bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intranodal implantation of benign thyroid tissue as a late complication of ethanol ablation: A case report
Authors: Ahn Dongbin , Kawk Ji Hye , Cho Heungrae 
Published: April 2023

Rationale:
Ethanol ablation (EA) is recommended as the primary treatment for benign thyroid cysts and its use is increasing. Although complications, such as pain, hoarseness, and hematoma, have been reported after EA, implantation of benign thyroid tissue has not been previously reported. Here, we present a case of intranodal implantation of benign thyroid tissue as a late complication of EA.

Patient concerns:
A 46-year-old man underwent EA for a benign cystic nodule in the left thyroid lobe and developed a thyroid abscess after several days. The patient was treated with incision and drainage and was discharged without complications. Two years later, the patient presented with multiple masses in both cervical regions. Ultrasound (US) and computed tomography indicated metastatic papillary thyroid carcinoma (PTC) at bilateral levels III, IV, and VI. The results of US-guided fine-needle aspiration cytology (FNAC) indicated benign lesions; however, thyroglobulin levels in the needle washout fluid were >250,000 ng/mL.

Diagnosis:
Total thyroidectomy with neck dissection was performed to remove the thyroid and lymph node masses and confirm the diagnosis. Histopathological findings revealed multiple areas of benign thyroid tissue in the bilateral cervical lymph nodes, with no indication of metastatic PTC, even after a BRAF gene mutation study and immunohistochemical staining for HBME-1 and galectin-3.

Outcomes:
No recurrence or complications were observed during the follow-up for 29 months.

Lessons:
Complicated EA may be associated with the dissemination of benign thyroid tissue into lymph nodes, with a confusing clinical presentation mimicking metastatic PTC. Radiologists and thyroid surgeons should consider the risk of intranodal implantation of benign thyroid tissue as a late complication of EA.
Hybrid stent in management of malignant airway obstruction with carina esophageal fistula: A case report
Authors: Zhu Chenghua , Liu Jingning , Ke Mingyao , Yong Yazhi , Luo Bingqing , Feng Ganzhu 
Published: April 2023

Rationale:
Airway stents have been developed rapidly to treat airway stenosis and fistula caused by various reasons. Malignant conditions that lead to central airway obstruction, especially the invasion of trachea carina and formation of esophageal fistula, are still a challenge for clinicians.

Patient concerns:
A 61-year-old man presented with malignant airway obstruction and fistula between trachea carina and esophagus accompanied by severe respiratory failure.

Diagnosis:
The patient was clinically diagnosed with esophageal squamous cell cancer of stage IV, carina esophageal fistula, severe pneumonia, hypoproteinemia.

Interventions:
Y-shaped covered metallic stent and Y-type silicone stent (hybrid stent) were placed in the airway to increase tracheal patency, block the fistula and perform carinal plasty.

Outcomes:
The clinical symptoms of the patient improved rapidly and the lung infection was controlled effectively. This patient was followed up for more than 2 month, and the quality of life was better than before.

Lessons:
Hybrid stent can be used as 1 of options for airway reconstruction and palliative treatment for patients with complex airway diseases caused by malignant tumors.
Primary cervical meningeal melanocytoma with a dumbbell shape: Case report and review of the literature
Authors: Hou Weina , Yu Jianmin , Gao Sumei , Chu Yujing 
Published: April 2023

Rationale:
Meningeal melanocytoma is a rare benign pigmented tumor originat from leptomeningeal melanocytes. Here, we report the case of a female who presented with numbness and weakness of the limbs for approximately 6 months.

Patient concerns:
We report the case of a 60-year-old Chinese female who presented with numbness and weakness of the limbs for approximately 6 months. computed tomography (CT) and magnetic resonance imaging (MRI) revealed a dumbbell-shaped tumor inside and outside the cervical (C) spinal canal.

Diagnoses:
The patient was using CT and MRI. Subsequently, the patient underwent surgery, and low-grade melanocytoma was diagnosed pathologically.

Interventions:
Subsequently, the patient underwent a surgery, and the tumor was completely removed.

Outcomes:
The tumor did not recur after 6 months.

