bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cystic encapsulated papillary carcinoma with ductal carcinoma in situ in the male breast: a clinicopathologic feature with a diagnostic challenge: A case report and review of literature
Authors: Wang Bo , Wang Li , Zhao Zhenya , Xu Xin 
Published: November 2023

Rationale:
Encapsulated papillary carcinoma (EPC) is a rare subset of breast carcinoma accounting for 0.5% to 2.0% of all patients with breast cancer and occuring mostly in postmenopausal women. It is even rarer in male breast cancer, and male EPC has only been reported in few cases. EPC has a distinctive histological pattern and a better prognosis compared with other types of breast carcinoma. Compared to the previously reported EPC cases, the lesion was unusually cystic made the diagnosis challenging. Accordingly, herein, we describe a rare case of EPC was unusually cystic in an elder male breast, associated with ductal carcinoma in situ (DCIS), along with an indepth literature discussion, and then to improve our understanding more about this uncommon tumor and further to provide more experience to treat this disease.

Patient concerns:
A 73-year-old man noticed a slowly enlarging mass in the right breast 1 year ago and sought medical attention. The patient presented with a right breast mass of 1-year duration and bloody nipple discharge in the first couple of days. The medical history was unremarkable.

Diagnoses:
Physical examination, an elastic hard, smooth and movable 4-cm lesion was palpated below the right papilla. On the sonography, a well-defined predominantly cystic-solid tumor of 3.6 × 2.3 cm was confirmed. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of breast EPC with DCIS.

Interventions:
The patient underwent surgery. A diagnosis of “a little papillary neoplasm of the breast with epithelial atypia and hypertrophy in the fibrous cystic wall” was made by the frozen section. Further, total mastectomy was performed.

Outcomes:
The operation was successful. Then the male patient recovered completely, did not require any additional treatment and continued to do well on postsurgical mammary surgical clinic visits. The patient had been followed-up regularly for 2 years after surgery; he did not experience any complications and remained disease-free.
The effectiveness and safety of herbal medicine on suicidal behavior: A PRISMA-compliant systematic review and meta-analysis
Authors: Kwon Chan-Young , Lee Boram 
Published: November 2023

Background:
Suicide is the leading cause of death worldwide. Herbal medicine (HM) has been reported to be related to clinical improvement of some risk factors for suicide including depression. This systematic review aimed to comprehensively investigate the effectiveness and safety of HM on suicidal behaviors.

Methods:
Fifteen electronic databases were searched to search relevant intervention studies, up to September 2022. The methodological quality of the included studies was assessed using the modified Cochrane risk-of-bias tool. In the included studies, outcome on suicidal behavior were analyzed, and the effect sizes were presented as mean differences (MDs) or risk ratios (RRs) with their 95% confidence intervals (CIs) through meta-analysis. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results:
A total of 13 randomized controlled trials (RCTs) were included in this review. Two RCTs of HM in patients with suicidal behavior found significant benefits of HM as an adjunct to fluoxetine or cognitive therapy in improving symptoms of depression. In 11 RCTs of HM in patients with other conditions, there was no statistically significant difference between HM and antidepressants in cognitive disturbance (MD, 0.12; 95% CIs, −0.20 to 0.45), a subscale of the Hamilton Rating Scale for Depression (HAMD), and suicidal ideation (0.18; −0.16 to 0.53), an item of HAMD. The overall quality of the included studies was poor. The strength of evidence assessed by GRADE was low or very low.

Conclusions:
Though some of the studies reported significant benefits of HM in improving suicidal behavior in patients with depression, further clarification on some unsolved questions is needed in future well-designed clinical trials.
Heart rate variability analysis in toxic leukoencephalopathy-induced malignant catatonia: A case report
Authors: Srichawla Bahadar S. , Kipkorir Vincent , Hayward Lawrence 
Published: November 2023

Rationale:
Toxic leukoencephalopathy, a condition resulting from exposure to toxic substances, can lead to malignant catatonia, a severe motor dysfunction with symptoms such as muscle rigidity and high-spiking fever, hypertensive urgency, and tachycardia. This case study investigates the relationship between toxic leukoencephalopathy-induced malignant catatonia and heart rate variability (HRV), a marker of autonomic nervous system function.

Patient Concerns:
A 51-year-old male presented to the emergency department with acute onset of progressively worsening mental status.

Diagnoses:
The patient was diagnosed with cocaine-induced toxic leukoencephalopathy causing malignant catatonia.

