bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study
Authors: Borhani Ali , Daskareh Mahyar , Gilanchi Samira , Vakilpour Azin , Poursharif Maryam , Vojdanian Mehdi 
Published: April 2023

Introduction and importance:
Primary bone lymphoma is a rare entity that constitutes less than 1% of all non-Hodgkin lymphomas and 3–5% of malignant bone tumors. Chronic immune and inflammatory diseases carry a level of risk for the development of malignancies that is correlated with the disease severity. There is conflicting evidence regarding the risk of lymphoma in spondyloarthritis.

Case presentation:
The authors present a rare case of primary diffuse large B-cell lymphoma of the sternum in a 41-year-old Iranian woman with ankylosing spondylitis (AS). Physical examination revealed a 7×7.5 cm firm swelling of the anterior midline chest wall above the breasts, and MRI showed a lesion within the sternal marrow with an associated soft-tissue mass in the anterior aspect of the sternum. Following core-needle biopsy under ultrasound guidance, a histopathological study demonstrated diffuse sheets of large noncleaved atypical cells with large multilobated prominent nuclei and fine chromatin compatible with diffuse large B-cell lymphoma.

Clinical discussion:
Primary and exclusive involvement of the sternum is an uncommon presentation of lymphoma. Radiological, histological, and clinical characteristics of primary bone lymphoma can resemble those of other medical disorders. Although infrequent, existing evidence shows that AS seems to be associated with a small but significant risk for malignancy.

Conclusion:
Even though inflammatory involvement of the anterior chest wall could be a common clinical finding in patients with AS, it is recommended that anterior chest wall pain or any mass almost always needs comprehensive assessment and imaging evaluation in such patients to avoid any delayed diagnosis, misdiagnosis, and ensuing morbidity or mortality.
Marked reduction in the hospital admission rate of a man with nonislet cell tumor hypoglycemia after starting steroids: a case report
Authors: Elsdai Ibrahim , Elsdai Taher 
Published: April 2023

Introduction and importance:
Nonislet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia. It results from the secretion of insulin-like growth factor 2 from various tumors, which acts on insulin receptors, increasing glucose utilization by the tumor. Among the treatment options for patients with NICTH, steroids have the best palliative effects.

Case presentation:
The authors present the case of a man with metastatic lung cancer who had multiple hospitalizations for hypoglycemia and associated anorexia, weight loss, and depression. After receiving steroids, the patient’s hospital admission rate due to hypoglycemia reduced, depression improved, and weight loss reversed.

Clinical discussion:
Steroids, diazoxide, octreotide, glucagon infusion, and recombinant growth hormone have shown good results in treating NICTH. Steroids have many advantages: they are easy to administer and relatively inexpensive. In our patient, steroids had the added benefit of improving the appetite with subsequent weight gain and controlling depression. They also significantly reduced the readmission rate.

Conclusion:
NICTH is a rare cause of hypoglycemia. Glucocorticoids show better palliative effects than other medical treatments. In our patient, steroids dramatically reduced the number of hospitalizations due to hypoglycemia while improving the appetite, weight, and depression.
Obturator hernia (the little old lady’s hernia) diagnosed via computed tomography: a case report
Authors: Bohara Sujan , Karki Samikshya , Gautam Anu , Regmi Binit U. , Rimal Sabin , Khadka Laxman , Pokharel Anuj , Gurung Bibek , Rawal Sushil B. 
Published: April 2023

Introduction and importance:
Obturator hernia is an infrequent clinical entity of abdominal wall hernia, accounting for an incidence rate ranging from 0.073 to 2.2% of all hernias and being responsible for 0.2–1.6% of all cases of mechanical intestinal obstruction. The computed tomography (CT) scan, as an imaging modality, is critical in improving the diagnostic rate of obturator hernia.

Case presentation:
The authors herein report an 87-year-old thin male patient with a known history of chronic obstructive pulmonary disease who presenting with complaints of abdominal pain for 3 days and constipation for 2 days, as well as one episode of vomiting without any features of peritoneal irritation, which was diagnosed early as a right-sided obturator hernia via CT and managed with exploratory laparotomy with hernia reduction and polypropylene mesh repair.

