bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flow diversion in the treatment of intracranial aneurysms using the novel FRED X device: An early experience from a single high-volume center
Authors: Clausen Thomas Mandel , Nakamura Ryan , Conching Andie , Choi Joo Won , Zhang Yi Jonathan , Hui Ferdinand , Tsappidi Samuel 
Published: February 2025

Background The Flow Re-Direction Endoluminal Device X (FRED X) offers several benefits over other flow-diverter devices including an antithrombotic coating, optimized in-vessel stability, and increased flexibility for easier device placement. We present a to-date experience of the safety and utility of the FRED X device in the repair of posterior and anterior circulation aneurysms. Methods A retrospective review was conducted on all endovascular procedures that utilized the FRED X device at our center from May 2022 to November 2023. Results 77 patients (72.7% women, mean age 58.9), underwent a total of 85 procedures using the FRED X device. Indications included treatment of incidentally discovered aneurysms, acute dissections, aneurysm rupture, repair of residual filling following prior intervention, and use of FRED X for recanalization of non-aneurysmal extracranial stroke. 31.3% of the aneurysms were in the posterior circulation, 68.7% were in the anterior circulation. 9.4% of patients presented with SAH due to acute aneurysm rupture. Patients treated with FRED X were separated into OFF-Label (40.0%) or ON-label (60.0%) indications. Occlusion rate at 6-month follow-up were 72.2% in the OFF-label group, 66.7% in the ON-label group, and 68.4% overall. Rate of major periprocedural complications was 1.2% and the cumulative rate of postprocedural complication at follow-up was 5.3%. Conclusion This study shows that FRED X treatment of intracranial aneurysms is safe in both OFF-label and ON-label indications. Continued follow-up of our patient population will further establish the safety, efficacy, and long-term stability of this device.
Significance of whole-blood EBV DNA status in T/NK-cell lymphoma-associated hemophagocytic lymphohistiocytosis: a single-center retrospective analysis
Authors: Xiong Mengqi , Li Li , Wang Lulu , Zhu Lixia , Chen Rongrong , He Jingsong , Ye Xiujin 
Published: February 2025

Background: Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition often triggered by malignancies, especially T/NK-cell lymphoma-associated HLH (T/NK-LAHLH). Epstein-Barr virus (EBV) infection is strongly linked to T/NK-LAHLH and worsens prognosis. However, the prognostic value of whole-blood EBV DNA levels in T/NK-LAHLH remains unclear, necessitating further investigation to improve risk assessment and treatment strategies. Objective: To investigate the clinical characteristics and prognostic significance of whole-blood EBV DNA status in patients with T/NK-LAHLH. Design: A single-center, retrospective study was conducted, including 85 patients diagnosed with T/NK-LAHLH between January 2017 and August 2022. Patients were categorized based on EBV DNA status, and clinical outcomes were compared. Methods: EBV DNA levels were quantified using polymerase chain reaction (PCR) assays. Kaplan-Meier survival and Cox regression models to assess overall survival (OS) and identify independent prognostic factors. Results: A total of 85 T/NK-LAHLH patients were included, with a median age of 52 years (range: 18–81 years) and 60% male. The OS rates at 1, 3, 6, and 12 months were 66.6%, 49.8%, 33.8%, and 28.4%, respectively. Among these patients, 67 (78.8%) were EBV DNA-positive, while 18 (21.2%) were EBV DNA negative. EBV DNA-positive patients exhibited significantly lower platelet and globulin levels, higher IL-10 levels, and prolonged activated partial thromboplastin time compared to EBV DNA-negative patients ( p < 0.05). The 6-month OS rate was significantly lower in EBV DNA-positive patients compared to EBV DNA-negative patients (22.5% vs 75.1%, p < 0.001). Multivariate analysis identified EBV DNA positivity as an independent risk factor for shorter 6-month OS (hazard ratio (HR): 4.715; 95% CI: 1.662–13.377; p = 0.004). Among the four patients who underwent allogeneic hematopoietic stem cell transplantation, all achieved complete remission and remained alive at the last follow-up. Conclusion: Whole-blood EBV DNA positivity is a significant prognostic factor for poor outcomes in T/NK-LAHLH patients. These findings highlight the need for incorporating EBV DNA monitoring into clinical management and further research to refine therapeutic strategies.
ACU-Net: Attention-based convolutional U-Net model for segmenting brain tumors in fMRI images
Authors: Talukder Md Alamin , Layek Md Abu , Hossain Md Aslam , Islam Md Aminul , Nur-e-Alam Mohammad , Kazi Mohsin 
Published: February 2025

