bluuebunny/crossref_metadata_2025_split huggingface dataset:
An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report
Authors: Lin Mengyuan , Wang Honghua , Wang Yan , Jiang Shi-Wen 
Published: June 2023

Rationale:
Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED.

Patient concerns:
The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges.

Diagnoses:
Atypical ED, psychogenic ED not excluded; infertility.

Interventions:
Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife.

Outcomes:
The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization.

Conclusions:
The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.
Aloe vera gel for prevention of chemotherapy-induced hyperpigmentation: Four case reports
Authors: Chiu Chia-Chi , Hsiao Yi-Wen , Wen Yu-Chuan , Chang Tsung-Yen , Chen Shih-Hsiang , Jaing Tang-Her 
Published: June 2023

Rationale:
This study aimed to evaluate the efficacy of topical application of Aloe vera gel in preventing chemotherapy-induced hyperpigmentation (CIH). CIH is a common side effect of chemotherapy that causes skin irritation, redness, and itching. Aloe vera has been studied for its potential use in treating radiation-induced dermatitis, which may help alleviate some of the symptoms associated with this condition.

Patient concerns:
In this study, 4 children requiring curative chemotherapy were prospectively enrolled and treated with Aloe vera gel.

Diagnosis:
Acute skin reactions were monitored and classified according to the Common Terminology Criteria for Adverse Events Grading Scale.

Interventions:
Patients were asked to use the gel on one-half of the body field twice daily from the beginning of treatment until 4 weeks after the completion of chemotherapy, with no medication to be used on the other half.

Outcomes:
The results indicate that applying Aloe vera gel may reduce the visibility of hyperpigmentation at subsequent time points. The most important observation was that the continued application of Aloe vera gel 4 weeks after the completion of chemotherapy was effective in reducing the grading of CIH.

Lessons:
These effects highlight the potential of Aloe vera gel as a topical onconutraceutical treatment for CIH.
WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy: A randomized controlled study
Authors: Huang Xiaofen , Kang Yueming , Wang Meixin , Liu Qianqian , Wang Feng , Zeng Mingzhu 
Published: June 2023

Objective:
The present research was designed to study the effect of WeChat-based remote follow-up management on the burden of home care and anxiety on parents of children with refractory epilepsy.

Methods:
161 refractory epileptic children were included in this study. They were divided into control group and WeChat group according to their management protocols after discharge, namely, control group with traditional follow-up (n = 81) and WeChat group with remote follow-up based on WeChat (n = 81). We evaluated home care burden by family caregiver task Inventory (FCTI) scale and zarit burden interview (ZBI) scale, and evaluated negative emotion by self-rating anxiety Scale (SAS) scale and self-Rating depression scale (SDS) scale.

Results:
There was no significant difference in the demographic characteristics of epileptic children and their parents and the scores of FCTI, ZBI, SAS and SDS before treatment between the 2 groups (all P > .05), and the score of FCTI (20.86 ± 4.26), ZBI (39.63 ± 4.46), SAS (44.49 ± 4.15) and SDS (50.02 ± 4.13) in WeChat group were all significantly lower than the score of FCTI (25.25 ± 3.71), ZBI (45.47 ± 4.61), SAS (52.75 ± 4.93) and SDS (54.51 ± 6.59) in control group (all P < .05).

Conclusion:
WeChat-based remote follow-up management reduces the burden of home care and anxiety on parents of children with refractory epilepsy.
A patient with the highly suspected B cell lymphoma accompanied by the erythrocytes cold agglutination: Case report
Authors: Lin Huijun , Feng Dujin , Tao Shuting , Wu Jianguo , Shen Yan , Wang Weizhong 
Published: June 2023

Rationale:
Cold agglutinins are related with B cell lymphoproliferative disorder and lymphoma, and can agglutinate red blood cells (RBCs) at an optimum temperature of 3–4°C, which is the undergoing cause of RBCs cold agglutination. RBC cold agglutination may lead to an extreme abnormality of RBC parameters of complete blood count (CBC).

