bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indocyanine green fluorescence imaging to localize insulinoma and provide three-dimensional demarcation for laparoscopic enucleation: a retrospective single-arm cohort study
Authors: Tao Haisu , Zeng Xiaojun , Lin Wenjun , Wang Zhuangxiong , Lin Jinyu , Li Jiang , Qian Yinling , Yang Jian , Fang Chihua 
Published: April 2023

Background:
Indocyanine green (ICG) fluorescence imaging is a new technology that can improve the real-time location of tumor edges and small nodules during surgery. However, no study has investigated its application in laparoscopic insulinoma enucleation. This study aimed to evaluate the feasibility and accuracy of this method for intraoperative localization of insulinomas and margin assessment during laparoscopic insulinoma enucleation.

Materials and Methods:
Eight patients who underwent laparoscopic insulinoma enucleation from October 2016 to June 2022 were enrolled. Two methods of ICG administration, ICG dynamic perfusion and three-dimensional (3D) demarcation staining, were utilized in the laparoscopic insulinoma enucleation. Tumor-to-background ratio (TBR) and histopathologic analysis were used to evaluate the feasibility and accuracy of these novel navigation methods in laparoscopic insulinoma enucleation.

Results:
All eight enrolled patients underwent both ICG dynamic perfusion and 3D demarcation staining. ICG dynamic perfusion images were available for six of them, among which five tumors could be recognized by TBR (largest TBR in each case 4.42±2.76), while the other could be distinguished by the disordered blood vessels in the tumor area. Seven out of eight specimens had successful 3D demarcation staining (TBR 7.62±2.62). All wound bed margins had negative frozen sections and final histopathologic diagnoses.

Conclusions:
ICG dynamic perfusion may be helpful in observing the abnormal vascular perfusion of tumors, providing similar functionality to intraoperative real-time angiography. ICG injection under the tumor pseudocapsule may be a useful method for acquiring real-time, 3D demarcation for the resection of insulinoma.
Impact of HER2 on prognosis and benefit from adjuvant chemotherapy in stage II/III gastric cancer patients: a multicenter observational study
Authors: Gao Xianchun , Zhao Lulu , Zhang Nannan , Han Weili , Liu Kun , Yan Junya , Chen Ling , Pan Yan , Li Renlong , Li Wenjiao , Zhang Haohao , Li Hongwei , Wang Shibo , Gao Xiaoliang , Niu Penghui , Wang Wanqing , Ji Gang , Zhao Qingchuan , Lu Yuanyuan , Li Zengshan , Shang Lei , Liang Han , Wu Kaichun , Deng Jingyu , Chen Yingtai , Nie Yongzhan ,   for the MAGIS Study Group
Published: April 2023

Background:
Human epidermal growth factor receptor 2 (HER2) is a well-developed therapeutic target in breast and gastric cancer (GC). However, the impact of HER2 on survival and benefit from fluorouracil-based adjuvant chemotherapy remains unclear in patients with GC.

Materials and Methods:
This multicenter cohort study involved 5622 consecutive stage II/III GC patients. HER2 expression was assessed prospectively via immunohistochemistry (IHC). The staining intensity was graded on a scale of 0 to 3+. An IHC score of 2+or 3+was defined as high expression, and a score of 3+was defined as overexpression.

Results:
HER2 overexpression was independently associated with a lower 5-year overall survival (OS) in stage II [hazard ratio (HR), 2.10; 95% CI: 1.41–3.11], but not in stage III GC (HR, 1.00; 95% CI, 0.82–1.20). Further analysis revealed that stage II patients with high HER2 expression showed a poorer response to chemotherapy than stage II patients with low HER2 expression (P
interaction=0.024). The HRs for 5-year OS were 0.51 (95% CI, 0.38–0.70) for stage II patients with low HER2 expression, 0.58 (95% CI, 0.51–0.66) for stage III patients with low HER2 expression, 1.13 (95% CI, 0.61–2.09) for stage II patients with high HER2 expression, and 0.47 (95% CI, 0.36–0.61) for stage III patients with high HER2 expression.

