bluuebunny/crossref_metadata_2025_split huggingface dataset:
Granulomatosis with polyangiitis presenting headache: A case report and review of literature
Authors: Li Zhao , Zhang Qiushuang , Wang Xuebin , Shi Fang 
Published: January 2024

Rationale:
Central nervous system involvement is a rare manifestation of active-phaselocalized Granulomatosis with polyangiitis (GPA). In hypertrophic dura meningitis, GPA with headache is typical. In this case, cerebral magnetic resonance (MR) enhancement revealed no meningeal thickening, to our knowledge, this manifestation had not been found previously.

Patient concerns:
The patient presented to the Rheumatology and Immunology Clinic with severe headache and hearing loss, and central nervous system granulomatosis with polyangiitis was confirmed after a series of examinations. The patient had no significant effect after treatment with cyclophosphamide (CTX), but after the use of rituximab, the headache and hearing loss were significantly improved, and laboratory indicators returned to normal levels.

Diagnosis:
We comprehensively screened for craniocerebral infection and malignant tumors, diagnosed central nervous system granulomatosis with polyangiitis.

Interventions:
We gave sequential treatment of rituximab.

Outcomes:
All indicators are mostly back to normal when the patient was monitored at the outpatient clinic.

Lessons:
GPA and severe headache are more prevalent in hypertrophic dura meningitis, but the patient early headache could not be explained by hypertrophic dura meningitis or localized granulomatous lesions that invaded the central nervous system. Patients with severe headaches likely have vascular inflammation and local bone destruction at the base of the skull.
Calling emergency medical services for terminally ill patients: a qualitative study exploring reasons why informal caregivers make the call
Authors: Poláková Kristýna , Brýdlová Helena , Uhlíř Marek , Peřan David , Vlčková Karolína , Loučka Martin 
Published: January 2024

Background
Although emergency medical service is focused on providing acute prehospital treatment, it is often used by terminally ill patients and their informal caregivers during the last days of patient’s life. Little is known about why they decide to use the emergency medical services.

Study objective
The aim was to explore informal caregivers’ motivation and decision-making process for calling emergency medical services for their terminally ill loved ones.

Methods
This study used a qualitative design. Data were collected by semi-structured interviews with 31 relatives of 30 patients who used the emergency medical services. Data were analyzed with NVivo software by utilizing principles of thematic analysis.

Results
Through the analysis, four distinct themes emerged: (1) limited availability of support from health care services; (2) insufficient planning of care; (3) decline in the health of the patient and (4) being lost and desperate.

Conclusion
For informal caregivers, emergency medical services represented an important source of support while caring for their terminally ill loved ones due to the limited availability of other sources of help, including a lack of specialist palliative care providers. Additionally, informal caregivers had limited knowledge of the dying process and used emergency medical services for professional advice.
Bone scintigraphy with SPECT/CT in paediatric patients with neck and back pain in comparison with other imaging modalities: the experience of a tertiary paediatric referral centre
Authors: Eseonu Kelechi , Oduoza Uche , Robinson Phillip , Easty Marina , Nadarajah Ramesh , Biassoni Lorenzo 
Published: January 2024

Objective
Retrospective review of the additional clinical value provided by single photon emission computed tomography-computed tomography (SPECT/CT) in children and adolescents with back pain.

Methods
A total of 207 consecutive paediatric patients (94 males, 113 females, age range 5–17 years, median age 14 years) were reviewed after referral to the spinal surgery clinic of a paediatric teaching hospital between November 2009 and February 2021. All patients had either only whole spine X-rays or whole spine x-rays and MRI, along with bone scan with planar whole-body images and SPECT/CT (with spot views of painful area).

Results
X-ray identified the pain generator in 23 of 177 (13.0%) cases. MRI identified the pain generator in 49 of 165 (29.7%) cases. SPECT/CT reported relevant positive findings which identified the pain generator in 107 of 185 (57.8%) cases. SPECT/CT changed patients’ management in 72 of 185 (38.9%) cases. SPECT/CT was most effective at identifying the pain generator in cases of facet arthropathy, previous vertebral fracture and patients with previous deformity correction, where the pain generator was identified in 76.5% (13 of 17), 71.4% (5 of 7) and 63.4% (26 of 41) of cases, respectively. CT settings were adjusted to minimise the radiation burden (50 mAs/80kVp under 8 years, 24 mAs/110 kVp over 8 years).

