bluuebunny/crossref_metadata_2025_split huggingface dataset:
Over-supplement of vitamin D may cause delirium, abdominal distension, and muscle weakness in the elderly: A case report and literature review
Authors: Yu Ching-Hsiang , Tseng Hsiang-Kuang , Chien Ding-Kuo , Liao En-Chih 
Published: December 2024

Rationale:
Vitamin D deficiency is common among the elderly due to limited sunlight exposure, increasing osteoporosis risk. Over-supplementation poses risks, especially with caregiver involvement.

Patient concerns:
Rising vitamin D overdose cases underscore the need for better education on safe intake and monitoring practices to prevent toxicity, particularly hypercalcemia from excessive doses.

Diagnoses:
This case report details the clinical presentation and management of a woman who exhibited progressive lower limb weakness, delirium, and abdominal distension over a 3-day period. Initial assessments ruled out intracranial hemorrhage but revealed significant electrolyte imbalances, including hyponatremia, hypokalemia, hypomagnesemia, and severe hypercalcemia. Upon further inquiry, it was discovered that the patient had consumed an excessive amount of liquid Vitamin D3 over the preceding 3 weeks, surpassing the threshold for vitamin D intoxication.

Interventions:
Intravenous fluid hydration was initiated to promote calcium excretion. Bisphosphonates and calcitonin were administered to reduce serum calcium levels. Electrolyte imbalances, including hyponatremia, hypokalemia, and hypomagnesemia, were corrected. Continuous monitoring and supportive care were provided in the geriatric ward.

Outcomes:
After these treatments, the patient’s electrolyte levels stabilized, and her symptoms, such as confusion and muscle weakness, gradually improved, leading to a full recovery.

Lessons:
This case underscores the importance of recognizing hypercalcemia, particularly in the elderly, where symptoms may manifest nonspecifically. Additionally, it highlights the potential risks associated with medication errors and inadvertent overdoses, particularly in situations involving elderly spousal caregivers.
Musculoskeletal ultrasound-guided needle knife therapy in the treatment of refractory nonspecific low back pain: A single-blind, randomized controlled trial
Authors: Li Xia , Zhang Hongkai , Zhang Sidi , Wu Mingqi , Wang Shiyun , Tang Zhanying , Xiao Jing 
Published: December 2024

Background:
This clinical study aimed to evaluate the Numerical Rating Scale (NRS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores at 2, 4, 6, and 12 weeks, and the thickness of the 4th lumbar multifidus under ultrasound at 6 and 12 weeks, using musculoskeletal ultrasound (MU)-guided needle-knife loosening therapy for treating refractory nonspecific low back pain (RNSLBP) compared to usual care, to demonstrate the clinical efficacy of needle knife therapy for RNSLBP. This study used a single-blind, randomized controlled design.

Methods:
A total of 66 patients with RNSLBP who met the inclusion criteria were randomly divided into an observation group and a control group of 33 patients. The observation group underwent MU-guided needle knife release for RNSLBP, whereas the control group underwent low-frequency transcutaneous electrical nerve stimulation therapy, exercise therapy, and oral celecoxib capsules if necessary.

Results:
No statistically significant differences were observed in the baseline data (sex, age, body mass index, disease duration, NRS score, ODI score, JOA score, and 4th lumbar multifidus muscle thickness) (P > .05) between the 2 groups, with both groups having flat baseline and comparable indices. After 2, 4, 6, and 12 weeks of treatment, NRS and ODI scores decreased, while JOA scores increased in both groups, with statistically significant differences both within and between the 2 groups. The observation group showed better results than did the control group. The difference in multifidus muscle thickness between the 2 groups was not statistically significant after the final treatment; however, at the 12-week follow-up, the observation group showed significantly greater multifidus muscle thickness than the control group, with a statistically significant difference.

Conclusion:
This study demonstrated that MU-guided needle knife release effectively treats RNSLBP by reducing pain, improving lumbar spine function, and increasing the multifidus muscle thickness. It is efficient, safe, has a shorter treatment period, and causes fewer adverse reactions.
Predictive value of platelet parameters for bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis
Authors: Zhang Shunyou , He Yulin , Liu Chonghai 
Published: December 2024

Background:
To systematically evaluate the predictive value of platelet (PLT) parameters for bronchopulmonary dysplasia (BPD) in preterm infants.

