bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapidly Progressive and Debilitating Epithelioid Hemangioendothelioma: An Atypical Presentation of a Rare Malignant Cutaneous Vascular Neoplasm
Authors: Dash Siddhartha , Behera Biswanath , Viswan Parvathy , Garg Kunal , Sethy Madhusmita , Ayyanar Pavithra 
Published: February 2024

Abstract:
Epithelioid hemangioendothelioma (EHE) is a rare vascular malignant tumor that comprises less than 1% of all vascular tumors. Cutaneous involvement in EHE can occur either by spreading from underlying bone or rarely could be limited to the skin and mostly presents as solitary well-circumscribed mass to an ill-defined infiltrative lesion. We present a case of rapidly progressive and debilitating EHE presenting multiple vascular papules and nodules. Histopathology showed an ill-circumscribed nodular proliferation of epithelioid and spindled cells in the dermis that extended into the subcutaneous tissue. The tumor cells had moderate eosinophilic cytoplasm, vesicular chromatin, and prominent nucleoli. In addition, they showed evidence of lumen formation and intracytoplasmic vacuoles. Brisk mitosis was noted. On immunohistochemistry, the cells were strongly positive for CD31, CD34, and ERG (ETS [erythroblast transformation-specific]-related gene). MIB-1 labeling index was more than 75% in the highest proliferating areas. A high degree of clinical suspicion and immunopathological examination is recommended for early diagnosis of this rare condition before it becomes function or life-threatening.
Association between ambient temperature and genitourinary emergency ambulance dispatches in Japan: A nationwide case-crossover study
Authors: Mano Yasuko , Yuan Lei , Ng Chris Fook Sheng , Hashizume Masahiro 
Published: February 2024

Background:
Although the effects of temperature on genitourinary morbidity and mortality have been investigated in several countries, it remains largely unexplored in Japan. We investigated the association between ambient temperature and genitourinary emergency ambulance dispatches (EADs) in Japan and the modifying roles of sex, age, and illness severity.

Methods:
We conducted a time-stratified case-crossover study with conditional quasi-Poisson regression to estimate the association between mean temperature and genitourinary EADs in all prefectures of Japan between 2015 and 2019. A mixed-effects meta-analysis was used to pool the association at the country level. Subgroup analyses were performed to explore differences in associations stratified by sex, age, and illness severity.

Results:
We found an increased risk of genitourinary EAD associated with higher temperatures. The cumulative relative risk (RR) at the 99th temperature percentile compared with that at the 1st percentile was 1.74 (95% confidence interval (CI) = [1.60, 1.89]). We observed higher heat-related RRs in males (RR = 1.89; 95% CI = [1.73, 2.07]) than females (RR = 1.56; 95% CI = [1.37, 1.76]), and in the younger (RR = 2.13; 95% CI = [1.86, 2.45]) than elderly (RR = 1.39; 95% CI = [1.22, 1.58]). We found a significant association for those with mild or moderate cases (RR = 1.77; 95% CI = [1.62, 1.93]), but not for severe or life-threatening cases (RR = 1.20; 95% CI = [0.80, 1.82]).

Conclusion:
Our study revealed heat effects on genitourinary EADs in Japan. Men, youth, and mild-moderate illnesses were particularly vulnerable subgroups. These findings underscore the need for preventative measures aimed at mitigating the impact of temperature on genitourinary emergencies.
The Feasibility of Chest Wall Resection and Reconstruction during an Operation in Breast Cancer, Phyllodes Tumor, and Osteoradionecrosis
Authors: Chirappapha Prakasit , Adireklarpwong Lakkana , Lertsithichai Panuwat , Sukarayothin Thongchai , Suvikapakornkul Ronnarat , Leesombatpaiboon Monchai , Wasuthit Yodying , Kiranantawat Kidakorn , Cherntanomwong Piya 
Published: February 2024

Background:
The effectiveness and safety of chest wall surgery for various breast conditions remain unclear. Previous studies have reported a high risk of morbidity. We hypothesized that the limited chest wall resection can be performed under safe and good technique and aim to identify the extent of safe surgery.

Methods:
A retrospective study analyzed patients who underwent chest wall resection for chest wall recurrence breast cancer, locally advanced breast cancer, phyllodes, fibromatosis breast tumor, and osteoradionecrosis from January 1, 2008, to April 10, 2023. The primary objectives were the extent of safe chest wall surgery and performance status postoperatively.