Conclusion
The role of SPECT/CT in diagnosing back pain is justified in selected paediatric patients, particularly with diagnostic uncertainty using conventional imaging. The CT component of the SPECT/CT study produced a lower radiation dose than conventional CT imaging, whilst producing bone images of diagnostic quality.
Evaluating therapeutic efficacy of extended shelf-life 90Y glass microspheres in transarterial radioembolization for colorectal cancer: a quantitative FDG PET/CT analysis
Authors: Kesim Selin , Balaban Genc Zeynep Ceren , Soydemir Efe , Baltacioglu Feyyaz , Kissa Tugba Nergiz , Ozdemir Berdan , Ozguven Salih , Filizoglu Nuh , Niftaliyeva Khanim , Engur Ceren Ozge , Kostek Osman , Akdeniz Esra , Turoglu Halil Turgut , Erdil Tanju Yusuf , Cimsit Cagatay , Ones Tunc 
Published: January 2024

Objectives
There is a lack of sufficient evidence regarding the use of extended shelf-life (ExSL) Yttrium-90 (90Y) glass radiomicrospheres in metastatic colorectal cancer (mCRC) patients. We aimed to investigate the efficacy of ExSL 90Y glass radiomicrospheres with a personalized treatment approach by analyzing 18F-FDG PET/CT quantitative parameters [metabolic tumor volume (MTV) and total lesion glycolysis (TLG)] separately before and after the treatment.

Methods
A total of 93 radioembolization sessions involving 77 patients were included. Simplicit90Y software was utilized to perform multicompartmental voxel-based dosimetry. Adverse events were recorded using the CTCAE v5.0 criteria. The survival data were recorded in detail.

Results
The overall disease control rate was 84.9%, with a median overall survival (OS) of 12.7 months and median progression-free survival (PFS) of 8.3 months. A statistically significant increase in treatment response rate was observed when there was an increase in absorbed tumor dose for pre-treatment unit MTV (P = 0.005) and TLG (P = 0.004) values. We didn’t observe any additional side effects/vital risks that could be considered clinically significant.

Conclusion
Our study has provided evidence on the therapeutic effectiveness and safety in terms of dose-toxicity profile of ExSL 90Y glass microspheres in a large cohort of mCRC patients. With a personalized treatment approach, the increase in radiation dose absorbed by the tumor has shown a significant contribution to treatment response rate, as indicated by quantitative measurements obtained through 18F-FDG PET/CT.
Investigation of multi-infections and breast disease comorbidities in granulomatous mastitis
Authors: Esmaeil Nawzad Kh. , Salih Abdulwahid M. 
Published: January 2024

Introduction:Granulomatous mastitis (GM) is an inflammatory breast disease typically caused by infection, posing diagnostic challenges. It can coexist with other breast disorders or multiple infections, which have been vaguely discussed. This study investigates the incidence of multi-infection and breast disease comorbidities in GM.Method:The study enroled 63 females who had a confirmed diagnosis of GM. Laboratory investigations and bacterial cultures had been conducted for all the cases. The patients had undergone ultrasonography examination utilizing the LOGIQ E9 system. Core needle biopsy had been done to procure tissue samples for histopathological examination. Thorough scrutiny and assessment of patients’ records were performed. The variables encompassed age at presentation, breastfeeding data, parity, smoking status, seasonal affliction, hair-washing agents, exposure to radiation, comorbidities, and clinical, ultrasound and histopathological findings.Results:The patients’ ages ranged from 24 to 50. Breastfeeding history was positive in nearly all cases (97%). The majority of cases exhibited multiparity (81%). In total, 63.5% were passive smokers. Multi-infections were detected in six cases (9.5%). Among them,B. cepacia complexandToxoplasma gondiiwere identified in two cases (3.16%). Other multi-infections involvedStaphylococcus epidermidisandToxoplasma gondii,Burkholderia cepaciaandS. kloosiiandToxoplasma gondii,Staphylococcus epidermisandBrucellaspp.,Candidaspp. andBrucellaspp. Histopathological analysis revealed GM comorbidities with other breast diseases in 35% of the cases.Conclusion:Multi-infections and breast disease comorbidities may further complicate diagnosis and management of GM. The findings of this study may raise additional questions about the nature of the disease or potential complications associated with it.
Efficacy of metamizole to prevent kidney injury after renal-ischaemic reperfusion injury in Wistar rats
Authors: Kadar Dhirajaya Dharma , Warli Syah Mirsya , Ritarwan Kiking , Ichwan Muhammad , Ismi Jufriady , Fikri Erjan , Harahap Juliandi , Alferraly Ibnu 
Published: January 2024

Background:
Renal ischaemia-reperfusion injury (RIRI) is a common kidney procedure complication due to temporary blood flow interruption, leading to kidney injuries. This study aimed to analyze the effect of metamizole on the levels of interleukin-18 (IL-18), neutrophil-gelatinase-associated lipocalin (NGAL), myeloperoxidase (MPO), and histopathological changes in rats with RIRI.

