He Fang , Chen Jingsi , Yu Lin , Zhu Qiying , Chen Dunjin , Du Lili 
Published: February 2025

OBJECTIVE:
To evaluate the association between previous non–cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies.

DATA SOURCES:
PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov, CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches.

METHODS OF STUDY SELECTION:
Studies included prospective, retrospective cohort, case–control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery.

TABULATION, INTEGRATION, AND RESULTS:
Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle–Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity (I
2) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non–cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43–3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77–2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50–90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78–2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10–14.53), abortion (OR 1.65, 95% CI, 1.43–1.92), endometrial ablation (OR 20.26, 95% CI, 17.15–23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86–5.18).

CONCLUSION:
Prior non–cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO: CRD42024552210.
Thiotepa-Induced Toxicity: A Clinical Mimic of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Featuring Severe Mucositis, Diffuse Dusky Discoloration, and Skin Sloughing
Authors: Shaker Nada , Phelps Robert , Niedt George , Ben Musa Ruwaida , Bhowmik Rituja , Sangueza Omar P. , Pradhan Dinesh 
Published: February 2025

Background:
Thiotepa, an alkylating agent commonly used in chemotherapy, is increasingly recognized to induce cutaneous reactions resembling toxic erythema of chemotherapy (TEC). This condition is characterized by erythema, hyperpigmentation, and mucositis, often affecting intertriginous areas, and can mimic the early stages of Stevens–Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Case description:
A 31-year-old woman with a history of systemic lupus erythematosus, antiphospholipid antibody syndrome, seizures, and chronic kidney disease was admitted for the management of central nervous system (CNS) lymphoma. Seven days after receiving thiotepa during an autologous stem cell transplant, she developed severe mucositis, requiring intubation for airway protection, followed by a dusky, gray, full-body rash with sloughing in the groin, axillae, and buttocks. A skin biopsy from the back revealed vacuolar interface changes, eccrine gland necrosis, and occasional necrotic keratinocytes at the dermal-epidermal junction, with no evidence of full-thickness necrosis or significant eosinophilic infiltration. The differential diagnosis included thiotepa-induced toxicity, SJS/TEN, and drug eruption. Based on the patient's clinical presentation and the biopsy findings, thiotepa-induced TEC was favored over SJS/TEN.

Discussion:
Thiotepa is a potent lipophilic alkylating agent widely used in chemotherapy for pediatric and adult patients with various solid tumors and hematologic malignancies. Its anticancer mechanism involves DNA alkylation, leading to DNA strand cross-linking that disrupts replication and transcription, ultimately inhibiting cancer cell proliferation and survival. While thiotepa is primarily utilized in high-dose preparative regimens for stem cell transplantation in pediatric patients, its use in the adult population remains comparatively limited.
This case emphasizes the importance of differentiating thiotepa-induced TEC from severe cutaneous adverse reactions such as SJS/TEN. While these conditions share clinical and histologic features, the absence of extensive epidermal necrosis, satellite cell necrosis, and systemic involvement, along with recent thiotepa exposure, supported a diagnosis of TEC.

Conclusions:
This case highlights the diagnostic challenge of distinguishing thiotepa-induced TEC from SJS/TEN in post-transplant patients. Recognizing the characteristic involvement of intertriginous areas and eccrine gland necrosis in TEC is critical for accurate diagnosis and management. Awareness of this potential complication in patients receiving thiotepa is essential to avoid misdiagnosis and inappropriate treatment.
Circumferential Eschar-Covered Necrotic Leg Ulcers in a Case of Granulomatous Vasculitis: Looking Beyond ANCA Serology
Authors: Tyagi Shilpi , Kumar Shubham , Alam Afroz , Vedant Deepak , Singh Saurabh 
Published: February 2025

