cometadata/datacite-titles-descriptions-related-identifiers huggingface dataset:
DOI: 10.6084/m9.figshare.30868661.v1
title: Supplementary Material for: Tailoring the surgical approach to Chiari I malformation with Intraoperative Ultrasounds: Advantages, limitations, and controversies

description: Introduction Decompression of posterior cranial fossa remains the mainstay of surgical treatment of Chiari Malformation type I (CMI), though several surgical manoeuvres have been differently combined to bony decompression aiming to increase the efficacy of surgery. In this context, Intraoperative Ultrasounds (IOUS) claims to offer a real-time feedback of adequacy of surgical decompression, thus accordingly tailoring the aggressiveness of surgery. The present review aims to highlighting benefits, limitations, and areas in need of further investigation. 
Materials and Methods A comprehensive literature search of PubMed, Scopus, and Google Scholar was performed for studies published in English in the last 30 years. The following keywords - including MeSH terms - were used to retrieve eligible papers: “Chiari Malformation Type I”, “posterior fossa decompression”, “ultrasonography”.
Results A total of 3189 results was collected. Duplicate records were then removed (n=1591). A total of 1598 papers were screened, and 1531 records were excluded through title and abstract screening; 65 studies were considered relevant to our research question and were assessed for eligibility. Finally 23 articles were included in the review.
Conclusions IOUS has been frequently used to evaluate the adequacy of surgical decompression, though this qualitative assessment remains subjective with obvious inter-operator variability. On the other side, a quantitative assessment has been more rarely used through the literature, as this approach is difficult to reproduce. Despite the obvious advantages of IOUS, further investigation is required to standardize this approach.
DOI: 10.6084/m9.figshare.30868664
title: Supplementary Material for: A Silvery Hair Revolution: Case Report of Marie Antoinette syndrome in a child

description: Background: Sudden diffuse hair whitening (canities subita) is exceptionally rare in childhood and may mimic congenital pigment dilution syndromes.
Case presentation: We describe a 17-month-old girl who developed abrupt hair depigmentation during hospitalization for septic shock. Clinical examination, trichoscopy, and light microscopy confirmed diffuse alopecia areata and achromotrichia. Hematologic and immunologic investigations were normal. Spontaneous repigmentation occurred within three months. 
Conclusion: This case—one of the youngest reported—highlights systemic stress as a potential trigger for pediatric canities subita associated with diffuse alopecia areata and underscores the importance of distinguishing it from congenital silvery hair syndromes, which carry markedly different prognostic and therapeutic implications.
DOI: 10.6084/m9.figshare.30868664.v1
title: Supplementary Material for: A Silvery Hair Revolution: Case Report of Marie Antoinette syndrome in a child

description: Background: Sudden diffuse hair whitening (canities subita) is exceptionally rare in childhood and may mimic congenital pigment dilution syndromes.
Case presentation: We describe a 17-month-old girl who developed abrupt hair depigmentation during hospitalization for septic shock. Clinical examination, trichoscopy, and light microscopy confirmed diffuse alopecia areata and achromotrichia. Hematologic and immunologic investigations were normal. Spontaneous repigmentation occurred within three months. 
Conclusion: This case—one of the youngest reported—highlights systemic stress as a potential trigger for pediatric canities subita associated with diffuse alopecia areata and underscores the importance of distinguishing it from congenital silvery hair syndromes, which carry markedly different prognostic and therapeutic implications.
DOI: 10.17026/ar/psh8wa
title: PAN-00175518 - handle with dolphin motif (Roman period)

description: &lt;p&gt;This find is registered at Portable Antiquities of the Netherlands with number PAN-00175518&lt;/p&gt;
description: Modified: 2025-06-16T10:11:17+02:00
DOI: 10.6084/m9.figshare.30868667
title: Supplementary Material for: Proton Radiotherapy Alone versus Combined with Immunotherapies or Tyrosine Kinase Inhibitors for BCLC Stage B or C Hepatocellular Carcinoma

