bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of early palliative care intervention on medical resource use among end-of-life patients
Authors: Lin Chia-Chia , Ho Tsing-Fen , Lin Chang-Hung , Tsai Nu-Man , Kuo Yu-Hung , Chien Ju-Huei 
Published: December 2024

Abstract

Background
In Taiwan, as the population ages, palliative care services (PCS) have expanded significantly to include comprehensive benefit plans for critically ill individuals, supported by reimbursements from the National Health Insurance program. However, incorporating palliative care into the medical management of these patients presents several challenges. We aim to evaluate the effects of palliative care interventions on medical resources in end-of-life scenarios, to promote earlier palliative care access and provide high-quality healthcare services for patients.

Methods
A total of 2202 patients were included in this study. Primary diagnosis and referral for PCS were assessed using ICD-10 and HNI code. All study subjects were divided into three groups: patients who did not receive PCS (no-PCS), patients who received PCS before their final hospital admission (PCS-before), and patients who received PCS after their final admission (PCS-after). We evaluated (i) the effects of PCS on eight medical resource utilization outcomes within the 30 days preceding death and (ii) the effects of early intervention on two major diseases.

Results
Initiating PCS before a patient’s last hospital admission was associated with less aggressive medical interventions in the 30 days before death, including reduced length of intensive care unit (ICU) [odds ratio (OR) = 0.25], and rates of endotracheal intubation (OR = 0.12), respiratory ventilator support (OR = 0.20), cardiopulmonary resuscitation (OR = 0.18), and blood transfusion (OR = 0.65). Among patients with cancer and lung diseases, those who received PCS prior to their final hospitalization of over 14 days experienced reduced hospitalization duration (OR = 0.52 and 0.24, respectively). Patients with lung disease also had significantly lower odds of ICU stays (OR = 0.44) and respiratory ventilation (OR = 0.33).

Conclusion
The timing of palliative care intervention critically impacts on duration of hospitalization and ICU stay and the need for intubation procedures or cardiopulmonary resuscitation. The findings can help the government and medical providers in developing comprehensive palliative care policies and programs to improve care quality and patient rights.
Advancing an Embodied Understanding of Accessibility for Persons with Disabilities
Authors: Ferri Delia 
Published: December 2024

Abstract
The UN Convention on the Rights of Persons with Disabilities (CRPD) includes accessibility among its general principles and articulates it in Article 9. Further, accessibility obligations are included in several other provisions of the Convention. In that regard, the CRPD recognizes the significance of accessibility as an enabling factor, and as a precondition for persons with disabilities to participate fully in society. Embracing an interdisciplinary approach, and on foot of arts-based research in the form of inclusive dance, this article aims to re-construe the inherent dimensions of accessibility as a normative concept. It puts forward an ‘embodied understanding’ of accessibility with a view of advancing existing legal analysis and adding to traditional cognitive ways of knowing. On the whole, this article identifies three inherent and intertwined facets of such embodied understanding of accessibility—namely, respect for difference, collaboration and care, and layered complexity. It argues that this embodied understanding may help achieving the overall paradigm shift of the CRPD.
Impact of neurotoxicity and steroid therapy on cancer progression-free survival in lymphoma patients treated with anti-CD19 CAR T cells
Authors: Pensato Umberto , Muccioli Lorenzo , Taurino Daniela , Pondrelli Federica , Asioli Gian Maria , de Philippis Chiara , Mannina Daniele , Bagnato Gianmarco , Marcheselli Simona , Zinzani Pier Luigi , Bonifazi Francesca , Bramanti Stefania , Guarino Maria 
Published: December 2024

Abstract

Background
Immune effector cell–associated neurotoxicity syndrome (ICANS) is a frequent complication of chimeric antigen receptor (CAR) T-cell therapy. Most patients achieve complete symptom resolution without long-term neurological sequelae, yet the impact of ICANS and steroid therapy on oncological outcomes remains inadequately explored. We investigated the association between ICANS and steroid therapy with progression-free survival (PFS).

Methods
We included large B-cell lymphoma patients treated with anti-CD19 CAR T cells. The primary outcome was 90-day PFS. The secondary outcomes included PFS, complete response, and overall survival (OS) at 30, 90, 180, and 365 days. The association between outcomes and ICANS and steroid treatment was assessed using logistic regression analyses adjusted for baseline factors.

