bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical excision of giant vulvar angiofibroma: A case report and a review of literature
Authors: Altal Omar F. , Rawashdeh Shireen , Al Sharie Sarah , Al Zu’bi Yazan O. , Al Sharie Ahmed H. , Daoud Majd N. , Alkhawaldeh Khaled M. 
Published: September 2022

Rationale:
Cellular angiofibroma (CA) is a rare tumor of the soft tissue classified as a benign fibroblastic/myofibroblastic tumor. Considering this, the literature regarding CA mainly, but not exclusively, comprises single case reports and case series. Here, we report a case of giant CA of the vulva with comprehensive literature review.

Patient concerns:
We present a case of a massive vulvar CA arising in 53-year-old woman with no notable medical or surgical history. The mass has grown considerably over time, causing pain and difficult urination, defecation, and movement. The patient had normal regular menstrual cycle with no previous contraception use. Vaginal examination exposed a right-sided large tender vulvar mass with normal-looking vagina.

Diagnoses:
Pelvic magnetic resonance imaging with contrast revealed a large right vulvar heterogeneously enhancing soft tissue mass measuring 13.1 × 10.9 × 10.7 cm expending the left vulva, with internal and peripheral voids resembling feeding vessels. The mass was surgically removed, and subsequent histopathology showed skin-covered dermal-based lesion composed of fibroblast-like bland and spindle cell proliferation with thin-walled blood vessels of various sizes. Immunohistostaining of CD34 and smooth muscle antigen were both positive, while desmin was found to be negative. A diagnosis of vulvar angiofibroma was made based on the clinical scenario, imaging, and histopathology.

Interventions:
Mass vulvectomy was performed starting with a circumferential incision at the base of the mass and structural dissection to separate the mass from the vulvar wall. The incision was successfully closed, and subcuticular stitches were applied to the skin.

Outcomes:
The patient’s complaints were significantly relieved with no postoperative complications and the patient is being followed regularly in an outpatient setting.

Lessons:
Due to its extremely benign nature of CA, and the implausible ability of its recurrence, it was decided to surgically excise it. Despite its rarity, it can be readily identified at its earlier stages preventing the vexing and exasperating symptoms accompanied with increased size as mentioned.
Incidence risk of peripheral edema in cancer patients treated with PD-1/PD-L1 inhibitors: A PRISMA guideline systematic review and meta-analysis
Authors: Tian Yuan , Huang Alan , Tian Mei , Wang Kaiyong , Dang Qi , Zhang Caiqing , Liu Hongmei , Zhao Junyan , Yang Xiaowei , Zhang Chi , Guo Liang , Chen Feng 
Published: September 2022

Purpose:
To elucidate the relationship between peripheral edema and programmed cell death-1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors, the meta-analysis was performed.

Method:
Following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses, all-grade and grade 3-5 of peripheral edema data extracted from clinical trials were taken into account for the final comprehensive assessments.

Results:
Twenty-seven PD-1/PD-L1-related clinical trials with peripheral edema data were collected. Compared with chemotherapy (PD-1/PD-L1 vs chemotherapy), the risk of developing peripheral edema for all-grade was much lower (odds ratio [OR] = 0.36, 95% confidence interval [CI]: [0.23, 0.56], Z = 4.55 [P < .00001]). When PD-1/PD-L1 plus chemotherapy were compared with chemotherapy, no significant analysis results for all-grade was found (OR = 1.15, 95% CI:[0.93, 1.44], I
2 = 25%, Z = 1.27 [P = .20]). Similar risk trends could also be found when the incidence risk of peripheral edema for grade 3–5 was evaluated. No obvious publication bias was identified throughout the total analysis process.

Conclusion:
The effect of PD-1/PD-L1 inhibitor on the risk of developing peripheral edema was weaker than that of chemotherapy, and the combination with chemotherapy slightly increased the incidence risk of developing peripheral edema without statistical significance.
Two novel predictive biomarkers for osteosarcoma and glycolysis pathways: A profiling study on HS2ST1 and SDC3
Authors: Yang Guozhi , Jiang Jie , Yin Ruifeng , Li Zhian , Li Lei , Gao Feng , Liu Chong , Zhan Xinli 
Published: September 2022

Introduction:
Prognostic biomarkers for osteosarcoma (OS) are still very few, and this study aims to examine 2 novel prognostic biomarkers for OS through combined bioinformatics and experimental approach.