Methods:
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for studies on PLT parameters predicting BPD in preterm infants from inception to December 2023. The Newcastle-Ottawa Scale was adopted to judge the article’s quality. RevMan 5.4 was utilized for Meta-analysis, and Stata/SE 15.1 was applied for sensitivity analysis and Egger regression test.

Results:
Ten studies were included, including 1637 preterm infants, of which 540 were diagnosed with BPD. Meta-analysis showed that PLTs (SMD = −0.98, 95% CI [−1.57, −0.38], P = .001), mean platelet volume (MPV) (SMD = 0.67, 95% CI [0.19, 1.15], P = .006), and PMI (SMD = −0.47, 95% CI [−0.65, −0.28], P < .00001) could assist in predicting BPD in preterm infants. Subgroup analyses showed that PLT parameters 3 days after birth had better predictive performance for BPD in preterm infants. Sensitivity analysis implied no significant change in the results after excluding the studies 1 by 1, suggesting robust results of meta-analysis. There was a significant publication bias in the enrolled studies (P < .001).

Conclusion:
PLT, MPV, and PMI have a predictive value for BPD in preterm infants.
The clinical and radiographic features of eastern equine encephalitis: A single-center retrospective case series
Authors: Garcia-Dominguez Maria A. , Moonis Majaz , Kipkorir Vincent , Srichawla Bahadar S. 
Published: December 2024

Rationale:
This case series aims to describe the clinical and radiographic findings associated with eastern equine encephalitis (EEE) virus.

Patient concerns:
Patients in this series presented with a variety of neurological symptoms, including altered mental status, seizures, and focal neurological deficits. Common initial concerns included confusion, hemiparesis, fever, and flu-like symptoms. In all cases, the progression of neurological symptoms prompted urgent medical evaluation and hospitalization.

Diagnoses:
Diagnosis of EEE was confirmed in all 4 patients by detection of EEE-specific IgM antibodies in cerebrospinal fluid. Cerebrospinal fluid studies also showed elevated protein, red blood cells, normal or high glucose, and elevated white blood cells with lymphocytic or neutrophil predominance. Magnetic resonance imaging showed T2 hyperintensities in the basal ganglia, thalamus, and cortical regions. Two cases showed encapsulation as evidence by a hyperintense ring around the basal ganglia or thalamus. Electroencephalogram findings ranged from normal, focal irritability, and spikes to nonconvulsive status epilepticus. Clinical and/or electrographic evidence of seizure was seen in all 4 cases.

Interventions:
All patients received supportive care, including anticonvulsant therapy, often using levetiracetam. Two patients were treated with high-dose intravenous methylprednisolone and one with intravenous immunoglobulin (IVIG) to modulate the immune response. Empiric antibiotics and antivirals were initiated in most cases until the diagnosis of EEE was confirmed. Two patients required intubation and mechanical ventilation, one of which was due to seizure activity and nonconvulsive status epilepticus.

Outcomes:
We report a 1/4 (25%) mortality rate. The average hospital stay among survivors was 10 days. Two-fourth (50%) required intubation and mechanical ventilation. Two patients were discharged to rehabilitation facilities, one patient recovered fully with resolution of magnetic resonance imaging abnormalities at follow-up, and one patient experienced a fatal outcome after the family opted to withdraw care due to a poor prognosis.

Lessons:
This case series underscores the importance of maintaining a high clinical suspicion of EEE in patients with acute neurological symptoms, especially in endemic areas. Early diagnosis and treatment are crucial, but the variability in presentation and imaging findings complicates this process. Early use of high-dose steroids can improve outcomes.
Review of Point-of-Care Diaphragmatic Ultrasound in Emergency Medicine
Authors: Kharasch Sigmund J. , Salandy Sonja , Hoover Paloma , Kharasch Virginia 
Published: December 2024