Results:
Thirteen chest wall resections with an average of two to three ribs removed were performed. Patients who had two or more rib resections underwent mesh stabilization; nevertheless, paradoxical chest without deteriorating oxygenation remained. Anterolateral thigh-free flap, pedicled-TRAM or latissimus dorsi flap, pectoralis major myocutaneous flap, and local fasciocutaneous bilateral advancement flap were performed on five, four, three, and one patient, respectively. Patients with a maximum of three ribs removed had an ECOG score of 0–1 postoperatively. Hematoma and wound dehiscence affected two patients. In a small series of chest wall recurrence cases (N  = 7), R0 resection had better disease-free survival of 13 months.

Conclusions:
The procedure of chest wall resection and reconstruction can be performed safely with a maximum of three ribs removed, using mesh and myocutaneous flaps in two or more rib resections. Further studies with larger sample sizes will provide better understanding.
Physician selection for hospital integration: Theoretical considerations and empirical findings
Authors: Alinezhad Farbod , Post Brady , Young Gary J. 
Published: February 2024

Background
The U.S. health care system has seen an increase in hospital-physician integration, with hospitals acquiring increasing numbers of physician practices. This shift has been linked to higher costs without significant improvements in quality.

Purpose
This study sought to identify the characteristics of physicians who transitioned from independent practice to hospital integration.

Methodology/Approach
We used physician variables, including quality scores, medical school rankings, years of experience, experience treating socially or medically complex patients, practice style, and location, as well as health care market and county-level variables to understand these determinants using a fixed-effects logistic regression model.

Results
A total of 101,746 physicians representing 66 clinical specialties satisfied our inclusion criteria, of which 3,656 became hospital-integrated between 2018 and 2020. The integrating physicians were generally less experienced, had lower quality scores, and generated less revenue per Medicare patient. Their patients, on average, had higher comorbidity scores, were more likely to be dually eligible, and resided in counties with higher poverty rates.

Conclusion
Our findings indicate that the physicians most likely to become hospital integrated are those facing reimbursement pressures due to a complex case mix and the associated challenges of performing well on the quality metrics. We also found some support for the anticompetitive aspects of hospital–physician integration. Our results suggest that hospitals are integrating with a relatively less experienced physician workforce but one that is perhaps more capable of treating clinically and socioeconomically complex patients.

Practice Implications
Hospitals interested in using physician integration strategically to improve care quality should put more emphasis on physician quality. Such an approach has the potential to increase efficiency without sacrificing quality of care.
Comparison of the efficacy and safety of pegylated liposomal doxorubicin and epirubicin in neoadjuvant chemotherapy for HER2-negative breast cancer: a real-world case–control study
Authors: Yang Lixian , Zhang Shiyu , Zheng Lei , Pu Pengpeng , Li Xiaowei , Jia Lining 
Published: February 2024

Purpose:
The purpose of this study was to assess the effectiveness and side effects of pegylated liposomal doxorubicin (PLD) and epirubicin in neoadjuvant treatment for HER2-negative breast cancer.

Patients and methods:
The authors performed a retrospective analysis of 107 patients diagnosed with HER2-negative breast cancer who underwent TA (PLD 35 mg/m2, docetaxel 75 mg/m2) or TE (epirubicin 100 mg/m2, docetaxel 75 mg/m2) neoadjuvant chemotherapy (NAC) from January 2021 to December 2022. PLD was administered in 57 instances, while epirubicin was used in 50 cases. The clinicopathological features, chemotherapy effects, and adverse responses of these individuals were examined, and logistic regression was applied to determine the parameters defining the effectiveness of NAC.

Results:
The clinicopathological characteristics of the PLD and epirubicin groups were consistent, and there was no statistical difference. Also, there was no statistical difference in the efficacy of NAC between the two groups. Leukopenia, hair loss, digestive tract responses, and irregular electrocardiograms were dramatically decreased in the PLD group compared to the epirubicin group. However, hand-foot syndrome and hypersensitivity were significantly increased, with statistical relevance.

Conclusion:
PLD has the same efficacy as traditional epirubicin in NAC for HER2-negative breast cancer.
Updates on respiratory syncytial virus prophylaxis: the past, present and future
Authors: Coates Anne , Sadreameli Christy 
Published: February 2024

Purpose of review
Human respiratory syncytial virus (RSV) causes acute respiratory infection in individuals of all age groups. It is the most common pathogen identified in infants and young children with acute lower respiratory infection. Although most infants and young children experience mild, cold-like symptoms, some infants develop severe lower respiratory tract disease such as pneumonia and bronchiolitis that may result in an emergency department visit or hospitalization.