Conclusions:
Fluorouracil-based adjuvant chemotherapy is insufficient for stage II GC patients with high HER2 expression, indicating that prospective trials are required to validate alternative HER2-targeted adjuvant therapies in the individuals above.
Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study
Authors: Martín-Rodríguez Francisco , Enriquez de Salamanca Gambara Rodrigo , Sanz-García Ancor , Castro Villamor Miguel A. , del Pozo Vegas Carlos , Sánchez Soberón Irene , Delgado Benito Juan F. , Martín-Conty José L. , López-Izquierdo Raúl 
Published: April 2023

Background The long-term predictive validity of early warning scores (EWS) has not been fully elucidated yet.
Objective The aim of the present study is to compare seven prehospital EWS to predict 1-year mortality.

Methods
A prospective, multicenter, ambulance-based study of adult patients with an acute illness involving six advanced life support units and 38 basic life support units, referring to five emergency departments in Spain.

Results
The primary outcome was long-term mortality with a 1-year follow-up. The compared scores included: National Early Warning Score 2, VitalPAC early warning score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score, and Triage Early Warning Score. Discriminative power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare the scores. Additionally, a Cox regression and Kaplan–Meier method were used. Between 8 October 2019, and 31 July 2021, a total of 2674 patients were selected. The MREMS presented the highest AUC of 0.77 (95% confidence interval, 0.75–0.79), significantly higher than those of the other EWS. It also exhibited the best performance in the DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94–4.31) for MREMS between 9 and 18 points, and 11.71 (7.21–19.02) for MREMS > 18].

Conclusion
Among seven tested EWS, the use of the MREMS presented better characteristics to predict 1-year mortality; however, all these scores present moderate performances.
Association between out-of-hospital cardiac arrest and survival in paediatric traumatic population: results from the French national registry
Authors: Lockhart-Bouron Marguerite , Baert Valentine , Leteurtre Stéphane , Hubert Hervé , Recher Morgan 
Published: April 2023

Background and importance
Trauma is an important cause of paediatric out-of-hospital cardiac arrest (OHCA) with a high mortality rate.

Objectives
The first aim of this study was to compare the survival rate at day 30 and at hospital discharge following paediatric traumatic and medical OHCA. The second aim was to compare the rates of return of spontaneous circulation and survival rates at hospital admission (Day 0).

Setting and participants
This multicentre comparative post-hoc study was conducted between July 2011 and February 2022 based on the French National Cardiac Arrest Registry data. All patients aged <18 years with OHCA were included in the study.

Outcome measures and analysis
Patients with traumatic aetiology were matched with those with medical aetiology using propensity score matching. Endpoint was the survival rate at day 30.

Main results
There were 398 traumatic and 1061 medical OHCAs. Matching yielded 227 pairs. In non-adjusted comparisons, days 0 and 30 survival rates were lower in the traumatic aetiology group than in the medical aetiology group [19.1% vs. 24.0%, odds ratio (OR) 0.75, 95% confidence interval (CI) 0.56–0.99, and 2.0% vs. 4.5%, OR 0.43, 95% CI, 0.20–0.92, respectively]. In adjusted comparisons, day 30 survival rate was lower in the traumatic aetiology group than in the medical aetiology group (2.2% vs. 6.2%, OR 0.36, 95% CI, 0.13–0.99).

Conclusion
In this post-hoc analysis, paediatric traumatic OHCA was associated with a lower survival rate than medical cardiac arrest.
Prognostic value of initial [18F]FDG PET/computed tomography volumetric and texture analysis-based parameters in patients with head and neck squamous cell carcinoma
Authors: Elahmadawy Mai Amr , Ashraf Aya , Moustafa Hosna , Kotb Magdy , Abd El-Gaid Salwa 
Published: April 2023

Aim of work
To determine the predictive value of initial [18F]FDG PET/computed tomography (CT) volumetric and radiomics-derived analyses in patients with head and neck squamous cell carcinoma (HNSCC).

Methods
Forty-six adult patients had pathologically proven HNSCC and underwent pretherapy [18F]FDG PET/CT were enrolled. Semi-quantitative PET-derived volumetric [(maximum standardized uptake value (SUVmax) and mean SUV (SUVmean), total lesion glycolysis (TLG) and metabolic tumor volume (MTV)] and radiomics analyses using LIFEx 6.73.3 software were performed.

