bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury*
Authors: Laws Jennifer C. , Vance E. Haley , Betters Kristina A. , Anderson Jessica J. , Fleishman Sydney , Bonfield Christopher M. , Wellons John C. , Xu Meng , Slaughter James C. , Giuse Dario A. , Patel Neal , Jordan Lori C. , Wolf Michael S. 
Published: February 2023

OBJECTIVES:
The acute cerebral physiologic effects of ketamine in children have been incompletely described. We assessed the acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI).

DESIGN:
In this retrospective observational study, patients received bolus doses of ketamine for sedation or as a treatment for ICP crisis (ICP > 20 mm Hg for > 5 min). Administration times were synchronized with ICP and CPP recordings at 1-minute intervals logged in an automated database within the electronic health record. ICP and CPP were each averaged in epochs following drug administration and compared with baseline values. Age-based CPP thresholds were subtracted from CPP recordings and compared with baseline values. Trends in ICP and CPP over time were assessed using generalized least squares regression.

SETTING:
A 30-bed tertiary care children’s hospital PICU.

PATIENTS:
Children with severe TBI who underwent ICP monitoring.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We analyzed data from 33 patients, ages 1 month to 16 years, 22 of whom received bolus doses of ketamine, with 127 doses analyzed. Demographics, patient, and injury characteristics were similar between patients who did versus did not receive ketamine boluses. In analysis of the subset of ketamine doses used only for sedation, there was no significant difference in ICP or CPP from baseline. Eighteen ketamine doses were given during ICP crises in 11 patients. ICP decreased following these doses and threshold-subtracted CPP rose.

CONCLUSIONS:
In this retrospective, exploratory study, ICP did not increase following ketamine administration. In the setting of a guidelines-based protocol, ketamine was associated with a reduction in ICP during ICP crises. If these findings are reproduced in a larger study, ketamine may warrant consideration as a treatment for intracranial hypertension in children with severe TBI.
Cystic lesions in giant intraventricular meningioma: Two case reports
Authors: Yu Hai , He Junhua , Yang Min 
Published: February 2023

Rationale:
Giant meningioma stemming from the intraventricular zone has been reported to be extremely few. Two cases of supersize (>8 cm) intraventricular meningiomas presenting with cystic lesions and their clinical characteristics were collected in our study.

Patient concerns:
One patient was a 56-year-old man who was hospitalized for blunt headache and weakness of the right lower limb along with a defect of the right visual field for 12 months. The other patient is a 22-year-old lady who presented with a slight headache accompanied by right facial numbness for 1 week. None of them had a significant past medical history.

Diagnoses:
Computed tomography and magnetic resonance imaging of both patients revealed a giant heterogeneous, enhancing tumor mainly in the left trigonum with low-density or hypointense cystic lesions located within or around the tumor. The pathological and immunohistochemical staining indicated fibroblastic meningioma (case 1) and atypical meningioma (case 2) respectively, thus the patients’ diagnoses were confirmed.

Interventions:
Total microsurgical resection, including the cystic wall, was performed via a transcortical (transtemporoparietal occipital) approach in both patients, and a ventricular drainage tube was placed for 24 to 48 hours routinely after removed the tumor.

Outcomes:
Postoperatively, both patients recovered free from episodes of symptoms, and imaging examinations confirmed no evidence of regrowth of the meningioma during an average 24 months follow-up.

Lessons:
Cystic lesions may indicate the histopathologic malignancy of intraventricular meningioma. Transcortical approach through the posterior temporal lobe or the parieto-occipital lobe is an effective technology for giant intraventricular meningiomas.
The efficacy of pectoral nerve block for pain control after breast augmentation: A meta-analysis of randomized controlled studies
Authors: Liang Zanjiang , Xu Yang 
Published: February 2023

Background:
The efficacy of pectoral nerve block for pain control remains unknown in patients undergoing breast augmentation. This meta-analysis aims to explore the analgesic efficacy of pectoral nerve block for breast augmentation.