Recent findings
In the United States, hospitalization rates have risen during the last decades, and while premature infants with chronic lung disease and congenital heart disease are at increased risk for severe presentations, the majority of hospitalizations occur in previously healthy infants. Until recently, RSV prophylaxis was only available for former preterm infants and those with certain underlying medical conditions.

Summary
The need for preventive interventions against RSV is crucial. This paper will provide a review of the vaccine development, the spectrum of RSV prophylaxis, current challenges associated with the cost, insurance coverage and equitable distribution of targeted therapies.
The Signal Intensity Ratio of Pancreas to Spleen in Magnetic Resonance Imaging Can Predict Nonalcoholic Fatty Liver Disease After Pancreaticoduodenectomy
Authors: Tsunematsu Masashi , Haruki Koichiro , Shirai Yoshihiro , Onda Shinji , Furukawa Kenei , Okui Norimitsu , Abe Kyohei , Sakamoto Taro , Gocho Takeshi , Ikegami Toru 
Published: February 2024

Objectives
Signal intensity ratio of pancreas to spleen (SI ratiop/s) on fat-suppressed T1-weighted images of magnetic resonance imaging has been associated with pancreatic exocrine function. We here investigated the predictive value of the SI ratiop/s for the development of nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD).

Materials and Methods
This study comprised 208 patients who underwent PD. NAFLD was defined as a liver-to-spleen attenuation ratio of <0.9 calculated by a computed tomography 1 year after surgery. SI ratiop/s was calculated by dividing the average pancreas SI by the spleen SI. We retrospectively investigated the association of clinical variables including the SI ratiop/s and NAFLD by univariate and multivariate analyses.

Results
NAFLD after 1 year was developed in 27 patients (13%). In multivariate analysis, the SI ratiop/s < 1 (P < 0.001) was an independent predictor of incidence of NAFLD. The SI ratiop/s < 1 was associated with low amylase level of the pancreatic juice (P < 0.001) and progressed pancreatic fibrosis (P = 0.017). According to the receiver operating characteristics curve, the SI ratiop/s had better prognostic ability of NAFLD than the remnant pancreas volume.

Conclusions
The SI ratiop/s is useful to predict NAFLD development after PD. Moreover, the SI ratiop/s can be a surrogate marker, which represents exocrine function of the pancreas.
An Elemental Diet Reduces Chylous Ascites of Patients Undergoing Pancreatoduodenectomy in the Setting of Early Enteral Feeding
Authors: Matsumura Masaru , Mise Yoshihiro , Takemura Nobuyuki , Ono Yoshihiro , Sato Takafumi , Ito Hiromichi , Inoue Yosuke , Takahashi Yu , Saiura Akio 
Published: February 2024

Objectives
The elemental diet (ED) is a formula to support nutritional status without increasing chylous burden. This study evaluates the efficacy of early ED feeding after pancreatoduodenectomy (PD).

Materials and Methods
A prospective phase II study of consecutive patients who underwent PD with early ED feeding was conducted. Patient backgrounds, surgical outcomes, and ED feeding tolerability were compared with a historical cohort of 74 PD patients with early enteral feeding of a low residue diet (LRD).

Results
The ED group comprised 104 patients. No patient in the ED group discontinued enteral feeding because of chylous ascites (CAs), whereas 17.6% of the LRD group experienced refractory CAs that disrupted further enteral feeding. The CAs rate was significantly decreased in the ED group compared with the LRD group (3.9% and 48.7%, respectively; P < 0.001). There was no significant difference in the incidence of major complications (ED: 17.3%, LRD: 18.9%; P = 0.844). Postoperative prognostic nutritional index was similar between the 2 groups (P = 0.764). In multivariate analysis, enteral feeding formula, and sex were independent risk factors for CAs (LRD: P < 0.001, odds ratio, 22.87; female: P = 0.019, odds ratio, 2.78).

Conclusions
An ED reduces postoperative CAs of patients undergoing PD in the setting of early enteral feeding.
Neuro-ophthalmic manifestations in traumatic brain injury: a hospital-based study from Nepal
Authors: Gurung Jamuna , Karn Mitesh , Gurung Prakash Kumar , Sapkota Shabal 
Published: February 2024

Objective:
Neuro-ophthalmic manifestations occur frequently in patients with a traumatic head injury which are often ignored, leading to late presentation with permanent visual disability and visual field defects. This study aimed to find the various neuro-ophthalmic manifestations of traumatic brain injury and correlate them with the neurological status and neuro-imaging abnormality.