Interventions:
A 5-day escalating treatment regimen was instituted for the management of malignant catatonia until resolution. Daily HRV parameters in the temporal and frequency domain, geometric data, and cardiac entropy were recorded using HRVAnalysis v.1.2 (ANS Lab Tools). The HRV analysis was correlated with pharmacologic management, the Bush-Francis catatonia rating scale, and hemodynamic parameters, including blood pressure, heart rate, and temperature.

Outcomes:
The results showed a correlation between the severity and frequency of malignant catatonic episodes and the patient autonomic dysfunction. Improvement in malignant catatonia with pharmacological management was associated with an improved HRV, including elevated rMSSD, SDNN, cardiac entropy, and pNN50%.

Lessons:
Malignant catatonia is associated with decreased HRV, and its management is associated with an increase. This suggests a link between malignant catatonia and autonomic dysfunction, highlighting the potential benefits of treating malignant catatonia to improve autonomic function and reduce cardiovascular risk.
Maturity degree assessment of hospital ward system using integrated fuzzy AHP-TOPSIS model
Authors: Li Lan , Tong Junping , Wang Huan , Ren Ruihua , Xiong Luning , Wang Jiyun 
Published: November 2023

Background:
The hospital ward system is the core service unit of a hospital and an important aspect of hospital management. The maturity of the hospital ward system represents the level of development and improvement in ward management and services. In order to improve the quality of hospital services, it is significant to assess the maturity of the ward system. Although various assessment methods have been proposed in existing studies, there are some issues such as a single-dimensional factor system, subjectivity in qualitative factor values, and insufficient objectivity in the evaluation methods.

Methods:
Therefore, based on the data collection of the factors used in the existing literature, this study made correlation analysis, determined the similarity of factors, and established a maturity assessment factor system satisfying distinctiveness and comprehensiveness. Furthermore, an evaluation method for the weights of each factor was proposed based on the fuzzy analytic hierarchy process, while taking account of the ambiguity of expert information. In addition, through the technique for order of preference by similarity to ideal solution method, an objective evaluation method for the maturity of the hospital ward system was established. Finally, a case study involving 6 hospitals in a specific location was conducted.

Results:
There are a total of 16 factors used to assess the maturity of the hospital ward system, among which the most important is Doctor service. The maturity degree of the 6 researched hospitals are 0.4517, 0.0035, 0.4254, 0.8681, 0.6636, 0.1586, and the maturity degree of the 6 researched hospitals are II, I, II, IV, III, I.

Conclusion:
The factor system constructed in this study effectively reflected the importance of human-related factors in the development process of ward system. The evaluation results were consistent with the actual situation, demonstrating the effectiveness of the proposed method.
The ulcerative colitis endoscopic index of severity score is superior to reflecting long-term prognosis in ulcerative colitis patients treated with vedolizumab
Authors: Yan Jing , Liu Ailing , Fang Liang , Wu Jun , Ding Xueli , Xu Yonghong 
Published: November 2023

The scoring systems commonly used to assess endoscopic disease severity of ulcerative colitis (UC) in clinical research and practice include the Mayo endoscopic score (MES), ulcerative colitis endoscopic severity index (UCEIS), and degree of ulcerative colitis burden of luminal inflammation (DUBLIN). We aimed to assess and compare the predictive efficacy of the MES, DUBLIN score and UCEIS score for prognosis in UC patients treated with vedolizumab (VDZ).
Seventy-four UC patients who treated with VDZ from September 2021 to February 2023 were retrospectively enrolled. We used the MES, DUBLIN and UCEIS score to evaluate endoscopic findings. The predictive capability of these 3 scores for surgery or therapeutic escalation was assessed using the receiver operating characteristic curve.
The mean MES, DUBLIN and UCEIS score significantly improved from 2.83 ± 0.38, 7.80 ± 1.82 and 6.24 ± 1.51 to 2.07 ± 0.88, 5.57 ± 2.68, and 3.72 ± 2.12, respectively (P < .001). Lower pre-therapeutic UCEIS scores were associated with favorable short-term outcomes. Importantly, the post-therapeutic UCEIS score showed the best predictive capability with an area under curve of 0.871 (95% confidence interval: 0.767–0.976), specificity of 0.654, sensitivity of 0.900, and cutoff value of 3.5. A UCEIS score of ≥ 4 after treatment was correlated with surgical operation or treatment escalation.
The UCEIS score is superior to the MES and DUBLIN score in reflecting short-term outcomes and long-term prognosis in UC patients treated with VDZ, and clinical remission could be defined as a UCEIS score ≤ 3.
Effects of music therapy on pain relief during fundus screening in infants: Randomized controlled clinical trial
Authors: Chen Renyi , Duan Shijie , Wang Yin , He Fengqin , Ren Li , Peng Wentao 
Published: November 2023

Background:
To determine the efficacy of music therapy on pain relief during fundus screening in infants.

