bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of vestibular function tests in nontuberculous mycobacterial otomastoiditis: A case report
Authors: Yueh Hann-Ziong , Chu Hung-Lun , Lu Shih-Chun , Lee Yuarn-Jang , Lin Che-Hsuan 
Published: February 2024

Background:
Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections.

Patient concerns:
A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months.

Diagnosis:
The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery.

Interventions:
The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months.

Outcomes:
The patient’s clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation.

Lessons:
The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.
The cervical blood patch: A therapeutic “miraculous” for cerebrospinal fluid leaks: A case report
Authors: Coşarcan Sami Kaan , Erçelen Ömür 
Published: February 2024

Rationale:
Cerebrospinal fluid (CSF) leaks, arising from abnormal openings in the protective layers surrounding the spinal cord and brain, are a significant medical concern. These leaks, triggered by various factors including trauma, medical interventions, or spontaneous rupture, lead to the draining of CSF—an essential fluid safeguarding the nervous system. A classic symptom of CSF leaks is an incapacitating headache exacerbated by sitting or standing but relieved by lying down. Spontaneous intracranial hypotension (SIH) denotes the clinical condition marked by postural headaches due to spontaneous CSF leakage and hypotension, often misdiagnosed or underdiagnosed. While orthostatic headaches are the hallmark, SIH may manifest with an array of symptoms including nausea, tinnitus, hearing loss, visual disturbances, and dizziness. Treatment options encompass conservative measures, epidural blood patches (EBP), and surgery, with EBP being the primary intervention.

Patient Concern:
The patient did not express any specific concerns regarding their medical diagnosis. However, they did harbor apprehensions that their condition might necessitate surgical intervention in the future.

Diagnosis:
The patient had been treated with antibiotics with a pre-diagnosis of sinusitis and was admitted to the neurology department of our hospital when his symptoms failed to improve. Cranial magnetic resonance imaging was interpreted as thickening of the dural surfaces and increased contrast uptake, thought to be due to intracranial hypotension. Cranial MR angiography was normal. Full-spine magnetic resonance imaging revealed a micro-spur at the C2 to 3 level and the T1 to 2 level in the posterior part of the corpus.

Interventions:
The cervical EBP was performed in the prone position under fluoroscopic guidance. There were no complications.

Outcomes:
The patient was invited for follow-up 1 week after the procedure, and control examination was normal.

Lessons:
SIH poses a diagnostic challenge due to its diverse clinical presentation and necessitates precise imaging for effective intervention. Cervical EBP emerges as a promising treatment modality, offering relief and improved quality of life for individuals grappling with this condition. However, clinicians must carefully assess patients and discuss potential risks and benefits before opting for cervical blood patches.
Role of wet-cupping therapy in physiological and mental pains in patients with migraine: A quasi-clinical trial
Authors: Abdulah Deldar Morad , Younis Heewa Abdelsalam , Mustafa Zuhair Rushdi 
Published: February 2024

Background:
There is growing evidence of the potential benefits of wet-cupping therapy in reducing physiological pain severity in migraine; however, the role of this therapy on mental pain is unclear in this process. Therefore, this study aimed to examine the effectiveness of wet-cupping therapy on physiological and mental pains in patients with migraine. In this study, 72 migraine patients were treated with wet-cupping therapy and followed up after 1 month.

Methods:
The severity of physiological and mental pain was measured before therapy, 10 minutes and 1 month following therapy.

Results:
The study showed that patients in the wet-cupping therapy had a significantly lower mean value of physiological (0.42 vs 3.39; P < .001) and mental pain (1.60 vs 3.06; P < .001) compared to the patients in the control group, respectively. The mean value of the physiological was significantly decreased from 6.97 (baseline) to 0.73 (10 minutes) and 0.63 (1 month; P < .001) in the wet-cupping therapy patients, and the mean value of mental pain from 3.76 (baseline) to 0.71 (10 minutes) and 1.71 (1 month; P < .001). The mean values of physiological and mental pains were significantly reduced (from 7.80–3.39; P < .001) and (from 3.48–3.06; P = .0044), respectively. The level of physiological pain severity was significantly decreased with a decreasing level of mental pain severity at the posttest within the control (r = 0.5471; P = .0002) and the wet-cupping therapy (r = 0.3814; P .0412).

