bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishment of a scoring model for the differential diagnosis of white coat hypertension and sustained hypertension
Authors: Cai Peng , Lin Qingshu , Lv Dan , Zhang Jing , Wang Yan , Wang Xukai 
Published: April 2023

Objectives
This study aimed to establish a scoring model for the differential diagnosis of white coat hypertension (WCH) and sustained hypertension (SHT).

Methods
This study comprised 553 adults with elevated office blood pressure, normal renal function, and no antihypertensive medications. Through questionnaire investigation and biochemical detection, 17 parameters, such as gender and age, were acquired. WCH and SHT were distinguished by 24 h ambulatory blood pressure monitoring. The participants were randomly divided into a training set (445 cases) and a validation set (108 cases). The above parameters were screened using least absolute shrinkage and selection operator regression and univariate logistic regression analysis in the training set. Afterward, a scoring model was constructed through multivariate logistic regression analysis.

Results
Finally, six parameters were selected, including isolated systolic hypertension, office systolic blood pressure, office diastolic blood pressure, triglyceride, serum creatinine, and cardiovascular and cerebrovascular diseases. Multivariate logistic regression was used to establish a scoring model. The R
2 and area under the ROC curve (AUC) of the scoring model in the training set were 0.163 and 0.705, respectively. In the validation set, the R
2 of the scoring model was 0.206, and AUC was 0.718. The calibration test results revealed that the scoring model had good stability in both the training and validation sets (mean square error = 0.001, mean absolute error = 0.014; mean square error = 0.001, mean absolute error = 0.025).

Conclusion
A stable scoring model for distinguishing WCH was established, which can assist clinicians in identifying WCH at the first diagnosis.
A prognostic model for bladder cancer based on cytoskeleton-related genes
Authors: Peng Chunting , Guo Sufan , Yang Zheng , Li Xiaohong , Su Qisheng , Mo Wuning 
Published: April 2023

Background:
A typical cancerous growth in the urinary tract, bladder cancer (BLCA) has a dismal survival rate and a poor chance of being cured. The cytoskeleton has been shown to be tightly related to tumor invasion and metastasis. Nevertheless, the expression of genes associated with the cytoskeleton and their prognostic significance in BLCA remain unknown.

Methods:
In our study, we performed differential expression analysis of cytoskeleton-related genes between BLCA versus normal bladder tissues. According to the outcomes of this analysis of differentially expressed genes, all BLCA cases doing nonnegative matrix decomposition clustering analysis be classified into different molecular subtypes and were subjected to Immune cell infiltration analysis. We then constructed a cytoskeleton-associated gene prediction model for BLCA, and performed risk score independent prognostic analysis and receiver operating characteristic curve analyses to evaluate and validate the prognostic value of the model. Furthermore, enrichment analysis, clinical correlation analysis of prognostic models, and immune cell correlation analysis were carried out.

Results:
We identified 546 differentially expressed genes that are linked to the cytoskeleton, including 314 up-regulated genes and 232 down-regulated genes. All BLCA cases doing nonnegative matrix decomposition clustering analysis could be classified into 2 molecular subtypes, and we observed differences (P < .05) in C1 and C2 immune scores about 9 cell types. Next, we obtained 129 significantly expressed cytoskeleton-related genes. A final optimized model was constructed consisting of 11 cytoskeleton-related genes. Survival curves and risk assessment predicted the prognostic risk in both groups of patients with BLCA. Survival curves and receiver operating characteristic curves were used to evaluate and validate the prognostic value of the model. Significant enrichment pathways for cytoskeleton-associated genes in bladder cancer samples were explored by Gene set enrichment analysis enrichment analysis. After we obtained the risk scores, a clinical correlation analysis was performed to examine which clinical traits were related to the risk scores. Finally, we demonstrated a correlation between different immune cells.