Objective Accurate segmentation of brain tumors in medical imaging is essential for diagnosis and treatment planning. Current techniques often struggle with capturing complex tumor features and are computationally demanding, limiting their clinical application. This study introduces the attention-based convolutional U-Net (ACU-Net) model, designed to improve segmentation accuracy and efficiency in fMRI images by incorporating attention mechanisms that selectively highlight critical features while preserving spatial context. Methods The ACU-Net model combines convolutional neural networks (CNNs) with attention mechanisms to enhance feature extraction and spatial coherence. We evaluated ACU-Net on the BraTS 2018 and BraTS 2020 fMRI datasets using rigorous data splitting for training, validation, and testing. Performance metrics, particularly Dice scores, were used to assess segmentation accuracy across different tumor regions, including whole tumor (WT), tumor core (TC), and enhancing tumor (ET) classes. Results ACU-Net demonstrated high segmentation accuracy, achieving Dice scores of 99.23%, 99.27%, and 96.99% for WT, TC, and ET, respectively, on the BraTS 2018 dataset, and 98.72%, 98.40%, and 97.66% for WT, TC, and ET on the BraTS 2020 dataset. These results indicate that ACU-Net effectively captures tumor boundaries and subregions with precision, surpassing traditional segmentation approaches. Conclusion The ACU-Net model shows significant potential to enhance clinical diagnosis and treatment planning by providing precise and efficient brain tumor segmentation in fMRI images. The integration of attention mechanisms within a CNN architecture proves beneficial for identifying complex tumor structures, suggesting that ACU-Net can be a valuable tool in medical imaging applications.
The Association Between Mindfulness and Social Media Addiction Among Nurses: A Cross-Sectional Study
Authors: Kang Chunliang , Wang Huan , Li Jinfang , Zhang Qiuxiang , Xie Wenzhao 
Published: February 2025

Background: With the increasing use of social media, social media addiction (SMA) has become a pressing issue and is associated with multiple negative outcomes. Lack of mindfulness has been shown to be associated with an increased risk of SMA, yet such an association has never been explored among nurses in China. Methods From December 4, 2022 to March 14, 2023, a cross-sectional study was conducted in 29 hospitals in Hunan Province, China. A total of 1,141 nurses were recruited and completed the online questionnaires. Mindfulness and SMA were assessed by the Mindful Awareness Attention Scale (MAAS) and Social Networking Service Addiction Scale (SNSAS), respectively. Multivariate linear regression analysis was used to explore the association between mindfulness and SMA, and other influencing factors of SMA. Results The nurses had an average score of 68.02 ± 11.86 for mindfulness and 46.15 ± 15.09 for SMA. The results of linear regression analysis showed that lower levels of mindfulness (β = –0.06, p < .001), shorter working years (β = –0.21, p = .014), and experiencing more frequent workplace violence (β = 0.21, p =.007) were associated with an increased risk of SMA. Conclusions/Application to Practice Our study shows a generally moderate level of SMA among nurses in Hunan Province, which was influenced by mindfulness, working years, and workplace violence. Mindfulness-based interventions may be effective interventions to alleviate nurses’ SMA. Special attention should also be paid to nurses with shorter working years and those who experienced workplace violence.
Rare Complications in Endoscopic Spinal Surgery: A Narrative Review of Unique Cases
Authors: Stadler Ryan D. , Shrestha Nancy , Dara Gabriel , Yu Alexander , Kurapatti Mark , Etigunta Suhas , Berman Daniel , Lee Joshua , Cho Brian , Cho Samuel K. 
Published: February 2025

