bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lutetium-177 Therapy in Italy: Environmental Impact Assessment in Anticipation of Its Widespread Use in Prostate Cancer Treatment
Authors: Brusa Anna , Campi Fabrizio , Cavatorta Claudia , Porta Alessandro Antonio , Viganò Sofia 
Published: September 2024

Abstract
This article addresses the evolving state of lutetium-177 radiopharmaceutical therapies in Italy, focusing on the importance of the definition of patient management practices regarding the approved treatments based on [177Lu]Lu-DOTATATE for neuroendocrine tumors and [177Lu]Lu-PSMA-617 for metastatic castration-resistant prostate cancer. Italian medical facilities are facing new challenges with the increase in the demand for such therapies while transitioning from restrictive hospitalization requirements to more flexible outpatient options. Therefore, four management strategies are described here, varying from immediate discharge after the administration to 24-h hospitalization, and their environmental and radiation safety implications are evaluated through simple models aimed at assessing the effective doses on the local population and wastewater purification plant workers. Results show that, while higher effective doses may be caused by an immediate discharge-based modality, they remain within acceptable limits, particularly when dealing with a smaller number of patients. Prolonged hospitalizations guarantee superior radiation safety levels but might not be sustainable with the expected increase in patient volumes in the future.
Predictors of Psychiatric Hospitalization After Discharge From Inpatient Neurorehabilitation for Traumatic Brain Injury
Authors: Silva Marc A. , Fox Michelle E. , Klocksieben Farina , Hoffman Jeanne M. , Nakase-Richardson Risa 
Published: September 2024

Objective: To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI psychiatric hospitalization following rehabilitation discharge, up to 5 years post-TBI. Setting: Five Veterans Affairs Polytrauma Rehabilitation Centers. Participants: Participants with nonmissing rehospitalization status and reason, who were followed at 1 year (N = 1006), 2 years (N = 985), and 5 years (N = 772) post-TBI. Design: A secondary analysis of the Veterans Affairs TBI Model Systems, a multicenter, longitudinal study of veterans and active-duty service members with a history of mild, moderate, or severe TBI previously admitted to comprehensive inpatient medical rehabilitation. This study examined participants cross-sectionally at 3 follow-up timepoints. Main Measures: Psychiatric Rehospitalization was classified according to Healthcare Cost and Utilization Project multilevel Clinical Classifications diagnosis terminology (Category 5). Results: Rates of post-TBI psychiatric hospitalization at years 1, 2, and 5 were 4.3%, 4.7%, and 4.1%, respectively. While bivariate comparisons identified pre-TBI psychiatric hospitalization and pre-TBI mental health treatment as factors associated with psychiatric rehospitalization after TBI across all postinjury timepoints, these factors were statistically nonsignificant when examined in a multivariate model across all timepoints. In the multivariable analysis, pre-TBI psychiatric hospitalization was significantly associated with increased odds of post-TBI psychiatric hospitalization only at 1-year post-TBI (adjusted odds ratio = 2.65; 95% confidence interval, 1.07-6.55, P = .04). Posttraumatic amnesia duration was unrelated to psychiatric rehospitalization. Conclusions: Study findings suggest the limited utility of age, education, and pre-TBI substance use and mental health utilization in predicting post-TBI psychiatric hospitalization. Temporally closer social and behavior factors, particularly those that are potentially modifiable, should be considered in future research.
One case of spinal bulbar muscular atrophy misdiagnosed as polymyositis: Case report
Authors: Mu Yv-sen , Yao Jia-yi , Li Fang 
Published: September 2024

Rationale:
Spinal bulbar muscular atrophy (SBMA) is a rare X-linked recessive motor neuron degenerative disease. Due to the lack of specificity in its early clinical manifestations, SBMA is easily misdiagnosed. Herein, we present a case in which SBMA was misdiagnosed as polymyositis.

Patient concerns:
A 58-year-old patient began to develop symptoms of limb weakness 20 years ago and was admitted to the Second Hospital of Hebei Medical University 10 years ago without special treatment. Two years ago, the above symptoms worsened and he was admitted to Peking Union Medical College Hospital. The patient was misdiagnosed as polymyositis. According to the gene mutation characteristics of SBMA, the patient was diagnosed with SBMA.

Diagnoses:
The result of the Kennedy gene test was positive, and the patient was diagnosed with Kennedy disease.

Interventions:
After the diagnosis of SBMA, the patient was given symptomatic treatment to alleviate the condition.

