bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anaesthetic management of cerebral arteriovenous malformation hemorrhage during pregnancy: A case series
Authors: Ji Yong , Liang Yi , Liu Bin , Wang Yaxin , Li Ling , Liu Yan , Feng Yifan , Dong Nuo , Xiong Wei , Yue Hongli , Jin Xu 
Published: February 2023

Rationale:
There is no clear consensus guidance for anesthesiologists on how to manage patients with cerebral arteriovenous malformation (cAVM) rupture and hemorrhage during pregnancy who need craniotomy. Our objective was to review the anesthesia management of pregnant women who underwent resection of cAVM at our institution and to provide opinions and suggestions.

Patient concerns:
Herein, we report of 3 patients with cAVM rupture and hemorrhage during pregnancy who underwent neurosurgery at the 22nd, 28th, and 20th weeks of pregnancy.

Diagnoses:
All 3 patients were admitted to the emergency department of our hospital due to sudden symptoms. Subsequently, their head imaging results confirmed the rupture and hemorrhage of cAVM. The rupture and hemorrhage of cAVM during pregnancy has a low incidence and high mortality, which seriously endangers the safety of the mother and fetus. For this emergency condition, craniotomy for removing intracranial lesions and clear hematoma can result in a chance of a successful delivery. Especially in the second and third trimesters of pregnancy, the management goal of anesthesia is to ensure the maternofetal safety and to maintain continuous pregnancy.

Interventions:
This article describes the process of intraoperative anesthesia management and maternal-fetal outcomes and discusses the key issues for the anesthesia management of cAVM rupture during pregnancy, including considerations of physiological changes during pregnancy and anesthesia medication, intraoperative monitoring, the maintenance of hemodynamic stability, and the control of intracranial pressure, among other considerations. Resection of intracranial lesions should be performed whenever possible while maintaining the pregnancy for better maternal and infant outcomes.

Outcomes:
The operations of the 3 pregnant women were successfully completed under our detailed anesthesia planning and careful anesthesia management. All the patients recovered well after the operation, and underwent cesarean section to give birth smoothly.

Lessons:
The preservation of pregnancy under cAVM resection is a complex challenge for anesthesiologists, and these 3 cases provide an extensive amount of experience for anesthesia management in similar situations. Detailed anesthesia planning and careful anesthesia management by anesthesiologists are important guarantees for good maternal and fetal outcomes.
Effect of oral Xiao-xian decoction combined with acupoint application therapy on pediatric adenoid hypertrophy: A randomized trial
Authors: Zhao Xue , Xu Jie , Wang Ming-Yue , Hou Zi-Wei , Shi Hui-Shan , Zhang Xiao-Xia 
Published: February 2023

Background:
This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH).

Methods:
We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life.

Results:
The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment.

Conclusion:
Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.
Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series
Authors: Ju Jiayu , Cheng Ziyao , Zhu Qingliang , Deng Mingming , Zhang Hailong 
Published: February 2023

Rationale:
Owing to the anatomical characteristics of the duodenum, gastroduodenal artery (GDA) pseudoaneurysms can be caused by duodenal ulcers, which may rupture and lead to massive or repeated bleeding. Pseudoaneurysms are usually diagnosed using enhanced computerized tomography or angiography, whereas endoscopic signs have rarely been reported.

Patient concerns:
Three patients aged 18 to 83 years with bleeding duodenal ulcers and GDA pseudoaneurysms were treated.

Diagnosis:
All patients had symptoms of gastrointestinal bleeding, and endoscopy revealed duodenal ulcers with visible vessels or adherent clot pulsations. Angiography confirmed the presence of a GDA pseudoaneurysm, which had an adjacent relationship with the duodenum.

Interventions:
The GDA pseudoaneurysm was embolized in each patient.

Outcomes:
Through transcatheter arterial embolization, endoscopic treatment, and traditional treatment, hematemesis or melena was gradually stopped and all patients were discharged.

