bluuebunny/crossref_metadata_2025_split huggingface dataset:
The contributions of relative brain viscosity to brain function and health
Authors: McIlvain Grace 
Published: December 2024

Abstract
Magnetic resonance elastography has emerged over the last two decades as a non-invasive method for quantitatively measuring the mechanical properties of the brain. Since the inception of the technology, brain stiffness has been the primary metric used to describe brain microstructural mechanics. However, more recently, a secondary measure has emerged as both theoretical and experimental significance, which is the ratio of tissue viscosity relative to tissue elasticity. This viscous-to-elastic ratio describes different but complementary aspects of brain microstructural health and is theorized to relate to microstructural organization, as opposed to stiffness, which is related to tissue composition. The relative viscosity of brain tissue changes regionally during maturation, aging and neurodegenerative disease. It also exhibits unique characteristics in brain tumours and hydrocephalus, and is of interest for characterizing traumatic head impacts. Most notably, regional measures of relative brain tissue viscosity appear to hold a unique role in describing cognitive function. For instance, in young adults, relatively lower hippocampal viscosity compared to elasticity repeatedly and sensitively relates to spatial, declarative and verbal memory performance. Importantly, these same trends are not found with hippocampal stiffness, or hippocampal volume, highlighting a potential sensitivity of relative viscosity to underlying cellularity that contributions to normal healthy brain function. Likewise in young adults, in the orbitofrontal cortex, lower relative viscosity relates to better performance on fluid intelligence tasks, and in the Broca’s area of children ages 5–7, lower relative viscosity is indicative of better language performance. In these instances, this ratio shows heightened sensitivity over other structural MRI metrics, and importantly, provides a quantitative and intrinsic alternative to measuring structure–function relationships with task-based fMRI. There are ongoing efforts to improve the accuracy and repeatability of the relative viscosity measurement, and much work is needed to reveal the cellular underpinning of changes to tissue viscosity. But it appears clear that regionally measuring the viscous-to-elastic ratio holds the potential to noninvasively reveal an aspect of tissue microstructure that is clinically, cognitively and functionally relevant to our understanding of brain function and health.
Dysplasia of the tricuspid valve leading to recurrent atrial flutter and fibrillation: a case report
Authors: Yoshida Taemi , Gatterer Edmund , Strouhal Andreas , Harrer Marieluise , Stöllberger Claudia 
Published: December 2024

Abstract

Background
Atrial flutter (AFL) is usually effectively treated by cavotricuspid isthmus (CTI) ablation. If AFL recurs despite ablation, there is risk of progression to atrial fibrillation (AF) and clinicians should consider underlying structural heart diseases. This consideration becomes especially critical when right-heart-chambers are dilated.

Case summary
A 50-year-old man presented with palpitations due to AFL. Fifteen years earlier, after polytrauma, mild tricuspid regurgitation (TR) and pericardial effusion had been diagnosed on transthoracic echocardiography (TTE). At present, TTE showed dilated right-heart-chambers and moderate TR. Despite two CTI-ablations, he developed AF for which he underwent pulmonary vein isolation (PVI). A further ablation was performed because of right-sided AFL due to transcrista conduction. Atrial fibrillation recurred, accompanied by heart failure. Tricuspid regurgitation severity and right-heart-chamber dilatation worsened. Finally, 3D-transoesophageal echocardiography (3D-TEE), performed 20 years after the first TTE, revealed that TR was due to restriction of the septal leaflet. The patient underwent surgery. The tricuspid valve was repaired by ring annuloplasty and a cleft between the anterior and septal leaflets was closed. Three years post-operatively, he is asymptomatic with chronic AF but no recurrent AFL. Transthoracic echocardiography shows only mild TR, though the right-heart-chambers remain dilated, likely due to long-standing TR.