Outcomes:
Conservative treatment after discharge was requested. It is recommended that patients avoid bucking to prevent complications.

Lessons:
This is a case of milder SBMA being misdiagnosed as polymyositis. For patients with weak limbs, the possibility of SBMA should be considered.
Warning of severe pulmonary embolism after cerebral angiography: A case report and literature review
Authors: Zhang Xiaolin , Zhang Wenjing , Yu Wangfang , Yu Wei , Shen Wei , Wu Qi , Huang Zhiping , Zhang Yonghua 
Published: September 2024

Rationale:
Acute pulmonary embolism (PE), which can lead to cardiac and respiratory arrest, is a rare complication of cerebral angiography. However, neurologists do not pay attention to this.

Patient concerns:
A 47-year-old male with a history of type 2 diabetes was admitted to our hospital for evaluation of surgical indications for unruptured ophthalmic aneurysms. After cerebral angiography, a fatal PE occurred. Through rapid identification and effective drug treatment, the patient recovered and was discharged.

Diagnoses:
A diagnosis of fatal PE was made based on the bedside ultrasonography and blood d-dimer level.

Interventions:
Cardiopulmonary resuscitation and intravenous thrombolysis of “50 mg alteplase” for continuous intravenous drip for 2 hours.

Outcomes:
The patient was recovered and no special discomfort was reported.

Lessons:
PE is a rare complication of cerebral angiography, but the fatality rate is very high. Neurologists must not only early identify and effectively treat this complication, but more importantly, pay attention to this complication, prevent it in advance, and reduce the occurrence of catastrophic events.
Successful treatments of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome–related macular edema and exudation by intravitreal aflibercept injection in a senile patient: A case report
Authors: Tung Hsiao-Fan , Wu Jian-Sheng , Chen San-Ni 
Published: September 2024

Rationale:
The prevalence of idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is <1/1,000,000, and it tends to occur in young women. Panretinal photocoagulation, focal laser photocoagulation, peripheral cryopexy, vitrectomy, and corticosteroid therapy are the traditional treatments. We reported a case of a senile patient with IRVAN syndrome who presented with severe exudation in both eyes and macular edema in the left eye, successfully treated by serial intravitreal aflibercept injections.

Patient Concerns:
A 77-year-old Taiwanese woman complained of progressive blurred vision in the left eye and ocular examinations revealed a visual acuity of 20/125 in the left eye.

Diagnosis:
Indirect fundoscopy and fluorescein angiography showed bilateral multiple aneurysms, vasculitis, optic nerve staining, and neovascularizations. In addition, optical coherence tomography demonstrated macular edema with subretinal fluid and exudations in the left eye.

Interventions:
Monthly intravitreal injections of antivascular endothelial growth factor with aflibercept 2.0 mg were administered in the left eye.

Outcomes:
The visual acuity in the left eye improved to 20/50 after 18 months of treatment. Macular edema and subretinal fluid regressed. Furthermore, vessel leakage and optic disc staining also improved.

Lessons:
This case is the first to demonstrate successful treatment of IRVAN syndrome-related central macular edema and exudations, in the absence of neovascularization, using a series of intravitreal aflibercept injections as monotherapy.
A case of alternating hemiplegia in 2-month-old children with nystagmus as the first symptom: A case report
Authors: Qiao Qicheng , Li Qiubo 
Published: September 2024

Rationale:
This case report delves into the rare neurological condition known as alternating hemiplegia of childhood (AHC), focusing on its clinical manifestations, diagnostic approaches, and treatment options. AHC typically presents in infants under the age of 18 months with intermittent episodes of hemiplegia, often triggered by stressors such as environmental changes, bathing, or emotional stress. Recognizing the clinical features of AHC is crucial for early identification and intervention.

Patient concerns:
The paper presents a case of a 2-month-old child with nystagmus as the initial symptom, followed by limb movement disorder in the left upper limb and weakness in the right limbs. The child's condition did not improve with treatment at an external hospital, highlighting the complexity of the disease and the need for specialized care.

Diagnoses:
After a comprehensive review of the patient's medical history, physical examination, and imaging studies, the child was diagnosed with AHC. The diagnosis was confirmed through video electroencephalogram and whole-exome gene detection, which revealed a de novo mutation in the ATP1A3 gene, identified as pathogenic according to the American College of Medical Genetics and Genomics guidelines.