Methods:
A hospital-based cross-sectional study was carried out among patients admitted to our center with a diagnosis of traumatic brain injury for a period of six months from August 2020 to January 2021. Glasgow Coma Score was used to grade the severity of the head injury. Detailed ophthalmological examinations were documented in predesigned proforma. Descriptive statistics were used to describe the outcomes.

Results:
A total of 377 head injury patients underwent neuro-ophthalmic examination- 271 (71.9%) were males and 106 (28.1%) were females. The mean age in our study population was 38.6  16.8 years, their age ranging from 3 to 85 years. Time from injury to ophthalmologic examination ranged from 30 minutes to 12 days post-injury, the mean duration being 24.2  34 hours. Road traffic accidents were the most common cause of head injury, with 203 cases (53.8%). 38 (10.1%) patients had neuro-ophthalmic manifestations- 16 (42.0%) had afferent pathway deficits and 22 (57.9%) had efferent pathway deficits. The most frequently encountered neuro-ophthalmic abnormality was optic neuropathy in 14 (36.8%) followed by trochlear, oculomotor, abducens nerve, and chiasmal injury. The presence of brain contusion was associated with traumatic optic neuropathy while skull fractures were associated with trochlear nerve palsy, these associations being statistically significant (P<0.05).

Conclusion:
Neuro-imaging abnormalities, particularly brain contusions and skull fractures were significantly associated with neuro-ophthalmic deficits.
“A Case Report of Uncommon Giant Epidermal Inclusion Cyst Found in the Thyroid Gland.”
Authors: Mousa Hana , Aljassem Razan 
Published: February 2024

Introduction and importance:
This case report describes a rare occurrence of an epidermal inclusion cyst (EIC) being found in the thyroid gland and highlights the importance of considering uncommon entities like EIC in the differential diagnosis of thyroid lesions.

Case presentation:
A 68-year-old male presented with a large, painless swelling in the anterior neck, causing dysphagia and dysphonia. Imaging and cytology confirmed a benign Epidermal Inclusion Cyst involving the left lobe of the thyroid, which was successfully removed via hemithyroidectomy, resulting in resolution of symptoms.

Clinical discussion:
Epidermoid inclusion cysts are rare in the thyroid gland, with only sixteen reported cases worldwide. The cyst was diagnosed through ultrasound-guided fine needle aspiration and confirmed by surgical pathology. Treatment involves complete removal of the cyst and its capsule, which was successfully performed in this case under local anesthesia with sedation due to the patient’s medical history of COPD.

Conclusion:
it is important to consider the possibility of EIC when benign squamous cells are detected in a thyroid aspirate without any follicular cells. In such cases, hemithyroidectomy can be a successful management strategy.
Effects of breastfeeding in postoperative complication in pediatric and adolescent population- a systematic review
Authors: Ghosh Bikona , Sripathi Samhrutha , Nuthalapati Bhargav Sai , Dwivedi Ayush , Pandey Ayush , Sarkar Prianka 
Published: February 2024

Introduction:
Surgical complications in younger patients can lead to infections, delayed healing, prolonged hospital stays, and other negative outcomes, significantly affecting their recovery. This study explores the potential impact of breastfeeding on mitigating these complications, aiming to enhance our understanding of postoperative care for pediatric and adolescent patients.

Methodology:
We conducted a systematic search on databases such as PubMed, Scopus, Web of Science, and EMBASE, using relevant MESH keywords, adhering to the “Preferred Reporting Items for Systematic Reviews and Meta-analysis” methodology. Quality assessments were performed, and studies scoring above 70% were included for standardized data incorporation. Data extraction followed Cochrane Consumers and Communication Review group’s guidelines. Bias and ethical criteria were considered and provided valuable evidence to answer the research question.

Results:
Among 402 initially reviewed articles, six met inclusion criteria: 3 observational cohort studies, 2 systematic reviews, and 1 randomized controlled trial. The selected literature consistently demonstrates a significant reduction in postoperative infection rates and improved outcomes. Breastfeeding shortened postoperative hospital stays, accelerated recovery, and enhanced nutritional status, potentially reducing healthcare resource utilization and patient financial burden. Lower mortality and morbidity rates were also observed.