Methods:
The sample consisted of infants aged 0 to 3 months who required fundus screening. Infants were randomized to fast music, slow music, and control groups. All groups underwent fundus screening under topical anesthesia. Music therapy was provided to the music groups prior to, during, and after the operation. The patient’s heart rate (HR), transcutaneous oxygen saturation, and crying decibel were measured. The Face, Legs, Activity, Cry, Consolability scale was used for pain measurement.

Results:
A total of 300 subjects’ data were collected. The quantitative analysis revealed that in both music groups, peripheral capillary oxygen saturation and satisfaction levels increased while pain scores decreased (P < .05). The slow music group’s HR was shown to have significantly decreased (P < .05).

Conclusion:
Music therapy can effectively reduce pain and crying, and increase blood oxygen saturation during fundus examination of infants. Music with a rhythm of 60 to 80 beats per minute can decrease HR. Music therapy must be remembered to increase infants’ comfort during fundus examination.
Ultrasonographic Features of Nonneoplastic Protrusions in Pancreatic Cysts by Contrast-Enhanced Endoscopic Ultrasound
Authors: Hisa Takeshi , Kudo Akiharu , Shimizu Takehiro , Nishiyama Shigeru , Yamada Takahiro , Osera Shozo , Fukushima Hideki , Tomori Akihisa 
Published: November 2023

Objectives
Most of the pancreatic cyst protrusions detected by B-mode endoscopic ultrasound (BM-EUS) are nonneoplastic and are not enhanced by contrast-enhanced EUS (CE-EUS) using ultrasound contrast agent (USCA). This study aimed to identify useful findings for distinguishing between neoplastic and nonneoplastic pancreatic cyst protrusions on BM-EUS to facilitate efficient USCA use.

Materials and Methods
A total of 151 pancreatic cyst protrusions in 119 consecutive patients who underwent CE-EUS were analyzed. We focused on the echo level (hyperechoic/isoechoic/hypoechoic/anechoic), base type (sessile without a basal waist/sessile with a basal waist/pedunculated), surface type (smooth/irregular), and the presence/absence of a hyperechoic surface layer. Enhanced and unenhanced protrusions on CE-EUS were interpreted as neoplastic and nonneoplastic, respectively.

Results
Forty-five and 106 protrusions were enhanced and unenhanced, respectively, on CE-EUS performed using USCA. In univariable analysis of predictors of nonneoplastic protrusion on BM-EUS, the following factors were found to be significant: echo level (hypoechoic/anechoic), base type (sessile with a basal waist/pedunculated), a smooth surface, and a hyperechoic surface layer. Of these, only a hyperechoic surface layer remained significant in the multivariable analysis (P < 0.0001; odds ratio, 40.74; 95% confidence interval, 7.07–387.49).

Conclusions
Pancreatic cyst protrusions with a hyperechoic surface layer on BM-EUS are suggestive of nonneoplastic disease.
Outcomes of a Fatigue Management Intervention for People With Post COVID-19 Condition
Authors: Stapleton Tadhg , Norris Louise , Clancy Kathleen , O’Gorman Aoife , Bannan Ciaran , Kent Brian , Conlon Peter , Nadajaran Parthiban , Kerr Colm , Connolly Deirdre 
Published: November 2023

Objective
Fatigue is identified as one of the most prevalent and persistent problems reported by people with post COVID-19 condition that negatively impacts on everyday living and resumption of pre–COVID-19 lifestyle. A pilot occupational therapy fatigue management intervention was designed for patients presenting with post COVID-19 condition fatigue.

Design
A retrospective analysis was carried out after the delivery of the fatigue management intervention. Self-reported measures of fatigue, well-being, and health status were taken at baseline and repeated at 2 wks after intervention. Baseline and postintervention scores were compared using nonparametric analysis.