Patient concerns:
The present study reports a case of an old patient with severe infectious fever and anemia presenting extremely abnormal levels of RBC parameters in CBC and a sand-like appearance of blood on tube wall. The validating tests indicated the presence of the RBCs cold agglutination and the highly suspected B cell lymphoma.

Diagnoses:
The 37°C-incubation corrected the CBC results of the patient, and the microscopic observation and flow cytometry analysis of blood and marrow indicated many abnormal B lymphocytes. Subsequently, the patient was diagnosed with a highly suspected B-cell lymphoma.

Interventions:
The blood with a sand-like appearance was reanalyzed to validate the cold agglutination by 37°C-water incubation. The smears of peripheral blood and marrow were made for morphological observation by using optical microscopy. Moreover, the clusters of differentiation of the white blood cells were analyzed to confirm the type of abnormal white blood cells with a flow cytometer.

Outcomes:
The RBCs cold agglutination was validated, and the highly suspected B cell lymphoma was proved as the undergoing cause.

Lessons:
This case focuses on the discovery and solutions of RBCs cold agglutination, and emphasizes the importance of microscopic observation in the exploration of undergoing causes of cold agglutination.
Recurrent intestinal ulcer with bloody stool for >10 years in an adolescent boy of 15 years: A case report
Authors: Li Wei , Wang Yang , Wang Yufang , Yang Chuan , Lu Zhen , He Zhaoxia , Peng Lan 
Published: June 2023

Rationale:
Infectious diseases, autoimmune diseases and vascular diseases can lead to intestinal ulcers, and inflammatory bowel disease is typically suspected as the underlying cause of ulcer and bleeding from the intestinal ulcers leading to bloody stool, and malnutrition. Here we report a rare case of successfully treated case of intestinal ulcer, bloody stool, and malnutrition by dietary modification and avoidance of long term barbecued spicy food and carbonated drinks.

Patient concerns:
A 15-year-old male patient had repeated symptoms of blood in the stool for >10 years. Treatment for Chron’s disease was not successful. An exhaustive investigation failed to confirm the diagnosis.

Diagnosis interventions:
Through changing diet structure, avoiding spicy food, and supplementing enteral nutrition and recurrent glutamine.

Outcomes:
The patient’s symptoms improved significantly, and the intestinal ulcer healed under endoscope.

Lessons:
Pay attention to healthy diet in life and avoid long-term consumption of spicy food and carbonated drinks.
Case series: Noninfectious myositis of temporal muscle: a report of 2 cases
Authors: Kong Mi-Sun , Huh Kyung-Hoe , Kho Hong-Seop 
Published: June 2023

Background:
Noninfectious myositis (NIM) of the masticatory muscles is uncommon local myalgia disorder persisted by a centrally-mediated neurogenic mechanism. Due to the rarity of this condition and the lack of appropriate data regarding it, diagnosing this pathology when it affects the temporal muscle (TM) is challenging.

Case presentation:
Clinical signs and symptoms, diagnostic process, and treatment outcome of 2 rare cases of NIM of the TM were presented. The signs and symptoms of the patients were not pathognomonic. There were restrictions on the mouth opening and lateral excursion of the mandible. The duration of the symptoms may not be chronic. The findings of clinical evaluation may indicate the diagnosis of anterior disc displacement (DD) without reduction of the temporomandibular joint (TMJ) and/or local myalgia. Swelling of the involved muscle could be evident and identified on palpation depending on the involved site of myositis. The axial T2-weighted magnetic resonance (MR) imaging was important for the accurate diagnosis of this rare condition. Application of non-surgical conservative treatment modalities such as administration of non-steroidal anti-inflammatory analgesics for a sufficient period of time, control of oral parafunctional habits, and jaw exercises were effective for the management of NIM of the TM.

