bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical but commonly neglected factors that affect contrast medium administration in CT
Authors: McDermott Michael C. , Wildberger Joachim E. , Bae Kyongtae T. 
Published: August 2024

Abstract
Objective
Past decades of research into contrast media injections and optimization thereof in radiology clinics have focused on scan acquisition parameters, patient-related factors, and contrast injection protocol variables. In this review, evidence is provided that a fourth bucket of crucial variables has been missed which account for previously unexplained phenomena and higher-than-expected variability in data. We propose how these critical factors should be considered and implemented in the contrast-medium administration protocols to optimize contrast enhancement.

Methods
This article leverages a combination of methodologies for uncovering and quantifying confounding variables associated with or affecting the contrast-medium injection. Engineering benchtop equipment such as Coriolis flow meters, pressure transducers, and volumetric measurement devices are combined with small, targeted systematic evaluations querying operators, equipment, and the physics and fluid dynamics that make a seemingly simple task of injecting fluid into a patient a complex and non-linear endeavor.

Results
Evidence is presented around seven key factors affecting the contrast-medium injection including a new way of selecting optimal IV catheters, degraded performance from longer tubing sets, variability associated with the mechanical injection system technology, common operator errors, fluids exchanging places stealthily based on gravity and density, wasted contrast media and inefficient saline flushes, as well as variability in the injected flow rate vs. theoretical expectations.

Conclusion
There remain several critical, but not commonly known, sources of error associated with contrast-medium injections. Elimination of these hidden sources of error where possible can bring immediate benefits and help to drive standardized and optimized contrast-media injections.

Critical relevance statement
This review brings to light the commonly neglected/unknown factors negatively impacting contrast-medium injections and provides recommendations that can result in patient benefits, quality improvements, sustainability increases, and financial benefits by enabling otherwise unachievable optimization.

Key Points

How IV contrast media is administered is a rarely considered source of CT imaging variability.

IV catheter selection, tubing length, injection systems, and insufficient flushing can result in unintended variability.

These findings can be immediately addressed to improve standardization in contrast-enhanced CT imaging.

Graphical Abstract
3D fascicular reconstruction of median and ulnar nerve: initial experience and comparison between high-resolution ultrasound and MR microscopy
Authors: Pušnik Luka , Lechner Lisa , Serša Igor , Cvetko Erika , Haas Philipp , Jengojan Suren Armeni , Snoj Žiga 
Published: August 2024

Abstract
Background
The complex anatomy of peripheral nerves has been traditionally investigated through histological microsections, with inherent limitations. We aimed to compare three-dimensional (3D) reconstructions of median and ulnar nerves acquired with tomographic high-resolution ultrasound (HRUS) and magnetic resonance microscopy (MRM) and assess their capacity to depict intraneural anatomy.

Methods
Three fresh-frozen human upper extremity specimens were prepared for HRUS imaging by submersion in a water medium. The median and ulnar nerves were pierced with sutures to improve orientation during imaging. Peripheral nerve 3D HRUS scanning was performed on the mid-upper arm using a broadband linear probe (10–22 MHz) equipped with a tomographic 3D HRUS system. Following excision, nerves were cut into 16-mm segments and loaded into the MRM probe of a 9.4-T system (scanning time 27 h). Fascicle and nerve counting was performed to estimate the nerve volume, fascicle volume, fascicle count, and number of interfascicular connections. HRUS reconstructions employed artificial intelligence-based algorithms, while MRM reconstructions were generated using an open-source imaging software 3D slicer.

Results
Compared to MRM, 3D HRUS underestimated nerve volume by up to 22% and volume of all fascicles by up to 11%. Additionally, 3D HRUS depicted 6–60% fewer fascicles compared to MRM and visualized approximately half as many interfascicular connections.

Conclusion
MRM demonstrated a more detailed fascicular depiction compared to 3D HRUS, with a greater capacity for visualizing smaller fascicles. While 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, their limitations in depicting interfascicular connections and small fascicles within clusters necessitate cautious interpretation.

Clinical relevance statement
Although 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, even in intraoperative settings, their limitations in depicting interfascicular branches and small fascicles within clusters require cautious interpretation.

Key Points

3D HRUS was limited in visualizing nerve interfascicular connections.

MRM demonstrated better nerve fascicle depiction than 3D HRUS.

MRM depicted more nerve interfascicular connections than 3D HRUS.

Graphical Abstract
Outcomes of myocardial revascularization in patients with obesity and multivessel coronary artery disease
Authors: Madiyeva Maira I. , Aripov Marat A. , Goncharov Alexey Y. , Zholdasbekova Rakhima Y. 
Published: August 2024

Abstract
Background
There is uncertainty regarding the best revascularization approach—whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)—for obese patients suffering from multi-vessel coronary artery disease.