Conclusion:
This case suggested 2 “take-away” lessons: first, spinal meningeal melanocytomas may be dumbbell-shaped; and second, melanocytoma could appear as hyperintense, isointense, or hypointense on T2-weighted MRI.
Paradoxical massive pulmonary thromboembolism in a postpartum woman with factor VII deficiency with bleeding tendency: A case report
Authors: Kang Donghoon , Cha Hojeong , Park Sung Eun , Ahn Jong-Hwa , Park Ji Kwon , Kwon Iyun , Park Ji Eun 
Published: April 2023

Rationale:
Factor VII (FVII) deficiency is an inherited bleeding disorder, and women with FVII deficiency are at risk of gynecological bleeding and postpartum hemorrhage. There have been no reports of pulmonary embolism in a postpartum woman with FVII deficiency as of yet. We report a case of postpartum massive pulmonary embolism with FVII deficiency.

Patient concerns:
A 32-year-old woman visited the hospital with premature rupture of membranes at 24 weeks and 4 days of gestation. She was diagnosed with FVII deficiency in an additional blood test after her laboratory results at admission included an increased prothrombin time and international normalized ratio abnormalities. After 12 days of pregnancy maintenance treatment, an emergency cesarean delivery was performed due to uncontrolled preterm labor. The day after the operation, she suffered a sudden loss of consciousness and cardiac arrest, and after she received 1 cycle of cardiopulmonary resuscitation, she was moved to the intensive care unit.

Diagnoses:
She was diagnosed with massive pulmonary thromboembolism with heart failure by chest enhanced computed tomography, C-echo, and angiography.

Interventions:
She was successfully treated with the early application of extracorporeal membrane oxygenation, catheter-guided thrombectomy, and anticoagulants.

Outcomes:
There were no major sequelae over 2 months of follow-up.

Lessons:
FVII deficiency does not protect against thrombosis. Due to the high thrombotic risk after childbirth, the risk of thrombosis should be recognized, and thromboprophylaxis should be considered if additional obstetric thrombotic risk factors are present.
PICU treatment of 3 cases of pediatric thyroid storm: Case series and literature review
Authors: Li Xinyao , Chen Jun , Li Zhuo 
Published: April 2023

Rationale:
Thyroid storm (TS), also known as thyroid crisis, is a life-threatening condition that involves multiple organ dysfunction and high mortality due to uncontrolled hyperthyroidism. TS in children is extremely rare, early diagnosis and treatment can significantly improve the prognosis of the children.

Patient concerns:
Three female children who diagnosed as “thyroid storm” were admitted to Pediatric Intensive Care Unit (PICU). One of them had a family history of hyperthyroidism and others had infection factors induced TS. They presented with characteristic manifestations of TS and were evaluated with Burch-Wartofsky Point Scale (BWPS) hyperthyroidism score.

Diagnoses:
Three cases showed that free triiodothyronine 3 (FT3) and free triiodothyronine 4 (FT4) were increased and Thyroid-Stimulating-Hormone was significantly decreased, which were characteristic in hyperthyroidism. They presented with characteristic manifestations of TS and were evaluated with BWPS hyperthyroidism score.

Interventions:
All the cases were given antithyroid drugs (ATDs) for treatment. In addition, 1 of them underwent therapeutic plasma exchange (TPE) after transferring to PICU.

Outcomes:
One of the cases was declared dead and others were survived.

Lessons:
TS should be identified timely and treated early. Further studies are needed to determine the diagnostic criteria and scoring system for TS in pediatric.
Descending necrotizing mediastinitis caused by Streptococcus constellatus: A case report and review of the literature
Authors: Guo Jian , Lin Liheng , Zhou Haoge , Yang Wenfan , Shi Sen 
Published: April 2023

Rationale:
Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here, we shared a successful diagnosis and treatment case of DNM that originates from oral to neck and mediastinum caused by Streptococcus constellatus (S constellatus). S constellatus is a clinically uncommon gram-positive coccus and is known for its ability to form abscesses. Timely surgical drainage and the correct use of antibiotics are key to successful treatment.

Patient concerns:
A 53-year-old male admitted to hospital with painful swelling of the right cheek, persistent oral pus and moderate fever lasting 1 week, followed by rapid development of a mediastinal abscess.

Diagnoses:
He was diagnosed with DNM caused by S constellatus.

Interventions:
On the evening of admission, an emergency tracheotomy and thoracoscopic exploration and drainage of the right mediastinum, floor of the mouth, parapharynx and neck abscess were performed. Antibiotics were administered immediately.