Conclusion:
A thorough clinical examination and MR imaging including the axial T2-weighted view are required for accurate diagnosis and effective management of NIM of the TM.
Tocilizumab-induced mucosal injury in the terminal ileum mimicking intestinal Behçet’s disease: A case report
Authors: Ozaka Sotaro , Fukuda Masahide , Takahashi Haruhiko , Tsutsumi Koshiro , Iwao Masao , Hirashita Yuka , Fukuda Kensuke , Okamoto Kazuhisa , Arakawa Mie , Ogawa Ryo , Endo Mizuki , Mizukami Kazuhiro , Kamiyama Naganori , Kobayashi Takashi , Kodama Masaaki , Murakami Kazunari 
Published: June 2023

Rationale:
Tocilizumab, a humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody, is used for the treatment of adult-onset Still disease (AOSD). Despite its efficacy in many clinical situations, concerns have been raised regarding intestinal mucosal injury in patients receiving tocilizumab.

Patient concerns:
A 64-year-old woman with a history of AOSD was admitted to our hospital with hematochezia. She had AOSD for 15 years and underwent treatment with biweekly tocilizumab 9 months prior to admission. Colonoscopy revealed a large punched-out ulcer in the terminal ileum. On pathological evaluation, nonspecific enteritis with lymphocytes and eosinophils were seen. Based on the location and shape of the lesion, we suspected intestinal Behçet’s disease. However, the ulcer reduced in size over time by discontinuation of tocilizumab without additional drug treatment, indicating that it was a drug-induced ulcer.

Diagnosis:
The patient was diagnosed with tocilizumab-induced small intestinal ulcer.

Interventions:
The patient treated with the discontinuation of tocilizumab.

Outcomes:
The discontinuation of tocilizumab resulted in ulcer scarring. There was no recurrence of hematochezia.

Lessons:
Tocilizumab can cause deep ulcerative lesions in the terminal ileum, which may resemble intestinal Behçet’s disease. It is important to continuously monitor abdominal symptoms during tocilizumab therapy and aggressively perform colonoscopy when hematochezia or abdominal pain is observed.
Diagnosis and treatment of traumatic Descemet’s membrane detachment: A case series
Authors: Li Zhao , Gao Wen , Yang Yongli , Liang Weilin 
Published: June 2023

Rationale:
The Descemet layer is a dense layer of tissue that does not detach under normal circumstances. Descemet layer detachment may occur after intraocular surgery, but the Descemet layer spontaneously detached after trauma in this child, which is relatively rare. After looking for the cause, we found that the child was diagnosed with congenital glaucoma, and the trauma induced the Descemet’s membrane detachment.

Patient concerns:
The parents of the patient expected the child to recover the normal shape of the cornea as soon as possible, improve vision, and solve the problem of congenital glaucoma.

Diagnoses:
The patient was diagnosed with Descemet's membrane detachment of the left eye and congenital glaucoma in both eyes.

Interventions:
During operation, inflation gas is injected into the anterior chamber, the Descemet’s membrane is reset, and glaucoma surgery is performed.

Outcomes:
The Descemet’s membrane in the child’s eye was reset, and after glaucoma surgery, the intraocular pressure of the child was normal.

Lessons:
The analysis of the disease is not only to solve the problems seen but also to deeply analyze the internal causes and pathological changes in combination with the symptoms and signs, so as to discover the essence of the problem and solve the fundamental problem of the patient.
Efficacy of acupuncture on acute pharynx infections: A systematic review and meta-analysis
Authors: Zhang Shuo , Cui Yang , Zhou Xinyu , Wang Delong , Yin Jiantao , Meng Xiangyue , Cao Yu , Li Quan , Yin Hongna 
Published: June 2023