Conclusion:
Cytoskeleton-related genes have an important predictive value for BLCA, and the prognostic model we constructed may enable personalized treatment of BLCA.
CT findings of glycogen storage disease I complicated with pancreatitis: A case report
Authors: Chen Shuo , Chen Feng , Cheng Fei , Xu Xiao 
Published: April 2023

Rationale:
The incidence of glycogen storage disease type I (GSD I) in the overall population is 1/100,000.[1] Hyperlipidemia in patients with GSD I can induce pancreatitis. Three cases of GSD I complicated with pancreatitis have been reported.[2] Here, the computed tomography (CT) features of GSD I complicated with pancreatitis are reported for the first time

Patient concerns:
A 22-year-old female presents with growth retardation for 20 years and recurrent epigastric pain for 3 years. No abnormality in physical examination. Laboratory examination: GPT 81 U/L, GOT 111 U/L, DBIL 1.7 umol/L, TBIL 0.7 umol/L, Albumen 41.4 g/L, blood ammonia 54 umol/L, fasting blood glucose 3.02 mmol/L, G6PD 1829 U/L, lactic acid 7.9 mmol/L, triglyceride 18.79 mmol/L, TCH 9.46 mmol/L, uric acid 510 umol/L, urinary protein +++ (3.0) g/L.

Diagnosis:
The CT findings of the upper abdomen show that the liver is obviously enlarged, and the density of the liver is obviously uneven on plain scan. Unclear boundaries and increased blood vessels of the pancreas are found, especially in the head of the pancreas. The patient is diagnosed with GSD I complicated with pancreatitis.

Interventions:
The patient undergoes split liver transplantation and splenectomy under general anesthesia in our hospital.

Outcomes:
Upper abdominal CT is reexamined half a month and 2 and a half months after the operation. It is found that the transplanted liver is not enlarged and the density is not abnormal. The pancreas shrinks, its boundary is clear, and its blood vessels decrease, especially in the head of the pancreas

Lessons:
The density of the liver depends on the relative amount of glycogen and fat, which can be increased, normal, or decreased. Hyperlipidemia in patients with GSD I can induce pancreatitis.
Inter-observer variability between readers in detection of bone metastases comparing different modalities; PET/CT, SPECT/CT and planar bone scintigraphy
Authors: Bashank Nahla , Hussein Aalaa , Mekawy Mohamed , Askar Hebatallah 
Published: April 2023

Objective
To assess the inter-observer variability between readers in the detection of bone metastases for different modalities [planar bone scintigraphy (BS), single photon emission computed tomography/computed tomography (SPECT/CT), and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) (F-18 FDG PET/CT)].

Methods
Patients with known primary tumors referred for metastatic workup either by F-18 FDG PET/CT or conventional planar BS and SPECT/CT were enrolled in this prospective study. The three modalities (BS, SPECT/CT, and PET/CT) were acquired for each patient. Interpretation was done by two independent nuclear medicine physicians separately and blindly; reader 1 (R1) and reader 2 (R2). A three-point subjective scale was used (1 = negative for bone metastases, 2 = equivocal, and 3 = positive). The findings were compared to the final patient status based on clinical and radiological follow-up for at least 6 months. The Kappa test was used to assess the degree of agreement between readers in their interpretation of each modality.

Results
A total of 54 patients (39 females and 15 males, ages 26–76; mean: 54.7 ± 12) were eligible for this study. Fair agreement 0.372 between R1 and R2 in interpretation of BS was noticed that improved to 0.847 after addition of SPECT/CT. Perfect agreement was achieved between R1 and R2 while interpreting PET/CT images (kappa = 0.964, P < 0.001).

Conclusion
F-18 FDG PET/CT significantly improved the inter-observer variability between readers, allowing for better diagnosis of bone metastases in known cancer patients. Also, it was superior to BS and SPECT/CT in the detection of bone metastases.
A rare case of concomitant Klebsiella pneumonia and panophthalmitis in a poorly controlled diabetic patient: the first case report from Syria
Authors: Kashkash Mohamad F. , Douba Zain , Kaddour Samer H. , Khouri Abdulla 
Published: April 2023

