bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global trends in analgesic opioid use in pregnancy: A retrospective cohort study
Authors: Brett J , Cesta CE , Gillies MB , Bateman BT , Chan AYL , Cheng MCY , Cho Y , Choi EY , Cohen JM , Donald S , Furu K , Gissler M , Gomes T , Havard A , Hernandez-Diaz S , Hsieh MHC , Huybrechts KF , Karlsson P , Kelty E , Lai ECC , Ledlie S , Wang T , Leinonen MK , Parkin L , Reutfors J , Shin JY , Su CTT , Varney B , Wong ICK , Man KKC , Zoega H 
Published: February 2025

Background:
Pain is common during pregnancy yet there are few contemporary studies of opioid utilisation in pregnancy. We aimed to describe prescription analgesic opioid use during pregnancy across four regions: Oceania [New South Wales (Australia), New Zealand], North America [Ontario (Canada), United States (US)], Northern Europe [Denmark, Finland, Iceland, Norway, Sweden, United Kingdom (UK)], and East Asia (Hong Kong, South Korea, Taiwan).

Methods:
We applied a common protocol to population-based data to measure analgesic opioid dispensing or prescriptions during pregnancy prior to birth in 2000-2020. Populations captured included those with public and private insurance in the US, a sample of primary care practices in the UK and whole-of-population cohorts in the remainder. We examined prevalence of use, defined as at least one dispensing or prescribing and estimated trends over time. We described use by sociodemographic- and pregnancy characteristics.

Results:
Among a total of 20,306,228 pregnancies, 1,115,853 (55 per 1000) had at least one analgesic opioid dispensing or prescription, ranging from 4 per 1000 in the UK to 191 per 1000 in the US publicly insured population. We observed the greatest relative decrease in prevalence in Hong Kong (prevalence ratio 0.2; 95% CI 0.1-0.2 between 2005 and 2020) and greatest increase in Iceland (prevalence ratio 4.4; 95% CI 3.7-5.2 between 2004 and 2017). Codeine and tramadol were among the three most prevalent opioids in most populations. In a sensitivity analysis defining opioid use as two or more opioid dispensing or prescribing events, the prevalence of opioid use across populations was 17 per 1000.

Conclusions:
In this large multinational study, we observed wide global variation in prevalence of analgesic opioid use in pregnancy, yet patterns of use by sociodemographic- and pregnancy characteristics were relatively consistent. Analgesic opioid use remained stable or downward trending over time in most, but not all, countries.
Understanding the Process of Integration in Binaural Cochlear Implant Configurations
Authors: Muegge John B. , McMurray Bob 
Published: February 2025

Objectives:
Cochlear implant (CI) users with access to hearing in both ears (binaural configurations) tend to perform better in speech perception tasks than users with a single-hearing ear alone. This benefit derives from several sources, but one central contributor may be that binaural hearing allows listeners to integrate content across ears. A substantial literature demonstrates that binaural integration differs between CI users and normal hearing controls. However, there are still questions about the underlying process of this integration. Here, we test both normal-hearing listeners and CI users to examine this process.

Design:
Twenty-three CI users (7 bimodal, 7 bilateral, and 9 single sided deafness CI users) and 28 age-matched normal-hearing listeners completed a dichotic listening task, in which first and second formants from one of four vowels were played to each ear in various configurations: with both formants heard diotically, with one formant heard diotically, or with one formant heard in one ear and the second formant heard in the other (dichotically). Each formant heard alone should provide minimal information for identifying the vowel. Thus, listeners must successfully integrate information from both ears if they are to show good performance in the dichotic condition.

Results:
Normal-hearing listeners showed no noticeable difference in performance when formants were heard diotically or dichotically. CI users showed significantly reduced performance in the dichotic condition relative to when formants were heard diotically. A deeper examination of individual participants suggests that CI users show important variation in their integration process.

Conclusions:
Using a dichotic listening task we provide evidence that while normal-hearing listeners successfully integrate content dichotically, CI users show remarkable differences in how they approach integration. This opens further questions regarding the circumstances in which listeners display different integration profiles and has implications for understanding variation in real-world performance outcomes.
The Role of the Glymphatic System in Cervical Spondylotic Myelopathy
Authors: Zhang Justin K. , Javeed Saad , Greenberg Jacob K. , Yakdan Salim , Noroozi Gilandehi Sama , Shah Lubdha M. , Iyer Rajiv R. , Dailey Andrew T. , Bisson Erica F. , Mahan Mark A. , Mazur Marcus D. , Song Sheng-Kwei , Ray Wilson Z. 
Published: February 2025

Study Design:
Prospective cohort study.