Discussion:
Obturator hernia is a rare surgical phenomenon with a varied clinical spectrum, ranging from asymptomatic to presenting as intestinal obstruction. The CT scan plays a critical role in the detection of obturator hernias, which ameliorates the possible significant postoperative morbidity and mortality.

Conclusion:
This report demonstrates that a high index of suspicion combined with CT imaging aids in early diagnosis and management, thus overcoming the reluctant morbidity.
Affective Temperaments Misdiagnosed as Adult Attention Deficit Disorder
Authors: Mauer Sivan , Ghazarian Garo , Ghaemi S. Nassir 
Published: April 2023

Abstract
Adult attention-deficit disorder (ADD) is a common diagnosis, and amphetamine medications are increasingly used. Recent reports suggest high prevalence of affective temperaments, such as cyclothymia, in adult ADD. This study reexamines prevalence rates as reflecting misdiagnosis and reports for the first time on the effects of amphetamine medications on mood/anxiety and cognition in relation to affective temperaments. Among outpatients treated at the Tufts Medical Center Mood Disorders Program (2008–2017), 87 cases treated with amphetamines were identified, versus 163 non–amphetamine-treated control subjects. Using the Temperament Scale of Memphis, Pisa, Paris and San Diego–Autoquestionnaire, 62% had an affective temperament, most commonly cyclothymia (42%). In amphetamine-treated cases, mood/anxiety symptoms worsened notably in 27% (vs. 4% in the control group, risk ratio [RR] 6.2, confidence interval [CI], 2.8–13.8), whereas 24% had moderate improvement in cognition (vs. 6% in the control group; RR, 3.93; CI, 1.9–8.0). Affective temperaments, especially cyclothymia, are present in persons about one-half of persons diagnosed with adult ADD and/or treated with amphetamines.
The Case Against “Excited Delirium”
Authors: Weiss Kenneth J. , Lanzillotta Cristina 
Published: April 2023

Abstract
Citizens' deaths in police custody are sometimes attributed to “excited delirium syndrome” (ExDS). This terminology is rejected by the American Medical Association and the American Psychiatric Association. ExDS has no demonstrable pathology but has been proposed as predisposing to sudden death, thus exonerating police. Ketamine use during arrests complicates manner of death. ExDS deaths trigger lawsuits claiming police misconduct and excessive force. Defendant officers and municipalities have used ExDS to distance themselves from liability, using expert testimony from nonpsychiatrists. This argument is expressed despite lack of autopsy findings, the false idea that mental illness itself can lead to sudden death, and the absence of consistent diagnostic criteria. This article traces the history of ExDS and reviews the arguments for and against its use in psychiatry and law enforcement. The authors conclude that the label is medically unreliable, has eroded confidence in police-citizen interactions, and obscures dynamics of deaths in custody.
Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder
Authors: Sejdiu Albulena , Jaka Sanobar , Younis Hadia , Kidambi Neil S. , Faruki Farzana , Patel Rikinkumar S. , Gunturu Sasidhar 
Published: April 2023

Abstract
Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.
Enteral Nutrition During Extracorporeal Membrane Oxygenation in the Neonatal and Pediatric Populations: A Literature Review
Authors: Dennis Jocelyn L. , Jordan Jeremy , Rice Marti , Lee Amy E. 
Published: April 2023

OBJECTIVES:
The number of infants and children requiring extracorporeal membrane oxygenation (ECMO) is rising. While critically ill, providers may believe that enteral nutrition puts the patient at risk for severe complications such as necrotizing enterocolitis. However, enteral nutrition is associated with the potential to improve the gut barrier and reduce the risk of morbidity and mortality. The purpose of this article is to review the existing evidence about providing exclusive enteral and parenteral nutrition and its association with rates of complications and mortality in critically ill neonatal and pediatric populations on ECMO.