Background:Several clinical reports have focused on acupuncture for the treatment of acute pharyngeal infections. However, the efficacy and safety of acupuncture for the treatment of acute pharyngeal infections are controversial. To systematically assess the efficacy and safety of acupuncture in treating acute pharynx infections, thus providing a reference for clinical decision-making.Methods:We searched PubMed, CENTRAL, Embase, Web of Science, China National Knowledge Infrastructure, China Biomedical, clinical research registration platforms, gray literature, and reference lists of the selected studies from inception to October 30, 2022. The risk of bias assessment was performed using RevMan. The meta-analysis was performed using STATA with the Hedges’gvalue. We also performed a subgroup analysis, meta-regression, and publication bias detection using Harbord’s and Egger’s tests.Results:We included 19 randomized controlled trials comprising 1701 patients, of which only one study had a high risk of bias. The primary outcome, i.e., the response rate, revealed that acupuncture was more effective than antibiotics. The secondary results revealed that the differences in the reduction of VAS scores, sore throat duration, and white blood cell counts were statistically significant in the acupuncture group compared with the antibiotic group. However, the difference in the modulation of the neutrophil percentage and C-reactive protein levels was insignificant. Moreover, the acupuncture treatment resulted in a lower incidence of adverse events than the antibiotic treatment.Conclusions:Thus, acupuncture therapy for acute pharyngeal infections is safe and its response rate is superior to that of antibiotics. Acupuncture showed positive outcomes for alleviating the sore throat symptoms, shortening the sore throat duration, and improving the immune inflammation index. Nevertheless, owing to the limitations of this study, our conclusions should be interpreted with caution. More high-quality trials are warranted in the future for improving the methodology and reporting quality.
Group B Streptococcus infection-induced ovarian vein thrombosis identified during cesarean section: A case report and a literature review
Authors: Li Jianqiong , Zhou Meifang , He Chaoman , Liang Fengbing 
Published: June 2023

Rationale:
Ovarian vein thrombosis (OVT) is a rare yet potentially life-threatening condition associated with thromboembolic events. Group B Streptococcus (GBS) is a type of β-hemolytic Gram-positive bacterium known for asymptomatic colonization in the lower genital and gastrointestinal tracts. Here we reported a 35-year-old multiparous woman with gestational diabetes who suffered from placental abruption, stillbirth, OVT, septic shock, and renal failure due to severe GBS infection.

Patient concerns:
A 35-year-old woman with gestational diabetes presented with acute and sustained lower abdominal cramping, vaginal bleeding, and fever at 35 gestational weeks.

Diagnoses:
Based on preoperative ultrasound and intraoperative findings, the patient was diagnosed with placental abruption, intrauterine fetal demise, and right OVT. GBS was cultured from the amniotic fluid obtained during cesarean section.

Interventions:
The patient underwent a right adnexectomy during a cesarean section and received intravenous antibiotics. Subsequently, an ultrasound-guided uterine curettage was performed due to recurrent fever.

Outcomes:
After a prolonged course of intravenous antibiotics for over a month, the patient recovered and was discharged from the hospital.

Lessons:
This case underscores the need for early initiation of anticoagulant protocols in cases of OVT, particularly when GBS infection is identified as a predisposing factor. Further research and awareness are warranted to better understand the relationship between GBS infection and OVT and to optimize management strategies in such cases.
Cerebral venous thrombosis after high-dose steroid in patient with multiple sclerosis: A case report
Authors: Zhu Manmin , Cui Wenxiu , Huang Wei , Liu Zheng , Xu Zucai , Huang Hao 
Published: June 2023

Rationale:
Multiple sclerosis (MS) is a central nervous system disease mainly mediated by immunity, which is one of the most common causes of neurological dysfunction in young people worldwide. In the acute phase, high-dose steroid therapy is effective. There are few reports about cerebral venous thrombosis (CVT) after high-dose steroid therapy.

Patient concerns:
We present a case of a 19-year-old female diagnosed with MS who developed a headache after high-dose steroid therapy was diagnosed with CVT. Headache symptoms improved after anticoagulant treatment.

Diagnoses:
MS comorbid CVT.

Interventions:
Anticoagulant therapy was added and hormone therapy was reduced.

Outcomes:
Clinical symptoms such as headache, limb numbness, and involuntary tremors in the right hand were improved, and the muscle strength of the right limb recovered to grade 4. The patient did not suffer from headaches after discharge and no abnormality in the computed tomography (CT) scan of the cephalic vein at the 5-months follow-up.