Materials and methods:
Expression profile data of OS and paraneoplastic tissues were downloaded from several online databases, and prognostic genes were screened by differential expression analysis, Univariate Cox analysis, least absolute shrinkage and selection operator regression analysis, and multivariate Cox regression analysis to construct prognostic models. The accuracy of the model was validated using principal component analysis, constructing calibration plots, and column line plots. We also analyzed the relationship between genes and drug sensitivity. Gene expression profiles were analyzed by immunocytotyping. Also, protein expressions of the constructed biomarkers in OS and paraneoplastic tissues were verified by immunohistochemistry.

Results:
Heparan sulfate 2-O-sulfotransferase 1 (HS2ST1) and Syndecan 3 (SDC3, met all our requirements after screening. The constructed prognostic model indicated that patients in the high-risk group had a much lower patient survival rate than in the low-risk group. Moreover, these genes were closely related to immune cells (P < .05). Drug sensitivity analysis showed that the 2 genes modeled were strongly correlated with multiple drugs. Immunohistochemical analysis showed significantly higher protein expression of both genes in OS than in paraneoplastic tissues.

Conclusions:
HS2ST1 and SDC3 are significantly dysregulated in OS, and the prognostic models constructed based on these 2 genes have much lower survival rates in the high-risk group than in the low-risk group. HS2ST1 and SDC3 can be used as glycolytic and immune-related prognostic biomarkers in OS.
Identification and validation of the necroptosis-related gene signature related to prognosis and tumor immune in hepatocellular carcinoma
Authors: Xiang Zhiping , Mranda Geofrey Mahiki , Zhou Xingguo , Xue Ying , Wang Yu , Wei Tian , Liu Junjian , Ding Yinlu 
Published: September 2022

Background:
Hepatocellular carcinoma (HCC) is the sixth most common cancer, which is characterized by complicated etiology, excessive heterogeneity, and poor prognosis. Necroptosis is a new kind of programmed cell death, which is intently associated with the occurrence and development of tumors. Although researchers have had a deep understanding of necroptosis in recent years, the expression level of necroptosis-related genes in HCC and its relationship with the survival time of HCC patients are not clear.

Methods:
According to the expression of necroptosis-related genes and the survival of HCC patients, HCC patients in the TCGA database were divided into 2 groups that were relatively independent of each other. The genes related to the survival time of HCC patients were screened from the 2 groups of differentially expressed genes. By using the Least Absolute Shrinkage and Selection Operator Cox regression analysis, the optimal λ value was obtained, and the 10-gene signature model was established.

Results:
According to the median risk score of the TCGA cohort, HCC patients were averagely divided into high- and low-risk groups. Compared with the low-risk group, the death toll of the high-risk group was relatively higher and the survival time was relatively shorter. Principal component analysis and t-distributed stochastic neighbor embedding analysis showed that there was a significant separation between high- and low-risk groups. Through Kaplan–Meier analysis, it was found that the survival time of HCC patients in the high-risk group was significantly shorter than that in the low-risk group. Through receiver operating characteristic analysis, it was found that the sensitivity and specificity of the model were good. We also make a comprehensive analysis of the international cancer genome consortium database as a verification queue and prove the reliability of the 10-gene signature model. Gene Ontolog, Kyoto Encyclopedia of Genes and Genomes, and single-sample gene set enrichment analysis showed that many biological processes and pathways related to immunity had been enriched, and the antitumor immune function was weakened in the high-risk population.