description: Purpose: This study aimed to compare the outcomes of proton radiotherapy alone versus its combination with immunotherapies (Proton-IO) or tyrosine kinase inhibitors (Proton-TKI) in patients with intermediate- to advanced-stage hepatocellular carcinoma (HCC).
Methods: We retrospectively reviewed the medical records of 137 patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC treated with proton radiotherapy at Linkou Chang Gung Memorial Hospital between 2020 and 2023. Patients were stratified into three groups: proton radiotherapy alone (n = 64), Proton-IO (n = 44), and Proton-TKI (n = 29). The most frequently used immuno-oncology agents were atezolizumab-bevacizumab (n = 33) and pembrolizumab (n = 5). Tyrosine kinase inhibitors (TKIs) included lenvatinib (n = 16) and sorafenib (n = 13).
Results: With a median follow-up of 30 months, patients in the Proton-IO group were significantly associated with higher 2-year overall survival (OS) rates compared with those receiving Proton-TKI or proton radiotherapy alone (77.0% vs. 47.2% vs. 52.7%; P = 0.002). Proton-IO was also associated with significantly longer time to progression (TTP) and distant metastasis-free survival (DMFS) (2-year TTP: 50.5% vs. 28.1% vs. 24.2%, P = 0.003; 2-year DMFS: 83.4% vs. 61.1% vs. 67.2%, P = 0.027). No significant differences in 2-year local control (LC) rates were observed among the treatment groups (97.7% vs. 92.9% vs. 86.8%; P = 0.230). Multivariate analysis identified Proton-IO as an independent predictor of improved OS (P &lt;0.001), TTP (P &lt;0.001), and DMFS (P = 0.004). Grade 3–4 upper gastrointestinal (UGI) bleeding was observed in two (1.5%) patients (proton monotherapy, n = 1; Proton-IO, n = 1). There were no significant differences among the groups in the incidence of grade ≥3 UGI bleeding, liver toxicity, colitis, rib fractures, or hematologic adverse events.
Conclusion: In BCLC stage B/C HCC, proton radiotherapy combined with immunotherapy was significantly associated with higher OS, TTP, and DMFS without an increase in grade ≥3 toxicity compared with proton radiotherapy alone or in combination with TKIs.
DOI: 10.6084/m9.figshare.30868667.v1
title: Supplementary Material for: Proton Radiotherapy Alone versus Combined with Immunotherapies or Tyrosine Kinase Inhibitors for BCLC Stage B or C Hepatocellular Carcinoma

description: Purpose: This study aimed to compare the outcomes of proton radiotherapy alone versus its combination with immunotherapies (Proton-IO) or tyrosine kinase inhibitors (Proton-TKI) in patients with intermediate- to advanced-stage hepatocellular carcinoma (HCC).
Methods: We retrospectively reviewed the medical records of 137 patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC treated with proton radiotherapy at Linkou Chang Gung Memorial Hospital between 2020 and 2023. Patients were stratified into three groups: proton radiotherapy alone (n = 64), Proton-IO (n = 44), and Proton-TKI (n = 29). The most frequently used immuno-oncology agents were atezolizumab-bevacizumab (n = 33) and pembrolizumab (n = 5). Tyrosine kinase inhibitors (TKIs) included lenvatinib (n = 16) and sorafenib (n = 13).
Results: With a median follow-up of 30 months, patients in the Proton-IO group were significantly associated with higher 2-year overall survival (OS) rates compared with those receiving Proton-TKI or proton radiotherapy alone (77.0% vs. 47.2% vs. 52.7%; P = 0.002). Proton-IO was also associated with significantly longer time to progression (TTP) and distant metastasis-free survival (DMFS) (2-year TTP: 50.5% vs. 28.1% vs. 24.2%, P = 0.003; 2-year DMFS: 83.4% vs. 61.1% vs. 67.2%, P = 0.027). No significant differences in 2-year local control (LC) rates were observed among the treatment groups (97.7% vs. 92.9% vs. 86.8%; P = 0.230). Multivariate analysis identified Proton-IO as an independent predictor of improved OS (P &lt;0.001), TTP (P &lt;0.001), and DMFS (P = 0.004). Grade 3–4 upper gastrointestinal (UGI) bleeding was observed in two (1.5%) patients (proton monotherapy, n = 1; Proton-IO, n = 1). There were no significant differences among the groups in the incidence of grade ≥3 UGI bleeding, liver toxicity, colitis, rib fractures, or hematologic adverse events.
Conclusion: In BCLC stage B/C HCC, proton radiotherapy combined with immunotherapy was significantly associated with higher OS, TTP, and DMFS without an increase in grade ≥3 toxicity compared with proton radiotherapy alone or in combination with TKIs.
DOI: 10.6084/m9.figshare.30868670
title: Supplementary Material for: Epilepsy Surgery in Drug-Resistant Epilepsy Facilitated by Artificial Intelligence: A Case of Left Temporal Encephalocele