Abstract:
Cutaneous vasculitis, either as a single organ or part of systemic vasculitis, can take various forms. Granulomatosis with polyangiitis (GPA) is characterized by necrotizing granulomatous inflammation in the respiratory tract and vasculitis affecting small- to medium-sized blood vessels. Skin-limited GPA, an uncommon presentation, poses diagnostic challenges and may result in delayed diagnosis. We describe a 32-year-old man with painful ulcers and black eschars on both lower limbs, evolving from purpura. Despite lacking typical anti neutrophil cytoplasmic antibodies and systemic involvement, histopathology revealed granulomatous vasculitis. Treatment with prednisolone and methotrexate led to complete symptom resolution within 8 months. Skin-limited GPA, often without anti neutrophil cytoplasmic antibody positivity, warrants clinical suspicion, early intervention, and increased awareness to enhance patient outcomes.
Gene Fusion-Driven Cutaneous Adnexal Neoplasms: An Updated Review Emphasizing Molecular Characteristics
Authors: Cazzato Gerardo , Daruish Maged , Fortarezza Francesco , Colagrande Anna , Marzullo Andrea , Ingravallo Giuseppe , Dei Tos Angelo Paolo , Yang Richard K. , Cho Woo Cheal 
Published: February 2025

Abstract:
Gene rearrangements or fusions have emerged as critical oncogenic drivers in various cutaneous adnexal neoplasms. This review offers a comprehensive overview of both established and recently identified molecular alterations, with a specific focus on gene fusions. Key alterations discussed include YAP1 rearrangements, CRTC1::MAML2 fusions, BRD3 rearrangements, MYB::NFIB fusions, ETV6::NTRK3 fusions, and PLAG1 rearrangements, alongside rarer fusion transcripts, such as MEF2C::SS18, FOXK1::GRHL1/2, GPS2::GRHL, and RARA::NPEPPS. The article highlights the significance of these genetic changes in tumor biology and their potential therapeutic implications for locally advanced and metastatic skin adnexal tumors. It also addresses diagnostic challenges and molecular distinctions, providing updated insights into adnexal tumors driven by these gene fusions.
Expression of p16 in Hypertrophic Lichen Planus
Authors: Xu Katie R. , Honda Kord , Rohr Bethany R. 
Published: February 2025

Background:
Although cutaneous squamous cell carcinoma (SCC) arising from lichen planus is rare, hypertrophic lichen planus (HLP) accounts for most of these malignant transformations. Although the mechanism of malignant pathogenesis remains unknown, reports of similar premalignant conditions suggest a potential role of tumor suppressor p16. This is the first study to our knowledge to examine p16 expression in HLP in comparison to cutaneous invasive SCC and normal skin and its implications for malignant transformation.

Methods:
p16 immunohistochemistry of HLP (n = 34) was performed alongside location-matched well-differentiated SCC (WDSCC) and normal skin. Percentage of positive cells, nuclear and cytoplasmic staining intensity, and staining distribution patterns were reviewed by 2 Board-certified dermatopathologists.

Results:
HLP and WDSCC both showed an increased percentage of positive cells compared with normal skin (P < 0.001). Cytoplasmic p16 was overexpressed in HLP compared with WDSCC (P < 0.05). Most cases of HLP and WDSCC demonstrated stronger basal and suprabasal keratinocyte staining with weaker superficial staining. In WDSCC, a predominant pattern of focal cytoplasmic margination of staining along the cellular periphery was observed.

Conclusions:
Our finding of cytoplasmic p16 overexpression in HLP suggests a potential mechanism of p16-mediated cell cycle dysregulation seen in other premalignant conditions. p16 overexpression seems to be a possible contributor in the malignant transformation of HLP to SCC.
Continuous ropivacaine wound infiltration versus epidural morphine after unplanned caesarean delivery
Authors: Bruillot Marine , Pieper Audrey , Sourd Dimitri , Roge Ana , Ramain Edith , Salah Samia , Bosson Jean-Luc , Payen Jean-Francois 
Published: February 2025

BACKGROUND
Treatment programs designed to enhance recovery after caesarean delivery include multimodal analgesia to ensure optimal analgesia while reducing exposure to systemic opioids. Evidence for the effectiveness of continuous wound infiltration with local anaesthetic after unplanned caesarean delivery is needed.

OBJECTIVE
To determine whether continuous ropivacaine wound infiltration has noninferior analgesic properties compared to epidural morphine, while reducing side effects related to opioids.

DESIGN
Triple-blinded, noninferiority, randomised controlled trial.