Introduction:Diabetes mellitus is the most common endocrine metabolic disease. Uncontrolled diabetes affects almost all components of immunity. Diabetes mellitus patients have an increased susceptibility to infections which aggravates in the cases of uncontrolled hyperglycemia.Case presentation:The authors present the case of a 63-year-old female patient with a history of poorly controlled type 2 diabetes. She went to the ambulance complaining of fever, poor appetite, dyspnea, cough, fatigue, and asthenia. The chest computed tomography showed the presence of bilateral ovoid infiltration densities, mostly on the upper-right side. The initial diagnosis was community-acquired pneumonia in an immunocompromised host due to poorly controlled diabetes. A swelling was observed in the right cheek and around the right eye, along with ptosis of the right eyelid. The ophthalmologist indicated the presence of panophthalmitis of the entire right eye with optic neuritis and right orbital cellulitis. The bacterial culture of bronchoalveolar lavage showed Gram-negative bacteria known asKlebsiella. After 17 days of hospitalization, the patient was discharged from the hospital on treatment with oral fluconazole, oral ciprofloxacin, and intramuscular gentamicin.Conclusion:In conclusion, the case highlights the importance of early detection of systematic infection manifestations in diabetic patients, regarding their age, history, and other comorbidities. Ocular symptoms are highly recommended to be evaluated in this context ofKlebsiellainfection.
Management of pediatric Madelung’s deformity of the forearm due to physeal growth arrest of the distal ulna: a case report
Authors: Meirizal  , Muhammad Hilmi , Rukmoyo Tedjo , Angriawan Tedy 
Published: April 2023

Introduction and importance:
The authors presented a treatment option for Madelung’s deformity due to physeal growth arrest of the distal ulna after Kirschner wire (K-wire) fixation for pediatric forearm fractures.

Case presentation:
A boy, 16 years old, suffered from a close fracture of the middle third of the left radius and ulna and was treated with open reduction and internal fixation (ORIF) pinning with intramedullary K-wires. Eight months after surgery, the implant was removed. There was no complaint for more than 10 years. Nevertheless, the patient complained of a bowing hand and was diagnosed with Madelung’s deformity of the left forearm due to physeal growth arrest 12 years ago. The authors treated this patient with the release of fibrous tissue of the distal ulna, Darrach’s procedure, and extensor carpi ulnaris (ECU) tenodesis, along with a close wedge osteotomy of the distal radius and an ORIF of the distal radius. Four months after surgery, the clinical and radiological results were satisfactory.

Clinical discussion:
Pinning across a physis has the potential to cause full or partial development to stop. Madelung’s deformity is usually treated conservatively or surgically, depending on the severity of the symptoms. Darrach’s procedure, ECU tenodesis, close wedge osteotomy, and ORIF of the distal radius are available options to treat Madelung’s deformity.

Conclusion:
The use of transphyseal K-wires may result in physeal growth interruption. The developed Madelung’s deformity can be satisfactorily managed by Darrach’s procedure, ECU tenodesis, in combination with a close wedge osteotomy and ORIF of the distal radius.
Cesarean section of a patient with combined severe mitral and aortic stenosis: a case report
Authors: Sheikh Haris , Samad Khalid , Mistry Akbar A. 
Published: April 2023

Introduction and Importance:
Cardiovascular diseases during pregnancy are rare but account for complications that pose risks to the mother as well as the child. In patients with fixed cardiac output due to stenotic valvular lesion(s), the physiological changes during pregnancy carry high risk of morbidity and mortality.

Case Presentation:
Our patient was diagnosed with severe mitral and aortic stenosis at her first antenatal visit at 24 weeks of gestation. She was also diagnosed with intrauterine growth restriction and was therefore planned to be operated on at a gestational age of 34 weeks. After careful selection of monitoring and anesthetic regime, the patient was managed without any intraoperative or postoperative complications.

Clinical Discussion:
This case reports how the anesthetists, obstetricians, and cardiac surgeons devised a well-designed plan to operate on a patient with a relatively rare disease manifestation. Our patient had coexisting severe stenotic lesions of both mitral and aortic valves and posed a clinical dilemma regarding the choice of anesthesia and perioperative management. Regardless of the anesthetic technique, goals for a patient with the combined valvular disease include maintenance of adequate preload, systemic vascular resistance, cardiac contractility, sinus rhythm and avoidance of tachycardia, bradycardia, aortocaval compression, and anesthetic or surgery-induced hemodynamic changes.