description: Epilepsy surgery remains substantially underutilised despite strong evidence supporting its efficacy for appropriately selected patients with drug resistant epilepsy. We describe the case of a 23 year old woman with a four year history of refractory focal impaired awareness seizures, experiencing up to four episodes per week despite multiple appropriately trialled antiseizure medications at maximally tolerated doses. Initial investigations including MRI, EEG, and paraneoplastic screening were unremarkable, and she was managed as having non lesional left temporal lobe epilepsy. As part of an artificial intelligence driven research initiative, a natural language processing based random forest algorithm reviewing free text neurology clinic documentation identified her as a potential surgical candidate. Complementary large language model analysis supported extraction of clinically relevant seizure and imaging information. This prompted re-evaluation of the case, with PET demonstrating left temporal hypometabolism and repeat MRI revealing a previously unrecognised encephalocele. She subsequently underwent left temporal lobe polectomy with encephalocele disconnection. The procedure was successful, and she has remained seizure free for one year post operatively, allowing initiation of ASM weaning and the possibility of long term cure.
This case illustrates both the transformative potential of epilepsy surgery for individuals with drug resistant epilepsy and the promising role of artificial intelligence augmented triage systems in reducing delays to surgical referral. Given the substantial morbidity, mortality, and economic burden associated with drug resistant epilepsy, timely surgical evaluation should be considered the standard of care for eligible patients. Integrating artificial intelligence enabled tools into clinical workflows may help overcome longstanding barriers to access and ensure that life changing interventions are offered earlier in the disease course.
DOI: 10.6084/m9.figshare.30868670.v1
title: Supplementary Material for: Epilepsy Surgery in Drug-Resistant Epilepsy Facilitated by Artificial Intelligence: A Case of Left Temporal Encephalocele

description: Epilepsy surgery remains substantially underutilised despite strong evidence supporting its efficacy for appropriately selected patients with drug resistant epilepsy. We describe the case of a 23 year old woman with a four year history of refractory focal impaired awareness seizures, experiencing up to four episodes per week despite multiple appropriately trialled antiseizure medications at maximally tolerated doses. Initial investigations including MRI, EEG, and paraneoplastic screening were unremarkable, and she was managed as having non lesional left temporal lobe epilepsy. As part of an artificial intelligence driven research initiative, a natural language processing based random forest algorithm reviewing free text neurology clinic documentation identified her as a potential surgical candidate. Complementary large language model analysis supported extraction of clinically relevant seizure and imaging information. This prompted re-evaluation of the case, with PET demonstrating left temporal hypometabolism and repeat MRI revealing a previously unrecognised encephalocele. She subsequently underwent left temporal lobe polectomy with encephalocele disconnection. The procedure was successful, and she has remained seizure free for one year post operatively, allowing initiation of ASM weaning and the possibility of long term cure.
This case illustrates both the transformative potential of epilepsy surgery for individuals with drug resistant epilepsy and the promising role of artificial intelligence augmented triage systems in reducing delays to surgical referral. Given the substantial morbidity, mortality, and economic burden associated with drug resistant epilepsy, timely surgical evaluation should be considered the standard of care for eligible patients. Integrating artificial intelligence enabled tools into clinical workflows may help overcome longstanding barriers to access and ensure that life changing interventions are offered earlier in the disease course.
DOI: 10.6084/m9.figshare.30868673
title: Supplementary Material for: Mineralizing Microangiopathy Presenting as Pediatric Stroke: A Case Report

description: Introduction:
Mineralizing angiopathy is a rare cause of pediatric stroke and has not previously been described in a Nordic European country. This case highlights the diagnostic value of CT imaging and the potential underdiagnosis of this condition in high-income countries.

