bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the hospital frailty risk score to assess oesophago-gastric cancer patient outcomes: a retrospective cohort study
Authors: Harris Alexander , Imam Towhid , Konstant-Hambling Rob , Flint Helene , Conroy Simon , Kumar Sacheen , Allum William 
Published: January 2025

Background:
The inclusion of clinical frailty in the assessment of patients planned for major surgery has proven to be an independent predictor of outcome. Since approximately half of all patients in the UK diagnosed with oesophagogastric (OG) cancer are over 75 years of age, assessment of frailty may be important in selection for surgery.

Materials and methods:
This retrospective cohort study applied the Hospital Frailty Risk Score to data obtained from the NHS Secondary Uses Service electronic database for patients aged 75 years or older undergoing oesophagectomy and gastrectomy between April 2017 and March 2020. Descriptive statistics were performed to assess the effect of patient frailty on length of stay, 30-day readmission, and 30-day mortality rates. These outcomes were compared with those published by the National Oesophago-Gastric Cancer Audit.

Results:
Over 90% of the 1775 patients identified according to the age and resection criteria exhibited some degree of frailty. The median length of stay and 30-day readmission rate increased as patient frailty increased following both oesophagectomy and gastrectomy, as did the 30-day mortality rate following gastrectomy.

Conclusion:
Frailty is a dynamic state and increasing age alone should not be a barrier to receiving the most appropriate treatment. Introducing standardized assessment of clinical frailty for patients with OG cancer to identify this cohort of patients earlier might enable targeted screening for frailty syndromes. This could facilitate the enhanced delivery of more holistic, frailty-attuned, approaches to person-centred care, and evidence-based treatment pathways for improved patient outcomes.
Acute lymphoblastic leukemia first presenting with ascites: A case report
Authors: Yu Fengxue , Tao Zhen , Cheng Cong , Wei Hongxia , Cai Rentian 
Published: January 2025

Rationale:
Acute lymphoblastic leukemia (ALL) is known for its tendency to present with extramedullary infiltrates, commonly affecting lymph nodes, the spleen, the central nervous system, the orbit, skin, and testes. Less commonly, leukemia can infiltrate unusual sites such as the cervix, gastrointestinal tract, lungs, and thyroid gland. However, it is exceedingly rare for leukemia to present with ascites as the initial symptom. By reporting this rare case, the study seeks to contribute to a better understanding of ALL’s varied presentations and improve early detection and management strategies, ultimately enhancing patient outcomes.

Patient concerns:
A 30-year-old male was admitted to the hospital with the primary complaint of ascites.

Diagnosis:
ALL.

Interventions:
The patient was initially diagnosed with suppurative peritonitis through abdominal puncture. The abdominal computed tomography scan revealed ileocecal lesions, which were thought to be the source of the purulent peritonitis. Despite receiving antibacterial therapy and undergoing peritoneal effusion drainage, the treatment proved ineffective. The patient chose to discontinue hospitalization and was discharged on June 22. On August 24, he was readmitted to Nanjing First Hospital. A follow-up abdominal computed tomography scan revealed multiple enlarged lymph nodes in the abdomen, raising suspicion of a hematological malignancy. Bone marrow cytology subsequently confirmed the diagnosis of ALL.

Outcomes:
The patient was admitted to the hematology department for further treatment. Unfortunately, despite intervention, the patient passed away.

Lessons:
Although it is rare for ALL to present initially with ascites, clinicians should consider leukemia as a potential diagnosis in patients presenting with ascites, particularly when conventional treatments for other diagnoses are ineffective.
Comprehensive treatment strategy for pancreaticopleural fistula: A rare case report and review of 91 cases
Authors: Zhao Chengsi , Yao Weijie , Wang Zuozheng 
Published: January 2025

Rationale:
Pancreaticopleural fistula (PPF) is a rare but serious complication of pancreatic disease, typically resulting from the rupture of a pancreatic pseudocyst or ductal injury. The condition often leads to misdiagnosis due to its nonspecific clinical manifestations, including dyspnea and chest pain.