Conclusion:
The course of management would give clinicians an idea of how to manage a patient with combined stenotic valvular lesions for cesarean section, ensuring a smooth course and a safe postoperative period.
A SCARE-compliant case report of recurrent meningioma in a 75-year-old patient after 10 years of surgical resection
Authors: Legmouz Maria , El Ouahabi Abdessamad , Boulbaroud Samira , Azzaoui Fatimazahra 
Published: April 2023

Introduction and importance:
Meningiomas are intracranial extracerebral tumors derived from arachnoid cells of the neural crest. They represent ∼20% of primary intracranial tumors and are seen as more common in elderly patients and women. Recurrence of meningioma can be observed during the early years after surgical treatment, but their occurrence within 10 years is rare.

Case presentation:
In this report, the authors discuss a case of a 75-year-old patient with a recurrence of a frontal meningioma after 10 years of successful surgical resection. Our patient was a female who presented amnesia and memory lapses associated with several weeks of progressive heaviness of the lower limbs accompanied by speech heaviness, intense headaches, asthenia, consciousness disorder, and tonic–clonic convulsive seizures for 10 days. The patient had previously been treated for a benign meningioma by surgical excision. Imaging was performed, and recurrent frontal meningioma was retained as a final diagnosis. The patient underwent a successful total resection of her frontal tumor.

Clinical discussion:
Recurrent tumors after complete surgical removal of meningiomas are rare and may be associated with microscopic residues. The more radical the surgery, the lower the risk of observing a recurrence. Adjuvant radiotherapy can be proposed, but the evidence is still lacking. Careful follow-up of all patients with or without complete surgical resection is therefore recommended.

Conclusion:
This case illustrates the importance of suspecting recurrence of meningioma in adult patients after successful surgical excision, even after 10 years of free disease. Clinicians should be aware of long-term meningioma recurrence in this population, and imaging is key for a positive diagnosis.
Acute abdomen due to rupture of a hydatid cyst of the liver: a rare complication – a case report
Authors: Adhikari Subodh , Bhattarai Madhur , Gyawali Sushil , Subedi Sudhan , Bhattarai Abhishek , Awale Laligen , Kansakar Prasan B.S. 
Published: April 2023

Introduction and importance:
Hydatid cyst is a parasitic disease that is transmitted from animals to humans caused by the larval stage Echinococcus, especially Echinococcus granulosus. A complication of a hydatid cyst of the liver is its rupture, either traumatic or spontaneously.

Case presentation:
A 19-year-old male presented with an acute abdomen for 12 h. After clinical assessment, contrast-enhanced computed tomography showed a rupture of the anterior wall of the hepatic hydatid cyst with intra-abdominal and pelvic dissemination. Exploratory laparotomy was performed with the evacuation of the daughter cyst and peritoneal lavage. The patient recovered well and was discharged with albendazole therapy.

Clinical discussion:
Hydatid cyst rupture is a rare but serious complication. Computed tomography has high sensitivity in demonstrating cyst rupture. The patient underwent laparotomy, where disseminated cysts were evacuated, and the anterior wall of the cyst was deroofed, along with the removal of a ruptured laminated membrane. Emergency surgery plus albendazole therapy are recommended protocols for cases like ours.

Conclusions:
A patient from an endemic region with acute presentation of right upper quadrant pain can have spontaneously ruptured hydatidosis as a differential diagnosis. Intraperitoneal rupture and dissemination of hydatid cysts of the liver can be life-threatening if intervention is delayed. Immediate surgery is life-saving and prevents complications.
A rare location of cardio hydatid cyst with multiple organ involvement: a case report
Authors: Ahmad Yara , Maree Gulan , Omar Sherawan , Alkhalaf Hussam 
Published: April 2023

Introduction:
Cardiac cysts in hydatid cysts, a parasitic disease, are extremely rare, and left-atrial hydatid cysts are even more unusual. Therefore, the authors report herein a rare case of a hydatid cyst in the left atrium. According to them, this is the third documented case of left-atrial hydatid cysts.

Presentation of Case:
A 25-year-old male presented at the outpatient clinic with atypical chest pain, hacking cough, dyspnoea, nausea, and vomiting for 2 months. Echocardiography showed a left-atrial unilocular, well-delineated mass. The authors also found multiple liver cysts and spleen cysts.

Discussion:
The widespread distribution of the disease in our regions, the dog contact story of the patient, and the appearance on echocardiograms were strong reasons to diagnose a hydatid cyst in the left atrium, which may cause many symptoms (bundle branch conduction, arrhythmias, myocardial infarction) or unexpected death.