SETTING
One university hospital, between February 2015 and August 2021.

PATIENTS
Eighty-one women undergoing unplanned lower segment caesarean section under epidural anaesthesia.

INTERVENTION
At the end of the procedure, randomly assigned patients received either an epidural bolus of 0.9% saline with 48 h continuous ropivacaine wound infusion (ropivacaine group) or an epidural bolus of morphine with 48 h 0.9% saline wound infusion (morphine group).

MAIN OUTCOME MEASURES
Pain during mobilisation at 24 h postsurgery was assessed using the visual analogue pain scale (VAS 0 to 10) with no indication of the allocated group.

RESULTS
Pain scores were 4.4 (95% CI, 3.6 to 5.1) in the ropivacaine group versus 3.1 (95% CI, 2.4 to 3.9) in the morphine group. The mean VAS pain difference between the two groups was 1.2 (95% CI, 0.2 to 2.3), which exceeded the prespecified noninferiority margin of 1. The differences between the two groups at rest and during mobilisation at 6 and 24 h were statistically significant. The ropivacaine group received rescue morphine more frequently, and were less satisfied despite fewer morphine-related side effects. Continuous wound infiltration was not technically feasible in 18% of the patients.

CONCLUSIONS
We failed to show that continuous ropivacaine wound infiltration was noninferior to epidural morphine in providing analgesia after unplanned caesarean delivery. Because of a significant rate of technical failures, continuous wound infiltration should only be considered when neuraxial morphine is contraindicated.
Current management of skin conditions in Kenya: exploring teledermatology preferences and perspectives among providers
Authors: Fernandez Jennifer M. , Kaderbhai Hashim , Adams Jennifer L. , Adam Mary B. , Adam Rodney D. 
Published: February 2025

Background:
Teledermatology programs may help expand access to care for skin conditions in areas that are underserved by dermatologists such as sub-Saharan Africa, but their success requires input from participating providers.

Objective:
This study assesses teledermatology preferences among healthcare providers in Kenya.

Methods:
An anonymous cross-sectional survey of nondermatology providers was conducted in Kenya from January to March 2024 at Aga Khan University Hospital-Nairobi and Kijabe Hospital.

Results:
Among the 38 providers, 81.6% were physicians. Patient population was primarily Fitzpatrick skin types V and VI. Almost all (97.4%) regularly encountered patients with skin disorders, yet only 5.3% felt comfortable diagnosing and treating 80 to 100% of these disorders independently. Providers anticipated referring cases of rashes (76.3%), unclear diagnoses (63.2%), and infectious diseases (50%), among others, for teledermatology consultation. Only 10.5% reported utilizing teledermatology, although the majority believed it would be useful (91.9%) and improve patient care (89.5%). Preferred response time was <24 hours (81.6%). Most favored submitting cases via personal cell phones (86.8%), with 87.9% preferring submission through WhatsApp.

Limitations:
Participants owned smartphones. The survey was distributed via WhatsApp.

Conclusion:
Nearly all providers in Kenya see patients with skin conditions, but few utilize teledermatology services. Teledermatology could be extremely beneficial for patients and providers seeking dermatologic expertise.
Effectiveness of intravenous lidocaine in treatment of burn pain: a systematic review and meta-analysis of randomised controlled trials
Authors: Elgadi Ammar , Mohmed Ahd , Elbadawi Mohamed H , Elawad Shaima O , Elamin Mohamed Yousif , Elhaj Nida Bakri , Elsadig Ahmed , Abdallah Hayat 
Published: February 2025

Background:
Burns are among the most agonizing injuries encountered in the clinical setting. Protocols for effective management of burn pain vary and mostly rely on opioids, a drug class well-known for dependence and adverse effects from misuse. Lidocaine, the most commonly used local anesthetic has shown potential to reduce the amount of opioids required. This study aims to assess the effectiveness of lidocaine infusion in reducing opioid use in patients with burn injuries.