Discussion
Tricuspid regurgitation and AFL/AF have a bidirectional relationship. Tricuspid regurgitation can both cause and result from AFL/AF. Structural heart diseases, including post-traumatic valve damage, should be considered in patients with recurrent AFL despite CTI-ablation and progression to AF. In cases with TR and right-heart-chamber enlargement, 3D-TEE is essential for accurate diagnosis and should be performed without delay.
Vaccines And Verdicts: How Smallpox Court Decisions Affect Anti-Vaccine Discourse and Mortality
Authors: Brehm Paul , Saavedra Martin 
Published: December 2024

Abstract
We estimate the effect of compulsory vaccination court decisions on anti-vaccine discourse and mortality. We measure anti-vaccine discourse using language in American newspapers. Using human-classified training data and machine learning techniques, we predict anti-vaccine discourse for nearly 48,000 newspaper pages. Staggered difference-in-differences estimates show that anti-vaccine discourse increased for a period of two years after pro-vaccine state-level Supreme Court decisions before returning to baseline. Regression-discontinuity-in-time estimates yield similar findings following the Jacobson v. Massachusetts US Supreme Court decision. While compulsory vaccinations increase anti-vaccine discourse, mandates appear to remain effective, and we estimate that smallpox mortality rates fell in the wake of pro-vaccine decisions.
Successful Treatment of Candida auris Ventriculitis With Intravenous Liposomal Amphotericin B and Oral Flucytosine: A Case Report
Authors: Kang Nayoung , Hsu Victor Yu-Ching , Bailey Charles Christopher 
Published: December 2024

Abstract
Candida auris is a rapidly emerging fungal pathogen associated with high resistance rates, particularly in healthcare settings. It most commonly affects patients with severe underlying medical conditions and requiring complex medical care. Patients with invasive medical devices tend to be at increased risk for getting C auris and developing infection. This article presents a case of C auris ventriculitis successfully treated with intravenous liposomal amphotericin B and oral flucytosine. A 41-year-old man with multiple comorbidities, including recent placement of a ventriculoperitoneal shunt, presented with suspected sepsis. Candida auris was isolated from cerebrospinal fluid cultures. Antifungal therapy along with removal of the shunt led to resolution of infection without complications. This case highlights the challenges posed by C auris infections and underscores the importance of appropriate treatment strategies.
Improving Senior Nursing Students’ Readiness Through Screen-Based Virtual Multipatient Simulation
Authors: Whiffen Lisa A. , DiCarlo Kristine 
Published: December 2024

Abstract
The goal in nursing education is to prepare students with knowledge, skills, and abilities to thrive as professional nurses. The purpose of this quasi-experimental quantitative study was to evaluate the use of a screen-based, virtual multipatient simulation for improving self-perception of readiness for practice in a sample of senior nursing students. Utilizing the Casey-Fink Readiness for Practice Survey, the results showed a significant increase in self-perception of readiness. Providing multipatient experiences through simulation can prepare nursing students with requisite skills to transition into professional practice.
Developing Practice Guidelines on Chest Masculinization: Designing Male Neo-nipple–Areolar Complex
Authors: Alaniz Leonardo , Ventura Jenny , Ghafari Arman , Cho Hoyune E. , Willens Sierra , Arora Jagmeet , Vallurupalli Medha , Cordero Justin , Tang Cathy J. 
Published: December 2024

Background:
Successful nipple–areolar complex (NAC) reconstruction greatly influences patient outcomes for transgender patients undergoing chest masculinization. Despite the recent rise in case volume, little is known on designing the ideal NAC that maintains its aesthetics in dynamic settings. This study aimed to examine the characteristics of male NACs and their dimensional variability to help develop guidelines on designing the neo-NAC.

Methods:
Thirty cisgender male participants were enrolled. NAC height and width, sternal notch-to-nipple distance, and internipple distance (IND) were measured in standing and supine positions with stable room temperature to prevent measurement bias. Other variables recorded included chest circumference, NAC angulation, body mass index, weight, height, age, and ethnicity.