Results
406 patients with low and intermediate SYNTAX scores (SS) underwent PCI with drug-eluting stents (n = 200, 100 with SS ≤ 22, and 100 with SS 23–32) and CABG (n = 206, 100 with SS ≤ 22, and 106 with SS 23–32). Patients were also categorized by body mass index (BMI): normal weight (12%, 48 patients), overweight (41.6%, 169 patients), and obese (46.6%, 189 patients). The follow-up period averaged 9 ± 1.9 years. The endpoints of the study were as follows: major adverse cardiac and cerebrovascular events, a repeat revascularization, diminished left ventricular ejection fraction (LVEF), and high SS (≥ 33) observed over time. When comparing PCI and CABG in overweight individuals, the risk of myocardial infarction (MI) following PCI was greater than after CABG (Hazard Ratio [HR] 2.7, 95% Confidence Interval [CI] 1.1–6.7, p = 0.03). In patients with overweight and Class I obesity, CABG was associated with the risk of coronary atherosclerosis progression (SS ≥ 33) (HR 4.4, 95% CI 1.5–13, p = 0.009 and HR 4.9, 95% CI 1.9–12, p = 0.001, respectively); whereas PCI was connected with the likelihood of repeat revascularization (HR 2.7, 95% CI 1.6–4.55, p < 0.0001 and HR 2, 95% CI 1.3–3.1, p = 0.002, respectively). At the same time, for stented patients, Class III obesity was associated with the risk of repeat revascularization (HR 2.5, 95% CI 1.02–6, p = 0.044).

Conclusion
There were no significant weight-related impacts on long-term outcomes among patients who underwent surgery. Whereas in stented patients, Class III obesity was associated with the risk of repeat revascularization. When comparing PCI and CABG, for overweight and Class I obesity patients, CABG was associated with a likelihood of coronary atherosclerosis progression (SS ≥ 33), while PCI was linked to the risk of repeat revascularization. For overweight patients, CABG outperformed PCI in terms of the risk of MI. For other adverse events in patients of different weight categories, PCI and CABG did not reveal any significant benefits.
Neurological applications of focused ultrasound: an introduction and update on clinical and research trends
Authors: Rollins Matthew , Harbaugh Thaddeus , Fawzi Mohamed , Hamed Mohamed , Alkasab Sami , Almekkawy Mohamed , Elhelf Islam 
Published: August 2024

Abstract
Background
Focused ultrasound has emerged as a non-invasive technology with potential for treating various medical conditions, particularly neurological diseases. This article aims to explore recent advancements in the utilization of focused ultrasound for treating neurological conditions.

Results
A comprehensive literature review was conducted to explore current clinical applications and investigational uses of focused ultrasound, aiming to provide an up-todate overview of the field's progress. By employing different combinations of intensity and frequency, focused ultrasound can induce diverse interactions with soft tissues, including tissue ablation, cavitation, and mechanical effects. High-intensity focused ultrasound is utilized for tissue ablation and has received FDA approval for treating medication-refractory essential tremor. Conversely, low-intensity focused ultrasound is employed for neuromodulation and opening the blood–brain barrier, facilitating enhanced drug delivery for treating brain tumors and other neurological conditions. This article reviews ongoing clinical trials investigating focused ultrasound's role in neurological condition treatment.

Conclusion
Focused ultrasound holds significant promise for managing and treating various neurologic conditions. Whether employed for tissue ablation or transiently opening the blood–brain barrier to enhance drug delivery, numerous potential applications exist. Further research is necessary to evaluate its safe implementation and compare clinical outcomes with standard-of-care therapies.
Mapping the landscape of Y90 radioembolisation research: a citation analysis of the top 100 papers
Authors: Mahmood Hassan , Deshwal Avinash , Khalid Aleena , Mc Manus Ethel 
Published: August 2024

Abstract
Background
This study aims to identify trends, research gaps, leading journals, institutions, countries, and authors by examining the top 100 cited Yttrium-90 Radioembolization (Y90) research articles. The insights gained will assist funding and collaboration efforts in Y90 research. The team analyzed 981 articles from 36 peer-reviewed journals, gathering data on authors, publication year, journal, citations, affiliations, keywords, and references. Author affiliations were scrutinized to pinpoint institutions and countries. p values < 0.05 were deemed statistically significant.