Materials and methods:
This systematic review was conducted according to PRISMA guidelines. A comprehensive search of the electronic databases was carried out using the keywords “lidocaine,” “lignocaine,” “xylocaine,” “burn,” and “analgesia.” Eligible studies were randomised control trials (RCTs) from peer-reviewed journals or registries. Two independent reviewers conducted the screening. The Cochrane ROB-2 Tool was used to assess the quality of the included studies. Meta-analysis was conducted using Revman software.

Results:
We included four RCTs with 152 burn patients with total body surface area (TBSA) burned ranged from 3% to 68%. Morphine use had a standardized mean difference (SMD) of −0.47 [−1.18 to 0.24], which was not significant (p = 0.19). The changes in pain score weren’t significant (SMD = − 0.01, CI = [−0.37; 0.34], p = 0.94). Nausea had RR of 1.06 (CI = [0.80; 1.40], p = 0.700). No serious adverse event was reported.

Conclusion:
Our findings were inconclusive about the safety and effectiveness of lidocaine as an adjunct in the analgesia of burns and reducing the required opioid dosage. Large-scale clinical trials are needed.
Rivaroxaban versus dalteparin for the treatment of cancer-associated venous thromboembolism: a systematic review and meta-analysis
Authors: Shrestha Bibek , Bhusal Suzit , Kandel Grishma , Bastakoti Sudip , Yadav Krishna Kumar 
Published: February 2025

Background and Aims:
Traditionally, low molecular weight heparin (LMWH), such as dalteparin, has been the first-line treatment for cancer-associated VTE. However, recent studies suggest that rivaroxaban, a direct oral anticoagulant, may offer comparable efficacy with the convenience of oral administration. This systematic review and meta-analysis aim to evaluate and compare the efficacy and safety of rivaroxaban versus dalteparin in managing cancer-associated VTE, focusing on recurrence rates, bleeding events, and patient adherence.

Methods:
This review follows the PRISMA guidelines, systematically retrieving data from PubMed and Cochrane databases using structured search terms related to cancer, VTE, and anticoagulation. Data on recurrent VTE, major bleeding, and patient outcomes were extracted, Statistical analyses were performed using a random-effects model to account for heterogeneity.

Results:
Nine studies were analysed, encompassing a range of study designs across multiple countries. The findings show no significant difference in major bleeding risk between rivaroxaban and dalteparin (RR 0.91, p = 0.69), nor in bleeding-related mortality (OR 4.00, p = 0.36). Rivaroxaban was associated with a significant reduction in DVT recurrence (OR 0.75, p = 0.04) and a marginally non-significant reduction in PE recurrence (OR 0.73, p = 0.05). Non-significant bleeding events were slightly higher with rivaroxaban but did not reach statistical significance.

Conclusion:
Rivaroxaban presents a viable alternative to dalteparin for treating cancer-associated VTE, showing comparable safety regarding major bleeding and potential efficacy in reducing DVT recurrence. This study supports the potential for more standardized guidelines that include rivaroxaban as a feasible option in cancer-associated VTE management.
“Aprocitentan in hypertension management: clinical efficacy, safety, and future prospects”
Authors: Riaz Rumaisa , Ahmed Usaid , Naqi Unaiza , Afaq Laiba , Shaukat Ayesha , Khan Yalnaz , Akilimali Aymar 
Published: February 2025

Hypertension (HTN) is a prevalent medical condition characterized by systolic blood pressure (SBP) ≥ 130 mm Hg and diastolic blood pressure (DBP) ≥ 80 mm Hg. In 2010, the global prevalence of hypertension was 31.1%, with higher rates in men and low- and middle-income countries (LMICs). The etiology of primary hypertension involves neurohumoral, renal, metabolic, genetic, and environmental factors, with the kidneys playing a significant role in long-term blood pressure regulation. Endothelin-1 (ET-1), a potent vasoconstrictor, contributes to hypertension by affecting salt-water balance and promoting vascular remodeling. Hypertension often presents without symptoms, leading to complications such as heart failure, stroke, and renal failure if untreated. Common treatment options include angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Aprocitentan, a novel dual endothelin receptor antagonist, has shown promise in reducing blood pressure in patients with resistant hypertension. Clinical trials, including the Phase 3 PRECISION study, demonstrated its efficacy and long-term control. However, Aprocitentan’s use is associated with safety concerns, such as hepatotoxicity, fluid retention, and embryo-fetal toxicity, necessitating careful monitoring. Aprocitentan represents a significant advancement in hypertension management, offering a new therapeutic option for patients with uncontrolled hypertension, although vigilant monitoring and informed decision-making are essential to mitigate potential risks and ensure optimal outcomes.
MRSA-positive sternoclavicular septic arthritis mimicking mediastinal malignancy in a patient with multiple injection history: a rare case report
Authors: Shakeel Muzammil , Saleem Saad , Ali Huzafa , Saqib Huzaifa , Adhikari Dipendra , Nazeef Ayesha , Tariq Aisha , Ud–Din Zeeshan , Kamran Maheen 
Published: February 2025