Patient concerns:
A 61-year-old male with a history of alcohol and tobacco use presented with severe dyspnea, chest pain, and cough. He had been diagnosed with acute pancreatitis 9 months prior and intermittently experienced upper abdominal pain and distension post-treatment.

Diagnoses:
PPF.

Interventions:
The patient underwent thoracic drainage, nasopancreatic duct drainage, and pancreatic duct stent placement, along with parenteral nutrition and somatostatin therapy.

Outcomes:
Treatment resulted in resolution of pleural effusion and pseudocyst. The patient had no recurrence during a 5-year follow-up period.

Lessons:
This case demonstrates the effectiveness of a comprehensive treatment strategy combining thoracic and pancreatic drainage for PPF. Long-term follow-up is crucial for monitoring recurrence and assessing treatment efficacy. Future research should focus on optimizing treatment plans, particularly regarding the best timing for intervention and improving long-term outcomes.
Rectal fistula induced artificial vascular graft infection: A case report
Authors: Zhou Honghua , Dai Kanghui , Ju Zhinan , Wan Liqun , Zhou Guangmao , Qiu Jiehua 
Published: January 2025

Rationale:
Artificial vascular graft infection (AVGI) is a rare but severe complication in vascular surgery, often associated with high morbidity and mortality. This case report highlights a unique instance of AVGI caused by a rectal fistula, emphasizing the diagnostic challenges and management strategies in such a rare scenario.

Patient concerns:
A 60-year-old female presented with low-grade fever and purulent discharge from an abdominal incision 1 year after antibiotic therapy had failed to resolve the infection. She had a history of aortofemoral dacron graft bypass 6 years prior, complicated by a rectal hematoma due to trauma.

Diagnoses:
The patient was diagnosed with a rectal fistula, AVGI, and perivascular sinus formation. Diagnostic workup revealed the presence of Escherichia coli infection.

Interventions:
The patient underwent graft excision and debridement. No vascular reconstruction was necessary due to the presence of sufficient collateral circulation. This intervention was performed following the failure of conservative antibiotic therapy.

Outcomes:
Postoperative recovery was uneventful, with normalization of inflammatory markers and no signs of limb ischemia upon follow-up. The patient’s symptoms resolved without complications.

Lessons:
This case underscores the importance of early diagnosis using imaging, particularly in patients with vascular prosthetic grafts who may have adjacent organ injuries such as a rectal fistula. It also highlights the need for tailored surgical approaches and the significance of regular follow-up in managing AVGI.
Gamma knife radiosurgery for metastatic brain tumors with contrast media leakage: Case series
Authors: Park Sue-Jee , Park Wan , Kim Yeong Jin , Ahn Kanghee , Moon Kyung-Sub , Kim In-Young , Jung Shin , Marcelina Correia Dircia Canisia , Kim Seul-Kee , Lee Kyung-Hwa , Jung Tae-Young 
Published: January 2025

Rationale:
The phenomenon of “contrast media leakage” in metastatic brain tumors, where contrast enhancement of perilesional edema can overestimate actual tumor volume.

Patient concerns and diagnosis:
The radiologic and pathologic characteristics of 3 surgically resected metastatic brain tumors with contrast media leakage were analyzed. Five metastatic tumors were treated with gamma knife radiosurgery (GKRS), deliberately avoiding areas of contrast media leakage.

Interventions:
The characteristics of these tumors, the administered radiation dosage, and progression-free survival were evaluated.

Outcomes:
The region of “contrast media leakage within edema” showed different signals from tumor boundaries on T2-weighted magnetic resonance imaging, fluid-attenuated inversion recovery, and apparent diffusion coefficient maps. No increased cerebral blood volume and a low transfer coefficient were indicated on perfusion images. Pathologically, these areas showed prominent endothelial proliferation and perivascular lymphocyte infiltration without tumor cell infiltration. Immunohistochemical staining revealed a weak positive for clauidin-5 and a strong positive with antibodies against leukocyte common antigen and cluster of differentiation 68. Five lesions treated with GKRS were adenocarcinomas of lung origin. The median radiation volume was 3.10 cc (range, 2.32–3.78), and the median radiation dose was 22 Gy (range, 20–22). Treatment responses were nearly complete in 1, partial in 3, and stable in 1. There were recurrences at 6.0 and 10.0 months after GKRS. Median progression-free survival was 18.2 months (95% confidence interval: 9.2–27.1), and there was no treatment-related complication.