Main body of abstract
The most cited paper (703 citations) was authored by Salem et al. (2010), and the journal with the most publications (16) was Journal of Vascular and Interventional Radiology. There was no significant correlation between journal impact factor and citation metrics. A decreasing trend in the number of top 100 articles was observed since the peak period (2008–2013). Most papers were published in high-impact factor (IF > 3, n = 31/35) and SCImago Q1 journals (86/100), with Northwestern University, Clínica Universidad de Navarra, and Ludwig Maximilian University of Munich being the leading institutions. The most prolific authors were Salem, R., Lewandowski, R.J., and Mulcahy, M.F., with Salem, R. as the most influential. A statistically significant positive correlation between collaborative links and published articles was also discovered.

Short conclusion
The top 100 cited articles were primarily published in high-impact journals, and Northwestern University and the USA showed greater productivity and collaboration. These findings have crucial implications for researchers, policymakers, and institutions, aiding in the improvement of Y90 application and understanding in clinical practice.
Alcohol-Induced Psychosis: Beyond Korsakoff. Case report and Literature Review
Authors: De Vicente Blanco Á. , Orgaz Álvarez B. , Ibáñez Mendoza P. , Velasco Santos M. , Garde González J. 
Published: August 2024

IntroductionChronic consumption of alcohol has clear deleterious effects on the nervous system. Among its less-recognized consequences are subacute and chronic alcohol-induced psychotic disorders. Lasègue, Garnier, Magnan, and Michaux provided exhaustive clinical descriptions of different presentations of subacute alcoholic delusional disorder, while Kraepelin, Allamagny, and Neveu defined the characteristics of chronic alcoholic hallucinatory psychosis. Both conditions are characterized by the occurrence of hallucinations and vivid dream-like content in their delusions, along with potential emotional detachment from the symptoms. Presently, both conditions are categorized under the generic term ‘Alcohol-Induced Psychotic Disorder,’ with limited available scientific literature.ObjectivesOur goal is to bring attention to the existence of subacute and chronic alcohol-induced psychosis in individuals with long-term alcohol users.MethodsCase report using clinical records and a non-systematic literature review.ResultsA 63-year-old male, with a forty-year history of chronic alcoholism and no other prior mental health issues, was admitted in the emergency department. He conveyed vague delusional notions regarding his roommate and described vivid morning dreams in which he tried to communicate but couldn’t speak. This led him to believe his roommate harboured harmful intentions. Additionally, he mentioned that for the past two months, he had developed a telepathic connection with his sister and his deceased mother, with whom he felt he communicated without speaking. He described feeling strangement and anxiety concerning these experiences, which he firmly believed to be undeniably real. He reported being able to hear the voices of his mother and sister. He also described short-term memory problems dating back two years. He denied any other psychopathology and exhibited probable ideational and emotional impoverishment secondary to chronic alcohol consumption. Confirmation of the patient’s account was provided by his family members. The prescribed treatment included antipsychotic medication and a recommendation for alcohol abstinence.ConclusionsDescriptions of chronic and subacute alcohol-induced psychoses are found in early psychiatric textbooks but have been omitted from contemporary classifications. While their incidence is low among chronic alcohol users, they represent a severe clinical entity. These disorders are usually distinguished by the presence of delusions and vivid hallucinations characterized by dream-like content. This distinct symptomatology aids in the accurate differentiation from other psychotic disorders and clinicians should be aware of their existence.Disclosure of InterestNone Declared
Association between G6PD deficiency and schizophrenia A case report
Authors: Abassi B. , Fekih-Romdhane F. , Baccar F. , Cheour M. , Damak R. , Ellini S. 
Published: August 2024

IntroductionG6PD is essential for the production of NADPH, which is a cofactor for many enzymes involved in antioxidant defense and neurotransmitter synthesis. A deficiency in this enzyme could lead to increased oxidative stress, impaired neurotransmitter and immune function. The latter have been implicated in the pathophysiology of schizophrenia.ObjectivesThe present case is presented to underscore the infrequent and uncharacteristic manifestation of this condition, in the context of clinical symptoms and the trajectory of evolution of schizophrenia when associated with G6PD Deficiency. Moreover, it sheds light on the challenges clinicians encounter in the management of such cases.MethodsA case report of a patient who was admitted to the Psychiatry Department (“Ibn Omrane”) of Razi Hospital”.ResultsMr. M.T is a 26 year-old unmarried man. He comes from a non-consanguineous marriage and has an educational level of a bachelor’s degree plus three additional years of study. He has a significant family medical history. His maternal uncle is under treatment for a chronic psychotic disorder. He has a personal history of G6PD deficiency and no specific habits to note. At the age of 24, he insidiously developed anxiety with incoherent statements of persecution accompanied by behavioral manifestations leading to mistrust and social isolation. He discontinued his studies for a year and began verbalizing suicidal thoughts accompanied by self-harm behaviors.The family sought help from a psychiatrist who prescribed 5 mg of olanzapine, which was covertly administered to the patient.At the age of 28, after a suicide attempt, he was involuntarily admitted to Razi Hospital. The clinical presentation was dominated by disorganization, with a partial response to treatment.ConclusionsMore research is needed to confirm the association between G6PD deficiency and schizophrenia and to determine the underlying mechanisms. Larger studies with well-defined populations and methodologies are needed. It is also important to study the interaction between G6PD deficiency and other genetic and environmental factors that contribute to schizophrenia.Disclosure of InterestNone Declared
Intractable Singultus: Causes, diagnosis and treatment. A case report
Authors: Díaz Mayoral C. , Arroyo Sánchez E. , Martínez Pillado A. , Setién Preciados P. 
Published: August 2024