Study Design Narrative Review. Objectives Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies. Methods A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis. Results A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia). Conclusions Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.
Can Preoperative C2 Slope Predict Postoperative Cervical Sagittal Imbalance After Laminoplasty?
Authors: Ruomu Qu , Siyuan Qin , Ben Wang , Yiyuan Yang , Yanbin Zhao , Shengfa Pan , Xin Chen , Zhongjun Liu , Feifei Zhou , Liang Jiang 
Published: February 2025

Study Design Retrospective study. Objective To investigate the impact of preoperative C2 slope (C2S) on change in sagittal vertical axis (SVA) and postoperative cervical sagittal imbalance (CSI) after laminoplasty (LP). Methods Consecutive patients who underwent LP between January 2015 and January 2022 with a minimum of 12-month follow-up were reviewed. The clinical variables and radiographic measurements were assessed. Patients were divided into improvement (ΔcSVA ≤ −10 mm), stable (−10 mm ≤ ΔcSVA <10 mm), and CSI groups (ΔcSVA≥10 mm). Correlation analysis was performed to explore the associations between ΔcSVA and preoperative factors, postoperative change and outcome variables. Multivariable logistics regression was conducted to determine the factors predicting CSI. Results Over the 186 enrolled patients, 23 developed CSI. The CSI group presented with significantly lower preoperative cSVA, greater cervical lordosis (CL) and C2S. At the final follow-up, the CSI group presented significantly higher increase in neck pain, C2S and C7S, and greater loss in CL and range of motion at flexion position. Correlation analysis revealed that ΔcSVA is correlated positively to preoperative CL and surgical segments and negatively to preoperative C2S and cSVA. Multivariable regression revealed that lower preoperative C2S ( P = 0.026) was risk factor for postoperative CSI, with 8.9 as a potential cut-off value for C2S. Conclusions Lower preoperative C2S slope was risk factor for post-laminoplasty CSI. The cut-off value of C2S was 8.9. Laminoplasty should be carefully considered for patients with low C2S due to risk of postoperative CSI.
Magnitude and Associated Factors of Depression among Hypertensive Patients Attending Hospitals in Arba Minch Town, South Ethiopia
Authors: Ezo Elias , Takele Tamirat , Mezgebu Taye , Zekiwos Asnakech , Admasu Sentayehu , Ossabo Getachew , Birhanu Bethelhem , Amare Eldana , Mechal Ayalnesh 
Published: February 2025