Lessons:
This study revealed that the region of “contrast media leakage within edema” showed more pronounced blood–brain barrier disruption associated with inflammatory cells. It was effective when the GKRS targeted the actual tumor, excluding the area with contrast media leakage.
Experience in the treatment of giant orbital intraconal teratoma: A case report
Authors: Li Ruimiao , Ren Mingyu , Liu Limin , Zhang Ruina , Guo Wensheng 
Published: January 2025

Rationale:
Orbital teratoma is a relatively rare disease in infancy. In the pediatric population undergoing significant growth and development, the presence of giant orbital masses can significantly affect orbital volumes and impair the visual function. Traditional treatments may not yield anticipated effectiveness, often leading to numerous complications. This report aims to present a rare case involving a giant orbital intraconal teratoma. The objective is to analyze the treatment course comprehensively, distill valuable experiences and lessons learned, enhance treatment strategies, and ultimately reduce the incidence of complications associated with these formidable pediatric tumors.

Patient concerns:
A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).

Diagnoses:
The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.

Interventions:
A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.

Outcomes:
No recurrence and other complications were noted during the 1-year follow-up.

Lessons:
Giant orbital teratomas in children are infrequent and pose significant challenges in the field of therapy. The potential consequences of larger orbital masses in childhood, including increased orbital volume and the risk of postoperative enophthalmos and keratitis. The findings emphasize the importance of timely implantation into the orbital after mass excision to enhance orbital volume and reduce the incidence of complications.
Systemic lupus erythematosus complicated by retroperitoneal fibrosis: A case report and literature review
Authors: Cheng Song , Wu Sikai , Wang Neng , Xu Wenjie , Wei Fuquan , Ao Weiqun , Yuan Li , Ning Xiaoxiang , Mao Yichuan , Zhang Xianzhen , Mao Guoqun 
Published: January 2025

Rationale:
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems. Retroperitoneal fibrosis (RPF) is a rare condition characterized by the development of fibrous tissue in the retroperitoneal space. The coexistence of SLE and RPF is extremely uncommon, and this report aims to enhance understanding of this complex relationship.

Patient concerns:
A 32-year-old woman presented with sudden-onset syncope. Her medical history revealed a 5-year history of SLE, and imaging studies identified a retroperitoneal mass.

Diagnoses:
A comprehensive diagnostic workup, including magnetic resonance imaging (MRI) and biopsy, confirmed retroperitoneal fibrosis secondary to SLE.

Interventions:
The patient was treated with high-dose corticosteroids, immunosuppressive therapy, and the biologic agent rituximab.

Outcomes:
The patient’s symptoms markedly improved, and follow-up MRI demonstrated significant regression of the retroperitoneal lesion.

Lessons:
RPF associated with SLE is exceptionally rare. This case underscores the importance of early diagnosis and a coordinated multidisciplinary approach in managing such complex conditions. Glucocorticoid therapy remains the cornerstone of treatment, augmented by immunosuppressants and biologic agents when necessary.
Orthotists' perspectives on the adjustment of 3D printed ankle foot orthoses: A mixed methods feasibility study
Authors: Leith Jessie , Andrysek Jan , Kuspinar Ayse 
Published: January 2025

Background:
An important part of the orthotic treatment process includes performing adjustments to the shape or design of the orthosis to improve its fit and function. However, the ability to adjust 3D printed (3DP) materials is not well understood.

Objectives:
(1) To evaluate the usability of completing adjustments on 3DP ankle foot orthoses (AFOs) vs. traditionally-fabricated AFOs, and (2) to explore orthotists' perspectives on the advantages, disadvantages, and similarities of adjusting 3DP materials and identify potential solutions for disadvantages.

Study design:
Mixed-methods cross-sectional study.

Methods:
Ten participating certified orthotists performed a sequence of predetermined adjustment tasks on 3DP AFOs. The Single Ease Question and the System Usability Scale (SUS) were compared between traditional vs. 3DP AFO adjustments. Semistructured interviews were conducted, and a thematic analysis identified key themes.