Conclusions:
The authors aimed to report this case due to the disease’s high probability of death, even asymptomatic patients with cardiac hydatid disease should all be referred for early surgery.
Leukemoid reaction in a patient with metastatic renal cell carcinoma—rare clinical presentation seen in Nepal: a case report
Authors: Khatiwada Pramit , Yadav Girendra , Guragain Prashant , Raut Pradip , Subedi Viplaw , Dulal Soniya 
Published: April 2023

Introduction and importance:
Leukemoid reaction (increase in leucocyte count >50 ×109 cell/l) occurs due to reactive causes of bone marrow and is diagnosed after excluding the malignant haematological disorder. Leukemoid reaction is a rare clinical presentation in metastatic renal cell carcinoma and is said to have a rare prognosis. This case has had been reported in the line of SCARE criteria.

Case presentation:
A case of a 35-year-old female with no known previous co-morbidities presented with a history of abdominal pain in the right flank region for 2 months, fever and cough for 2 months. Physical examination showed palpable mass and tenderness in the right flank and investigations showed leukemoid reaction in peripheral blood smear. The patient was initially treated with strong intravenous antibiotics with suspicion of pyelonephritis in another centre, despite which the patient still had elevated leucocyte count and referred to our centre, where the patient was evaluated for elevated leucocyte count and with further investigations, ruled out any malignant haematological disorder. Final diagnosis of renal cell carcinoma was made by renal mass biopsy. The patient underwent targeted therapy with sunitinib. The patient expired and further investigation and follow-up were not possible.

Conclusion:
The lack of data and evidence of extensive diagnostic tests is the reason we are unable to assume leukemoid reaction as a poor prognostic factor in case of metastatic renal cell carcinoma. The presence of other paraneoplastic syndromes with renal cell carcinoma might have resulted in the poor prognosis that cannot be excluded.
Agreement Between Measured Weight and Fluid Balance in Mechanically Ventilated Children in Intensive Care
Authors: Gelbart Ben , Marchesini Vanessa , Kapalavai Sudeep Kumar , Veysey Andrea , Serratore Alyssa , Appleyard Jessica , Bellomo Rinaldo , Butt Warwick , Duke Trevor 
Published: April 2023

OBJECTIVES:
To investigate the agreement between change in body weight (BW) and fluid balance (FB), and the precision and safety of BW measurement in mechanically ventilated infants in intensive care.

DESIGN:
Prospective observational study.

SETTING:
Tertiary PICU.

PATIENTS:
Infants following cardiac surgery, at baseline, 24 hours, and 48 hours.

INTERVENTIONS:
BW and FB measurement at three time points.

MEASUREMENTS AND MAIN RESULTS:
Between May 2021 and September 2022, we studied 61 children. The median age was 8 days (interquartile range [IQR], 1.0–14.0 d). The median BW at baseline was 3,518 g (IQR, 3,134–3,928 g). Change in BW was –36 g (IQR, –145 to 105 g) and –97 g (IQR, –240 to –28 g) between baseline and 24 hours, and between 24 and 48 hours, respectively. Change in FB was –82 mL (IQR, –173 to 12 mL) and –107 mL (IQR, –226 to 103) between baseline and 24 hours, and between 24 and 48 hours, respectively. In Bland-Altman analyses, the mean bias between BW and FB at 24 and 48 hours was 54 g (95% CI, 12–97) and –43 g (95% CI, –108 to 23), respectively. This exceeded 1% of the median BW, and limits of agreement ranged from 7.6% to 15% of baseline BW. The precision of paired weight measurements, performed sequentially at each time interval, was high (median difference of ≤1% of BW at each time point). The median weight of connected devices ranged from 2.7% to 3% of BW. There were no episodes of tube or device dislodgments and no change in vasoactive therapies during weight measurements.

CONCLUSIONS:
There is moderate agreement between the changes in FB and BW, albeit greater than 1% of baseline BW, and the limits of this agreement are wide. Weighing mechanically ventilated infants in intensive care is a relatively safe and precise method for estimating change in fluid status. Device weight represents a relatively large proportion of BW.