Conclusion:
This study showed that the physiological pain was controlled by the mental pain in the wet-cupping therapy.
Emerging trends in the blood spinal-cord barrier: A bibliometric analysis
Authors: Xu Bo , Zhang Dian , Yang Bowen , Chen Xin , Jin Zhefeng , Qin Xiaokuan , Ma Guoliang , Sun Kai , Zhu Liguo , Wei Xu , Yin He 
Published: February 2024

Background:
The blood-spinal cord barrier (BSCB) is a unique protective barrier located between the circulatory system and the central nervous system. BSCB plays a vital role in various diseases. However, there is little systematic research and recording in this field by bibliometrics analysis. We aim to visualize this field through bibliometrics to analyze the hotspots and trends of BSCB and in order to facilitate an understanding of future developments in basic and clinical research.

Methods:
To conduct a bibliometric study of original publications and their references, the keywords Blood Spinal-Cord Barrier and BSCB are searched and filtered from the Web of Science database (2000–2022), focusing on citations, authors, journals, and countries/regions. Additionally, clustering of the references and co-citation analysis was completed, including a total of 1926 articles and comments.

Results:
From the results, 193 authors were identified, among which Sharma Hs played a key role. As far as the analysis result of the clustering of the references is concerned, the most common type in cluster analysis is spinal cord injury (SCI) which is a current and developing research field. The keywords are also the specific content under these clusters. The most influential organization is Univ Calif San Francisco, and “Proceedings of The National Academy of Sciences of The United States of America” magazine is the most cited magazine.

Conclusion subsections:
The research on BSCB is booming focusing mainly on “BSCB in SCI” including “activation,” “pathway,” and “drug delivery” which is also the trend of future research.
Early-onset esophageal squamous cell carcinoma with achalasia: A case report
Authors: Li Shujin , Chen Xin , Zhang Lili , Jin Hong , Wang Bin , Liu Cong , Ru Shiwei , Liu Xuechai , Zhao Wei 
Published: February 2024

Rationale:
Individuals afflicted with achalasia of the cardia (AC) are more susceptible to the development of esophageal cancer (EC). However, the presence of esophageal retention obscured observation, making it difficult to detect EC early, which leads to misdiagnosis and poor prognosis in AC patients with EC. Besides, the persistence of high-risk factors may have contributed to the rapid progression of EC shortly after per-oral endoscopic myotomy (POEM). Therefore, it is imperative to alert clinicians to this extremely rare and instructive early-onset cancer.

Patient concerns:
The patient was a 67-year-old male who developed dysphagia 3 years ago without obvious causes, with intermittent onset and aggravating trend, accompanied by weight loss. He usually eats high-temperature foods and pickled foods, and has a family history of esophageal squamous cell carcinoma.

Diagnosis and interventions:
The patient was initially diagnosed with AC 2 years ago and subsequently underwent POEM surgery. One year after surgery, he was found to have mid-upper EC during follow-up and underwent partial esophagectomy in time.

Outcomes:
The patient’s symptoms have significantly improved with weight gain, and he is still adhering to regular follow-up and endoscopic examination.

Lessons:
In rare cases, EC develops early in patients with achalasia after POEM surgery. To avoid missed diagnosis, a comprehensive examination to improve the accuracy to diagnose achalasia and identify possible early-onset cancer is very important in clinical practice. Especially for patients with AC who have a family history of EC or other high-risk factors may develop EC early after POEM surgery. Therefore, regular endoscopic follow-up after POEM surgery is essential.
Extra-abdominal infections caused by Comamonas kerstersii: Case report
Authors: Wang Mingxi , Wang Hui , Chen Shicheng , Ming Desong , Nie Qingbin 
Published: February 2024

Rationale:

Comamonas kerstersii mainly causes intra-abdominal infections with favorable outcomes due to high antibiotic susceptibility. We report the first case of pneumonia caused by C Kerstersii, which promoted patient death, and a second urinary tract infection by C Kerstersii with extensive drug resistance.

Patient concerns:
A 46-year-old male (Case 1) with craniocerebral injury underwent emergency decompressive craniectomy, but his condition deteriorated further and presented with discontinuous fever, small moist rales on both lungs, and respiratory failure. Retrospective average nucleotide identity (ANI) analysis of the genomic sequence of the sputum isolate identified it as C Kerstersii 12322-1, antimicrobial susceptibility testing (AST) revealed that it was sensitive to 18 of 21 tested antibiotics.
An 82-year-old male (Case 2) with hypertrophic prostate experienced gradual obstruction during urination, and a urine test revealed WBC ++. Retrospective ANI analysis of the urine isolate identified it as C Kerstersii 121606, which was resistant to 18 of 21 tested antibiotics.

Diagnoses:
Case 1 was diagnosed empirically as pneumonia caused by C Kerstersii strain 12322-1 secondary to craniocerebral injury and confirmed by retrospective ANI analysis; case 2 was diagnosed empirically as urinary infection secondary to prostate hyperplasia caused by C Kerstersii strain 121606 confirmed by the retrospective ANI analysis.