Outcomes:
At 28 days post-operatively, the abscess was absorbed, bilateral lung exudate decreased and the patient temperature, aspartate transaminase, alanine transaminase, bilirubin and platelets returned to normal. The patient was discharged after completing 4 weeks of antibiotic therapy. Follow-up at 3 months after discharge revealed no recurrence of the abscess.

Lessons:
Early surgical drainage and antibiotics treatment are important in mediastinal abscesses and infectious shock due to Streptococcus asteroids.
Severe varicella-zoster virus meningoencephalomyelitis coexisting with visceral disseminated varicella-zoster virus infection in a patient with lupus nephritis: A case report
Authors: Tao Tian , Chen Jun , Long Kunlan , Zhi Lijia , Zhang Song , Liu Shuqin , Ma Yuexian , Yan Hong , Lv Lizeyu , Xu Yue , Wu Ling , Zhao Liangbin , Gao Peiyang 
Published: April 2023

Rationale:
Meningoencephalomyelitis and visceral dissemination infection are rare but life-threatening complications of either the primary infection or reactivation of varicella-zoster virus (VZV) in immunocompromised patients. To date, few studies have reported the co-existence of VZV meningoencephalomyelitis and the visceral dissemination of VZV infection.

Patient concerns:
A 23-year-old male was diagnosed with lupus nephritis class III and was being treated with oral prednisone and tacrolimus. The patient exhibited herpes zoster 21-day after the initiation of therapy and experienced unbearable abdominal pain and generalized seizures 11 days after the onset of a zoster rash. Magnetic resonance imaging showed progressive lesions in the cerebrum, brainstem, and cerebellum, as well as meningeal thickening and thoracic myelitis. Computed tomography showed pulmonary interstitial infiltration, partial intestinal dilatation, and effusion. Metagenomic next-generation sequencing revealed 198,269 and 152,222 VZV-specific reads in the cerebrospinal fluid and bronchoalveolar lavage fluid, respectively.

Diagnoses:
Based on the clinical and genetic findings, this patient was finally diagnosed with VZV meningoencephalomyelitis and visceral disseminated VZV infection.

Interventions:
The patient received intravenous acyclovir (0.5 g every 8 hours) combined with plasma exchange and intravenous immunoglobulin. Treatment against secondary bacterial and fungal infections, organ support therapy and rehabilitation training were given simultaneously.

Outcome:
The patient’s peripheral muscle strength did not improve and repeated metagenomic next-generation sequencing showed the persistence of VZV-specific reads in the cerebrospinal fluid. The patient finally abandoned therapy due to financial constraints at the 1-month follow-up.

Lessons:
Patients with autoimmune diseases receiving immunosuppressive therapy should be warned about the possibility of developing serious neurological infections and visceral disseminated VZV infections as side effects. Early diagnosis and the early initiation of intravenous acyclovir therapy are important for such cases.
The effect of ginsenoside Rg3 combined with chemotherapy on immune function in non-small cell lung cancer: A systematic review and meta-analysis of randomized controlled trials
Authors: Gao Song , Fang Cancan , Wang Tiancheng , Lu Wenjie , Wang Nan , Sun Lingfeng , Fang Wenyou , Chen Yang , Hu Rongfeng 
Published: April 2023

Background:
The occurrence and development of non-small cell lung cancer (NSCLC) are closely related to the immune status of the tumor-host. The immunosuppression caused by tumor cells and toxic side effects produced by chemotherapeutic drugs results in a decrease in immune function, ultimately leading to the failure of clinical chemotherapy treatment. Ginsenoside Rg3 has been clinically reported to have positive effects in enhancing immune function in patients. Thus, we screened and evaluated the quality of the evidence regarding the benefits of ginsenoside Rg3 and conducted a meta-analysis to assess the impact on improving immune function in NSCLC.

Methods:
The PubMed, EMBASE, Cochrane Library, CNKI, Weipu (VIP), and Wanfang databases were searched in this study, all from the time of library construction to January 2023.