Interventions:
The child was admitted to Peking University First Hospital and treated with levetiracetam and flunarizine oral administration. These medications were chosen for their efficacy in managing the symptoms of AHC, particularly the hemiplegic episodes.

Outcomes:
Post-treatment, the child experienced a reduction in the frequency and intensity of hemiplegic attacks compared to the initial stage. However, the child still exhibited paroxysmal symptoms and abnormal eye movements, and developmental milestones were delayed, indicating the need for ongoing care and monitoring.

Lessons:
This case underscores the importance of early recognition and prompt intervention in managing children with AHC. The varied clinical presentations of AHC necessitate vigilance for early differential diagnosis. Although AHC is currently incurable, appropriate treatment can mitigate the impact of complications and improve the long-term quality of life for affected children, facilitating better societal integration.
Transactivation DNA-binding protein–related genes were associated with salivary gland injury in primary Sjögren syndrome
Authors: Zhang Naidan , Zhang Hongsheng , Bao Xiao , Yuan Chengliang 
Published: September 2024

The purpose was to identify transactivation DNA-binding protein–related genes in salivary gland injury in primary Sjögren syndrome (pSS) in southwest China.
We downloaded the datasets of GSE7451, GSE23117, and GSE40611. In order to screen the candidate genes, 2 kinds of machine learning algorithms were used. We collected blood from 28 patients and 20 controls to verify the expression of candidate genes using quantitative real-time polymerase chain reaction. The receiver operating characteristic curve was used to evaluate the diagnostic efficiency. Correlations between candidate genes and immune cells were examined.
A total of 31 differentially expressed genes were obtained. Through different algorithms, 6 genes including IFIT1, CSF2RB, TRIM22, PPM1H, VAMP7, and C21orf2 were getted. Validation results suggested that the expression of CSF2RB, VAMP7, IFIT1, C21orf2, and TRIM22 was significantly increased in pSS. The area under the curve of CSF2RB was 0.937 and that of TRIM22 was 0.915. Immune infiltration analysis showed that the percentage of activated mast cells was lower than the controls (P = .025). Correlation analysis suggested that CSF2RB was associated with immune cell infiltration. The expression of CSF2RB was significantly upregulated, which could be related to the increase of γδ T cells.
We revealed that CSF2RB could be the candidate gene of pSS. CSF2RB was involved by regulating various immune cells. The expression of CSF2RB was significantly upregulated, which was related to the increase of γδ T cells.
Secondary diabetes mellitus in acromegaly: Case report and literature review
Authors: Wang Jinlin , Zhang Zaidong , Shi Yaru , Wang Wentao , Hu Yanli , Chen Zonglan 
Published: September 2024

Rationale:
Acromegaly, predominantly resulting from a pituitary adenoma, is marked by excessive secretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). However, normalization of blood glucose levels posttreatment is rarely achieved. This case study aims to highlight the diagnostic challenges posed by overlapping symptoms of acromegaly and diabetes, emphasizing the importance of precise diagnosis and effective treatment strategies for optimal patient outcomes.

Patient concerns:
A 22-year-old male was hospitalized for diabetic ketoacidosis and exhibited classic signs of acromegaly, such as enlarged hands and feet, and distinct facial changes.

Diagnoses:
The patient’s diagnosis of acromegaly, attributed to a pituitary adenoma, was confirmed through clinical observations, laboratory findings (notably raised serum GH and IGF-1 levels, and absence of GH suppression after glucose load during an OGTT), and pituitary MRI scans.

Interventions:
The patient underwent 2 surgical tumor resections followed by gamma knife radiosurgery (GKRS). After treatment, GH, IGF-1, and blood glucose levels normalized without further need for hypoglycemic intervention.

Outcomes:
Posttreatment, the patient achieved stable GH, IGF-1, and blood glucose levels. The hyperglycemia was attributed to the GH-secreting tumor, and its resolution followed the tumor’s removal.

Lessons:
This case emphasizes the need for comprehensive assessment in patients with acromegaly to address coexisting diabetic complications. Surgical and radiotherapeutic management of acromegaly can lead to significant metabolic improvements, highlighting the importance of interdisciplinary care in managing these complex cases.
Association between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery
Authors: Dolapoglu Nazan , Dolapoglu Ahmet , Tug Tuba 
Published: September 2024

Backgrounds:
A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery.

Methods:
This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire.

Results:
According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach.