Lessons:
The pulsation of visible vessels or adherent clots observed during endoscopy in patients with duodenal ulcer may indicate the formation of a gastroduodenal artery pseudoaneurysm. Therefore, we suggest that such patients receive enhanced computerized tomography or angiography to assess whether they need timely endovascular intervention treatment to avoid bleeding caused by a pseudoaneurysm.
Pancreatic serous cystic neoplasm mimicking intraductal papillary mucinous neoplasm: Two case reports and literature review
Authors: Park Mihyeon , Lee Jisun , Kim Yook , Yi Kyung Sik , Cho Bum Sang , Choi Chi-Hoon , Park Kil Sun 
Published: February 2023

Rationale:
Serous cystic neoplasms (SCNs) are treated as benign lesions. It is widely known that SCN rarely have a connection with the main pancreatic duct (MPD), which helps differentiate them from other cystic lesions, such as intraductal papillary mucinous neoplasm (IPMN). However, very rare cases where the SCN appears connected to the MPD cause diagnostic confusion.

Patient concerns:
We present 2 patients with SCN (1 male, 54, and 1 female, 42). Both patients were asymptomatic, without abnormal laboratory results.

Diagnosis:
In both cases, abdominopelvic computed tomography and pancreatic magnetic resonance imaging scans revealed a multilobulated cystic lesion in communication with the MPD. Since the size of each patient’s lesion was >3 cm and there was connectivity with the MPD, it was strongly suspected to be a branch duct-type IPMN with worrisome features rather than SCN and surgical intervention was considered.

Interventions:
Both neoplasms were misdiagnosed as IPMN due to appearing connected with the MPD on radiologic imaging. Surgery was performed.

Outcomes:
A final diagnosis of microcystic serous cystadenoma of the pancreas without connectivity of MPD was confirmed in both patients.

Lessons:
An unnecessary surgery was performed due to atypical radiologic features in which the pancreatic duct seems to be connected to the pancreatic cystic lesion on magnetic resonance imaging, leading to misdiagnosis of SCN as IPMN. Particular attention should be paid to interpretation of clinicoradiologic findings of pancreatic cystic lesions, especially to the decision of surgical intervention. Also, awareness of presence of the atypical radiologic features of SCN may broaden the knowledge base of radiologists.

Lessons:
An unnecessary surgery was performed due to atypical radiologic features in which the pancreatic duct seems to be connected to the pancreatic cystic lesion on magnetic resonance imaging, leading to misdiagnosis of SCN as IPMN. Particular attention should be paid to interpretation of clinicoradiologic findings of pancreatic cystic lesions, especially to the decision of surgical intervention. Also, awareness of presence of the atypical radiologic features of SCN may broaden the knowledge base of radiologists.
Pharmaceutical care of rituximab in the treatment of children with refractory anti-NMDAR encephalitis: A case report
Authors: Wu Haiyan , Xu Xiaoyan , Ding Qixuan , Zhu Shuangfei , Zheng Qiaozhen , Ding Shanshan , Li Jiyao , Zhao Hongyang 
Published: February 2023

Rationale:
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare disease of nervous system, which is mediated by autoimmune mechanisms. The treatment of anti-NMDAR encephalitis includes Immunotherapy, symptomatic and supportive treatment for seizures and psychiatric symptoms. There are many kinds of drugs, so drug treatment management and pharmaceutical care for children are particularly important. At present, there are few reports on pharmaceutical care for children with this disease. Clinical pharmacists participated in the pharmaceutical care of a child with refractory anti-NMDAR encephalitis treated with rituximab, conducted drug treatment management on the dosage, administration method, complications and other aspects of off-label use of rituximab, combined with the children’s clinical manifestations, inflammatory indicators, pathogenic detection, blood concentration, liver and kidney functions, drug interactions and other factors. The treatment plan of anti-infective drugs shall be adjusted, and attention shall be paid to whether there are adverse reactions during the treatment.

Patient concerns:
A 4-year-old girl presented with epileptic seizure, intermittent recurrent fever, high inflammatory markers, abnormal psychiatric function/cognitive impairment, language disorder, consciousness disturbance, and movement disorder/involuntary movement.

Diagnosis:
Refractory anti-NMDAR encephalitis.

Interventions:
The patient was given first-line (3 rounds of methylprednisolone pulse therapy and gamma globulin) and second-line (rituximab) immunotherapy. On the advice of a clinical pharmacist, the patient wasn’t given Advanced antibacterial agents (voriconazole, vancomycin) therapy. On the 41st day of admission, the patient’s temperature and inflammatory indicators were normal, CD19+ B cells were reduced to 0.