DATA SOURCES:
Literature addressing enteral nutrition while on ECMO for neonatal and pediatric populations was searched using PubMed, CINAHL, and Scopus.

STUDY SELECTION:
Studies ranged from 1998 to 2022 and were conducted mostly in the PICU and neonatal ICU settings.

DATA EXTRACTION:
Fourteen articles were reviewed after inclusion and exclusion criteria were applied.

DATA SYNTHESIS:
Characteristics included an even number of males and females in samples from mostly PICUs. The predominant underlying illnesses were neonatal pulmonary disease and cardiac disease. Upon reviewing the literature, three major themes were revealed: no significant complications with enteral feeding, underutilization of enteral feeding, and reduced mortality with enteral feeding.

CONCLUSION:
The use of enteral nutrition in the neonatal and pediatric population while on ECMO has the potential to improve survival rates and reduce complications. Further studies are needed to investigate how to optimize this population’s nutrition and develop feeding protocols and pathways.
Severe Acute Respiratory Syndrome Coronavirus 2 in Infants Younger Than 90 Days Presenting to the Pediatric Emergency Department
Authors: Benenson-Weinberg Talia , Gross Itai , Bamberger Zeev , Guzner Noa , Wolf Dana , Gordon Oren , Nama Ahmad , Hashavya Saar 
Published: April 2023

Objectives
There are scant data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in infants younger than 90 days. This study was designed to characterize COVID-19 presentation and clinical course in this age group and evaluate the risk of serious bacterial infection.

Methods
Data on all SARS-CoV-2–polymerase chain reaction-positive infants presenting to the pediatric emergency department (PED) were retrospectively collected, followed by a case-control study comparing those infants presenting with fever (COVID group) to febrile infants presenting to the PED and found to be SARS-CoV-2 negative (control group).

Results
Of the 96 PCR-positive SARS-CoV-2 infants who met the inclusion criteria, the most common presenting symptom was fever (74/96, 77.1%) followed by upper respiratory tract infection symptoms (42/96, 43.8%). Four (4.2%) presented with symptoms consistent with brief resolved unexplained event (4.2%).
Among the febrile infants, the presenting symptoms and vital signs were similar in the COVID and control groups, with the exception of irritability, which was more common in the control group (8% and 26%; P < 0.01). The SARS-CoV-2-positive infants had decreased inflammatory markers including: C-reactive protein (0.6 ± 1 mg/dL vs 2.1 ± 2.7 mg/dL; P < 0.0001), white blood cell count (9.3 ± 3.4 × 109/L vs 11.8 ± 5.1 × 109/L; P < 0.001), and absolute neutrophils count (3.4 ± 2.4 × 109/L vs 5.1 ± 3.7 × 109/L; P < 0.001). The rate of invasive bacterial infection was similar between groups (1.4% and 0%; P = 0.31). No mortality was recorded. Although not significantly different, urinary tract infections were less common in the COVID group (7% and 16%; P = 0.07)

Conclusions
The SARS-CoV-2 infection in infants aged 0 to 90 days who present to the PED seems to be mostly mild and self-limiting, with no increased risk of serious bacterial infection.
Minimal invasive treatment of trapeziometacarpal osteoarthritis: Results of a blinded, randomized controlled trial.
Authors: Winter Raimund , Tuca Alexandru-Cristian , Justich Ivo , Tschauner Sebastian , Friedl Herwig , Girsch Werner , Lebo Patricia , Zrim Robert , Lumenta David Benjamin , Kamolz Lars-P. 
Published: April 2023

Background:
Surgical therapy for widespread CMC1 arthritis permanently alters the physiological anatomy of the hand. The injection of autologous substances into the thumb saddle joint could achieve temporary pain relief and delay surgical indications.
This trial aimed to compare the pain-reducing effects of autologous fat and/or platelet-rich plasma (PRP) with saline 0.9% in the infiltration therapy of carpometacarpal arthritis of the thumb (CMC1 arthritis).