Conclusion:
The risk score can be considered as an independent prognostic factor to predict the prognosis of patients with HCC, and necroptosis-related genes are also closely related to tumor immune function.
Evaluation of continuous intravenous lidocaine on brain relaxation, intraoperative opioid consumption, and surgeon’s satisfaction in adult patients undergoing craniotomy tumor surgery: A randomized controlled trial
Authors: Chandra Susilo , Pryambodho Pry , Omega Andy 
Published: September 2022

Background:
In craniotomy tumor removal, brain relaxation after dura opening is essential. Lidocaine is known to have analgesic and antiinflammatory effects. It is excellent in decreasing cerebral metabolic rate of oxygen, cerebral blood flow, and cerebral blood volume; and can potentially reduce intracranial pressure, resulting in exceptional brain relaxation after dura opening. However, no study has examined continuous intravenous lidocaine infusion on brain relaxation, intraoperative opioid consumption and surgeon’s satisfaction in adult patients undergoing craniotomy tumor removal.

Methods:
A total of 60 subjects scheduled for craniotomy tumor removal were enrolled in a double-blind, randomized controlled trial with consecutive sampling. Patients received either an intravenous bolus of lidocaine (2%) 1.5 mg/kg before induction followed by 2 mg/kg/h continuous infusion up to skin closure (lidocaine group) or placebo with similar volume (NaCl 0.9%). Neurosurgeons evaluated brain relaxation and surgeon’s satisfaction with a 4-point scale, total intraoperative opioid consumption was recorded in μg and μg/kg/min.

Results:
All sixty subjects were included in the study. Lidocaine group showed better brain relaxation after dura opening (96.7% vs 70%; lidocaine vs placebo, P < .006), less intraoperative fentanyl consumption (369.2 μg vs 773.0 μg; P < .001, .0107 vs .0241 μg/kg/min; lidocaine vs placebo, P < .001). Higher surgeon’s satisfaction was found in lidocaine group (96.7% vs 70%, P = .006). No side effects were observed during this study.

Conclusions:
Continuous lidocaine intravenous infusion improves brain relaxation after dura opening, and decreases intraoperative opioid consumption, with good surgeon satisfaction in adult patients undergoing craniotomy tumor removal.
: A case report of re-challenge of immune checkpoint inhibitors after immune-related neurological adverse events: Review of literature
Authors: Moon Heesung , Kim Seul-Gi , Kim Seung Ki , Kim Jinkwon , Lee Seung Ryeol , Moon Yong Wha 
Published: September 2022

Introduction:
The indications for immune checkpoint inhibitors (ICIs) are expanding for various cancers because of their durable responses and tolerable safety profiles. Immune-related adverse events (irAEs), including neurological adverse events (nAEs), are associated with ICIs therapy. However, there have been few studies on whether re-challenge with ICIs can be clinically acceptable after neurological AE has improved.

Patient concerns:
A 69-year-old woman with recurrent ovarian cancer undergoing palliative chemotherapy was admitted to our hospital with sudden development of diplopia, dizziness, and gait instability. The patient was administered ICI therapy with anti-angiogenic agents for 9 weeks for 3 cycles.

Diagnosis:
We performed neurological examination, brain imaging, nerve conduction studies, and serology tests. The patient was diagnosed with Guillain–Barré syndrome variant, an immune-mediated polyneuropathy characterized by a triad of ataxia, areflexia, and ophthalmoplegia.

Intervention:
After prompt discontinuation of pembrolizumab, the patient was taken intravenous methylprednisolone (2 mg/kg) was administered for 5 days, and her symptoms were partially resolved. With the addition of immunoglobulin 0.4 g/kg for 5 days, her symptoms gradually improved.

Outcomes:
The patient’s neurological symptoms improved after immunosuppressive therapy, without sequelae. The NCV showed normal nerve conduction. Unfortunately, because there was little evidence for pembrolizumab rechallenge, pembrolizumab therapy was permanently discontinued, and the tumors eventually progressed.
Successful treatment of metastatic vulvar malignant melanoma with toripalimab: A rare case report and review of the literature
Authors: Li Yi-Hui , Zhou Yang , Zhang Guang-Ju , Wang Yu-Wei , Wang Jian-Gong , Wang Xiao-Hong , Li Yu-Feng 
Published: September 2022

Rationale:
Vulvar melanoma is a rare and aggressive tumor with a high risk of local recurrence and distant metastasis. The prognosis is poor with a 5-year overall survival rate of only 46.6%. Management of vulvar melanoma remains a clinical challenge. Recent evidences have shown that immune checkpoint inhibitors are effective in the treatment of vulvar melanoma.