Conclusions:
Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.
Does increased fracture comminution affect femoral version after intramedullary nailing? An analysis of 307 intramedullary femoral nails
Authors: Menken Luke G. , Galos David K. , Patel Neeraj M. , Yoon Richard S. , Liporace Frank A. 
Published: September 2024

Abstract

Objectives:
Does degree of comminution affect femoral version after intramedullary nailing of femoral shaft fractures?

Design:
Retrospective.

Setting:
Standard of care, Level II Trauma Center, Hospital.

Patients/Participants:
We reviewed electronic medical records of consecutive patients from 2000 to 2009 with diaphyseal femoral shaft fractures treated with intramedullary nailing and with available early postoperative computed tomography scanograms. Four hundred seventeen patients were identified, and 307 met inclusion criteria.

Intervention:
Intramedullary nailing of the femur.

Main Outcome Measurements:
Our primary study measure, determined before data collection, was the difference in femoral version between the uninjured limb and the injured limb. Femoral version was determined on postoperative computed tomography scanograms and reviewed by a fellowship trained musculoskeletal radiologist and a senior orthopaedic surgeon.

Results:
Fractures were classified by an experienced orthopaedic trauma attending surgeon. OTA/AO type A fractures were the most common (51.5%), followed by type B (30.0%) and type C (18.5%). When categorized according to the Winquist system, 49.5% were type 1, 14.7% were type 2, 21.2% were type 3, and 14.7% were type 4. In univariate analysis, none of the classification systems were predictive of postoperative difference in femoral version (OTA/AO types and subtypes, OTA/AO types only, all Winquist types, and low-grade vs. high-grade Winquist; P > 0.05 for all). Subsequently, multivariate models did not yield any significant predictors.

Conclusions:
Increasing degree of comminution based on fracture classifications had no significant impact on obtaining acceptable femoral version after intramedullary nailing.

Level of Evidence:
Level III.
A Personalized Protocol for Facial Rejuvenation Using Two Soft Hyaluronic Acid Fillers With High Cohesivity
Authors: Buttura da Prato Editta , Molina Beatriz , Tanzini Laura , Cigni Clara , Bellia Gilberto 
Published: September 2024

Minimally invasive injectable dermal fillers are one of the most commonly used aesthetic treatments for facial soft tissue restoration. Different formulations may be used simultaneously to target multiple areas of concern. Due to differences in their rheological properties that directly impact the recommended injection technique and overall result, the formulations in the Aliaxin®
line are each designed to target different soft facial tissues. This case series addresses two potential treatment approaches and a combination approach specifically developed to achieve harmony and promote a full but soft facial appearance. To reach this goal, we used two different formulations: Aliaxin®
Shape and Restore (ASR) and Aliaxin®
Global Performance (AGP). Four patients, 35–55 years received treatments with ASR, AGP, or both products. Utilizing the two protocols simultaneously achieved targeted support, lift, and volume, along with effective full facial softening and an authentic aesthetic outcome.
Descriptive Epidemiology and Management of Perilunate Injuries
Authors: Patel Alap U. , Thiara Jack , Rivas Zuivanna , Hansen Scott L. 
Published: September 2024

Introduction
Perilunate injuries and dislocations, typically caused by high-impact trauma, can lead to acute compression of the median nerve and subsequent complications if left untreated. This study examines the epidemiology, injury mechanisms, immediate treatment, and need for carpal tunnel release in such cases.

Methods
Perilunate injuries at a single level 1 trauma center were retrospectively reviewed from 2014 to 2023. Data on patient demographics, injury mechanism, initial management, and operative management were collected.

Results
Thirty-three cases were analyzed, averaging 33.9 years in age. Injury mechanisms included falls (24% each from 0 to 10 feet and >10 feet, and motor vehicle accidents), bicycle-auto collisions or assaults (10%), pedestrian-auto collisions (5%), and 1 crush injury (3%). Most cases involved trans-scaphoid perilunate dislocation (predominantly Mayfield 3). Initial reduction in the emergency department succeeded in 60% of cases, with 48% showing median nerve paresthesias. Thirty-three percent underwent surgery within 24 hours, and 95% required operative intervention, including open reduction internal fixation (56%), open reduction with percutaneous pinning (30%), and closed reduction with percutaneous pinning (7%). Fifty-two percent needed carpal tunnel release.

Conclusions
Prompt evaluation and treatment are crucial for perilunate injuries. If initial reduction fails, urgent operative intervention is warranted, although delayed management may be appropriate in some cases. Various operative fixation methods exist for realigning carpal bones, emphasizing the importance of tailored approaches to individual cases.