Materials and methods:
Animal pre-clinical design study was used. Thirty-two male Wistar rats (Rattus norvegicus) were divided into four groups: negative control, positive control, M100, and M200. Blood samples were collected by intracardiac puncture, followed by bilateral nephrectomy and analyzed histopathologically.

Results:
Significant difference in IL-18 levels between positive control vs negative control (114.1 + 12.07 vs. 94.0 + 11.4; P = 0.019) and positive control vs M100 (114.1 + 12.07 vs. 86.9 + 8.34; P = 0.007). There was no difference in NGAL. M100 group had the lowest serum MPO levels (14.78+2.01), there was a significant difference in MPO levels in all pairwise analyses. There was a difference in cumulative EGTI scores among the study groups [positive 10.5 (8–11) vs. negative 9 (7–10) vs. M100 9 (7–10) vs. M200 9 (7–11); P = 0.021].

Conclusion:
Metamizole 100 mg/kgBW can reduce IL-18 and MPO levels in RIRI, giving more optimal results without affecting NGAL levels. Metamizole administration can reduce cumulative EGTI scores in RIRI, both at doses of 100 mg/kgBW and 200 mg/kgBW. This study shows that Metamizole can be used to prevent kidney injury caused by RIRI. IL-18 and MPO can be biomarkers in predicting kidney injury in RIRI.
The administration of long in-vitro fertilization protocol in adenomyosis: case series
Authors: Tjahyadi Dian , Nulianti Rina , Nisa Aisyah Shofiatun , Djuwantono Tono 
Published: January 2024

Background.
Adenomyosis is a gynaecological condition characterized by the infiltration of endometrial glands and stroma resulting in ectopic intramyometrial, leading to the generalized enlargement of the uterus. Various cyclical regimens are employed globally to assist infertile women with adenomyosis during in-vitro fertilization (IVF) treatment because there is no consensus regarding the best protocol for managing adenomyosis.

Case:
The authors reported two cases the administration of long IVF protocol in Adenomyosis with pregnancy outcome. In both cases examined were found that the levels of anti-Mullerian hormone (AMH) were below the 25th percentile. Nevertheless, in both of these cases, the number of oocytes successfully retrieved was more than 5, which may have been influenced by the use of GnRH agonists in previous cycles of long protocol. Both of them were diagnosed with intrauterine pregnancy after transfer embryo.

Conclusion.
Although there is currently no consensus on the most suitable protocol for adenomyosis cases, the application of a long protocol in both of the aforementioned cases has yielded positive IVF outcomes.
The risk of bone fractures in dementia patients receiving acetylcholinesterase inhibitors: a meta-analysis
Authors: Elhalag Rowan H. , Chèbl Pensée , Bayoumy Nervana M. , Hassan Noheir Ashraf Ibrahem Fathy , Hagar Hanan , Abowafia Marwan , Gaber Hamed , Belal Mohamed Mohamed , Shah Jaffer , Motawea Karam R. 
Published: January 2024

Aim:
The authors aimed to conduct a meta-analysis to determine if acetylcholinesterase inhibitors may pose a direct threat, increasing the incidence of fractures in dementia patients.

Methods:
PubMed, Scopus, and Cochrane Library were searched. Inclusion criteria were any original studies that demonstrated the link between acetylcholinesterase inhibitors and the incidence of fracture in patients with dementia. RevMan(5.4) was used.

Results:
Seven observational studies were included. The total number of patients included in the acetylcholinesterase inhibitors group is 274 332 and 290 347 in the control group. The pooled analysis showed that the risk of bone fracture was not statistically different between dementia patients who received acetylcholinesterase inhibitors and those who did not receive them (odds ratio=1.44, CI 0.95, 2.19, P=0.09). Subgroup analysis showed no statistically significant difference between dementia patients who took acetylcholinesterase inhibitors, and those who didn’t take acetylcholinesterase inhibitors in those more than or equal to 80 years old and those less than 80 years old (P=0.44) and (P=0.34) respectively. However, our results showed a statistically significant association between dementia patients who received acetylcholinesterase inhibitors and decreased fracture risk in those receiving the treatment for more than or less than 2 years (risk ratio=0.48, CI= 0.45, 0.51, P<0.00001) and (risk ratio=0.84, CI 0.70, 0.99, P=0.04), respectively.