IntroductionHiccups are involuntary, spasmodic contractions of the diaphragm and intercostal muscles that cause inspiration and are interrupted by closure of the glottis. Most sources define the term “persistent hiccups” as lasting more than 2 days and “intractable” as lasting more than 1 month. Both are most likely associated with a pathologic process. “Intractable hiccups” should lead to investigation of organic pathology. If it does not improve, it can interfere with the patient’s ability to eat, socialize and sleep, leading to a significant worsening of quality of life. “Intractable hiccups” are more frequent in men (91%), over 50 years of age. Women suffer from psychogenic hiccups more frequently than men. Anxiety or stress can trigger hiccups. Multiple neurotransmitters are involved.ObjectivesWe present a theoretical review on the topic.MethodsA bibliographic review on the topic.ResultsIn recent years, new trials and case series have been published, and regulatory agencies have issued new recommendations on the use of pharmacologic agents for this indication. The literature has described the efficacy of several pharmacologic agents in the empiric treatment of persistent and intractable hiccups. Most of these target dopaminergic and GABAergic receptors.Based on limited efficacy and safety data, Baclofen and Gabapentin can be considered as first-line treatment for intractable and persistent hiccups, as they suggest efficacy and are less likely to cause long-term side effects than standard neuroleptic agents. Dopamine blocking agents such as Metoclopramide, Chlorpromazine, and Haloperidol, could be used as second line. In one study, withdrawal of Benzodiazepines or addition of Pregabalin was found to help reduce hiccups.The patient we consulted came for persistent hiccups or singultus of 2 years of evolution. Organic pathology was ruled out. She related the onset of the symptoms to different stressors that had caused her anxiety. We administered Escitalopram and Gabapentin and indicated withdrawal of Bromazepam, which she started taking months ago. In follow-up appointments she reported a decrease in the intensity and frequency of the symptoms, with a notable improvement in her quality of life.ConclusionsConsidering all available evidence, a treatment algorithm with Baclofen is recommended as first-line therapy for persistent and intractable hiccups. Gabapentin may also be safe and effective in the long-term treatment of this condition, especially for patients with CNS disease. Metoclopramide is no longer recommended for long-term treatment of hiccups. Clinical experience also supports the use of Chlorpromazine and other neuroleptics for acute, but not long-term, treatment. Going forward, large multicenter studies will be needed to create an adequate evidence base for the treatment of persistent and intractable hiccups. Until then, guidelines will continue to be based on unreliable data and clinical experience.Disclosure of InterestNone Declared
Medication related problems in elderly patients treated with antipsychotics
Authors: Stuhec M. 
Published: August 2024

AbstractElderly patients treated with antipsychotics are often prescribed multiple medications simultaneously (polypharmacy), leading to an increased risk of various medication-related problems, including irrational polypharmacy, drug-drug interactions, and potentially inappropriate medications (PIMs). Polypharmacy may be rational with clear indications and benefits, but it becomes irrational when better alternatives are available. This irrational polypharmacy is associated with poorer clinical and economic outcomes, including a higher mortality rate. Antipsychotic polypharmacy in elderly patients with schizophrenia is not well-studied and, therefore, is not generally recommended. Long-term antipsychotic use in patients with dementia has also been linked to a higher mortality rate. PIMs, representing a greater risk than benefit, are prevalent in mental health institutions at all healthcare levels, with a prevalence ranging from 40% to 60%. Antipsychotics, along with benzodiazepines, are among the most commonly included in PIMs and polypharmacy in these institutions. Moreover, antipsychotics are frequently implicated in potential severe drug-drug interactions in elderly patients with mental disorders, particularly with antibiotics and antiarrhythmics.Unfortunately, the existing treatment guidelines and meta-analyses mostly do not cover these aspects, which represent a gap between the ‘real clinical’ pharmacology and treatment guidelines. The speaker will summarize the medication-related problems in this population and present practical recommendations for daily clinical practice.Disclosure of InterestNone Declared