Objective:
To provide a primer of the glymphatic system, discuss its potential relevance in evaluating spinal diseases like cervical spondylotic myelopathy (CSM), and describe possible imaging markers of the glymphatic system derived from advanced diffusion-weighted imaging (dMRI), namely diffusion tensor imaging (DTI) and diffusion basis spectrum imaging (DBSI).

Summary of Background Data:
The glymphatic system is a recently described physiological process that plays an integral role in macroscopic waste clearance in the CNS through cerebrospinal fluid (CSF)-interstitial fluid (ISF) exchange. Chronic spinal cord compression in CSM leads to pathophysiological consequences that theoretically affect the glymphatic system, and advanced dMRI may be well positioned to characterize these changes.

Methods:
This single-center study enrolled participants (control and CSM) from 2018 through 2020. All participants underwent clinical assessments and dMRI, followed by DTI and DBSI analyses, preoperatively and 2 years postoperatively. CSF flow was characterized by DTI-derived apparent diffusion coefficient (ADC) and ISF flow by DBSI-derived extra-axonal axial diffusivity (EA-AD) and radial diffusivity (EA-RD). Imaging parameters were compared among participants.

Results:
Forty-two patients with CSM ﻿[23 (55%) mild, 9 (24%) moderate, 10 (21%) severe] and 20 control patients were included. Preoperatively, ADC was significantly lower in CSM (2.59±0.4 µm2/ms) than control (3.08±0.34 µm2/ms) patients (P<0.01). Conversely, EA-AD and EA-RD were significantly higher in CSM (2.53±0.33; 0.48±0.13 µm2/ms) compared with control (2.27±0.2; 0.40±0.04 µm2/ms) patients (both P<0.01). Two years postoperatively, only EA-RD significantly decreased for CSM patients (Δ-0.04±0.12 µm2/ms, P<0.01). More severe CSM preoperatively was associated with lower baseline ADC (ρ=0.49, P<0.001) and higher baseline EA-RD (ρ=−0.35, P=0.005).

Conclusions:
The pathophysiology of CSM may affect the glymphatic system because of chronic spinal cord compression that decreases CSF bulk flow, leading to compensatory increases in ISF flow. Although research in this topic remains nascent, greater glymphatic system function observed on ﻿dMRI may correspond with greater disease burden. Future studies examining the role of the glymphatic system in spinal cord pathology are critical to better understanding how these noninvasive imaging biomarkers can improve patient outcomes in CSM.

Level of Evidence:
Level II.
A Multimodal Intervention to Increase Total Mesorectal Excision Grading for Rectal Cancer in Michigan: A Randomized Controlled Trial
Authors: Vu Joceline V. , Kanters Arielle , Berho Mariana , Rivard Samantha , Sinco Brandy , Singh Kushal , Duby Ashley , Banerjee Mousumi , Hendren Samantha 
Published: February 2025

BACKGROUND:
The total mesorectal excision technique is associated with improved outcomes for rectal cancer, and grading the total mesorectal excision specimen is recommended. We implemented a multimodal intervention in Michigan Surgical Quality Collaborative hospitals to increase total mesorectal excision grading.

OBJECTIVE:
To compare total mesorectal excision grading rates over time between hospitals that received the intervention early and late in the study.

DESIGN:
Stepped wedge randomized controlled trial with hospitals randomized to receive the education intervention early in the trial or one year later. We used a generalized linear mixed model to compare rates of total mesorectal excision grading over time between groups, adjusting for hospital characteristics.

SETTING:
Twelve hospitals within the Michigan Surgical Quality Collaborative.

PATIENTS:
Adult patients undergoing total mesorectal excision for rectal cancer from 2014 to 2021.

INTERVENTION:
A multimodal educational intervention consisting of a webinar about total mesorectal excision grading, a pre- and post-webinar quiz, and site visits.

MAIN OUTCOME MEASURES:
Total mesorectal excision grading rate for each hospital over time.