Conclusion:
Our study revealed no role for acetylcholinesterase inhibitors in increasing the risk of fracture compared with controls. Hence, based on our analysis, they might have a protective role against fracture when used for long periods considering their positive action on bone growth and development. Therefore, Acetylcholinesterase inhibitors could be considered a safe option for improving cognitive functions in elderly demented patients without carrying any additional risks.
Acute psychosis and behavioural changes with seizure-like hyperactive psychomotor activity secondary to isotretinoin initiation in a healthy young male: case report
Authors: Albalawi Rawan , Alsahli Hamoud , Almutairi Naif , Alhashemi Moustafa 
Published: January 2024

Introduction and importance:Acute psychosis is a common brief psychiatric emergency period of delusions, hallucinations, disorganized thoughts and/or speech with or without psychomotor elements, which is not commonly induced by isotretinoin therapy. Dermatologists should counsel the patient before starting the treatment with all new, uncommon side effects, especially neuropsychiatric manifestations before starting this medication.Case presentation:A 23-year-old male smoker with a known case of acne vulgaris recently started on isotretinoin for 2 weeks after which he developed abnormal hyperactive psychomotor activity. He was diagnosed with isoteritoin-induced acute psychosis based on clinical findings and exclusion, and valproic acid and olanzapine were initiated. The patient showed significant improvement.Clinical discussion:Acute psychosis is a new, unfamiliar side effect presenting after initiation of isotretinoin therapy in young adults who were previously healthy. The mechanism is not well known but is thought to result from a decrease in the adult’s neurogenesis or alterations in exposure of the serotonergic neurotransmitter system.Conclusion:Isotretinoin is commonly used nowadays for treating young adults. Patients and their families should be counselled about all the psychiatric side effects. Antipsychotics and antiepileptics with mood stabilizers may improve the acute status for patients with isotertoin-induced psychosis.
Meleney’s gangrene managed with a single extensive debridement and resultant defect closure with abdominoplasty technique – a case report
Authors: Ahmed Somi , Maharjan Niran , Hirachan Niroj 
Published: January 2024

Introduction:
Meleney’s gangrene, or progressive bacterial synergistic gangrene, is a life-threatening subcutaneous tissue infection and skin necrosis of the abdomen that is persistent and quickly progressing and has documented cultural characteristics of a symbiotic organism. The nobility of this case lies in the use of the modern technique, abdominoplasty, used to close the wound post-radical debridement for Meleney’s gangrene. This uncommon illness has a high fatality rate and requires immediate diagnosis, aggressive antibiotic treatment, and extensive debridement.

Case presentation:
We report the case of a 55-year-old female with no known comorbidities, who presented to our center with features of Meleney’s gangrene and pleural effusion. Radical debridement was performed and empirical intravenous antibiotics were administered. The wound was closed using the abdominoplasty approach.

Clinical discussion:
Meleney’s gangrene should be identified quickly and treated with wide-spectrum antibiotics and rigorous surgical debridement. It is difficult to diagnose the illness early, and skepticism is strong during this process. An increased risk of death may follow a postponed diagnosis of Meleney’s gangrene. A long-term hospital stay can result from extensive debridement. Furthermore, skin transplants may be required to close wounds in certain instances.

Conclusion:
This case is presented to show how early intervention and radical debridement can improve the outcome in cases of Meleney’s gangrene, which is rare and clinically significant. Additionally, this suggests that a cosmetic procedure known as abdominoplasty could be a viable option for wound closure.
Review of surgical strategies in gastric cancer
Authors: Vyas Soumil , Supe Avinash 
Published: January 2024

AbstractSuccessful and effective management of gastric cancer involves a multidisciplinary approach.Accurate and appropriate staging of gastric cancer is mandatory to define the optimum treatment strategy. Safe surgery achieving R0 resection is considered potentially curative. Surgery remains the cornerstone of multimodal therapy. There is a well-defined role for neoadjuvant and adjuvant chemotherapy regimens. Newer medications and chemotherapy combinations have improved tumor response rates, which have translated into more effective surgery and reduced local recurrences and improved long-term survivals.
Characterization of Demographical Histologic Diversity in Small Renal Masses With the Clear Cell Likelihood Score
Authors: Vazquez Louis C. , Xi Yin , Rasmussen Robert G. , Venzor Jose E. Rodriguez , Kapur Payal , Zhong Hua , Dai Jessica C. , Morgan Tara N. , Cadeddu Jeffrey A. , Pedrosa Ivan 
Published: January 2024

Objective
This study aimed to develop a diagnostic model to estimate the distribution of small renal mass (SRM; ≤4 cm) histologic subtypes for patients with different demographic backgrounds and clear cell likelihood score (ccLS) designations.