Conclusion:
This systematic review provides compelling evidence of breastfeeding’s positive impact on surgical outcomes in the pediatric population. While our findings support the benefits of breastfeeding in this age group, further large-scale, multi-center research is needed to provide stronger evidence for guiding clinical practices.
Recurrent fibroepithelial vaginal polyp in a two-year-old girl: A case report and review of the literature
Authors: Shehadeh Mohammad Hakam , Abualrub Ahmad , Malhes Waleed , Msarweh Amar , Amro Wael 
Published: February 2024

Introduction and Importance:
Fibroepithelial vaginal polyps (FEPV) are rare mucosal polypoid lesions primarily found in adult women. However, FEPV in pediatric patients, especially beyond the neonatal period, is exceedingly uncommon. Documenting cases improves diagnosis and management. FEPV can mimic malignancy, posing challenges for interpretation. Early detection, treatment, and follow-up are crucial for optimal outcomes.

Case presentation:
We present the case of a two-year-old girl with a recurrent FEPV. The patient had a painless, reddish, smooth, soft, rubbery polypoid vaginal mass measuring 2.3 × 1.5 cm. Physical examination revealed no concurrent systemic issues. Surgical excision of the polyps confirmed them as fibroepithelial polyps. Despite previous excisions, the polyps recurred within a month. The patient’s postoperative recovery was uneventful, and subsequent follow-up showed no recurrence.

Clinical discussion:
FEPV presents as mucosal polypoid lesions with a connective tissue core covered by benign squamous epithelium. It is rare before menarche and after menopause. Although the pathophysiology remains unclear, hormonal factors and local injuries may contribute. FEPV is usually asymptomatic but may cause pressure, obstruction, bleeding, or discharge. Differential diagnosis includes vaginal connective tissue malignancies. The diagnosis was confirmed by surgical excision and histopathology. Complete excision is crucial for preventing recurrence.

Conclusion:
This case report highlights recurrent FEPV in a two-year-old girl. Despite previous excisions, polyps recurred, emphasizing the need for complete excision. Documenting cases will enhance our understanding. Further research is needed to elucidate the pathogenesis of pediatric FEPV. Early detection, treatment, and follow-up are essential for optimal management.
Association of an In-Hospital Desirability of Outcomes Ranking Scale With Postdischarge Health-Related Quality of Life: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation*
Authors: Logan Grace E. , Banks Russell K. , Reeder Ron , Miller Kristen , Mourani Peter M. , Bennett Tellen D. , Bourque Stephanie L. , Meert Kathleen L. , Zimmerman Jerry , Maddux Aline B. 
Published: February 2024

OBJECTIVES:To develop a desirability of outcome ranking (DOOR) scale for use in children with septic shock and determine its correlation with a decrease in 3-month postadmission health-related quality of life (HRQL) or death.DESIGN:Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective study.SETTING:Twelve U.S. PICUs, 2013–2017.PATIENTS:Children (1 mo–18 yr) with septic shock.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:We applied a 7-point pediatric critical care (PCC) DOOR scale: 7: death; 6: extracorporeal life support; 5: supported by life-sustaining therapies (continuous renal replacement therapy, vasoactive, or invasive ventilation); 4: hospitalized with or 3: without organ dysfunction; 2: discharged with or 1: without new morbidity to patients by assigning the highest applicable score on specific days post-PICU admission. We analyzed Spearman rank-order correlations (95% CIs) between proximal outcomes (PCC-DOOR scale on days 7, 14, and 21, ventilator-free days, cumulative 28-day Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores, and PICU-free days) and 3-month decrease in HRQL or death. HRQL was measured by Pediatric Quality of Life Inventory 4.0 or Functional Status II-R for patients with developmental delay. Patients who died were assigned the worst possible HRQL score. PCC-DOOR scores were applied to 385 patients, median age 6 years (interquartile range 2, 13) and 177 (46%) with a complex chronic condition(s). Three-month outcomes were available for 245 patients (64%) and 42 patients (17%) died. PCC-DOOR scale on days 7, 14, and 21 demonstrated fair correlation with the primary outcome (–0.42 [–0.52, –0.31], –0.47 [–0.56, –0.36], and –0.52 [–0.61, –0.42]), similar to the correlations for cumulative 28-day PELOD-2 scores (–0.51 [–0.59, –0.41]), ventilator-free days (0.43 [0.32, 0.53]), and PICU-free days (0.46 [0.35, 0.55]).CONCLUSIONS:The PCC-DOOR scale is a feasible, practical outcome for pediatric sepsis trials and demonstrates fair correlation with decrease in HRQL or death at 3 months.