RESULTS:
From 2014 to 2021, 560 patients underwent total mesorectal excision in participating hospitals, 350 at early intervention hospitals and 210 in late intervention hospitals. The early intervention began August 2018, and the late intervention began June 2019. Based on the mixed model, grading in early hospitals increased from 8.1% to 99.7% at the end of the study (p < 0.001). In the late group, grading increased from 47.8% to 94.0% (p < 0.001). The intervention was not associated with a change in total mesorectal excision grading in either group; rather, the increase in grading corresponded with a statewide collaborative presentation on this topic in December 2016.

LIMITATIONS:
Selection bias, as hospitals recruited to participate were already participating in colorectal cancer quality improvement and may reflect greater commitment to high-quality rectal cancer care.

CONCLUSIONS:
Our findings show an increase in total mesorectal excision grading in Michigan from 2014-2021 that preceded the dates of our intervention. These results highlight the importance of accounting for secular trends in measuring healthcare quality improvement interventions. See Video Abstract.
Serum Lenvatinib Concentration Monitoring in a Patient With Thyroid Cancer Exhibiting Hand-Foot Syndrome: A Case Report
Authors: Watanabe Yusuke , Doki Kosuke , Sekine Ikuo , Hara Hisato , Homma Masato 
Published: February 2025

Background:
Hand-foot syndrome (HFS) is a common adverse event associated with lenvatinib treatment. Lenvatinib dose adjustment using therapeutic drug monitoring may be beneficial in the management of HFS, as symptoms improve with dose reduction or treatment interruption. The serum lenvatinib levels were monitored in a patient with lenvatinib-induced HFS.

Case presentation:
A 74-year-old woman was administered lenvatinib (24 mg/d) for papillary thyroid cancer. Although lenvatinib was withheld several times owing to the occurrence of HFS, the severity of the HFS was controlled to within grade 1 by reducing the dose to 4 mg/d. The lenvatinib dose was subsequently increased to 8 mg/d owing to the progression of lung metastases, resulting in increased HFS severity. The association between serum lenvatinib levels and the severity of HFS was examined in this case: serum lenvatinib levels were higher in grade 2 HFS than in grade 1 HFS (median 42.1 vs. 22.5 ng/mL; P < 0.05).

Conclusions:
This case's findings suggest that serum lenvatinib concentrations are associated with the severity of lenvatinib-induced HFS and that there may be an overlap between drug concentrations, metastatic suppression, and the grade of HFS.
Integrative Korean medicine treatment without surgery for the management of subacute radiating pain attributed to vertebral artery loop formation: A case report and literature review
Authors: Yun Jung Min , Go Dong Hyun , Lee Sook-Hyun 
Published: February 2025

Rationale:
Vertebral artery loop formation (VALF) compresses the adjacent cervical nerve root, resulting in cervical radiculopathy at the affected level. Neurosurgical interventions for anatomical separation are typically employed to relieve the symptoms, regardless of their duration. We herein report the management of the subacute symptoms of a rare case of cervical radiculopathy attributed to VALF using integrative Korean medicine (iKM) treatment without surgery.

Patient concerns:
A 54-year-old male patient presenting with a chief complaint of headache radiating to the posterior cervical and right scapular regions was treated with a 4-day program of inpatient care.

Diagnoses:
Based on the findings of the cervical spine magnetic resonance imaging, the patient was diagnosed with VALF on the right side at the C3/C4 level.

Interventions:
He underwent iKM treatment comprising acupuncture, pharmacopuncture, Chuna therapy, and herbal medicine.

Outcomes:
Significant improvement was noted in the patient’s condition (neck pain Numeric Rating Scale scores of 5, 4, and 1; Neck Disability Index scores of 35.56, 20, and 4; and EuroQol 5-dimension index scores of 0.754, 0.787, and 0.862 at admission, discharge, and the 2-month follow-up, respectively; Patient Global Impression of Change scores of 3 and 1 at discharge and the 2-month follow-up, respectively).

Lessons:
This case report suggests that iKM treatment may be effective for subacute VALF symptoms without requiring surgery.
Efficacy of triamcinolone acetonide combined with recombinant bovine basic fibroblast growth factor in preventing scar formation after adult circumcision using a stapler device: A randomized controlled trial
Authors: Yuan Yang , Zhang Shihao , Hu Dingli , Wang Bing , Li Yunlong 
Published: February 2025

Background:
This randomized controlled trial aimed to investigate the potential benefits of local application of triamcinolone acetonide combined with topical recombinant bovine basic fibroblast growth factor in promoting wound healing and reducing scar formation after circumcision using a stapler device.