Background The presence of depression among hypertensive patients leads to a lack of adherence to treatment and poor compliance with lifestyle adjustments. Objectives To assess the magnitude and associated factors of depression among hypertensive patients attending hospitals in Arba Minch town, Gamo zone, south Ethiopia, 2024. Methods An institution-based cross-sectional study was employed from 1 May to 30 June 2024. The total sample size was 395. A systematic random sampling technique was used. Data was collected through face-to-face interviews. Data was entered into Epi Data version 3.1 and then exported to the SPSS version 25 statistical package for analysis. Logistic regression analysis tested the association between the independent and the outcome variables. Finally, a significant independent association was interpreted at a P-value of less than 0.05 with 95%CI. Result The magnitude of depression among hypertensive patients was 43.6% with 95% CI (38.2–48.7). Taking multiple antihypertensive medications [AOR: 2.19, 95%CI: 1.16–4.16], history of admission [AOR: 0.24, 95%CI: 0.12–0.46], blood pressure status [AOR: 0.07, 95%CI: 0.03–0.16], body mass index <18.5 kgm2 [AOR: 0.12, 95%CI: 0.02–0.83], 18.5–24.9 kgm2 [AOR: 0.14, 95%CI: 0.04–0.52], 25–29.9 kgm2 [AOR: 0.23, 95%CI: 0.06–0.91], family history of hypertension [AOR: 3.06, 95%CI: 1.27–7.37], family history of depression [AOR: 5.01, 95%CI: 2.02–12.43], ever alcohol drinker [AOR: 3.37, 95%CI: 1.32–8.58], and ever smoke cigarette [AOR: 3.44, 95%CI: 1.26–9.34] were associated with depression among hypertensive patients. Conclusion The number of antihypertensive medications, history of admission, blood pressure status, body mass index, family history of hypertension, family history of depression, ever alcohol drinker, and ever smoked cigarette were significantly associated with depression among hypertensive patients. Therefore, limiting the number of medications, controlling blood pressure, reducing body mass index, screening and treating family-related hypertension and depression, and abstinence from alcohol and smoking might reduce the burden of depression among hypertensive patients.
Developing and implementing a nurse-delivered and a web-based dyadic psychoeducational program for people with advanced cancer and their family caregivers: sharing experiences from a three-arm international randomized controlled trial (DIAdIC)
Authors: De Vleminck Aline , Van Goethem Vincent , Dierickx Sigrid , Matthys Orphé , Beernaert Kim , Gronvold Mogens , Larkin Philip , Guberti Monica , Witkamp Erica , Reid Joanne , Bristowe Katherine , Deliens Luc , Lapeire Lore ,   DIAdIC Team, Hudson Peter , Cohen Joachim 
Published: February 2025

Background: Each year millions are diagnosed with cancer, impacting both patients and caregivers. Few interventions target both patients and family caregivers together, despite their shared experiences. While dyadic psychoeducational programs are gaining attention, evidence on developing and implementing these in international trials is limited. The DIAdIC trial faced unique challenges requiring innovative solutions to maintain study integrity. Objectives: To present our experiences with the development and implementation of two dyadic psychoeducational home-based programs, FOCUS+ and iFOCUS in the context of a randomized controlled trial (RCT) in six European countries. Design: A case report detailing our experiences in the development and implementation of two dyadic psychoeducational home-based programs (one face-to-face and one web-based) across multiple countries, highlighting the challenges and mitigating strategies in an international context. Methods: A chronological narrative describing experiences with the development and implementation of iFOCUS and FOCUS+. Results: The FOCUS+ and iFOCUS programs were successfully developed for the European context through rigorous translation and adaptation processes. Despite recruitment challenges including COVID-19 restrictions and administrative hurdles, 431 patient-caregiver dyads were enrolled across 6 European countries. Quantitative and qualitative data assessed the outcomes of FOCUS+ and iFOCUS interventions, including the primary endpoints of emotional functioning and self-efficacy. Fidelity was evaluated using audio recordings, checklists, and user data. Challenges in trial management were addressed with flexible timelines and technical support. Conclusion: The international DIAdIC trial developed and implemented two psychoeducational dyadic programs for patients with advanced cancer and their family caregivers. Based on our experiences we share several insights for future similar studies. These relate to the attention needed for context-specific adaptations when using existing interventions or programs, the translation of human-facilitated programs to standalone eHealth versions, the challenges of adopting a dyadic focus in the study, the pragmatic challenges of conducting an RCT and evaluating implementation and effects, and the technology used for study management.
Community Perspectives on Inequalities in the Provision of Basic Healthcare Services for the Most Vulnerable Populations in the Eastern Congo: A Qualitative Study
Authors: Bwirire Dieudonné , Crutzen Rik , Letschert Rianne , Ntabe Namegabe Edmond , Cheruga Bonfils , Mukwege Juliette , Amisi Kasaya Trésor , de Vries Nanne 
Published: February 2025