Results:
In total,12 trials with a sample size of 1008 cases were included based on the eligible criteria. The results showed that compared with first-line chemotherapy alone, the combination of ginsenoside Rg3 and first-line chemotherapy could better improve level of the CD3+ T lymphocytes [mean difference (MD) = 4.72; 95% confidence intervals (CI): 3.92, 5.53; P < .00001], CD4+ T lymphocytes (MD = 4.93; 95% CI: 4.61, 5.26; P < .00001), CD8+ T lymphocytes (MD = 2.67; 95% CI: 0.93, 4.37; P = .003), CD4+/CD8+ T lymphocytes (MD = 0.20; 95% CI: 0.09, 0.32; P = .0006), increase the activity of nature killer cells (MD = 2.11; 95% CI: 0.58, 3.63; P = .007), recover the decline of the white blood cell count induced by chemotherapy, and improve the clinical efficacy for patients.

Conclusion:
This study confirmed that ginsenoside Rg3 has some efficacy advantages for improving immune function in patients with NSCLC.
Radical resection of trigeminal schwannoma at the cerebellopontine angle with support of the digital robotic exoscope Synaptive Modus V system: A case report and literature review
Authors: Chu Tan-Si , Chu Tan-Huy , Huynh Tri-Dung , Phan Van-Dinh , Dang Bao Ngoc , Tran Quoc Dat 
Published: April 2023

Rationale and patient concerns:
We report on a 67-year-old woman who experienced drowsy mental status, facial numbness, and hearing loss on the right side; the symptom gradually worsened over the last 4 years. Brain magnetic resonance imaging revealed a 4.8 × 1.8 × 2.6 cm lesion located in the right cerebellopontine angle.

Interventions:
She underwent surgery with the retrosigmoid suboccipital approach and support from the digital robotic exoscope Synaptive Modus V system. To the best of our knowledge, this is the first reported case that used the robotic exoscope system in Vietnam, and also in Asia.

Diagnosis:
We performed radical resection of the tumor, the surgery position and the pathology result concluded the diagnosis was trigeminal schwannoma.

Outcomes:
After 30 months of follow-up, she fully recovered and the magnetic resonance imaging showed radical resection of the tumor.

Lessons:
The aim of this study is to share our experience with the robotic exoscope system, which can improve optical field and image resolution, hence creating an opportunity for surgery that otherwise is impossible. The application of this robotic exoscope system is a breakthrough in neurosurgery in developing countries, such as Vietnam.
Clinical characterization of polycythemia vera associated with IgA nephropathy in a single Chinese center: A case series
Authors: Wang Xia , Yang Nannan , Lu Chunyu , Xu Feng , Wang Jinquan 
Published: April 2023

Background:
Polycythemia vera (PV) is a myeloproliferative neoplasm which is characterized by excessive production of erythrocytes as well as myeloid and megakaryocytic proliferation. PV associated with IgA nephropathy (IgAN) has rarely been reported in the literature. The long-term renal prognosis of these patients is unknown.

Methods:
Clinical and pathological characteristics of 7 patients with renal biopsy-proven IgAN associated with PV were retrospectively analyzed.

Results:
The 7 patients were all males, with a mean age of 49.1 ± 18.8 years when admitted to our hospital. Systemic symptoms include: hypertension in case 2, 3, 5, and 6, splenomegaly in case 2, 4, and 5, and multiple lacunar infarction in case 6. Bone marrow biopsy test revealed relative erythroid hyperplasia and atypical megakaryocyte proliferation which consistent with a chronic myeloproliferative neoplasm. All patients had JAK2V617F and BCR-ABL tested, and JAK2V617F positive in 2 patients. Mild mesangial proliferation was observed in 5 patients and moderate/severe mesangial proliferation in 2patients. Immunofluorescence mainly showed diffuse granular deposition of dominant IgA in mesangium. After follow-up of 56.7 ± 44.0 months, hemoglobin level was 144 ± 29 g/L and hematocrit lever was 0.470 ± 0.03, compared with 187 ± 29 g/L and 0.563 ± 0.087 respectively when admitted to our hospital. The urine protein was 0.85 ± 0.64 g/24 h compared with 3.97 ± 4.68 g/24 h. Case 3 progressed to end stage renal disease and had received hemodialysis for 5 years before renal transplantation.