Results:
Mean standing and supine measurements were as follows: NAC height, 21.2 mm (SD, 3.9) versus 23.4 mm (SD, 4.7); NAC width, 29.0 mm (SD, 5.1) versus 29.7 mm (SD, 5.6); sternal notch-to-nipple distance, 20.8 cm (SD, 2.1) versus 19.3 cm (SD, 1.8); and IND, 22.4 cm (SD, 2.3) versus 23.5 cm (SD, 2.5). NAC height-to-width ratio decreases from supine to standing, as well as IND, indicating a medialization of the NACs when upright.

Conclusions:
Our findings suggest that during chest masculinization surgery, the design of the male neo-NAC has a risk of being positioned too medial and elliptical with upright positioning. Care must be taken intraoperatively to account for changes in neo-NAC dimensions that occur with body position changes. We strongly recommend that surgeons determine the final position of the neo-NAC intraoperatively while having the patient in upright sitting position.
Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience
Authors: Rhodes Isaiah J. , Arbuiso Sophia , Alston Chase C. , Zhang Ashley , Medina Samuel J. , Liao Matthew , Chesang Patricia , Hayden Giles , Batdorf Niles J. , Rhodes William R. , Otterburn David M. 
Published: December 2024

Background:
Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures.

Methods:
A retrospective chart review was conducted on patients who received a free flap at the Kapsowar Hospital in 2022–2023. Captured parameters included age, sex, relevant medical history, etiology of wound, flap performed, intraoperative time, complications, surgical revisions, and length of stay. Billing information for all domestic patients who received free flaps were audited, and disability-adjusted life years was calculated.

Results:
Nineteen free flaps were performed on 17 patients. The most common flap performed was the anterolateral thigh flap (n = 11). Flap survival rate was 94.7%. The surgical cost associated with performing an anterolateral thigh flap was $548 ± $35. The total cost associated with other free flap performances was $863 ± $269. The cost per disability-adjusted life years averted was $121, indicating that the procedure was very cost-effective.

Conclusions:
Despite obstacles, microsurgical practices can be safely established in limited-resource African settings. Free flaps can be performed with greater cost-efficiency when performed by local teams. Surgical mission trips should emphasize educational components and ultimately transition care to local surgeons.
Risk prediction models for non-invasive ventilation failure in patients with chronic obstructive pulmonary disease: A systematic review
Authors: Gao Yuming , Yuan Bo , Fan Peng , Li Mingtao , Chen Jiarui 
Published: December 2024

Background:
Chronic obstructive pulmonary disease (COPD) is a common respiratory condition with high morbidity and mortality. Noninvasive mechanical ventilation (NIV) is often used to manage acute COPD exacerbations, but failure can lead to worse outcomes. This systematic review aimed to evaluate risk prediction models for NIV failure in patients with COPD.

Methods:
PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CBM, CNKI, Wanfang, and VIP databases, from database inception to January 10, 2024, were searched for studies on risk prediction models for failure in NIV among COPD patients. Two reviewers independently screened the literature, extracted data, assessed the quality of included studies using the Prediction Model Risk of Bias Assessment Tool, and conducted a systematic evaluation of the prediction models.

Results:
A total of 11 studies were included, encompassing 13 risk prediction models. The area under the receiver operating characteristic curve for the included models ranged from 0.810 to 0.978. Predictive factors in the models mainly included Acute Physiology And Chronic Health Evaluation II score, pH value, PaCO2, consciousness status, serum albumin level, and respiratory rate.

Conclusion:
Existing risk prediction models for failure in NIV among patients with COPD demonstrated overall good predictive performance, but exhibited a risk of bias. Further validation is needed to assess the clinical applicability of these models.
Idiopathic non-cirrhotic portal hypertension: A case report
Authors: Nie Qilong , Liang Qiuyan , Li Mingyang , Zhu Ronghuo , Ren Jian , Jiang Kaiping , Li Jianhong 
Published: December 2024

Rationale:
Idiopathic noncirrhotic portal hypertension (INCPH) is a rare liver disorder with elevated portal pressure without cirrhosis, making diagnosis challenging. This case report presents a 46-year-old Chinese male with INCPH, highlighting the crucial role of liver biopsy.