Methods:
We systematically searched PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases, and included randomized controlled trials reporting pectoral nerve block versus no block for breast augmentation.

Results:
Five randomized controlled trials were included in this meta-analysis. Compared with control group after breast augmentation, pectoral nerve block was associated with substantially reduced pain scores at 1 hour (standard mean difference [SMD] = −1.63; 95% confidence interval [CI] = −2.81 to −0.44; P = .007), maximal pain scores at 1 to 6 hours (SMD = −1.72; 95% CI = −2.75 to −0.69; P = .001) and 6 to 24 hours (SMD = −2.06; 95% CI = −3.40 to −0.72; P = .003), rescue analgesic (odd ratio = 0.17; 95% CI = 0.05–0.57; P = .004), nausea (SMD = 0.21; 95% CI = 0.08–0.54; P = .001), and vomiting (odd ratio = 0.15; 95% CI = 0.05–0.39; P = .0001).

Conclusions:
Pectoral nerve block benefits to alleviate pain intensity after breast augmentation.
Serum HMGB1 levels and its clinical significance in elderly patients with intertrochanteric fractures after intramedullary fixation surgery
Authors: Zhao Ling , Li Haoran , Zhang Shaohui , Dong Zhanyin , Cui Qing 
Published: February 2023

Background:
Intramedullary fixation is a valuable alternative for the treatment of intertrochanteric fractures. However, further development of new biomarkers to predict the prognosis of the patient is still needed for timely and effective treatment and intervention. The present study aimed to explore the serum high-mobility group box 1 (HMGB1) levels in the prognosis of intertrochanteric fracture patients and its correlation with clinical results.

Methods:
The present prospective cohort study recruited 115 intertrochanteric fracture patients who were admitted from January 2015 to December 2019. All patients were evaluated preoperatively and treated (proximal femoral nail antirotation or intramedullary proximal femoral nail) by the same team. The serum HMGB1, interleukin-6, interleukin-1β, tumor necrosis factor α, and C-reactive protein levels were measured by enzyme-linked immunosorbent assay. Demographic and clinical data of all patients were collected. Harris score was used to assess the prognosis of intertrochanteric fracture patients after 6 months of treatment. Statistical analysis was conducted using SPSS software with P < .05 as statistically different.

Results:
The time of the operation and the amount of bleeding in intramedullary proximal femoral nail were remarkably elevated compared with the proximal femoral nail antirotation group (P < .05). The age, proportion of complications and visual analogue score VAS after 72 hours of surgery in the Harris score < 80 group were remarkably increased compared with Harris score ≥ 80 group (P < .05). In addition, we found that the serum HMGB1 levels in Harris score < 80 group were markedly elevated than the patients in Harris score ≥ 80 group at all time points (P < .05). The results showed that the serum HMGB1 levels at postoperative 48 hours had the highest predictive value for predicting poor prognosis in intertrochanteric fracture patients. It was found that HMGB1, age and VAS after 72 hours of surgery were the risk factors for poor prognosis of intertrochanteric fracture patients.

Conclusion:
This study showed that the serum HMGB1 levels was significantly decreased in intertrochanteric fracture patients with bad prognoses. This study may provide a new approach to screening intertrochanteric fracture patients with worse prognoses in advance.
Effects of thoracic paravertebral nerve block on postoperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobectomy
Authors: Dongjie Qiu , Longbiao Zhao , Peng Liu , Li Jia , Hongmeng Xu , Zhiyan Chang , Long Yu 
Published: February 2023

Objectives:
To evaluate the effects of ultrasound-guided thoracic paravertebral nerve block on perioperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.

Methods:
Patients aged 60 to 80 years who underwent the surgery of thoracoscopic lobectomy were selected; ASA grades I to III and New York Heart Association (NYHA) grades I to II. Patients were randomly divided into two groups: group C (group Compaired) and group T (group Thoracic Paravertebral Nerve Block TPVB). Patients in group T received ultrason-guided TPVB while those in group C didn’t received TPVB. Postoperative patient-controlled intravenous analgesia was administered to all the patients. The consumption of intraoperative opioids, cases of hipoxemia, operative time, and extubation time was also recorded. Pain scores (static and dynamic) were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours point after the operation. Pain scores, occurrence of postoperative delirium occurrence, postoperative complications, total amount of analgesic drugs, length of hospital stay, rescue analgesic requirement, and side effects were recorded within 5 days.