Patient concerns and diagnoses:
A 63-year-old woman with vulvar malignant melanoma suffered inguinal lymph node metastasis after vulvectomy and chemotherapy. She underwent inguinal lymph node dissection and inguinal radiotherapy. The tumor progressed again and she received immunotherapy.

Interventions:
The tumor progressed again, and she was admitted to our hospital and received toripalimab combined with apatinib and abraxane.

Outcomes:
After 6 cycles of immunotherapy, the efficacy achieved partial remission. And with toripalimab as maintenance therapy, the patient achieved durable antitumor efficacy and good safety.

Lessons:
In this rare case, the patient with metastatic vulvar malignant melanoma had durable antitumor efficacy and good safety when receiving toripalimab.
An overview of gastrointestinal diseases in patients with COVID-19: A narrative review
Authors: Lin Cheng-Yao , Su Shih-Bin , Chen Kow-Tong 
Published: September 2022

Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has emerged as a global health concern. This study aimed to review the epidemiology and pathophysiology of COVID-19 and provide evidence for the implementation of control measures.
We utilized several online databases, including MEDLINE (National Library of Medicine, Bethesda, Maryland, USA), PubMed, EMBASE, Web of Science, and Google Scholar, to collect relevant published papers using a combination of the following keywords: “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” “epidemiology,” and “pathophysiology.” The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used in this study.
Globally, approximately 3–46% of patients with SARS-CoV-2 infection experience gastrointestinal symptoms. The clinical spectrum of COVID-19 is wide, ranging from mild to severe, and even fatal. COVID-19 was initially reported as a respiratory tract disease; however, gastrointestinal symptoms have only recently been reported. COVID-19 Patients with gastrointestinal symptoms may have more severe clinical manifestations and poor prognosis.
This study highlights the need to better understand the mechanisms involved in the development of gastrointestinal symptoms in patients with COVID-19 to prevent the further spread of this pathogen.
Two-stage aortic surgery for distal aortic arch and descending aorta aneurysms: A case report
Authors: Shimada Akie , Yamamoto Taira , Dohi Shizuyuki , Yokoyama Yasutaka , Endo Daisuke , Tabata Minoru 
Published: September 2022

Rationale:
Although surgical treatment strategies for patients with extensive thoracic aortic disease involving the aortic arch have improved considerably, the impact of stent graft length and placement site on aortic remodeling at long-term follow-up is not fully understood, and the protection of the Adamkiewicz artery (AKA) using the frozen elephant trunk (FET) method is also unclear.

Patient concerns:
The patient was a 69-year-old man with diabetic nephropathy who became increasingly fatigued and started maintenance hemodialysis 6 months prior to admission. At 64 years, he underwent clipping of a right cerebellar artery aneurysm. In addition, a 1.8 cm aneurysm was found in the contralateral extracranial internal carotid artery. He also had an atrial septal defect and moderate aortic regurgitation and was receiving continuous positive airway pressure therapy for sleep apnoea syndrome.

Diagnosis:
He had aneurysms in the aortic arch (4.8 cm in diameter) and descending aorta (6 cm in diameter), which was located at T6–9. Preoperative 3-dimensional computed tomography showed that the (AKA) bifurcated at T10–11.

Interventions:
Considering the patient’s several comorbidities and frailty, we planned to perform 1-stage extended aortic arch repair using the FET procedure. However, we performed 2-stage aortic surgery to prevent spinal ischemia, anticipating substantial cardiac enlargement and blood pressure instability due to dialysis treatment. Aortic valve replacement, atrial septal defect patch closure, and aortic arch surgery were performed. A 7-cm elephant trunk was inserted in the descending aorta. Postoperatively, the patient continued rehabilitation until his blood pressure stabilized during dialysis therapy. At postoperative week 4, he underwent thoracic endovascular aortic repair for a descending aortic aneurysm.