Abstract
The diaphragm is the major muscle of inspiration accounting for approximately 70% of the inspired tidal volume. Point-of-care diaphragmatic ultrasound offers the ability to quantitatively assess diaphragmatic function, perform serial evaluations over time, and visualize structures above and below the diaphragm. Although interest in point-of-care ultrasound (POCUS) of the diaphragm is developing in the emergency medicine, assessment of the diaphragm and its function is not recognized as a core application by national organizations or expert guidelines. As a result, it is infrequently performed, and its potential value in research or clinical practice may not be fully appreciated. The purpose of this review is to describe the developmental aspects of the diaphragm as it pertains to POCUS, discuss the POCUS techniques for evaluating diaphragmatic function, address competency acquisition in this POCUS application, summarize relevant research in the ED, and provide a summary of recommendations for further research and clinical utilization of POCUS in diaphragm evaluation.
Risk and Mortality of Cardiovascular Diseases in Patients with Dupuytren’s Disease: A Nationwide Population-Based Cohort Study
Authors: Ryu Jeong Yeop , Park Tae Hwan , Lee Joon Seok , Choi Kang Young , Yang Jung Dug , Chung Ho Yun 
Published: December 2024

Background:
Dupuytren’s disease (DD) is a type of fibroproliferative disease that involves the palmar aspect of the hand. Although many benign fibroproliferative diseases have been shown to increase the risk of cardiovascular disease, the relationship between DD and myocardial infarction (MI) or stroke has not been fully elucidated.

Methods:
A total of 35,909 patients with DD and a control cohort with 1,077,270 age- and sex-matched participants from the Korean National Health Insurance database were included. The incidence of MI, stroke, and survival after cardiovascular events, were compared between participants with DD and the control cohort.

Results:
Compared with the control cohort, the incidence rate ratio for cardiovascular diseases in DD was 1.51 (95% confidence interval, CI 1.44–1.58) for MI, 2.01 (CI 1.94–2.09) for ischemic stroke (IS), and 1.49 (CI 1.36–1.63) for hemorrhagic stroke (HS). After adjusting for other cardiovascular disease risk factors, DD was associated with an increased risk of IS. Based on the age-, sex-, and BMI-stratified analyses, an increased risk of MI was identified in the younger age group (<50 years) and thin subjects (BMI<18.5 kg/m2). Adjusted hazard ratios for mortality in subjects with DD who developed cardiovascular diseases were 0.51 (CI 0.43–0.60), 0.56 (CI 0.50–0.62), and 1.08 (CI 0.86–1.36), respectively.

Conclusions:
DD is associated with an increased risk of IS, independent of cardiovascular risk factors. DD is also associated with an increased risk of MI in individuals younger than 50 years of age. DD did not significantly aggravate mortality secondary to cardiovascular events.
Moving Towards the Outpatient DIEP Flap: Factors Influencing Early Discharge
Authors: Graziano Francis D. , Plotsker Ethan L. , Amakiri Uchechukwu O. , Shammas Ronnie L. , Vingan Perri S. , Mehrara Babak J. , Stern Carrie S. , Nelson Jonas A. , Matros Evan , Allen Robert J. 
Published: December 2024

BACKGROUND:
Enhanced Recovery After Surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay due to difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and assess safety of earlier discharge.

METHODS:
A retrospective review was performed of all patients who underwent unilateral DIEP reconstruction between January 2021 and December 2022 at Memorial Sloan Kettering. We assessed patient characteristics, comorbidities, and complications to identify correlations with LOS and milestone completion after implementation of an ERAS protocol.

RESULTS:
A total of 278 patients were included; the median LOS was 2.25 days (interquartile range: 2.19,2.33). Factors associated with delayed discharge included increased age, increased operative time, history of diabetes, and history of immunologic disease. Increased operative time was the only variable associated with prolonged milestone completion. A sub-analysis of the safety of an earlier discharge goal of postoperative day 1 when compared to a goal of postoperative day 2 demonstrated no significant differences in complication rates.