Case presentation:
An 11-month-old previously healthy boy presented with acute left-sided hemiparesis, with a pediatric National Institutes of Health Stroke (pedNIHSS) score of nine. Initial CT revealed bilateral basal ganglia calcifications and tortuous internal carotid arteries. MRI confirmed an acute infarction in the right basal ganglia. The diagnosis of mineralizing angiopathy was made based on the neuroimaging findings, with sagittal CT views visualizing calcifications following the contours of deep perforating vessels. An extensive stroke workup, including cardiac and metabolic evaluations, was unremarkable. The patient received supportive care, was discharged with a pedNIHSS of five, and is under neurological follow-up.

Conclusion:
Mineralizing angiopathy may be underrecognized in pediatric stroke, particularly in settings where MRI is preferred over CT. Early CT imaging can aid diagnosis. Longitudinal follow-up may offer novel insights into the pathophysiology of vascular calcifications.
DOI: 10.6084/m9.figshare.30868673.v1
title: Supplementary Material for: Mineralizing Microangiopathy Presenting as Pediatric Stroke: A Case Report

description: Introduction:
Mineralizing angiopathy is a rare cause of pediatric stroke and has not previously been described in a Nordic European country. This case highlights the diagnostic value of CT imaging and the potential underdiagnosis of this condition in high-income countries.

Case presentation:
An 11-month-old previously healthy boy presented with acute left-sided hemiparesis, with a pediatric National Institutes of Health Stroke (pedNIHSS) score of nine. Initial CT revealed bilateral basal ganglia calcifications and tortuous internal carotid arteries. MRI confirmed an acute infarction in the right basal ganglia. The diagnosis of mineralizing angiopathy was made based on the neuroimaging findings, with sagittal CT views visualizing calcifications following the contours of deep perforating vessels. An extensive stroke workup, including cardiac and metabolic evaluations, was unremarkable. The patient received supportive care, was discharged with a pedNIHSS of five, and is under neurological follow-up.

Conclusion:
Mineralizing angiopathy may be underrecognized in pediatric stroke, particularly in settings where MRI is preferred over CT. Early CT imaging can aid diagnosis. Longitudinal follow-up may offer novel insights into the pathophysiology of vascular calcifications.
DOI: 10.6084/m9.figshare.30868676
title: Supplementary Material for: Immunomodulatory Therapy and Mortality in Patients with Sepsis: A Meta-Analysis

description: Objective: Sepsis, a severe infectious disease, is characterized by high mortality and significant therapeutic challenges. This study aims to systematically review the impact of immunomodulatory therapy on sepsis-related mortality and create an evidence-based foundation for sepsis treatment.
Methods: A systematic search was conducted in multiple databases including CNKI, VIP, Wanfang Data, and PubMed, with a cutoff date of November 6, 2024. The Cochrane Risk of Bias 2.0 tool was employed to evaluate the risk of bias for randomized controlled trials (RCTs), and NOS was used for non-randomized controlled trials (NRCTs). Data analyses were conducted via the R package meta, with relative risk (RR) and 95% CI as effect sizes. Heterogeneity was evaluated using Cochran's Q test and I² statistic, and publication bias was judged by funnel plot.
Results: A total of 1783 articles were retrieved, and 21 articles (including 22 comparison groups) were finally included after screening, involving 19 RCTs and 2 NRCTs with a total of 5276 patients. Meta-analysis results indicated that immunomodulatory therapy could reduce the risk of death in patients with sepsis (RR=0.87, 95% CI 0.81-0.93, I²=44%, P=0.01). Subgroup analysis revealed that the overall heterogeneity mainly came from Immunoglobulin G (IgG) therapy (I²=63%), while the effects of afelimomab, methylprednisolone, Xuebijing, α1-thymosin, and ulinastatin+α1-thymosin therapies were highly consistent with zero heterogeneity.
Conclusion: Immunomodulatory therapy can reduce the risk of death in patients with sepsis, but there is moderate heterogeneity, and its efficacy may be affected by factors such as the type of specific immunomodulatory therapy.
Keywords: sepsis; immunomodulatory therapy; mortality; heterogeneity; Meta-analysis
DOI: 10.6084/m9.figshare.30868676.v1
title: Supplementary Material for: Immunomodulatory Therapy and Mortality in Patients with Sepsis: A Meta-Analysis