Results:
Intraoperative dosages of sufentanil and remifentanil were significantly lower in group T (Table 1). The postoperative recovery time in group T was significantly shortened (Table 1). The VAS pain scores of group T at 2, 4, 6, and 24 hours after surgery were much lower. The consumption of intraoperative opioids, number of rescue analgesic requirements, and the occurrence of postoperative delirium incidence in group T was significantly reduced (Table 2). There were no differences in hipoxemia events, postoperative nausea, vomiting and pulmonary complications between the two groups (Table 2).

Conclusion:
Preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) can obviously decrease the intraoperative and postoperative opioids consumption, shorten the recovery time, reduce the number of rescue analgesia and the incidence of postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.
Penetrating canaloplasty in angle-closure glaucoma secondary to iridocorneal endothelial syndrome following multiple failed filtering surgeries: A case report
Authors: Tian Xuelian , Guo Juan , Liao Jinying , He Meng , Shi Yinwen , Tang Li 
Published: February 2023

Rationale:
Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient.

Patient concerns:
A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye.

Diagnoses:
The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations.

Interventions:
Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye.

Outcomes:
The patient’s visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed.

Lessons:
Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.
Endometrioid adenofibroma of ovary: A case report and review of literature
Authors: Tong Hai-Chao , Li Ying-Chun , Li Le-Yao , Xu Hong-Tao , Ma Shuang , Zhang Wan-Lin , Wildes Tyler , Yang Lian-He , Wang Endi 
Published: February 2023

Rationale:
Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary, most of which are often unilateral. The symptoms of endometrioid adenofibroma are often nonspecific and misleading. Therefore, a full understanding of the characteristics, diagnosis, and treatment methods of this disease is of great importance. In this study, we report a 34-year-old woman who was found with an unidentified mass on the right ovary during the physical examination 3 years ago with nosymptoms or signs.

Patient concerns:
A 34-year-old Chinese female was found with an unidentified 6 cm mass on the right ovary for 3 years that presented with no symptoms or signs.

Diagnosis:
Pelvic ultrasound revealed a 6 cm cystic solid mixed mass on the right ovary. Through histological and immunohistochemical examinations, the tumor mass was finally diagnosed as endometrioid adenofibroma of ovary.

Interventions:
To confirm the diagnosis, the ovarian tumor was laparoscopically resected.

Outcomes:
The patient returned to hospital after 3 months with no recurrence or postoperative complications.

Lessons:
Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary. Complete surgical resection is required and rare cases can recur. Postsurgical pathologic and immunohistochemical testing can confirm a diagnosis of endometrioid adenofibroma. It is important to understand of the key points of differential diagnosis of the disease due to the different prognosis and clinical treatment.
Surgery for rare adenosquamous carcinoma of the scrotum: A case report and literature review
Authors: Sun Yexiao , Miao Xihong , Wang Lei , Zhang Yanfeng , Shen Zhihua 
Published: February 2023

Rationale:
Adenosquamous carcinoma of the scrotum is a rare cancer associated with poor prognosis. It is diagnosed through the presence of both adenocarcinoma and squamous cell carcinoma.

Patient concerns:
It may be difficult to diagnose at early stages and may have poor survival.

Diagnoses:
We report a case of adenosquamous carcinoma of the scrotum in a 58-year-old male patient who presented with left scrotal mass for >1 year.

Interventions:
This is the first case in the literature of primary adenosquamous carcinoma of the scrotum managed successfully with surgery and post-surgery chemotherapy and radiotherapy.

Outcomes:
The patient remained disease-free for 10 months postoperatively.