Results
Sixty participants (73% female), median age 50.5 yrs (range, 17–74), 93% reporting symptoms persisting for 12 wks or longer, completed the fatigue management intervention. All participants reported moderate to severe fatigue impacting on everyday activity at baseline. The greatest impact of fatigue was on engagement in leisure and work activity. Statistically significant improvement in fatigue (P < 0.001), well-being (P < 0.001), and health status (P < 0.001) were noted after the intervention.

Conclusions
Findings indicate the potential of occupational therapy fatigue management interventions to enable self-management strategies and reduce the negative impact of fatigue among people with post COVID-19 condition.
Experimental and numerical analyses of alternate materials for performance enhancement of Jaipur foot
Authors: Mali Harlal Singh , Singh Shamsher , Savasni Smitkumar 
Published: November 2023

Background:
The Jaipur foot is the gold standard in low-cost prosthetics, and the amputee population in low-income and middle-income countries has benefited immensely from this innovation. The ability of the Jaipur foot to mimic the behavior of a regular foot, albeit to a limited extent, has made it a popular choice among clinicians and patients. However, the immense popularity has also hindered further research because minimal efforts have been made to investigate the scope of improvement of the Jaipur foot, particularly with new materials.

Objective:
This article focuses on numerical and experimental analyses of various materials for the performance enhancements of the Jaipur foot.

Methods:
Contemporary materials are used in finite element analysis to filter the most suitable alternate material for microcellular rubber. The performance of the Jaipur foot fabricated with alternate material is compared with the conventional Jaipur foot through compression testing simulating gait cycle conditions.

Results:
The EVA foot showed 1–3 mm higher deformation than the MCR foot during the dorsiflexion or heel strike phases, which indicates an appropriate shock absorption and energy storage capacity in heel striking conditions. In forefoot strike phase or plantarflexion, the EVA foot and MCR foot showed identical behavior in deformations. Replacing the MCR with EVA also resulted in reduced weight of the Jaipur foot by 23%.

Conclusions:
The weight reduction can help the amputee to expend less energy, thereby improving patient comfort and walking patterns and hence a more natural performance similar to a regular human foot.
Photon-Counting Computed Tomography Versus Energy-Integrating Dual-Energy Computed Tomography: Virtual Noncontrast Image Quality Comparison
Authors: Dane Bari , Ruff Andrew , O'Donnell Thomas , El-Ali Alexander , Ginocchio Luke , Prabhu Vinay , Megibow Alec 
Published: November 2023

Purpose
This study aimed to compare the image quality of portal venous phase–derived virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) with energy-integrating dual-energy computed tomography (EI-DECT) in the same patient using quantitative and qualitative analyses.

Methods
Consecutive patients retrospectively identified with available portal venous phase–derived VNC images from both PCCT and EI-DECT were included. Patients without available VNC in picture archiving and communication system in PCCT or prior EI-DECT and non–portal venous phase acquisitions were excluded. Three fellowship-trained radiologists blinded to VNC source qualitatively assessed VNC images on a 5-point scale for overall image quality, image noise, small structure delineation, noise texture, artifacts, and degree of iodine removal. Quantitative assessment used region-of-interest measurements within the aorta at 4 standard locations, both psoas muscles, both renal cortices, spleen, retroperitoneal fat, and inferior vena cava. Attenuation (Hounsfield unit), quantitative noise (Hounsfield unit SD), contrast-to-noise ratio (CNR) (CNRvascular, CNRkidney, CNRspleen, CNRfat), signal-to-noise ratio (SNR) (SNRvascular, SNRkidney, SNRspleen, SNRfat), and radiation dose were compared between PCCT and EI-DECT with the Wilcoxon signed rank test. A P < 0.05 indicated statistical significance.

Results
A total of 74 patients (27 men; mean ± SD age, 63 ± 13 years) were included. Computed tomography dose index volumes for PCCT and EI-DECT were 9.2 ± 3.5 mGy and 9.4 ± 9.0 mGy, respectively (P = 0.06). Qualitatively, PCCT VNC images had better overall image quality, image noise, small structure delineation, noise texture, and fewer artifacts (all P < 0.00001). Virtual noncontrast images from PCCT had lower attenuation (all P < 0.05), noise (P = 0.006), and higher CNR (P < 0.0001–0.04). Contrast-enhanced structures had lower SNR on PCCT (P = 0.001, 0.002), reflecting greater contrast removal. The SNRfat (nonenhancing) was higher for PCCT than EI-DECT (P < 0.00001).