Outcomes:
After surgery, his physical strength decreased; however, he recovered and was discharged 1 month later without any complications. One year after the second operation, he is living a healthy life.

Lessons:
Extensive aortic arch surgery using the FET procedure is effective for distal aortic arch and descending aortic aneurysms. Nevertheless, in cases in which the position of the AKA is close to the aortic aneurysm and blood pressure control is difficult, a 2-stage procedure and accurate positioning of thoracic endovascular aortic repair are both desirable.
A meta-analysis on efficacy and safety of rituximab for neuromyelitis optica spectrum disorders
Authors: Dong Gu-Yi , Meng Yan-Hong , Xiao Xiang-Jian 
Published: September 2022

Background:
To assess the efficacy and safety of rituximab (RTX) in the treatment of neuromyelitis optica spectrum diseases (NMOSDs), and give a guideline on clinical medication

Methods:
The databases of Pubmed, Embase, Cochrane Library, CNKI, and Wan fang were systematically searched by computer, and the search period was from the establishment of the databases until January 2022. To collect the trials of RTX in the treatment of NMOSDs, two researchers completed literature screening, quality assessment, and data extraction independently. Statistical analysis was performed using Review Manager 5.3 and Stata 15.1 software.

Results:
There were 37 studies in the meta-analysis, including 5 randomized controlled trials (RCTs) and 32 observational studies. Meta-analysis results revealed that NMOSDs patients treated with RTX significantly reduced the annualized relapse rate (ARR) (weighted mean difference [WMD] = 1.45, 95% confidence interval [CI]: 1.24–1.66, P < .01) and the Expanded disability status scale (EDSS) scores (WMD = 1.34, 95%CI: 1.25–1.44, P < .01). RTX is more effective than azathioprine (AZA) in the treatment of NMOSDs (ARR: WMD = −0.54, 95% CI: −0.75 to −0.33; EDSS: WMD = −0.65, 95% CI: −0.83 to −0.48; P < .0001).There was no difference in ARR and EDSS scores between anti-aquapor in-4-antibody seropositive NMOSD and seronegative NMOSD patients treated with RTX (ARR: WMD = −0.01, 95% CI: −0.25 to 0.24, P = .96 > 0.05; EDSS: WMD = 0, 95% CI: −0.30 to 0.31, P = .99 > 0.05). In this study, 681 patients were recorded safety data of RTX therapy, 23% (156 patients) had adverse events, and 0.7% (5 patients) of NMOSDs discontinued due to severe adverse reactions.

Conclusions:
NMOSDs patients treated with RTX can significantly reduce the relapse frequency and EDSS scores, and also improve neurological dysfunction, besides the efficacy is better than azathioprine. RTX has a high incidence of adverse reactions, which are mild and with certain self limited, it should be cautious in clinical medication
Iodine-125 seed implantation combined chemotherapy for metastatic pancreatic adenocarcinoma with primary colon cancer: A case report
Authors: Song Yinghui , Qi Yuchen , Yu Zhangtao , Zhang Zhihua , Li Yuhang , Huang Junkai , Liu Sulai 
Published: September 2022

Rationale:
Colon cancer has a distinct migration aptitude. However, pancreatic metastasis is rare and treatment of inoperable pancreatic cancers is seldom seen.

Patient concerns:
A 47-year-old woman presented 2-month history of abdominal pain and abdominal distention, with anal cessation of exhaust and defecation for 4 days. A colon cancer radical resection was performed when she diagnosed with colon cancer. After 26 months, the patient complained shoulder and back pain. Multiple intraperitoneal metastases and nonisolated pancreatic metastasis of colon cancer were diagnosed.

Diagnosis:
Metastatic pancreatic adenocarcinoma (MPA) with primary colon cancer.

Intervention:
Iodine-125 seed implantation combined chemotherapy.

Outcomes:
She remains free of cancer metastasis and recurrence, and has a good quality of life during the period.

Lessons subsections:
Iodine-125 seed implantation is an effective and safe strategy for unresectable metastatic pancreatic cancer. Iodine-125 seed implantation combined with chemotherapy improve survival for advanced pancreatic metastasis of colon cancer.