Patient concerns:
A 46-year-old male presented with persistent fatigue that lasted for 2 months and significantly worsened over the last 3 days. The patient described his fatigue as a profound lack of energy that persisted throughout the day, which progressively impaired his ability to perform daily activities and maintain his usual work responsibilities. He reported feeling exhausted even after light physical exertion, such as walking or standing for short periods. The severity of the fatigue also led to frequent short rests during the day, and he experienced difficulty concentrating and carrying out routine tasks. In addition, he noted a loss of appetite and mild discomfort in the upper abdomen. Given his previous history of abnormal liver function tests and a liver biopsy showing mild chronic liver damage, the patient was initially diagnosed with cirrhosis at a local hospital. This initial diagnosis caused significant emotional distress, as the patient experienced a state of panic and anxiety over the implications of having a progressive liver disease. The psychological burden was evident in his reported difficulty sleeping and persistent worry about his health and future.

Diagnoses:
Initial imaging suggested portal hypertension and cirrhosis, but a liver biopsy ruled out cirrhotic changes, confirming INCPH by excluding other causes such as chronic hepatitis.

Interventions:
The patient received symptomatic treatment (acid suppression, gastric and liver protection) and underwent a liver biopsy. Histological analysis confirmed INCPH, ruling out cirrhosis.

Outcomes:
After the definitive diagnosis, the patient’s anxiety lessened. Fatigue and weakness improved with ongoing symptomatic treatment, and psychological support enhanced his overall well-being. His follow-up plan includes regular liver function monitoring, imaging for portal pressure changes, and potential anticoagulation therapy for thrombosis risks.

Lessons:
This case highlights the diagnostic difficulty of INCPH and underscores the importance of liver biopsy. Further research is needed to develop specific diagnostic tools and treatments for INCPH.
Genetic variation and clinical phenotype analysis of hypermethioninemia caused by MAT1A gene mutation: Case report
Authors: Mu Jialin , Li Yulin , Sun Meng , Li Panpan , Wang Jingyun , Zou Hui 
Published: December 2024

Rationale:
The high clinical heterogeneity of hypermethioninemia caused by MAT1A gene defects has resulted in a paucity of studies examining the association between clinical phenotypes, biochemical characteristics, and gene mutations in this patient group. Furthermore, the indications for therapeutic interventions in patients remain unclear. The objective of this study is to provide a foundation for clinical diagnosis, genetic counseling, and follow-up management of hypermethioninemia caused by MAT1A gene defects.

Patient concerns:
A retrospective analysis of children with hypermethioninemia at Jinan Maternal and Child Health Hospital from January 2016 to December 2023 was performed using tandem mass spectrometry (MS/MS). The screened and diagnosed children were tested for gene mutations using second-generation sequencing technology and confirmed using Sanger sequencing.

Diagnoses:
Newborn MS/MS screening for diseases demonstrated an elevated methionine level, which was outside the reference range. Upon recalling the newborns, the methionine levels remained elevated, necessitating further refinement of genetic testing. Ultimately, genetic testing confirmed hypermethioninemia, which was attributed to a mutation in the MAT1A gene.

Interventions:
The intervention for the patients in this study took the following forms: regular follow-up without treatment (n = 3), intake of methionine-free milk powder without any medication (n = 4), intake of methionine-free milk powder with some medication, and eventually liver transplantation (n = 1).

Outcomes:
A total of 14 mutation types were detected, including 3 compound heterozygous mutation types (c.926G > T, c.37_38delCT, and c.316G > A) that have not been previously reported. One patient had monoheterozygous mutations, including the novel mutation c.550-1G > A. Eight cases were monitored over time, 7 of which demonstrated typical growth and development. One infant with growth retardation was fed a special formula lacking methionine. The patient underwent liver transplantation. Subsequent follow-up examinations showed methionine and homocysteine levels within normal limits and no further neurological manifestations.