Lessons:
High-dose steroid therapy may be a risk factor for CVT in patients with MS. MS patients who develop headaches during high-dose steroid therapy should undergo further cranial CTV to rule out CVT.
Efficacy and safety of intravenous tranexamic acid in urologic surgery: A systematic review and meta-analysis of randomized controlled trials
Authors: Lin Yu-Hui , Lee Kuo-Chang , Hsu Chien-Chin , Chen Kuo-Tai 
Published: June 2023

Background:This meta-analysis compared the effects of intravenous Tranexamic acid (TXA) and a placebo on hemostasis, hospital course, and complications in adult patients undergoing various urologic surgeries.Methods:The literature was extensively searched using various databases. The primary outcomes were standardized mean differences (SMDs) of intraoperative blood loss and odds ratios (ORs) of necessary blood product transfusion. The secondary outcomes included SMDs of operative time, SMDs of decreased hemoglobulin levels at 24 hours after surgery, and ORs of thromboembolic events.Results:The meta-analysis included 13 randomized controlled trials (RCT) comprising 1814 participants in total. The SMD of intraoperative blood loss for TXA versus placebo was −0.705 (95% confidence interval [CI]: −1.113 to −0.297). The pooled ORs of transfusion in the TXA group compared with the placebo group was 0.426 (95% CI: 0.290–0.625). These findings indicated a significantly lower intraoperative blood loss and a reduced need for transfusion following intravenous TXA. The pooled ORs of thromboembolic events in the TXA group compared with the placebo group was 0.664 (95% CI: 0.146–3.024).Conclusions:Intravenous TXA can reduce intraoperative blood loss, decrease the need for transfusion, and shorten operative time, and it does not increase the risk of thromboembolic events.
Accelerating Detection and Intervention for Sepsis in Skilled Nursing Facilities Using a Sepsis Pathway
Authors: Ahmed Asma M. , Macapili Efy , Brenner Michael J. , Pandian Vinciya 
Published: June 2023

Background:
Early detection of sepsis decreases mortality in hospitals, but recognition of sepsis is often delayed in skilled nursing facilities (SNFs).

Local Problem:
A local SNF in the northeastern United States sought to use a standardized sepsis pathway to prevent hospital readmissions due to sepsis.

Methods:
A pre-/postimplementation design was used for this project. Outcome measures included sepsis detection and treatment, length of stay in the SNF, sepsis-related hospital transfer rate, mortality rate, and predictors of clinical outcomes.

Interventions:
A SNF sepsis pathway was developed based on current sepsis detection tools. The pathway incorporated a sepsis screening tool and a sepsis bundle. Implementation of the pathway involved education of nurses and certified nursing assistants on the pathway.

Results:
A total of 178 patients were included in data analysis (81 preimplementation and 97 implementation). Sepsis recognition increased from 56% to 86% (P < .001), and sepsis-related hospital transfers decreased from 68% to 44% (P = .07). Laboratory testing for lactate, white blood cell count, and blood cultures increased, and sepsis intervention rates significantly improved (P < .001).

Conclusions:
Implementing a modified SNF sepsis pathway accelerated identification of sepsis and improved clinical outcomes.
Effectiveness of a Modified Nurse-Led COUGH Bundle for Obese Patients After Bariatric Surgery
Authors: Yang Jumei , Turner Barbara S. , Teh Aline Hooi Ming , Liew Geoffrey Haw Chieh 
Published: June 2023

Background:
Obesity commonly affects postsurgical pulmonary outcomes and is associated with increased oxygen usage, length of recovery and hospital stay, discharge to high levels of care, cost, morbidity, and mortality.

Local Problem:
No standardized pulmonary care bundle for obese patients after bariatric surgery was available in the postanesthesia care unit (PACU) at a hospital in Singapore.

Methods:
This quality improvement project was a prospective, single-cohort, pre- and posttest intervention design with 151 patients recruited.

Interventions:
Teaching and implementation of a modified nurse-led COUGH bundle was carried out on obese patients after their bariatric surgery.

Results:
Postbariatric surgery patients with the nurse-led COUGH bundle had significantly less consumption of oxygen in the PACU and step-down units. The PACU and hospital length of stay were also reduced.

Conclusions:
The modified nurse-led COUGH bundle can reduce patients' oxygen usage and hospital stay after their bariatric surgery.