Conclusions:
The results of this study showed that PV associated with IgAN mainly occurs in males and is often accompanied by hematuria and mild-to-moderate renal insufficiency. The long-term prognosis was good for most patients, and few progressed relatively quickly to end stage renal disease.
Esophageal achalasia, diagnosed through the repeated manometry, alleviated using benzodiazepine: A case report
Authors: Nishi Ryusei , Amitani Haruka , Hamada Kazumasa , Fukumoto Takamasa , Kato Ryuichi , Yamamoto Takako , Fuku Yuuki , Sagiyama Kenichiro , Asakawa Akihiro 
Published: April 2023

Rationale:
Idiopathic achalasia is an esophageal peristaltic dysfunction of the lower esophageal sphincter (LES). The initial symptom is progressive dysphagia. However, due to its rarity, it is often misdiagnosed as an esophageal disorder. High LES pressure on esophageal manometry is an essential finding for the diagnosis.

Patient concerns:
A 55-year-old man was hospitalized with saliva-like vomitus, stuck-in-throat feeling of dysphagia, and weight loss.

Clinical findings:
On initial admission, gastrointestinal endoscopy, esophageal manometry, laboratory tests, and physical examination results were within normal limits.

Diagnoses, interventions, and outcomes:
Initially, the patient was diagnosed with globus sensation and recovered with medication. However, the symptoms recurred. He requested another examination on the second admission and was diagnosed with achalasia based on repeat esophageal manometry. The patient recovered after surgical treatment.

Lessons:
When patients still suffer from these symptoms, there is a need to reconsider achalasia, even if it is initially excluded from the differential diagnosis. Medication is not a radical treatment; however, it sometimes ameliorates symptoms. Moreover, the psychosomatic approach can be useful in such cases.
A novel treatment approach for a patient with advanced low rectal cancer: A case report and literature review
Authors: Jiang Xuejun , Zhou Feng , Yuan Fangjun , Lei Xinyi , Liu Cui , Ji Zujin 
Published: April 2023

Rationale:
In the treatment of low rectal cancer (LRC), preserving the anal sphincter is increasingly attracting the attention of colorectal surgeons. Many patients refused to perform a colostomy. Here, we report a case of LRC in a middle-aged woman and the clinical implications of the symptom, the treatment process of LRC, and the complications.

Patient concerns:
A 46-year-old woman visited our department with a tumor found on her physical examination because of hemafecia. Then she refused to perform abdominoperineal resection.

Diagnosis:
The patient first completed a colonoscopy and then underwent a rectal biopsy. The tumor was diagnosed as a rectal adenocarcinoma after pathological evaluation. Then it was staged by magnetic resonance imaging and enhanced computed X-ray tomography.

Interventions:
The treatment consisted of chemoradiotherapy followed by cryoablation.

Outcomes:
The patient achieved a good oncological outcome and preserved the sphincter successfully. The post-cryoablation course of the patient was uneventful and he remained healthy at the 1-year follow-up.

Lessons:
The preservation of anal sphincters has attracted more and more attention from colorectal surgeons. From the patient's perspective, the preservation of the anal sphincter was a key part of her treatment. We should try to meet the wishes of patients on the basis of curing the disease.
Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position
Authors: Choi Eun Kyung , Baek Jongyoon , Kim Do Young 
Published: April 2023

Background:
A sore throat is an adverse postoperative consequence of tracheal intubation under general anesthesia. Recently, dexmedetomidine, an anesthetic adjuvant, has shown beneficial effects in postoperative sore throat (POST). Herein, we compared the effects of dexmedetomidine and remifentanil on POST after spinal surgery in the prone position, which is a risk factor for developing POST.

Methods:
Ninety-eight patients were enrolled in the dexmedetomidine and remifentanil groups. Each drug was continuously infused using the following protocol: 1 μg/kg over 10 minutes followed by 0.2 to 0.8 μg/kg/h of dexmedetomidine, 3 to 4 ng/mL during induction followed by 1 to 3 ng/mL of remifentanil intraoperatively. The incidence and severity of POST were assessed serially at 24 hours postoperatively. Postoperative hoarseness, nausea, and pain scores were measured.

Results:
The incidence and severity of POST were significantly lower in the dexmedetomidine group than that in the remifentanil group. However, the incidence of hoarseness was comparable between the 2 groups. Postoperative nausea was lower in the dexmedetomidine group at 1 hour postoperatively; however, the postoperative pain score and analgesic requirements did not differ significantly.

Conclusions:
Dexmedetomidine infusion as an adjuvant during sevoflurane anesthesia significantly reduced the incidence and severity of POST in patients who underwent lumbar surgery 24 hours postoperatively.