Lessons:
Compound heterozygous mutations c.874C > T and c.896G > A may result in higher levels of methionine, affecting the central nervous system. For newborns with initial methionine levels of >500 µmol/L, treatment with a low-Met diet is recommended. Liver transplantation may be beneficial for children with severe hypermethioninemia, particularly in preventing central nervous system damage.
A rare perspective: fine-needle aspiration cytologic features of hyaline vascular type of Castleman disease: A case report
Authors: Shi Xiang , Wangsun Yingyuan , Wan Meiping , Li Sanyan 
Published: December 2024

Rationale:
Castleman disease, also known as Castleman syndrome, is a rare, nonmalignant lymphoproliferative disorder. The localized subtype of this disease is primarily the hyaline vascular type of Castleman disease (HVCD). Although this disease is a benign lesion, the histologic features are similar to those of some malignant lymphomas, so an accurate diagnosis of the disease is required. Lymph node hyperplasia lesions are usually diagnosed mainly by relying on biopsy histopathology, but the surgical process is time-consuming and expensive, and a part of patients usually refuse to undergo this examination method. Fine-needle aspiration cytology (FNAC) is a convenient, rapid, minimally invasive test for surface masses, and patients often receive cytopathology results in as little as a few minutes. Currently, there are few reports on the pathological features of FNAC in HVCD, so our cytopathological experience of using FNAC for rapid diagnosis of HVCD and other diseases that need to be differentiated are described in detail to give some meaningful references to the pathologists in recognizing HVCD from a rare cytological point of view.

Patient concerns:
A late 50s female patient presented to the hospital with a single subcutaneous enlarged nodule in the right side of the neck, which had been present for >6 months. The nodule exhibited a relatively clear border, and the patient presented with no signs of pain, no skin damage, and no other notable symptoms, but was concerned about the benignity or malignancy of the enlarged nodule.

Diagnoses:
To determine the exact diagnosis of the neck nodule, the patient first underwent FNAC, followed by surgical excision of the neck nodule for histopathologic examination.

Interventions:
Since HVCD is a benign lesion and the superficial neck nodes were removed by minimally invasive surgery, the patient did not receive any other interventions.

Outcomes:
We successfully and accurately diagnosed the rare HVCD using FNAC. Histologically similar lesion features of HVCD were successfully observed in cytology. The cytologic pattern of HVCD is distinctly different from that of other benign lymphoid tissue proliferative lesions or metastatic carcinomas.

Lessons:
This case shows important cytologic features for the diagnosis of HVCD using FNAC. The FNAC results showed abundant follicular dendritic cells and transparent blood vessels, and these cytologic features recapitulate the histopathologic alterations that were seen in HVCD. So by observing these cytologic features can help us to make an accurate diagnosis of HVCD using FNAC.
Umbilical needling therapy for neck pain during pregnancy: A case report
Authors: Zheng Lifang , Yao Shana , Jin Yabei , Sun Zhanling 
Published: December 2024

Rationale:
Neck pain during pregnancy is a common disease during pregnancy. It is urgent to find a safe and effective method without side effects. Acupuncture therapy including umbilical needling has been widely used in many diseases. But there is no report in such cases.

Patient concerns:
We report a case of umbilical needling therapy for neck pain during pregnancy and explore its possible mechanism of action. A 35-year-old Chinese woman was pregnant for more than 7 months and had neck pain for 1 week.

Diagnoses:
Neck pain was diagnosed in Western medicine, and neck arthralgia in traditional Chinese medicine. The syndrome differentiation was wind-cold arthralgia.

Interventions:
One patient with neck pain during pregnancy was treated with umbilical needling. According to the 12 branches and the 8 trigrams in the umbilicus, the umbilical needling Zhuque 3 acupuncture and di Tiantai guayi acupuncture were used to treat neck pain during pregnancy. The clinical improvement was evaluated by the changes in clinical symptoms and signs and the improvement rate of the Visual Analogue Scale score.

Outcomes:
After 7 times umbilical needling treatments, the improvement rate of neck pain symptoms and Visual Analogue Scale score of pregnant women reached 100%.

Lessons:
These results show that umbilical needling therapy can effectively improve the clinical symptoms of neck pain during pregnancy without affecting the fetus. Umbilical needling in neck pain treatment during pregnancy should be further investigated.