Methods:
A total of 192 patients with phimosis or redundant prepuce were randomly assigned to either the observation group (n = 96) or the control group (n = 96). Both groups underwent circumcision using a stapler device. Postoperatively, the observation group received wet dressings of 2 mg/mL triamcinolone acetonide solution combined with topical recombinant bovine basic fibroblast growth factor until complete wound healing. The control group received saline wet dressings and standard postoperative wound care. Outcome measures included: postoperative edema, time to resolution of swelling at the incision edges, wound exudate, healing time, staple removal time and rate, scar formation, and patient satisfaction with penile cosmesis.

Results:
The observation group demonstrated significantly faster healing times and lower incidence of edema from the seventh postoperative day compared to the control group (P < .05). Furthermore, the observation group exhibited superior outcomes in terms of complete staple removal time, staple detachment rate, scar hypertrophy, and cosmetic scores using the modified Stony Brook Scar Evaluation Scale (P < .05). Patient satisfaction with penile cosmesis was also significantly higher in the observation group (P < .05).

Conclusion:
This study underscores the principle of “prevention over treatment” in scar management following stapler circumcision. The findings suggest that the combined use of triamcinolone acetonide and recombinant bovine basic fibroblast growth factor may be beneficial in reducing postoperative edema, improving scar formation, and enhancing patient satisfaction. However, further research is warranted to validate these findings, establish optimal treatment protocols, and ultimately assess the long-term efficacy and safety of this combined therapy.
Identification of ferroptosis-related genes in heart tissues of patients with hypertrophic cardiomyopathy
Authors: Huang Fang , Li Shujuan , Zhang Ailei , Zhao Jihuai , Zhang Shaoqiang , Liu Dongwei , Chen Wei 
Published: February 2025

Background:
This study aims to investigate the role of ferroptosis in hypertrophic cardiomyopathy (HCM), a genetic disorder characterized by abnormal thickening of the heart muscle. The objective is to identify differentially expressed genes associated with ferroptosis in HCM and understand the potential molecular mechanisms underlying the disease.

Methods:
Comprehensive genomic analysis was conducted to identify differentially expressed genes associated with ferroptosis in HCM. The analysis focused on TFRC, SCD, SLC2A1, EGR1, GDF15, SNCA, PLIN2, and NQO1 as hub genes regulating ferroptosis. Functional enrichment analysis was performed to uncover their involvement in pathways such as ferroptosis, ubiquinone biosynthesis, and HIF-1 signaling. In addition, immune cell infiltration patterns in HCM were explored, and associations between the hub genes and immune infiltration were identified.

Results:
The analysis revealed TFRC, SCD, SLC2A1, EGR1, GDF15, SNCA, PLIN2, and NQO1 as hub genes involved in the regulation of ferroptosis in HCM. Functional enrichment analysis indicated their contribution to key pathways related to ferroptosis, ubiquinone biosynthesis, and HIF-1 signaling. Furthermore, associations between the hub genes and immune infiltration in HCM were observed.

Conclusion:
This study provides valuable insights into the molecular basis of HCM by identifying differentially expressed genes associated with ferroptosis. The findings suggest potential molecular mechanisms underlying the development of HCM. These findings contribute to a better understanding of HCM and may pave the way for the development of targeted therapies and improved diagnostic approaches for this debilitating cardiac disorder.
Enhanced stroke rehabilitation outcomes through Information-Motivation-Behavioral skills model and Hospital-Community-Family ternary linkage integration: A randomized controlled trial
Authors: Xiao Yamei , Xu Xiaomei 
Published: February 2025

Background:
Stroke remains a leading cause of disability and mortality globally, necessitating effective rehabilitation strategies to improve patient outcomes. This study aimed to evaluate the effectiveness of specialized routine nursing interventions, nursing interventions based on the Information-Motivation-Behavioral Skills (IMB) model, and nursing interventions combining the IMB model with a hospital-community-family triad model in patients with acute ischemic stroke.

Methods:
A total of 120 patients with acute ischemic stroke were randomly assigned to one of 3 groups: Control Group (specialized routine nursing interventions, n = 40), Experimental Group 1 (IMB model-based interventions, n = 40), and Experimental Group 2 (IMB model combined with hospital-community-family triad, n = 40). Clinical outcomes, including NIHSS scores, medication adherence, and functional exercise adherence, were assessed at discharge and 6 months post-intervention. Patient satisfaction was also evaluated.