Results:
Single Ease Question scores were significantly lower for 3DP adjustments in 50% of tasks. The mean SUS total score was significantly lower (p < 0.001) for tasks completed on 3DP AFOs compared with traditional AFOs. The thematic analysis identified challenges related to aesthetics, heating, grinding, brittleness, and timing of adjustments. Several similarities and some minor benefits were also noted. Despite challenges, orthotists demonstrated optimism about the 3DP material and proposed several solutions for improvement including optimizing techniques and introducing postprocessing.

Conclusions:
3D printed orthoses were more difficult to adjust and had lower usability for adjustment compared with traditional ones. However, orthotists felt that they would be able to use the material in clinical practice if some of the proposed solutions were implemented.
Comparison of Ultrasound Characteristics of Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS) and Optic Disc Drusen in Children
Authors: Bhagat Dhristie , Garcia Arielle , Ying Gui-Shuang , Liu Grant T. , Avery Robert A. 
Published: January 2025

Background:
In children, pseudopapilledema is frequently caused by peripapillary hyperreflective ovoid mass-like structures (PHOMS) or optic disc drusen (ODD). While enhanced depth imaging (EDI) OCT can identify both, lack of cooperation, especially from younger children due to the duration of testing, often necessitates the use of B-scan ultrasound (BSUS). This study investigated whether PHOMS are hyperreflective on BSUS and if BSUS can differentiate PHOMS from ODD.

Methods:
Pediatric patients referred by a neuro-ophthalmologist to the diagnostic ultrasound clinic for optic nerve head elevation between March 2019 and May 2021 were eligible. Subjects who underwent BSUS and EDI-OCT and were diagnosed with pseudopapilledema based on examination, imaging findings, stability on follow-up, and, in some cases, normal CSF opening pressure were included. ODD were identified on EDI-OCT as structures above the lamina cribrosa with a hyporeflective core and hyperreflective margin prominent superiorly. Hyperreflective horizontal lines (HHL) above the lamina cribrosa without ODD were identified. PHOMS were defined as ovoid, hyperreflective structures above Bruch's membrane external to the optic disc, with similar reflectivity to the retinal nerve fiber layer on OCT and upward deflection of other retinal layers. The BSUSs were read by a separate, masked evaluator who graded the size and reflectivity.

Results:
Two hundred thirty-nine eyes (120 patients; 58.3% female; mean age = 11.6 years) with pseudopapilledema were included. EDI-OCT mostly demonstrated PHOMS only (58.1%), followed by PHOMS and HHL (12.6%), and then PHOMS and ODD (11.7%). A combination of PHOMS, ODD, and HHL was found in 8.8%, 1.7% had HHL only, 0.8% had ODD and HHL, and 0.4% had ODD only. 5.9% of eyes were normal on OCT. On BSUS, 78.4% of eyes with only PHOMS demonstrated low or intermediate reflectivity, while 92.9% of eyes with both PHOMS and ODD demonstrated high reflectivity. When HHL was present with or without other findings, a majority demonstrated high reflectivity.

Conclusions:
Though PHOMS are hyperreflective on BSUS, ODD are more highly reflective, which may allow clinicians to differentiate between the two if EDI-OCT is unavailable. Eyes with both PHOMS and HHL have similar characteristics to those with ODD, supporting current theories that these lines may be early indicators of evolving drusen.
Genome sequences of pathogenic and non-pathogenic Pantoea ananatis strains in maize (Zea mays L.)
Authors: Moura Duin Izabela , Yumi Baba Viviane , D'Amico-Willman Katherine M. , Neves Paduan Fernanda , Sugahara Rodrigues Vanessa , Huguet-Tapia Jose , Jones Jeffrey , Giovanetti Canteri Marcelo , Pereira Leite Júnior Rui , Balbi-Peña Maria Isabel 
Published: January 2025