Introduction and importance:
Infection of the sternoclavicular joint is exceptionally rare, accounting for less than 1% of bone infections. The presence of MRSA-positive septic arthritis in the sternoclavicular joint, coupled with its resemblance to mediastinal conditions and a history of multiple injections, presents a rare and complex clinical case that demands thorough evaluation and management.

Case presentation:
A 60-year-old male with a complex medical history, including hypertension, diabetes mellitus, hepatitis C, and recurrent cellulitis due to multiple IV and IM injections, presented with drowsiness and a painful, erythematous swelling of the left anterior chest wall. Clinical examination revealed pallor, distended abdomen, and decreased left-sided airway entry. Diagnostic workup showed elevated creatinine, metabolic acidosis, and inflammatory markers. Imaging revealed extensive soft tissue swelling and a mediastinal mass. A core biopsy confirmed severe acute and chronic inflammation, abscess formation, and granulation tissue suggestive of an infectious etiology. CT scans further identified sternoclavicular septic arthritis, a rare diagnosis.

Clinical discussion:
This case report describes MRSA-positive sternoclavicular septic arthritis in a patient with a history of tramadol and multivitamin injections. Sternoclavicular joint (SCJ) infection is rare, complicating differentiation from mediastinal malignancies. Successful management required embolization, IV antibiotics, and physiotherapy.

Conclusion:
MRSA-positive sternoclavicular septic arthritis, mimicking mediastinal malignancy, presents diagnostic challenges. Successful management involves tailored strategies, interdisciplinary collaboration, and consideration of IV drug injections.
Effect of osteopathic manipulative treatment on pain in palliative care patients: a randomized placebo-controlled clinical trial
Authors: Galeazzi Yann , Houel Nicolas , Gouaux Léa , Rohan Anne , Le Heiget Hélène , Jung Camille , Housset Bruno , Stubbe Laurent 
Published: February 2025

Abstract

Introduction:
Standard osteopathic manipulative therapy (OMT) is used as a supportive care for pain management in cancer patients.

Objectives:
The present study aimed to compare the efficacy of OMT with that of a sham treatment to attenuate pain in cancer patients in a palliative care unit.

Methods:
This randomized clinical trial was a simple blind, monocentric, placebo-controlled study. Seventy-five patients were randomly distributed between standard and sham OMT sessions at a 1:1 ratio, receiving standard or sham treatment every 2 days for the 7 days of the study. Patients were assessed using a self-administered visual analog scale (VAS)—ranging from 0 to 100, recorded in the morning and evening. They also completed the QLQ-C15-PAL quality-of-life questionnaire on the first and last day of the study. For participants with controlled analgesia pumps, the number of analgesic doses was recorded.

Results:
The OMT group demonstrated a significant effect of days, circadian period, and group on VAS pain decrease (P < 0.05). The VAS pain score for the OMT group exhibited a notable decline from the third day (D3 pm) (P = 0.03) to D6 pm (P = 1.28 × 10−05) with 43.2% improvement by the conclusion of the study. On D6, the quality-of-life score exhibited a tendency towards improvement. Patients with analgesia pumps showed a 31.58% reduction in their demand for analgesics (P = 0.016). No significant results were observed between D0 and D3.

Conclusion:
It is hypothesized that OMT could prove an efficacious method of pain management in cancer patients receiving palliative care, in addition to conventional cancer treatment.