Outcomes:
The patient consciousness level, cognition and orientation were gradually improved, mental disorder was improved, involuntary movement was obviously controlled, no seizure occurred again, and the patient was discharged with stable condition.

Lessons:
Clinical pharmacists ensure the safety, effectiveness and economy of patients’ medication by carrying out the whole process of individualized drug treatment management and care for patients.
Comparison of ultrasound-guided radiofrequency ablation and hepatectomy for colorectal liver metastasis: A protocol for systematic review and meta-analysis
Authors: Wu Lianming , Xu Weiwei , Hu Yanzi , Chen Jing 
Published: February 2023

Background:
Colorectal cancer (CRC) is one of the most frequently occurring malignancy tumors. Surgical treatment has made great progress in CRC liver metastasis (CRLM), including radiofrequency ablation (RFA), and hepatectomy. We perform a protocol for systematic review and meta-analysis to compare the efficacy and safety of ultrasound-guided RFA and hepatectomy in treating CRLM.

Methods:
This systematic review protocol will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) 2015 Statement. The protocol has been registered in PROSPERO (CRD42022371561). PubMed, EMBASE, MEDLINE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, ClinicalTrials.gov trials registry, and Chinese Clinical Trial Registry will be searched from January 1980 to December 2022. Only randomized controlled trials will be included. Cochrane systematic evaluation tool is used to assess the risk of bias. The RevMan 5.3 software (Cochrane Collaboration, Oxford, UK) will be applied to conduct the meta-analyses.

Results:
The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal.

Conclusion:
This study may provide more convincing evidence to help surgeons make decisions when dealing with CRLM.
Improved survival for severely injured patients receiving massive transfusion at US teaching hospitals: A nationwide analysis
Authors: Ramsey Walter A. , O'Neil Christopher F. , Fils Aaron J. , Botero-Fonnegra Cristina , Saberi Rebecca A. , Gilna Gareth P. , Pizano Louis R. , Parker Brandon M. , Proctor Kenneth G. , Schulman Carl I. , Namias Nicholas , Meizoso Jonathan P. 
Published: February 2023

BACKGROUND
Previous studies have shown improved survival for patients treated at American College of Surgeons (ACS)–verified level I trauma centers compared with level II, level III, and undesignated centers. This mortality difference is more pronounced in severely injured patients. However, a survival benefit for severely injured trauma patients has not been established at teaching institutions compared with nonteaching centers. Because massive transfusion (MT) is associated with high mortality, we hypothesize that patients receiving MT have lower mortality at teaching hospitals than at nonteaching hospitals.

METHODS
All adult ACS Trauma Quality Improvement Program–eligible patients who underwent MT, defined as >10 U of packed red blood cells in the first 4 hours after arrival, in the 2019 ACS Trauma Quality Programs participant use file were eligible. Patients with severe head injury (head Abbreviated Injury Scale score, ≥3), prehospital cardiac arrest, and interhospital transfers were excluded. Logistic regression models were used to assess the effects of trauma center hospital teaching status on the adjusted odds of 3-hour, 6-hour, and 24-hour mortality.

RESULTS
A total of 1,849 patients received MT (81% male; median Injury Severity Score, 26 [18–35]), 72% were admitted to level I trauma centers, and 28% were admitted to level II centers. Overall hospital mortality was 41%; 17% of patients died in 3 hours, 25% in 6 hours, and 33% in 24 hours. Teaching hospitals were associated with decreased 3-hour (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.27–0.75), 6-hour (OR, 0.37; 95% CI, 0.24–0.56), 24-hour (OR, 0.50; 95% CI, 0.34–0.75), and overall mortality (OR, 0.66; 95% CI, 0.44–0.98), compared with nonteaching hospitals, controlling for sex, age, heart rate, injury severity, injury mechanism, and trauma center verification level.