Results
In the current study group, the receiver operating characteristic curve marked a cutoff point of 21.105 for primary MTV with area under the curve (AUC) of 0.727, sensitivity of 62.5%, and specificity of 86.8% (P value 0.041) to distinguish responders from non-responders, while no statistically significant primary SUVmean or max or primary TLG cut off points could be determined. It also marked the cutoff point for survival prediction of 10.845 for primary MTV with AUC 0.728, sensitivity of 80%, and specificity of 77.8% (P value 0.026). A test of the synergistic performance of PET-derived volumetric and textural features significant parameters was conducted in an attempt to develop the most accurate and stable prediction model. Therefore, multivariate logistic regression analysis was performed to detect independent predictors of mortality. With a high specificity of 97.1% and an overall accuracy of 89.1%, the combination of primary tumor MTV and the textural feature gray-level co-occurrence matrix correlation provided the most accurate prediction of mortality (P value < 0.001).

Conclusion
Textural feature indices are a noninvasive method for capturing intra-tumoral heterogeneity. In our study, a PET-derived prediction model was successfully generated with high specificity and accuracy.
A dosimetric comparison of systemic peptide receptor radionuclide therapy and intra-arterial peptide receptor radionuclide therapy in patients with liver dominant gastroenteropancreatic neuroendocrine tumours
Authors: Nautiyal Amit , Jha Ashish K , Konuparamban Acsah , Mithun Sneha , Srichandan Tusharkanta , Puranik Ameya , Gala Kunal , Shetty Nithin , Kulkarni Suyash , Rangarajan Venkatesh 
Published: April 2023

Objectives
Intra-arterial radionuclide therapy (IART) treatment allows direct delivery of 177Lu-DOTATATE to the overexpressed somatostatin-positive neuroendocrine liver metastases, which led to higher tumour concentration compared with systemic radionuclide therapy (SRT). The aim was to evaluate and compare the absorbed doses of both IART and SRT to organs and hepatic metastatic sites.

Methods
A total of 48 patients received SRT and IART. In SRT, activity was administered intravenously, whereas in IART, activity was administered directly into hepatic arteries. The sequential whole-body images were acquired at 2, 4, 24, 72 and 160 h. The reconstructed whole-body planar and single-photon emission computed tomography-computed tomography images were processed using the Dosimetry Toolkit for the estimation of normalized cumulated activity in the organs and tumour lesions. The absorbed dose was computed using OLINDA EXM 2.0 software.

Results
The median absorbed dose (mGy/MBq) of kidneys and spleen in IART was compared with SRT and found to be decreased by 30.7% (P = 0.03) and 37.5% (P = 0.08), whereas it was found to be increased by 40% (P = 0.26) and 8.1% (P = 0.28) in the liver and lungs. The median dose (mGy/MBq) of tumours determined in IART was found to be increased by 62.2% (P = 0.04).

Conclusion
IART with 177Lu-DOTATATE significantly increases tumour dose while reducing overall systemic toxicity in comparison to SRT treatment. After considering the maximum tolerance limit of kidneys in peptide receptor radionuclide therapy, the number of treatment cycles and injected activity can be optimized further with IART for better response and survival.
Transplant oncology: multivisceral transplantation for neuroendocrine tumor and liver metastasis
Authors: Nagai Shunji 
Published: April 2023

Purpose of review
Neuroendocrine tumor (NET) liver metastatic lesions are often multiple and found to be unresectable. Rationale of multivisceral transplantation (MVT: liver–pancreas–intestine transplantation) include radical and complete resection of primary, visible and invisible metastatic tumors by removing all abdominal organs and the lymphatic system. This review aims to describe the concept of MVT for NET and neuroendocrine liver metastasis (NELM), patient selection, timing of MVT, and posttransplant outcomes and management.

Recent findings
Although indication criteria of MVT for NET vary between transplant centers, the Milan-NET criteria for liver transplant are often applied to MVT candidates. Extra-abdominal tumors such as lung and/or bone lesions should be ruled out prior to MVT. Histology should be confirmed as low-grade (G1/G2). Ki-67 should be also checked to confirm biologic features. Timing of MVT remains controversial, whereas many experts recommend 6 months of disease stability prior to MVT.