Results:
No differences were noted between groups at baseline. Both IMB model-based interventions (Experimental Groups 1 and 2) significantly improved NIHSS scores, medication adherence, and functional exercise adherence compared to the Control Group at both discharge and 6 months post-intervention. The combined intervention (Experimental Group 2) yielded the most pronounced improvements. Patient satisfaction was highest in Experimental Group 2, followed by Experimental Group 1 and the Control Group. These improvements were greater in Experimental Group 2 than Group 1. The adjusted multivariate regression models indicated significant improvements in all measured outcomes for the experimental groups, with lower AIC and BIC values suggesting better model fit.

Conclusion:
Nursing interventions based on the IMB model, particularly when combined with a hospital-community-family triad, significantly enhance clinical outcomes and patient satisfaction in stroke rehabilitation. These findings advocate for the integration of comprehensive, behavior-focused interventions in routine stroke care, addressing critical gaps in current rehabilitation practices. Future research should explore the long-term benefits and broader applicability of these interventions.
A novel TSC2 variant cosegregating with TSC in the family: A case report
Authors: Cao Jianwei , Zeng Chuwen , Shao Longhui , Liu Meiling , Wu Ze’e , Zhang Xiaowen , Liu Mingxing , Zhong Runyu , Zheng Kaijun , Chen Jialong 
Published: February 2025

Rationale:
Tuberous sclerosis complex is a multisystem genetic disorder caused by variant of TSC1 or TSC2, which were defined as an independent diagnostic criterion for TSC.

Patient concerns:
We present a novel hereditary variant in a family. The family showed a phenomenon of familial aggregation in the Tuberous sclerosis complex.

Diagnoses:
The proband had the c.3974del (exon 33) (p.Gly1325Alafs*58) loss of heterozygosity frameshift in the TSC2 gene (chr16), which was 1 base deletion on the coding sequence of TSC2, leading to a frameshift mutation. Moreover, the novel variant occurred in the grandchildren (generation 3) also can be detected in the grandparental (generation 1) and parental (generation 2).

Interventions:
The proband had taken antiepileptic drugs (oxcarbazepine [30 mg/(kg·day)], depakine [28 mg/(kg·day)], levetiracetam [38 mg/(kg·day)], and lamotrigine [2 mg/(kg·day)]) and performed a right parietal resection of the epileptic lesion.

Outcomes:
The treatment received by the proband was ineffective.

Lessons:
The novel gene mutation sites to be found provide more research entry points for genetic diagnosis, providing new clinical data for tuberous sclerosis complex research.
Adenomyomatosis of distal common bile duct: A case report and systemic review
Authors: Weng Chong-You , Lee Cheng-Hung 
Published: February 2025

Rationale:
Adenomyomatosis is a rare benign condition characterized by epithelial proliferation and diverticular formation in the gastrointestinal tract, most commonly affecting the gallbladder. Its occurrence in the bile duct is uncommon but significant, as it can cause biliary obstruction, cholestasis, and abdominal pain—symptoms that closely mimic early-stage cholangiocarcinoma. This overlap creates diagnostic challenges and increases the risk of misdiagnosis and overtreatment, making accurate identification essential.

Patient concerns:
A 54-year-old woman presented with persistent epigastric dull pain. Imaging studies revealed a dilated common bile duct (CBD), raising concerns about biliary pathology.

Diagnoses:
Abdominal computed tomography demonstrated a contrast-enhanced 1.6 cm tumor-like mass in the distal CBD, leading to a presumptive diagnosis of malignancy. Laboratory findings showed an elevated γ-glutamyl transferase level, while other tumor markers were within normal ranges.

Interventions:
Due to the high suspicion of malignancy, the patient underwent a Whipple procedure for both diagnostic and therapeutic purposes.

Outcomes:
Histological examination of the resected specimen surprisingly revealed adenomyomatosis of the CBD, confirming a benign diagnosis. The patient had an uneventful postoperative recovery and was discharged 19 days after surgery.

Lessons:
This case highlights the diagnostic challenge posed by adenomyomatosis of the distal CBD, as its radiological appearance can closely resemble malignancy. Clinicians should be aware of this rare entity to avoid unnecessary aggressive surgical interventions.