Conclusions
Virtual noncontrast images from PCCT had improved image quality, lower noise, improved CNR and SNR compared with those derived from EI-DECT.
Pharmacokinetics and Tolerability of the Cancer-Targeting MRI Contrast Agent MT218 in Healthy Males
Authors: Li Yajuan , Apseloff Glen , Tweedle Michael F. , Gao Songqi , Henry Eugenia , Lu Zheng-Rong 
Published: November 2023

ObjectiveThe aim of this study was to evaluate the pharmacokinetics and safety profile of MT218, a peptide-targeted gadolinium-based contrast agent, in healthy males.Materials and MethodsThis was a double-blind, randomized, placebo-controlled, single-ascending-dose study including 30 healthy male subjects. In each dose group (0.01, 0.02, 0.04, and 0.08 mmol/kg), 4 subjects received MT218 and 2 subjects received placebo (saline) in bolus injections. The highest dose group (0.08 mmol/kg) was assessed in 2 cohorts, 1 fasted and 1 nonfasted. Clinical laboratory tests, vital signs, and electrocardiograms were investigated. Gadolinium concentrations were measured in plasma samples collected before administration and over a 24-hour period postinjection, and in urine specimens collected until 22 days. A noncompartmental model was used for pharmacokinetic analysis. A clinical and biological safety follow-up was carried out for up to 6 months.ResultsNo clinically significant modifications in biochemistry, hematology, urinalysis, electrocardiogram parameters, or vital signs were reported at any time point for any treatment group. No serious adverse events were observed in any dose group. Transient dizziness, hyperhidrosis, and injection site coldness were the main adverse events reported in both the MT218 and placebo groups. The mean total apparent clearance decreased slightly with increasing dose, and the median plasma t1/2ranged from 1.7 hours in the 0.01 mmol/kg group to 2.7 hours in the 0.08 mmol/kg nonfasted group. MT218 was rapidly excreted via renal filtration with 42.9% to 52.8% of the injected dose measured in urine within the first hour after administration, and 92.5% to 117.3% in urine within 24 hours. No Gd was detected by inductively coupled plasma mass spectrometry in urine after 21 days.ConclusionSingle intravenous administration of MT218 was safely tolerated in the healthy males. Itspharmacokineticparameters and safety profile are well aligned with those of other gadolinium-based contrast agents.
The Role of Dual-Phase 18F-FP-CIT PET to Early Diagnosis of Corticobasal Syndrome
Authors: Kim Min Seung , Park Dong Gueu , Shin In Ja , An Young Sil , Yoon Jung Han 
Published: November 2023

Background
Corticobasal syndrome (CBS) is a neurodegeneration characterized by asymmetric parkinsonism, dystonia, myoclonus, and apraxia. In the early stage, CBS presents with asymmetric parkinsonism and cortical symptoms (apraxia and alien hand), and neuroimaging finding is often vague, making early clinical differentiation from idiopathic Parkinson disease (IPD) challenging. This study was performed to delineate the specific patterns of cortical hypoperfusion, dopamine transporter (DAT) uptake using dual-phase FP-CIT PET in discriminating between CBS and IPD at early stage.

Patients and Methods
The study enrolled clinically diagnosed CBS (n = 11) and IPD (n = 22) patients (age and sex matched). All participants underwent dual-phase 18F-FP-CIT PET, and regional SUV ratio (SUVR) was obtained by semiquantitative analysis. The early perfusion imaging and DAT imaging were compared between groups.

Results
The regional SUVRs (early phase) of the frontal lobe, thalamus, cingulate, and caudate were significantly lower in patients with CBS, whereas the SUVR of occipital lobe was lower in the IPD group. The CBS group exhibited more prominent asymmetry than the IPD group, particularly in the perirolandic area, superior frontal gyrus, and anterior parietal lobe in early phase PET. Striatal DAT uptake (delayed phase) revealed that the caudate showed lower SUVR and prominent asymmetry in the CBS group, and the caudate-to-putamen ratio (CP ratio) was significantly lower in CBS patients (P < 0.001). Among the parameters (early and delayed), the CP ratio in DAT exhibited the most powerful discriminative power from receiver operating characteristic curve comparison (area under curve = 0.983).

Conclusions
This study demonstrated that the dual-phase FP-CIT PET is useful in differentiating CBS and IPD in the early stage of the disease, and a lower CP ratio of DAT imaging is highly informative for distinguishing between corticobasal degeneration and IPD.