Summary
Although MVT would not be a standard therapy because of limited access to MVT centers, benefit of MVT should be recognized, which includes its potential ability to better achieve curative resection of disseminated tumors in the abdominal cavity. Early referral of difficult cases to MVT centers should be considered before palliative best supportive cares.
Tetraparesis as an initial manifestation of biotinidase deficiency: a case report
Authors: Badour Maysaa , Hammed Ali , Baqla Sameer , Amer Fatema 
Published: April 2023

Introduction and importance:
Biotinidase deficiency (BTD) is an autosomal recessive disorder and causes the deficiency of four biotin-containing carboxylases. The prevalence is estimated at 1 in 60 000 births. BTD is associated with a wide spectrum of clinical manifestations, including abnormalities of the neurological, dermatological, immunological, and ophthalmological systems. Spinal cord demyelination as a manifestation of BTD has been infrequently described.

Case presentation:
The authors present a case of 2.5-year-old boy complained of progressive weakness in all four limbs, with difficulties in breathing.

Clinical discussion:
Abdominal examination revealed hepatomegaly and splenomegaly. Also, her parents were first-degree cousins. Therefore, tandem mass spectroscopy and urine organic acid analysis were planned to exclude metabolic disorders. Urinary organic acid analysis revealed elevated levels of methylmalonic acid and 3-hydroxyisovaleric acid. Serum biotinidase activity was found to be 3.9 nmol/min/ml. Oral biotin at a dose of 1 mg/kg daily was initiated. A marked improvement of his neurological deficit was noted over a period of 15 days after treatment and cutaneous manifestations resolved within 3 weeks.

Conclusion:
Myelopathy due to BTD is a challenging diagnosis. Spinal cord impairment is a rare complication of this disease and is frequently unrecognized. BTD should be included in the differential diagnosis of children presenting with demyelinating spinal cord disease.
Bouveret Syndrome simultaneous with an incidental solitary Gastric Neuroendocrine Tumor in a 44-year-old female - A Case Report
Authors: Shaheen Jack , Al Laham Omar , Ibrahim Basha Zein , Atia Fareed , Sharaf Aldeen Rahaf , Isaac Michel , Alhanwt Alaa 
Published: April 2023

Introduction and importance:
Bouveret Syndrome (BS) is a rare type of gallstone ileus, where a gallstone passes via a cholecystoduodenal fistula and causes gastric outlet obstruction. It comprises 0.3–0.5% of cholelithiasis complications. It primarily affects females with an average incidence age of 74 years. Gastric Neuroendocrine Tumors (G-NETs) make up merely 2% of all forms of gastric neoplasia and are known to be an extremely rare occurrence. Their annual incidence is estimated to be one to two per 1 million individuals, and they comprise 8.7% of all known neuroendocrine neoplasia of the gastrointestinal system.

Case presentation:
We present the case of a 44-year-old Middle Eastern female who presented to the clinic due to multiple episodes of food containing biliary nonprojectile emesis accompanied by epigastric pain. Preoperative radiological workup revealed a Bezoar blocking the gastric outlet and a G-NET in the mucosal layer of the stomach.

Clinical discussion:
Surgical intervention consisted of excising the impacted calculus to relieve the existing gastric outlet obstruction simultaneous to performing an uncut Roux-en-Y to treat the G-NET condition. The patient underwent complete recovery.

Conclusion:
BS is an extremely rare form of gallstone ileus and gastric outlet obstruction. Its clinical presentation is nonspecific and results in misdiagnosis. Additionally, it is rare to occur in our patient’s age group. NETs are also profoundly rare forms of neoplasia. To the best of our knowledge, no previous cases of simultaneous BS and G-NET have been documented. Therefore, clinical awareness should be raised to timely implement the necessary therapeutic interventions.
Kawasaki disease − often a diagnostic dilemma in pediatric population: a case report
Authors: Subedi Subash , Shrestha Swikriti , Khatri Chhetri Sujata , Lamichhane Sandesh , Dhakal Swastika , Dahal Pravakar , Baniya Shubha , Pokhrel Santosh 
Published: April 2023

Introduction:
Kawasaki disease (KD) is the most common cause of childhood vasculitis affecting small- and medium-sized arteries. The cause of this disease is unknown with an overall prevalence of 0.10% making this a rare entity.