Interventions:
Case 1 was administered cefoxitin, cefodizime, imipenem-cilastatin sodium, and underwent comprehensive salvage management. Case 2 was administered doxycycline alone.

Outcomes:
Case 1 died partially because of untimely identification of the responsible bacteria-12322-1. Case 2 was cured even 121606 exhibited an extensive drug resistance feature.

Lessons:
Except for intra-abdominal infections with good prognosis, we verified that C Kerstersii could also cause extra-abdominal infections, such as the first pneumonia case and urinary infection. It could promote patient death; actual infections were underestimated due to identification difficulties, posing a health threat due to the presence of extensive drug resistance.
Fatal arrythmia in a young man after COVID-19 vaccination: An autopsy report
Authors: Minato Hiroshi , Yoshikawa Akane , Tsuyama Sho , Katayanagi Kazuyoshi , Hachiya Satoaki , Ohta Keisuke , Myojo Yasuhiro 
Published: February 2024

Rationale:
The benefits of COVID-19 mRNA vaccination are claimed to be substantial; however, vaccination-related myocarditis and pericarditis have also been observed globally, particularly among young men. In most cases, the symptoms are mild and resolve on their own; however, fatal cases have rarely been described.

Patient concerns:
A healthy 40-year-old Japanese man suddenly experienced tachycardia and lost consciousness 2 days after vaccination. Continued resuscitation recovered the spontaneous heartbeat; however, the patient did not regain consciousness and died 9 days later. Electrocardiography after resuscitation showed marked ST-segment depression and incomplete right bundle branch block. Influenza antigen and polymerase chain reaction tests for SARS-CoV-2 were negative.

Diagnoses:
Fatal arrhythmia after a second COVID-19 mRNA vaccination.

Interventions:
We performed an autopsy and studied the material morphologically and immunohistochemically.

Outcomes:
At autopsy, several small inflammatory foci with cardiomyocytic necrosis were scattered in the right and left ventricles, with a propensity for the right side. Some inflammatory foci were located near the atrioventricular nodes and His bundles. The infiltrating cells predominantly consisted of CD68-positive histiocytes, with a small number of CD8-positive and CD4-positive T cells. In this case, myocarditis was focal and mild, as is mostly observed following COVID-19 mRNA vaccination. However, the inflammatory foci were close to the conduction system and were considered the cause of fatal arrhythmia.

Lessons:
Although the benefits of COVID-19 vaccination appear to outweigh the side effects, it should be noted that fatal arrhythmias may rarely occur, and caution should be taken if individuals, particularly young men, complain of any symptoms after vaccination.
Current evidence on local therapy in oligometastatic prostate cancer
Authors: Basourakos Spyridon P. , Henning Grant , Karnes R. Jeffrey 
Published: February 2024

Purpose of review
Metastatic prostate cancer (PCa) continues to be an invariably fatal condition. While historically, de-novo metastatic PCa was primarily treated with androgen deprivation therapy (ADT) and systemic therapy, there is a growing trend toward incorporating local treatments in the early management of the disease. This is particularly applicable to men with oligometastatic PCa (OMPC), which represents an ‘intermediate phase’ between localized and disseminated metastatic disease. Local treatment offers an opportunity for disease control before it progresses to a more advanced stage. This review discussed the current evidence for local treatment options for OMPC.

Recent findings
Currently, it has been suggested that men with OMPC may have a more indolent course and, therefore, favorable outcomes may be observed with metastasis-directed therapy (MDT). This review will not address the role of MDT to patients with OMPC but will focus on local treatments of the primary disease. The three main forms of local therapy employed for OMPC are cryotherapy, radiation therapy, and cytoreductive prostatectomy (CRP). Whole gland cryotherapy, either with ADT or with ADT and systemic chemotherapy, has shown some limited promising results. Radiation therapy combined with ADT has also demonstrated improvements in progression-free survival in clinical trials (primarily STAMPEDE Arm G and HORRAD). CRP often combined with ADT has emerged as a potential strategy for managing OMPC, with promising findings primarily from retrospective studies. Currently, several randomized controlled trials are underway to further investigate the role of CRP in the oligometastatic setting.

Summary
OMPC has become a unique category of disease with specific therapeutic implications. Lack of robust clinical data renders treatment selection controversial. Further studies with long follow up are necessary to identify men with oligometastatic disease who will benefit from local treatment.
Testicular cancer with small metastatic burden: optimal approach in 2024
Authors: Yuen Kit L. , Pandit Kshitij , Puri Dhruv , Yodkhunnatham Nuphat , Bagrodia Aditya 
Published: February 2024

Purpose of review
Recent advancements in the management of clinical stage II (CS II) testicular cancer have transformed it into a predominantly curable condition. This success in treatment advancements has markedly extended patient survival. However, these treatments carry risks and morbidities, which is important to consider given the disease's impact on young men and the emerging understanding of long-term treatment consequences.