We performed genome sequencing and comparative analysis of Pantoea ananatis strains isolated from corn leaves expressing typical bacterial leaf streak (BLS) and maize white spot (MWS) symptoms to confirm bacterial identity and to understand the relationship among these strains and P. ananatis strains isolated from different plant hosts in Brazil. In pathogenicity tests, strains 4.2 and 13.3 isolated from symptomatic BLS leaves were non-pathogenic on corn. In contrast, strain B13 isolated from MWS diseased leaf tissue caused symptoms typical of MWS. Our comparative analysis revealed that all three strains are very genetically similar. The G+C (%) content of the strains 4.2 and 13.3 was 53.5%, while B13 was 53.7%. Average nucleotide identity (ANI) analysis showed that strains B13 and 13.3, B13 and 4.2, and 4.2 and 13.3 shared ANIs of 99.17%, 99.15%, and 99.99%, respectively. Strains 13.3, B13 and 4.2 shared ~99% ANI with P. ananatis type strain LMG 2665. To our knowledge, these are the first genome sequences of P. ananatis strains isolated from corn in Brazil.
Transplant immunosuppressant therapies induce unique functional changes in lymph node and re-shape gut immune homeostasis
Authors: Wu Long , Kensiski Allison , Gavzy Samuel J , Song Yang , Lwin Hnin Wai , France Michael , Kong Dejun , Li Lushen , Lakhan Ram , Saxena Vikas , Piao Wenji , Shirkey Marina W. , Mas Valeria , Lohmsr Brendan , Bromberg Jonathan S , Ma Bing 
Published: January 2025

AbstractCurrent immunosuppressants effectively suppress adaptive and innate immune responses, but their broad, antigen-non-specific effects often result in significant complications. Here, we conducted a systematic investigation of drug effects on gut microbiome, metabolic pathways, lymphoid architecture and lymphocyte trafficking of four major immunosuppressants classes including tacrolimus, prednisone, mycophenolate mofetil (MMF), and Fingolimod (FTY). We show that immunosuppressants induced progressive alterations in the gut microbiome and metabolic pathways, where initial drug-specific effects converged by day 30 into a common dysbiotic state enriched in Muribaculaceae. Gut transcriptome analyses revealed minimal overlap in differentially expressed genes between early and late time points, indicating transient early effects and marked late-stage changes induced by these drugs. These microbiome and metabolic shifts were accompanied by time-dependent changes in lymph node (LN) organization and cellular composition, transitioning between pro-tolerogenic and pro-inflammatory states. Under alloantigen-stimulated conditions, MMF and FTY suppressed inflammation through dual regulation of regulatory T cells and LN remodeling, mediated through LN stromal cell-derived laminins. Together, our findings highlight previously underappreciated temporal dynamics in immunosuppressant mechanisms, linking immune tissue organization, gut microbiome and intestinal responses to long-term immunosuppression and metabolic complications in transplant patients.
Brief disruption of the microbiome has age-dependent effects on morphine reward and gene expression in the medial prefrontal cortex of adolescent and adult mice
Authors: Hofford Rebecca S. , Sens Jonathon P. , Shipman Ava L. , Kimble Violet M. , Coric Christina , Meckel Katherine R. , Kiraly Drew D. 
Published: January 2025

AbstractAdolescence is a critical period for the initiation of problematic drug use, which significantly increases the risk of developing substance use disorders later in life. This heightened vulnerability is partly attributed to the immaturity of the prefrontal cortex, a brain region both essential for decision-making and implicated in drug reward. During adolescence, peripheral systems, such as the gut microbiome, also undergo substantial changes. Emerging evidence suggests that disruptions to the gut microbiome can influence gene expression and drug reward behaviors in rodent models. In this study, we investigated the effects of microbiome disruption on morphine reward and prefrontal cortical gene expression in adolescent and adult mice. Using oral antibiotics to transiently disrupt the microbiome, we found that short-term antibiotic exposure reduced morphine place preference specifically in adolescent mice. In a separate cohort, we observed that antibiotic treatment altered the transcriptomic response to morphine in the medial prefrontal cortex across all age groups. Notably, the transcriptomic changes induced by antibiotics and morphine were age-specific, with distinct gene expression patterns observed in adolescents compared to adults. These findings establish a foundation for future research into the role of the gut microbiome in opioid reward and highlight potential gene pathways underlying age-dependent differences in opioid sensitivity.