description: Objective: Sepsis, a severe infectious disease, is characterized by high mortality and significant therapeutic challenges. This study aims to systematically review the impact of immunomodulatory therapy on sepsis-related mortality and create an evidence-based foundation for sepsis treatment.
Methods: A systematic search was conducted in multiple databases including CNKI, VIP, Wanfang Data, and PubMed, with a cutoff date of November 6, 2024. The Cochrane Risk of Bias 2.0 tool was employed to evaluate the risk of bias for randomized controlled trials (RCTs), and NOS was used for non-randomized controlled trials (NRCTs). Data analyses were conducted via the R package meta, with relative risk (RR) and 95% CI as effect sizes. Heterogeneity was evaluated using Cochran's Q test and I² statistic, and publication bias was judged by funnel plot.
Results: A total of 1783 articles were retrieved, and 21 articles (including 22 comparison groups) were finally included after screening, involving 19 RCTs and 2 NRCTs with a total of 5276 patients. Meta-analysis results indicated that immunomodulatory therapy could reduce the risk of death in patients with sepsis (RR=0.87, 95% CI 0.81-0.93, I²=44%, P=0.01). Subgroup analysis revealed that the overall heterogeneity mainly came from Immunoglobulin G (IgG) therapy (I²=63%), while the effects of afelimomab, methylprednisolone, Xuebijing, α1-thymosin, and ulinastatin+α1-thymosin therapies were highly consistent with zero heterogeneity.
Conclusion: Immunomodulatory therapy can reduce the risk of death in patients with sepsis, but there is moderate heterogeneity, and its efficacy may be affected by factors such as the type of specific immunomodulatory therapy.
Keywords: sepsis; immunomodulatory therapy; mortality; heterogeneity; Meta-analysis
DOI: 10.6084/m9.figshare.30868679
title: Supplementary Material for: Latex-contaminated kidney graft as a source of perioperative anaphylaxis: a case report

description: Introduction:
Latex allergy is a leading cause of perioperative anaphylaxis, yet the risk of graft-mediated exposure during solid organ transplantation is poorly characterised.

Case Presentation:
We report the case of a 45-year-old man with end-stage renal disease and confirmed latex allergy who underwent kidney transplantation with a graft that had been handled with latex gloves during procurement. Following multidisciplinary discussion, the graft was repeatedly rinsed with preservation solution to reduce antigenic load. The operating theatre was prepared as latex-free, and the anesthesia team implemented enhanced readiness for anaphylaxis. The surgery and perioperative course were uneventful, and the patient was extubated in theatre and transferred to intensive care without complication.

Conclusion:
This case underscores the potential for graft-mediated anaphylaxis due to latex contamination during procurement. Systematic latex avoidance from organ retrieval to implantation, along with communication between procurement and implant teams, is crucial to mitigate risk in sensitised recipients.
DOI: 10.6084/m9.figshare.30868679.v1
title: Supplementary Material for: Latex-contaminated kidney graft as a source of perioperative anaphylaxis: a case report

description: Introduction:
Latex allergy is a leading cause of perioperative anaphylaxis, yet the risk of graft-mediated exposure during solid organ transplantation is poorly characterised.

Case Presentation:
We report the case of a 45-year-old man with end-stage renal disease and confirmed latex allergy who underwent kidney transplantation with a graft that had been handled with latex gloves during procurement. Following multidisciplinary discussion, the graft was repeatedly rinsed with preservation solution to reduce antigenic load. The operating theatre was prepared as latex-free, and the anesthesia team implemented enhanced readiness for anaphylaxis. The surgery and perioperative course were uneventful, and the patient was extubated in theatre and transferred to intensive care without complication.

Conclusion:
This case underscores the potential for graft-mediated anaphylaxis due to latex contamination during procurement. Systematic latex avoidance from organ retrieval to implantation, along with communication between procurement and implant teams, is crucial to mitigate risk in sensitised recipients.