Patients and Methods:
A blinded, randomized controlled trial was conducted. 95 patients with CMC1 arthritis were included in the study. The mean follow-up period was 2 years. Participants were injected with 1.5ml of autologous fat, PRP, autologous fat and PRP, or saline solution 0.9% into the CMC1 joint depending on the group allocation.
The primary outcome of this study was the evaluation of pain reduction in each treatment group.

Results:
The combination of fat and PRP was the only treatment that resulted in a significantly greater reduction in pain compared to 0.9% saline (p=0.003). Similarly, fat and PRP in combination was the only therapy group to achieve clinically relevant quick disabilities of arm, shoulder, and hand (Dash) score reduction, and the only group that showed a significantly better Short Form (SF)-36 score than 0.9% saline (p=0.016). No major complications were noted.

Conclusion:
In addition to pain reduction, the combination of autologous fat and PRP yields a relevant improvement in hand function and a corresponding improvement in quality of life, and seems to be a viable and safe alternative to short-acting glucocorticoids.
Combined great toe dorsal nail-skin flap and medial plantar flap for reconstruction of degloved finger loss
Authors: Tang Lin , Zhou Xin , Huang Shuqing , Zou Yonggen 
Published: April 2023

Background:
Historically, the degloved finger with the total loss of nails and skin had been resurfaced into two stages. Further, proximal finger amputation requires an additional bone-tendon graft and an expanded great toe wraparound flap transfer for better outcomes. The article recommends a novel strategy to address these problems in a single stage using a dorsal nail-skin flap and medial plantar artery perforator (MPAP) flap.

Method:
From March 2015 to June 2018, nine fingers were performed to resurface with skin loss to the metacarpophalangeal (MCP) joint level, and three amputated fingers were reconstructed with an extra bone-joint-tendon graft simultaneously. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. A standardized assessment of outcome in terms of sensory, functional, and esthetic performance was completed.

Results:
All flaps survived. The contour and length of the reconstructed digits were comparable with the contralateral finger. The mean static two-point discrimination was 11.0 mm (ranged, 9.0-14.0 mm). The average score of the Disabilities of the Arm, Shoulder and Hand questionnaire and Michigan Hand Outcomes Questionnaire were 2.5 (ranged,0-5) and 90.1 (ranged,82-96). The mean Foot and ankle disability index score was 95.6 (ranged, 93-99). At the last follow-up, the functional and aesthetic outcomes were satisfied for all fingers, as well as the restored sensory.

Conclusion:
This strategy may provide an alternative for the selected patients, seeking cosmetic resurface and functional reconstruction, preserving a weight-bearing plantar area with less morbidity.

Clinical question/Level of Evidence:
Therapeutic, IV
Survival prediction in advanced cancer patients – a narrative review
Authors: Lee Shing Fung , Simone Charles B. 
Published: April 2023

Purpose of review
The exploration for accurate ways to predict survival for advanced cancer patients continues to be a significant theme despite the advent of objective criteria and their combination with clinical criteria. The purpose of this article was to review some of the latest studies relating to prognostication and the capacity to predict survival during the terminal cancer stage.

Recent findings
Recent studies show notable prognostication approaches using genetic tests and advanced computation methods such as machine learning, which we will summarize.

Summary
Significant effort has been made to improve the accuracy of survival estimation for advanced cancer patients. The main goals are to optimize individualized patient management and uses of resources. Advanced techniques, including genetic markers and machine learning techniques, may improve the accuracy of prediction.
The untapped health and climate potential of cycling in France: a national assessment from individual travel data
Authors: Schwarz Emilie , Leroutier Marion , De Nazelle Audrey , Quirion Philippe , Jean Kévin 
Published: April 2023