CONCLUSIONS:
Discharge timing and milestone completion after unilateral DIEP flap reconstruction is variable and dependent on patient and operative characteristics. These insights can aid in patient optimization and may suggest ERAS protocol adjustments to enable earlier discharge for more patients. Furthermore, earlier discharge goals appear safe for appropriate patients.
225Ac-PSMA-617 Augmentation After Insufficient Response Under 177Lu-PSMA-617 Radioligand Therapy in mCRPC: Evaluation of Outcome and Safety From a Prospective Registry (REALITY Study)
Authors: Rosar Florian , Khreish Fadi , Nagel Lea Sophie , Blickle Arne , Burgard Caroline , Petto Sven , Bastian Moritz B. , Speicher Tilman , Bartholomä Mark , Maus Stephan , Schaefer-Schuler Andrea , Ezziddin Samer 
Published: December 2024

Background
Even though the introduction of 177Lu-PSMA-617 RLT represents a major milestone in the treatment of mCRPC, there are still patients who do not respond adequately to this therapy and for whom there are only limited options left. Augmenting 177Lu-PSMA-617 RLT with the alpha-emitter 225Ac-PSMA-617 may present an escalating treatment option to increase efficacy. In this study, we aim to evaluate outcome and safety of 225Ac-PSMA-617 augmentation to 177Lu-PSMA-617 RLT in patients who present insufficient response to monotherapy with 177Lu-PSMA-617 RLT.

Patients and Methods
The study included n = 51 mCRPC patients enrolled in a prospective registry receiving 177Lu-PSMA-617 monotherapy and showing insufficient response, followed by initiation of 225Ac-PSMA-617 augmentation, with adjusted activities depending on individual patient characteristics. Biochemical response, progression-free survival, and overall survival were assessed. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE v.5.0).

Results
After initiation of 225Ac-PSMA-617 augmentation to 177Lu-PSMA-617 RLT, 24/51 patients (47.1%) exhibited partial remission, 16/51 (31.4%) stable disease, and 11/51 (21.6%) progressive disease. The median progression-free survival and overall survival rates were 6.3 months and 9.1 months, respectively. The majority of CTCAE gradings remained stable after initiating augmentation. Severe adverse events were rare, and no treatment termination due to side effects was recorded.

Conclusions

225Ac-PSMA-617 augmented 177Lu-PSMA-617 radioligand therapy seems to be an effective escalating treatment option in patients after failure of conventional 177Lu-PSMA-617 RLT and represents a promising approach balancing antitumor effect and tolerable side effects.
Advancing Healthcare AI Governance: A Comprehensive Maturity Model Based on Systematic Review
Authors: Hussein Rowan , Zink Anna , Ramadan Bashar , Howard Frederick M , Hightower Maia , Shah Sachin , Beaulieu-Jones Brett K 
Published: December 2024

AbstractArtificial Intelligence (AI) deployment in healthcare is accelerating, yet comprehensive governance frameworks remain fragmented and often assume extensive resources. Through a systematic review of 22 frameworks published between 2019-2024, we identified seven critical domains of healthcare AI governance: organizational structure, problem formulation, external product evaluation, algorithm development, model evaluation, deployment integration, and monitoring maintenance. While existing frameworks provide valuable guidance, they frequently target only large academic medical centers, creating barriers for smaller healthcare organizations. To address this gap, we propose the Healthcare AI governance Readiness Assessment (HAIRA), a five-level maturity model that provides actionable governance pathways based on organizational resources and capabilities. HAIRA spans from Level 1 (Initial / Ad Hoc) suitable for small practices to Level 5 (Leading) for major academic centers, with specific benchmarks across all seven governance domains. This tiered approach enables healthcare organizations to assess their current AI governance capabilities and establish appropriate advancement targets. Our framework addresses a critical need for adaptive governance strategies that can support AI-enabled healthcare value across diverse settings and ensures that AI implementation delivers tangible benefits to healthcare systems of varying sizes and resource levels.
Weight Transfer in the Reinforcement Learning Model of Songbird Acquisition
Authors: Tran Khue , Koulakov Alexei 
Published: December 2024