Lessons:
The surgery treatment combined with postoperative radiotherapy and chemotherapy can improve the survival of adenosquamous carcinoma.
Basal cell carcinoma of the umbilicus associated with sweat gland structures: Two case reports
Authors: Kurosaki Yukiho , Itoi-Ochi Saori , Ota Asako , Miyazaki Akiko , Kato Hiroko , Nojima Satoshi , Morii Eiichi , Yokoi Kazunori , Fujimoto Manabu , Tanemura Atsushi 
Published: February 2023

Rationale:
Basal cell carcinoma (BCC) arising in the umbilicus is relatively rare, and in particular, there have been few reports mentioning peritumoral sweat gland structures histopathologically. We herein, report 2 cases of umbilical BCC with sweat gland structures within and around the tumor.

Patient concerns:
A 61-year-old woman had a 2-year history of black exudative plaque in her umbilicus, and an 80-year-old woman had a 6-month history of dark brownish plaque in the umbilicus, with exudation 2 months prior to her first visit.

Diagnoses:
Based on the histopathological finding, both cases were confirmed as BCC. The results of immunohistochemical staining showed that the tumor cells were Ber-EP4 positive. In addition, EMA-positive glandular structures were seen within and around the tumor.

Interventions:
Curative resection at the level of the linea alba on the bottom side was performed.

Outcomes:
No relapse has been observed since resection in either patient.

Lessons:
We herein report 2 cases of umbilical BCC with sweat glands and ducts. Although whether peri- and/or intra-tumor sweat gland structures are the source of the tumor or arise by transdifferentiation from tumor cells remains unclear, these findings may provide clues to help understand the morphopathogenesis of umbilical BCC in the future.
Prevalence and predictors of arthralgia after initiation of vedolizumab in patients with inflammatory bowel disease: a retrospective cohort study
Authors: Kokkotis Georgios , Zampeli Evanthia , Tzouvala Maria , Giotis Ioannis , Orfanos Philippos , Benetou Vassiliki , Stoupaki Maria , Leontidis Nikolaos , Leonidakis Georgios , Kitsou Vassiliki , Gaki Aikaterini , Lagiou Pagona , Michopoulos Spyridon , Bamias Giorgos 
Published: February 2023

Objectives
Vedolizumab is a mAb used for the treatment of moderate to severe ulcerative colitis and Crohn’s disease. There is evidence that administration of vedolizumab has been associated with either new onset or reactivation of extra-intestinal manifestations, among which arthralgia is the most prominent. We aimed to study the incidence, characteristics and predictors for the occurrence of arthralgias in patients with inflammatory bowel disease (IBD) who receive vedolizumab.

Methods
A retrospective cohort study was implemented in patients with IBD. The occurrence of new-onset and recurrent arthralgias were recorded. Multivariate Cox proportional-hazards models were used to identify factors associated with the endpoints of interest.

Results
A total of 115 vedolizumab-treated IBD patients (male = 50.4%; ulcerative colitis  = 70.4%; median follow-up = 12.7 months) participated. New-onset arthralgia occurred in 20.9%, and recurrent in 46.7% (45 patients at risk). Among patients with ulcerative colitis, multivariate Cox’s proportional-hazards models showed, that new onset arthralgia was significantly associated with extensive colitis (hazard ratio = 2.91; 95% confidence interval, 1.04–8.12). Of 15 patients with concomitant treatment of azathioprine, no one manifested new-onset arthralgia (X2
P = 0.03; Fisher’s exact test P = 0.038). No predictors were identified for recurrent arthralgia.