ABSTRACTBackgroundPromoting active modes of transportation such as cycling may generate important public health, economic, and climate mitigation benefits. We aim to assess mortality and morbidity impacts of cycling in a country with relatively low levels of cycling, France, along with associated monetary benefits; we further assess the potential additional benefits of shifting a portion of short trips from cars to bikes, including projected greenhouse gas emissions savings.MethodsUsing individual data from a nationally-representative mobility survey, we described the French 2019 cycling levels by age and sex. We conducted a burden of disease analysis to assess the incidence of five chronic diseases (breast cancer, colon cancer, cardio-vascular diseases, dementia, and type-2 diabetes) and numbers of deaths prevented by cycling, based on national incidence and mortality data and dose-response relationships from meta-analyses. We assessed the corresponding direct medical cost savings and the intangible costs prevented based on the value of a statistical life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<5km) car trips were shifted to cycling.FindingsThe French adult (20-89 years) population was estimated to cycle on average of 1min 17sec pers-1.day-1in 2019, with important heterogeneity across gender and age. This yielded benefits of 1,919 (uncertainty interval, UI: 1,101-2,736) premature deaths and 5,963 (UI: 3,178-8,749) chronic disease cases prevented, with males enjoying nearly 75% of these benefits. Direct medical costs prevented were estimated at €191 million (UI: 98-285) annually, while the corresponding intangible costs were nearly 25 times higher (€4.8 billion, UI: 3.0-6.5). We estimated that in average, €1.02 (UI: 0.59-1.62) of intangible costs were prevented for every km cycled. Shifting 25% of short car trips to biking would yield approximatively a 2-fold increase in death prevented, while also generating important CO2emission reductions (0.257 MtCO2e, UI: 0.231-0.288).InterpretationIn a country of low- to moderate cycling culture, cycling already generates important public health and health-related economic benefits. Further development of active transportation would increase these benefits while also contributing to climate change mitigation targets.FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
A neural mass model for the EEG in ischemia
Authors: Kalia Manu , Ligtenstein Sophie L.B. , Meijer Hil G.E. , van Putten Michel J.A.M. 
Published: April 2023

AbstractNormal brain function depends on continuous cerebral blood flow for the supply of oxygen and glucose, and is quickly compromised in conditions where the metabolic demand cannot be met. Insufficient cerebral perfusion can result in ischemic stroke, with symptoms ranging from loss of motor or language function to coma, depending on the brain areas affected. Cerebral ischemia also results in changes in the electroencephalogram. Initially, a reduction of the frequency of the rhythms occurs. Depending on the depth and duration of energy deprivation, this eventually leads to the disappearance of all rhythmic activity. Here, we study the relationship between electroencephalogram (EEG) phenomenology and cellular biophysical principles using a model of interacting thalamic and cortical neural masses coupled with energy-dependent synaptic transmission. Our model faithfully reproduces the characteristic EEG phenomenology during acute cerebral ischemia and shows that synaptic arrest occurs before cell swelling and irreversible neuronal depolarization. The early synaptic arrest is attributed to ion homeostatic failure due to dysfunctional Na+/K+-ATPase. Moreover, we show that the excitatory input from relay cells to the cortex controls rhythmic behavior. In particular, weak relay-interneuron interaction manifests in burst-like EEG behavior immediately prior to synaptic arrest. We corroborate our observations with human EEG data from patients undergoing carotid endarterectomy and patients after cardiac arrest with a postanoxic encephalopathy. The model thus reconciles the implications of stroke on a cellular, synaptic and circuit level and provides a basis for exploring other multi-scale therapeutic interventions.Significance statementReliable synaptic transmission and preservation of ion gradients across cellular membranes are essential for physiological brain function and consume significant energy. During cerebral ischemia, synaptic arrest occurs early due to energy deprivation (ED), which is characterized clinically by the loss of physiological electroencephalographic (EEG) rhythms. In this work, we explore connections between cellular and network behavior during ED by means of a novel computational model that describes ion dynamics in the cortex and thalamus, and resulting EEG. We reproduce characteristic EEG behavior during ED and show that synaptic arrest occurs before other pathologies like swelling and depolarization. Moreover, we predict that low excitatory thalamocortical projections cause burst-like EEG patterns before synaptic arrest, which may explain observations regarding post-stroke synaptic reorganization.