AbstractSong acquisition behavior observed in the songbird system provides a notable example of learning through trial- and-error which parallels human speech acquisition. Studying songbird vocal learning can offer insights into mechanisms underlying human language. We present a computational model of song learning that integrates reinforcement learning (RL) and Hebbian learning and agrees with known songbird circuitry. The song circuit outputs activity from nucleus RA, which receives two primary inputs: timing information from area HVC and stochastic activity from nucleus LMAN. Additionally, song learning relies on Area X, a basal ganglia area that receives dopaminergic inputs from VTA. In our model, song is first acquired in the HVC-to-Area X connectivity, employing an RL mechanism that involves node perturbation. This information is then consolidated into HVC-to-RA synapses through a Hebbian mechanism. The transfer of weights from Area X to RA takes place via the thalamus, utilizing a specific form of spike-timing-dependent plasticity (STDP). Thus, we present a computational model grounded in songbird circuitry in which the optimal policy is initially guided by RL and subsequently transferred to another circuit through Hebbian plasticity.
Gender minorities at music festivals
Authors: Kinnunen Maarit , Honkanen Antti 
Published: December 2024

PurposeThe purpose was to examine the prevalence and type of inappropriate behaviour gender minorities face and how they perceive such behaviour. The study is framed within Gidley et al.’s social inclusion model, indicating areas where actions are needed to avoid social exclusion.Design/methodology/approachThe research data comprised over 12,000 responses to a web survey, which included 184 responses from gender minority members and four in-depth, semi-structured interviews. The data were analysed using statistical methods and interpretative phenomenological analysis.FindingsAbout 59% of gender minority members had experienced inappropriate behaviour, compared to 34% of female festival attendees. The most common form of inappropriate behaviour towards gender minorities was harassment because of gender, followed by sexual harassment, physically threatening situations and harassment because of appearance or clothing. Interviews were analysed against the theoretical framework of social inclusion, determining how the experiences influenced access, participation and empowerment.Practical implicationsFestivals must have unisex toilets. Safer space policies should be better communicated, more visible and more practical. Instead of having one harassment contact person, there should be a whole team. Training the festival personnel, particularly the security staff, is highly important. People are reluctant to report problems to the security personnel since those personnel might be part of the problem. There should be members of gender minorities among performers, workers, security staff and volunteers.Originality/valueStudies on inappropriate behaviour at festivals have concentrated on female experiences of sexual harassment. Gender minorities have hardly been studied, even though they face more inappropriate behaviour than any other minority group. Furthermore, gender minorities are typically grouped with sexual minorities even though their experiences differ from one another. We applied Gidley et al.’s hierarchical model of social inclusion to gender minority members in the context of music festivals. In doing so, we added knowledge of attitudes and practices that reduce and endanger feelings of access, participation and empowerment.
Study on the sealing mechanism of ribbed oil-slinging ring composite seal at the axle end of high-speed train gearboxes
Authors: Lin Jiaxu , Li Yana , Liu Ziyuan , Liu Yu , Li Baoliang , Sha Zhihua 
Published: December 2024

Purpose
This study aims to investigate the sealing performance of a novel ribbed oil-slinging ring composite seal (ROSRCS) for the axle end of train gearboxes. The ROSRCS design incorporates added ribs and an inclined outer edge to enhance the sealing mechanism and reduce oil leakage.

Design/methodology/approach
Computational fluid dynamics simulations were used to analyze the leakage characteristics of ROSRCS under varying angles, outer edge inclinations and rib numbers and heights. The sealing performance was compared to a traditional oil-slinging ring composite seal (OSRCS). Key parameters such as oil leakage rate, turbulence dissipation intensity and jet strength were evaluated.

Findings
Results indicate that ROSRCS reduces the oil leakage rate by 5.7% compared to OSRCS. At a slinger ring inclination of 35°, the turbulence dissipation center in the ROSRCS flow field shifts toward the inlet, increasing the maximum turbulence dissipation intensity by 22.56%. A proper outer edge inclination enhances jet intensity, strengthening turbulence dissipation by up to 9.21%. While adding ribs may generate negative pressure zones, strategic rib configurations improve axle-end sealing performance by modifying the number, position and intensity of vortices.

Originality/value
This research presents a refined composite seal design that enhances the sealing efficiency of train gearbox axle ends, demonstrating improved oil retention through innovative geometric modifications. The findings contribute to the development of more efficient sealing technologies in high-speed train applications.

Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-10-2024-0370/