Materials and Methods
A bi-institution retrospective cohort study was conducted where 347 patients (366 SRMs) underwent magnetic resonance imaging and received a ccLS before pathologic confirmation between June 2016 and November 2021. Age, sex, race, ethnicity, socioeconomic status, body mass index (BMI), and the ccLS were tabulated. The socioeconomic status for each patient was determined using the Area Deprivation Index associated with their residential address. The magnetic resonance imaging–derived ccLS assists in the characterization of SRMs by providing a likelihood of clear cell renal cell carcinoma (ccRCC). Pathological subtypes were grouped into four categories (ccRCC, papillary renal cell carcinoma, other renal cell carcinomas, or benign). Generalized estimating equations were used to estimate probabilities of the pathological subtypes across different patient subgroups.

Results
Race and ethnicity, BMI, and ccLS were significant predictors of histology (all P < 0.001). Obese (BMI, ≥30 kg/m2) Hispanic patients with ccLS of ≥4 had the highest estimated rate of ccRCC (97.1%), and normal-weight (BMI, <25 kg/m2) non-Hispanic Black patients with ccLS ≤2 had the lowest (0.2%). The highest estimated rates of papillary renal cell carcinoma were found in overweight (BMI, 25–30 kg/m2) non-Hispanic Black patients with ccLS ≤2 (92.3%), and the lowest, in obese Hispanic patients with ccLS ≥4 (<0.1%).

Conclusions
Patient race, ethnicity, BMI, and ccLS offer synergistic information to estimate the probabilities of SRM histologic subtypes.
Photon-Counting Detector CT
Authors: Marth Adrian A. , Goller Sophia S. , Kajdi Georg W. , Marcus Roy P. , Sutter Reto 
Published: January 2024

ObjectivesThe aim of this study was to compare the effectiveness and clinical utility of virtual monoenergetic image (VMI) reconstructions in computed tomography (CT) scans with and without tin prefiltration on a photon-counting detector (PCD) CT system to reduce metal implant artifacts in the postoperative ankle.Materials and MethodsThis retrospective study included patients with internal fixation of the ankle scanned with and without tin prefiltration (Sn) on a PCD CT scanner between March and October 2023. Virtual monoenergetic images between 60 and 190 keV were reconstructed with a 10-keV increment in a bone kernel for both acquisitions (VMISnand VMIStd, respectively). Noise measurements assessed artifact reduction in the most prominent near-metal image distortions and were compared between acquisitions modes as well as between polychromatic images and VMIs. Three readers assessed the visibility of osseous healing along with interpretability and artifact extent for 5 reconstruction levels.ResultsA total of 48 patients (21 females, 27 males; mean age, 55.1 ± 19.4 years) were included in this study. Tin-prefiltered acquisitions (n = 30) had a lower artifact level for polychromatic images and VMIs compared with non–tin-prefiltered acquisitions (n = 18;P≤ 0.043). A significant reduction of metal artifacts was observed for VMISn≥120 keV compared with polychromatic images (hyperdense artifacts: 40.2 HU [interquartile range (IQR) 39.8] vs 14.0 HU [IQR 11.1];P≤ 0.01 and hypodense artifacts: 91.2 HU [IQR 82.4] vs 29.7 HU [IQR 39.6];P≤ 0.001). For VMIStd, this applied to reconstructions ≥100 keV (hyperdense artifacts: 57.7 HU [IQR 33.4] vs 19.4 HU [IQR 27.6];P≤ 0.001 and hypodense artifacts: 106.9 HU [IQR 76.1] vs 57.4 HU [IQR 55.7];P≤ 0.021). For visibility of osseous healing, VMISnat 120 keV yielded higher ratings compared with polychromatic images (P≤ 0.001), whereas image interpretability was rated better (P= 0.023), and artifact extent was rated lower (P≤ 0.001) compared with polychromatic images.ConclusionsTin-prefiltered VMI at 120 keV showed a significant reduction in metal artifacts compared with polychromatic images, whereas visibility of osseous healing and image interpretability was improved. Therefore, tin-prefiltration PCD CT with VMI reconstructions may be a helpful complement to postsurgical CT imaging of the ankle in patients with metal implants.