CONCLUSION
Severely injured patients requiring MT experience significantly lower mortality at teaching hospitals compared with nonteaching hospitals, independently of trauma center verification level.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
In Vivo Regeneration of Tubular Small Intestine With Motility: A Novel Approach by Orthotopic Transplantation of Decellularized Scaffold
Authors: Kojima Hidenobu , Ishii Takamichi , Fukumitsu Ken , Ogiso Satoshi , Tomofuji Katsuhiro , Oshima Yu , Horie Hiroshi , Ito Takashi , Wakama Satoshi , Makino Kenta , Hatano Etsuro 
Published: February 2023

Background.
Whole-intestine engineering can provide a therapeutic alternative to bowel transplantation. Intestinal components including the mucosa, muscular layer, enteric nervous system, and vasculature must be reestablished as a tubular organ to generate an artificial small intestine. This study proposes a novel approach to produce a transplantable, well-organized tubular small intestine using a decellularized scaffold.

Methods.
Male Lewis rat intestines were used to generate decellularized scaffolds. Patch or tubular grafts were prepared from the decellularized intestine and transplanted into the rat intestine orthotopically. Histological analysis of the decellularized intestine was performed up to 12 wk after transplantation.

Results.
Histological examination revealed abundant vascularization into the decellularized patch graft 1 wk after transplantation. Muscular and nervous components, as well as cryptogenesis, were observed in the decellularized patch graft 2 wk after transplantation. Sixteen of the 18 rats survived with normal intake of food and water after the decellularized tubular graft transplantation. Compared with silicone tube grafts, the decellularized tubular grafts significantly promoted the infiltration and growth of intestinal components including the mucosa, muscular layer, and nerve plexus from the recipients. Circular and longitudinal muscle with a well-developed myenteric plexus was regenerated, and intestinal motility was confirmed in the decellularized tubular graft 12 wk after transplantation.

Conclusions.
Orthotopic transplantation of decellularized intestine enhanced the reconstruction of the well-organized tubular small intestine with an enteric nervous system in vivo. Our method using a decellularized scaffold represents a promising approach toward whole-intestine engineering and provides a therapeutic alternative for the irreversible intestinal failure.
Rare variants found in multiplex families with orofacial clefts: Does expanding the phenotype make a difference?
Authors: Diaz Perez Kimberly K. , Chung Sydney , Head S. Taylor , Epstein Michael P. , Hecht Jacqueline T. , Wehby George L. , Weinberg Seth M. , Murray Jeffrey C. , Marazita Mary L. , Leslie Elizabeth J. 
Published: February 2023

ABSTRACTWhole-exome sequencing (WES) is now a relatively straightforward process to identify causal variants in Mendelian disorders. However, the same is not true for WES in families where the inheritance patterns are less clear, and a complex etiology is suspected. Orofacial clefts (OFCs) are highly heritable birth defects with both Mendelian and complex etiologies. The phenotypic spectrum of OFCs may include overt clefts and several subclinical phenotypes, such as discontinuities in theorbicularis orismuscle (OOM) in the upper lip, velopharyngeal insufficiency (VPI), microform clefts or bifid uvulas. We hypothesize that expanding the OFC phenotype to include these phenotypes can clarify inheritance patterns in multiplex families, making them appear more Mendelian. We performed whole-exome sequencing to find rare, likely causal genetic variants in 31 multiplex OFC families, which included families with multiple individuals with OFCs and individuals with subclinical phenotypes. We identified likely causal variants inCOL11A2, IRF6, KLF4, SHROOM3, SMC3, TP63, andTBX3in seven families. Although we did not find clear evidence supporting the subclinical phenotype hypothesis, our findings support a role for rare variants in the etiology of OFCs.
Longitudinal and Quantitative Fecal Shedding Dynamics of SARS-CoV-2, Pepper Mild Mottle Virus and CrAssphage
Authors: Arts Peter J. , Kelly J. Daniel , Midgley Claire M. , Anglin Khamal , Lu Scott , Abedi Glen R. , Andino Raul , Bakker Kevin M. , Banman Bryon , Boehm Alexandria B. , Briggs-Hagen Melissa , Brouwer Andrew F. , Davidson Michelle C. , Eisenberg Marisa C. , Garcia-Knight Miguel , Knight Sterling , Peluso Michael J. , Pineda-Ramirez Jesus , Sanchez Ruth Diaz , Saydah Sharon , Tassetto Michel , Martin Jeffrey N. , Wigginton Krista R. 
Published: February 2023