Case presentation:
Here the authors present an index case of a 2-year-old child presenting with a persistent high-grade fever of more than 5 days and a 3-day history of bilateral swelling of hands and feet along with cervical lymphadenopathy. On the subsequent day of admission, the child developed mucocutaneous symptoms and cervical lymphadenopathy. The diagnosis of KD was made, and it was successfully treated with intravenous immunoglobulin and aspirin.

Clinical discussion:
Timely diagnosis and early treatment of KD are challenging due to the lack of definitive diagnostic tests. Watchful waiting for symptoms may be necessary before a diagnosis can be made because not all clinical symptoms are present simultaneously as in the index case.

Conclusions:
This case highlights considering KD as a differential diagnosis of nonresolving fever in children with mucocutaneous findings. Intravenous immunoglobulin along with aspirin is the mainstay of therapy and should be started as early as possible to prevent detrimental cardiac complications. There is a high tendency of diagnostic dilemmas due to a wide array of nonspecific presentations thus healthcare providers must be more vigilant of this entity.
A rare case of pediatric orbital rhabdomyosarcoma in Nepal: a case report
Authors: Shrestha Tina , Mainali Sumina , Poudel Sandhya , K.C Narendra , Dulal Aliza 
Published: April 2023

Introduction and Importance:
Orbital rhabdomyosarcoma (RMS) is a highly malignant, mesenchymal orbital tumor of childhood with a predilection in children less than 20 years of age. It presents as a space-occupying lesion in the orbit, most commonly over the superior nasal quadrant of the orbit. The patient usually presents with rapid onset unilateral proptosis and eyelid edema.

Case Ppresentation:
In this article, a 14-year-old male presented with rapidly progressive swelling of the right orbit. On ocular examination, there was nonaxial inferolateral proptosis of the right eye. Computed tomography revealed a large soft tissue density tissue lesion in the right nasal cavity and meati measuring at least 3.2×2.7×5.4 cm in size with the erosion of the right orbit along with extension of the lesion in the extraconal compartment of the orbit. An MRI of the brain with contrast showed a heterogeneously enhancing altered signal intensity lesion. Debulking was planned, and a biopsy of the mass was sent that gave an impression of alveolar RMS. He also received radiotherapy and chemotherapy at one of the cancer hospitals in Nepal. Postsurgical follow-up showed gradual improvement in the visual acuity of the right eye. No evidence of metastasis and recurrence was found upon subsequent follow-up.

Conclusion:
Thus, early diagnosis and prompt treatment is most for a favorable prognosis in the case of RMS. The main aim of this article was to briefly overview a rare case of RMS, its clinical presentation, diagnosis, treatment modalities, and its prognosis.
The outcome of spine metastatic after surgery: a case series
Authors: Azharuddin  , Kamarlis Reno Keumalazia , Akbar Fikri 
Published: April 2023

Introduction:
Spine metastases occur because of the spread of the primary tumour that causes back pain and neurological deficits in the sufferer and has a high risk for surgery.

Case presentation:
In this case series, all three patients had the same initial symptoms; back pain and lower limb weakness and had a history of previous primary tumours that metastasized to the spine. The MRI showed a tumour mass on T11 accompanied by a burst fracture in the first patient, L4 in the second patient, and T3 in the third case accompanied by a dislocated fracture. The three reported patients underwent a posterior decompression procedure, and a histopathological examination showed a metastatic adenocarcinoma.

Outcomes:
Postoperatively the patient underwent physiotherapy and showed a change in the Frankel grade condition. However, in the second case, the patient had complications such as a pathological fracture that made the patient undergo further surgery for this. Still, after the operation, the patient died due to hemodynamic instability due to heavy blood loss. In this report, the indication for surgery is because the three patients complained of pain and neurological deficits resulting in the patient having limited motor movement in the lower limbs.

Conclusion:
Surgery is one of the things that can improve spine metastatic patients’ activities of daily living and quality of life even though it is a high-risk procedure; The surgeon must carefully assess the patient’s condition in determining the classification, evaluation, and scoring system to provide the necessary therapy.