Background There is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings. Purpose This study aimed to explore and describe the factors influencing the provision of basic health care services for the most vulnerable populations in the Eastern Congo. Method Employing a qualitative research approach, twenty individual interviews with community members and thirteen focus group discussions were conducted. Participants were drawn from three geographically and demographically diverse locations with a history of decades-long armed conflicts in the Congo. Inductive thematic coding used the Health System Dynamics Framework categories (i.e. goals and outcomes, values and principles; service delivery; the population; the context; leadership & governance; and the organization of resources (finances; human resources; infrastructure and supplies; knowledge and information), while allowing for additional themes. Results Our findings are presented thematically according to these ten categories. The following factors were perceived as key areas enabling or hindering healthcare provision to the community: (1) the context for organizing basic healthcare service delivery is complex and challenging; (2) the population plays a crucial role as an active producer of health and potential change agents; (3) there is a poor strategic policy framework to guide local-level communities in the provision of basic healthcare services; (4) several critical barriers and facilitators related to effective healthcare service delivery were identified; (5) the classification of basic health service delivery methods to meet the healthcare needs of the vulnerable population; (6) the healthcare system is pluralistic and consists of multiple overlapping systems and providers; and (7) service providers and potential service users still consider access to basic healthcare services challenging, potentially resulting in reduced coverage. Conclusion These findings suggest that substantial changes in the factors contributing to the provision of basic healthcare services are necessary to ensure the delivery of basic healthcare services to the most vulnerable populations in the Eastern Congo. Consequently, there is a critical need to reconsider the healthcare delivery system, specifically addressing these contributing factors in the context of the Eastern Congo.
Effects of neuromuscular electrical stimulation during hemodialysis on muscle strength, functional capacity and postural balance in patients with end-stage renal disease: a randomized controlled trial
Authors: Machfer Amal , Fekih Nadia , Ammar Achraf , Hassen Hayfa Ben Haj , Daab Wael , Amor Hassen Ibn Hadj , Bouzid Mohamed Amine , Chtourou Hamdi 
Published: February 2025

Abstract

Background
Hemodialysis patients (HD) have a limited physical capacity and this often means low adherence to rehabilitation programs based on conventional exercise. This study investigated the effectiveness of neuromuscular electrical stimulation (NMES) during HD therapy on muscle strength, functional capacity and postural balance in HD patients.

Methods
Twenty-two HD patients were randomly assigned to a control group (CG) or a neuromuscular electrical stimulation training group (NSTG). The NSTG underwent NMES on the quadriceps muscle during HD sessions for 12 weeks, three times per week (40 min per session. Center of pressure (COP) displacement in the mediolateral direction (COPx), in the anteroposterior direction (COPy), and the COP area (COP area) were recorded using a stabilometric platform. Timed Up and Go test (TUG) and Sit to Stand (STS30) tests, 6-minute walking test (6MWT), and the maximal voluntary contraction (MVC) were measured before and after the intervention in both groups.

Results
There was a significant increase in MVC (+ 24.5%; P < 0.01), 6MWT (+ 9.8%; P < 0.05) and STS30 (+ 25.6%; P < 0.01) performance in the NSTG following the NMES intervention period. A significant reduction was observed in TUG (-11.8%; P < 0.01), COPx(-20.1%; P < 0.05) and COPy (-24.7%; P < 0.01) following the intervention period only in the NSTG. However, no significant changes were observed in the CG following the intervention period.

Conclusion
This study supports the effectiveness of intradialytic NMES to improve muscular strength, functional capacity and postural balance in HD patients. Given the limited implementation of exercise programs in dialysis clinical practice, NMES during HD sessions offers a novel therapeutic alternative to enhance physical condition and quality of life in these patients.

Trial registration
Pan African Clinical Trial Registry Identifer: PACTR202206634181851 Registered on 21/06/2022. Registered trial name: Beneficial Effect of Intradialytic Electrical Muscle Stimulation in Hemodialysis Patients.