Conclusion
Arthralgias is a common manifestation of vedolizumab treatment. Patients with extensive ulcerative colitis demonstrate a higher risk for new-onset arthralgia, whereas, concomitant treatment with azathioprine appears to be protective. These associations may be mediated by re-directed lymphocyte trafficking and may support concomitant immunomodulator administration in specific patient subpopulations who commence treatment with vedolizumab.
Nonvisualized sentinel node on preoperative lymphoscintigraphy in primary cutaneous melanoma: an 11-year retrospective survey
Authors: Pallara Tiziano , Annovazzi Alessio , Cristiani Renzo , Vinci Federica , Bertozzi Ettore , Bonadies Antonio , Romani Claudia , Tedesco Marinella , Bellei Barbara , Papaccio Federica , Caputo Silvia , Cota Carlo , Sperduti Isabella , Govoni Flavio Andrea , Morrone Aldo , Migliano Emilia 
Published: February 2023

Background
Sentinel lymph node (SLN) biopsy in cutaneous melanoma patients evaluates the regional draining basin for occult micrometastatic disease. Occasionally, nonidentification of SLN impairs the acquisition of this important prognostic factor.

Objectives
To investigate the outcomes of melanoma patients with negative lymphoscintigraphic findings and patients who underwent SLN biopsy from 2004 to 2015 (n = 1200) were retrospectively reviewed for tumor characteristics and clinical outcomes.

Methods
Patients with nonvisualized lymph nodes (NV group) who underwent only preoperative lymphoscintigraphy were separated and compared with a cohort drawn from all melanoma patients who completed the surgical procedure within the same period (V group).

Results
A negative lymphoscintigraphic scan was observed in 38 cases (3.2% of all patients). The NV group showed a significantly older age (median 66.0 vs. 48.3 years; P < 0.0001). Head and neck melanomas were more frequent in the NV group compared to the control group (25.1 vs. 7.8%; P = 0.009). Tumor characteristics such as ulceration and Breslow thickness do not influence the lymphoscintigraphy result. No differences were found in overall survival (OS) and disease-free survival (DFS) between the groups.

Conclusions
The nonvisualization of regional lymph nodes by lymphoscintigraphy is more frequent in older patients with head and neck melanomas. From the clinical point of view, no specific recommendation emerged for patients’ management because the nonvisualization of the SLN did not show a significant influence on DFS and OS rates. However, lack of knowledge of lymph node status suggests performing a tighter follow-up eventually by ultrasound evaluation of all potential lymph node drainage basins.
Topical Tranexamic Acid in Breast Reconstruction: A Double-Blind, Randomized Controlled Trial
Authors: Safran Tyler , Vorstenbosch Joshua , Viezel-Mathieu Alex , Davison Peter , Dionisopoulos Tassos 
Published: February 2023

BACKGROUND
Excess fluid accumulation (seroma/hematoma) around the breast implant post reconstruction can lead to significant complications. Topical administration of tranexamic acid (TXA) may reduce fluid accumulation and reduce post-operative complications. This trial aims to investigate if TXA treated mastectomy pockets will exhibit less postoperative fluid production and complications.

METHODS:
This paired, double-blinded, randomized-controlled trial enrolled patients undergoing bilateral mastectomies with immediate direct to implant reconstruction. In each patient, one breast was randomized to receive 3g TXA (100cc), and the other received 100cc of NS. The blinded solutions were soaked in the mastectomy pocket for five minutes before implant placement. Postoperatively, daily drain outputs, complications, and baseline demographics were recorded.

RESULTS
53 eligible patients, representing 106 breasts, were enrolled. All patients underwent bilateral nipple-sparing mastectomies. After randomization, TXA was placed in the right breast in 56.6% (n=30) of patients. The use of topical TXA resulted in a mean drain output reduction of 30.5% (RANGE: -83.6% - 26.6%). Drains on the TXA treated breast were eligible for removal 1.4(RANGE: 0-4) days sooner than the control side. TXA treated group had three complications (5.67%) versus 15 (28.3%) in the control group (Odds Ratio: 0.1920, p= 0.0129). Specifically, for operative hematomas, the TXA group had none(0%) versus three in the control group (5.7%)(Odds Ratio: 0.1348, P=0.18).

CONCLUSION
Soaking the mastectomy bed with 3% topical TXA before implant insertion leads to a decrease in drain output and a decrease in complications. Topical administration of TXA represents an option to decrease complications in alloplastic breast reconstruction.