AbstractWastewater-based epidemiology (WBE) emerged during the COVID-19 pandemic as a scalable and broadly applicable method for community-level monitoring of infectious disease burden, though the lack of high-quality, longitudinal fecal shedding data of SARS-CoV-2 and other viruses limits the interpretation and applicability of wastewater measurements. In this study, we present longitudinal, quantitative fecal shedding data for SARS-CoV-2 RNA, as well as the commonly used fecal indicators Pepper Mild Mottle Virus (PMMoV) RNA and crAss-like phage (crAssphage) DNA. The shedding trajectories from 48 SARS-CoV-2 infected individuals suggest a highly individualized, dynamic course of SARS-CoV-2 RNA fecal shedding, with individual measurements varying from below limit of detection to 2.79×106gene copies/mg - dry mass of stool (gc/mg-dw). Of individuals that contributed at least 3 samples covering a range of at least 15 of the first 30 days after initial acute symptom onset, 77.4% had at least one positive SARS-CoV-2 RNA stool sample measurement. We detected PMMoV RNA in at least one sample from all individuals and in 96% (352/367) of samples overall; and measured crAssphage DNA above detection limits in 80% (38/48) of individuals and 48% (179/371) of samples. Median shedding values for PMMoV and crAssphage nucleic acids were 1×105gc/mg-dw and 1.86×103gc/mg-dw, respectively. These results can be used to inform and build mechanistic models to significantly broaden the potential of WBE modeling and to provide more accurate insight into SARS-CoV-2 prevalence estimates.
The National Transportation Noise Exposure Map
Authors: Seto Edmund , Huang Ching-Hsuan 
Published: February 2023

AbstractWe describe the development and public availability of the National Transportation Noise Exposure Map with the goal of estimating population exposures to various noise levels at the census tract level in the United States. The map was created by overlaying the Bureau of Transportation Statistics’ National Transportation Noise Map with 5-year block group population estimates from the American Community Survey, and aggregating exposed population estimates to the census tract level. Based on the exposure map, an estimated 94.9 million people (29.1 % of the total U. S. population) were exposed to ≥ 45 dB LAeq of transportation-related noise, and approximately 11.9 million (3.6 %) were exposed to ≥ 60 dB in the year 2020.The exposure maps indicate that the greatest population proportion and number of individuals exposed were in California, while generally the map illustrates high proportions of exposure for populations living along major U. S. roadways and in airport communities. The availability of this new exposure map will facilitate the integration of noise exposures into a variety of studies, including regional and national health impact assessments, epidemiologic, and environmental justice studies.
Evaluating ChatGPT as an Adjunct for Radiologic Decision-Making
Authors: Rao Arya , Kim John , Kamineni Meghana , Pang Michael , Lie Winston , Succi Marc D. 
Published: February 2023

ABSTRACTBACKGROUNDChatGPT, a popular new large language model (LLM) built by OpenAI, has shown impressive performance in a number of specialized applications. Despite the rising popularity and performance of AI, studies evaluating the use of LLMs for clinical decision support are lacking.PURPOSETo evaluate ChatGPT’s capacity for clinical decision support in radiology via the identification of appropriate imaging services for two important clinical presentations: breast cancer screening and breast pain.MATERIALS AND METHODSWe compared ChatGPT’s responses to the American College of Radiology (ACR) Appropriateness Criteria for breast pain and breast cancer screening. Our prompt formats included an open-ended (OE) format, where ChatGPT was asked to provide the single most appropriate imaging procedure, and a select all that apply (SATA) format, where ChatGPT was given a list of imaging modalities to assess. Scoring criteria evaluated whether proposed imaging modalities were in accordance with ACR guidelines.RESULTSChatGPT achieved an average OE score of 1.83 (out of 2) and a SATA average percentage correct of 88.9% for breast cancer screening prompts, and an average OE score of 1.125 (out of 2) and a SATA average percentage correct of 58.3% for breast pain prompts.CONCLUSIONOur results demonstrate the feasibility of using ChatGPT for radiologic decision making, with the potential to improve clinical workflow and responsible use of radiology services.