Recent findings
Emerging data support primary retroperitoneal lymph node dissection (RPLND) for select CS II seminoma patients, with similar short-term outcomes to chemotherapy but less treatment intensity. Recent studies have also challenged the reflexive use of adjuvant chemotherapy for pathologic node-positive disease, as growing evidence shows low relapse rates regardless of nodal stage. Furthermore, novel biomarkers like circulating serum microRNA-371a-3p levels can help predict the presence of viable germ cell tumor at time of RPLND.

Summary
Advances in risk stratification and therapy enable personalized de-escalation approaches for oligometastatic testicular cancer, optimizing survivorship. Upfront RPLND, reassessing adjuvant systemic therapy for RPLND pN+ disease, and novel biomarkers will shape precision treatment to achieve high cure rates with excellent quality of life. Ongoing trials of reduced-intensity regimens, accurate prognostic models, improved surgical strategy, and emerging biomarkers represent the next frontier in tailored curative therapy.
A 16-year-old boy presented with triple-A syndrome associated with neuromuscular disorders: a case report
Authors: Sultan Mohammad N. , Shakoo Noor , Razouk Ahmad , Alari Yaman , Aldaher Bashar , Niazi Ammar 
Published: February 2024

Introduction and importance:
Allgrove syndrome (AS) (AAA syndrome) is a rare autosomal recessive disease caused by mutations in the AAAS gene located on chromosome 12q13. The AAAS gene encodes for the ALADIN protein (alacrima, achalasia, adrenal insufficiency, neurologic disorder). AS can manifest with a plethora of symptoms. Early recognition of the syndrome remains challenging due to its rarity and progressive nature. This report presents an unusual case of triple-A syndrome (TAS) with concurrent neuromuscular manifestations. Understanding the atypical presentation of this syndrome is vital for early diagnosis and appropriate management.

Case presentation:
We report a 16-year-old boy with severe malnutrition presented with painful swallowing, fatigue, and bilateral congenital ptosis. Barium swallow, upper gastrointestinal endoscopy, and Shimmer test were performed, which led to the diagnosis of TAS. Treatment included laparoscopic Heller’s procedure, artificial tears, hydrocortisone.

Clinical discussion:
TAS, also known as AS, is a rare multisystem disorder characterized by achalasia, Addison’s disease, and alacrima. This syndrome is occasionally referred to as 4A syndrome due to the inclusion of autonomic dysfunction. There is no treatment for AS. Management includes artificial tears for alacrima, glucocorticoid replacement therapy to treat adrenal insufficiency, and treatment of achalasia.

Conclusion:
This case emphasizes the importance of considering atypical presentations of TAS. Early diagnosis and treatment are paramount in addressing the varied components of this rare disorder. Understanding the clinical complexities of this syndrome aids in improved patient care and underscores the necessity for comprehensive evaluation and management in similar cases.
Microsurgical treatment of posterior circulation aneurysms: an institutional experience from Nepal
Authors: Sharma Mohan Raj , Karki Susmin , Pradhanang Amit B. , Sedain Gopal 
Published: February 2024

Background
Management strategies and outcomes of patients with posterior circulation aneurysms are varied due to uncertainty in the optimal treatment modality and limited experience of neurosurgeons. Data are scarce regarding patients with posterior circulation aneurysms from developing countries. This study aims to describe the clinical characteristics, management strategies and outcome of patients with these aneurysms treated microsurgically in an academic institute in Nepal.

Methods
The clinical records of patients confirmed to have posterior circulation aneurysms treated microsurgically between July 2014 and July 2022 were retrospectively reviewed. Demographic and clinical characteristics, morphometric characteristics of aneurysms, management strategies, postoperative complications, and 1-year outcomes were described.

Results
Out of 220 aneurysms in 190 patients, 20 were posterior circulation aneurysms. The median age of the patients was 43 (15–60) years. All were ruptured aneurysms. The admission Hunt and Hess grades of 18 (90%) patients were less than or equal to III. The posterior inferior cerebellar artery (8) was the commonest location. The postoperative complications rate was 20%, with the overall mortality of 10%. 80% of patients had a favourable outcome at 1-year follow-up.

Conclusions
The patient characteristics and outcome are comparable with those described in the literature from other countries. With an individualized and careful selection strategy, our results are satisfactory despite fewer operations.