Results
Overall, 241 patients were included. The median age was 60 years (interquartile range [IQR] = 51–66), 81 (33.6%) were females, 67 (27.8%) developed ICANS, and 142 (58.9%) achieved 90-day PFS. There was no association between 90-day PFS and ICANS development (adjusted odds ratio [aOR] 1.39 [95% confidence interval {CI} = 0.75–2.61]), maximum grade (aOR 1.24 [0.97–1.59]), duration (aOR 1.00 [95% CI = 0.95–1.05] per 1-day increase), or day of onset (aOR 0.98 [95% CI = 0.86–1.11] per 1-day increase). There was no association between 90-day PFS and steroid therapy (aOR 1.25 [95% CI = 0.73–2.14]) or cumulative dose (aOR 1.00 [95% CI = 0.98–1.01] per 100-mg increase). Similar results were observed for secondary outcomes, except for an association between ICANS and OS at 30 days (aOR 0.05 [95% CI = 0.01–0.54]) and 90 days (aOR 0.35 [95% CI = 0.15–0.80]).

Conclusions
Our findings suggest that ICANS and steroid therapy do not adversely impact the PFS in lymphoma patients receiving anti-CD19 CAR T cells. Yet, ICANS might be associated with reduced early OS.
Artificial Doctors: Performance of Chatbots as a Tool for Patient Education on Keratoconus
Authors: Özer Özcan Zeynep , Doğan Levent , Yilmaz Ibrahim Edhem 
Published: December 2024

Purpose:
We aimed to compare the answers given by ChatGPT, Bard, and Copilot and that obtained from the American Academy of Ophthalmology (AAO) website to patient-written questions related to keratoconus in terms of accuracy, understandability, actionability, and readability to find out whether chatbots can be used in patient education.

Methods:
Twenty patient-written questions obtained from the AAO website related to keratoconus were asked to ChatGPT, Bard, and Copilot. Two ophthalmologists independently assessed the answers obtained from chatbots and the AAO website in terms of accuracy, understandability, and actionability according to the Structure of Observed Learning Outcome taxonomy, Patient Education Materials Assessment Tool-Understandability, and Patient Education Materials Assessment Tool-Actionability tests, respectively. The answers were also compared for readability according to the Flesch Reading Ease scores obtained through the website.

Results:
Bard had significantly higher scores compared with ChatGPT-3.5, Copilot, and AAO website according to Structure of Observed Learning Outcome taxonomy and Patient Education Materials Assessment Tool-Understandability (P<0.001 for each), whereas there was no significant difference between the other groups. Bard and ChatGPT achieved significantly higher scores than the AAO website according to the Patient Education Materials Assessment Tool-Actionability scale (P=0.001). The AAO website achieved significantly higher scores than the Bard on the Flesch Reading Ease scale, whereas there was no significant difference between the other groups (P=0.017).

Conclusion:
Chatbots are promising to provide accurate, understandable, and actionable answers. Chatbots can be a valuable aid in the education of patients with keratoconus under clinician supervision. In this way, unnecessary hospital visits can be prevented, and the burden on the health care system can be alleviated, while patient awareness can be raised.
Comparative Analysis of Cosmetic and Functional Outcomes in Corneal Tattooing (Keratopigmentation) versus Ocular Prosthesis
Authors: Durmus Ebubekir , Yilmaz Omer Faruk , Sahin Zahide Büsra , Ersoy Ozkan Esma Ecem , Mangan Mehmet Serhat , Oguz Halit 
Published: December 2024

Objectives:
This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being.

Methods:
Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted.

Results:
Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures (P<0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions (P<0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies.

Conclusion:
Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.
Assessing Long-Term Impacts of Occupational Welding Fume Exposure on Respiratory Health: A 5-Year Retrospective Cohort Analysis
Authors: Saadiani Elham , Sadeghi-Yarandi Mohsen , Nasiri Amirreza , Kalanatary Saba 
Published: December 2024

Abstract

Background
Welding in automobile manufacturing exposes workers to harmful fumes, impacting pulmonary function. This study examined changes in pulmonary function among welders.

Methods
A retrospective cohort study was conducted on 1200 welders and 1200 administrative staff in the automotive industry from 2018 to 2022. Pulmonary function tests were performed according to ATS guidelines, and metal fume sampling for copper, iron, and lead was conducted in welders' respiratory zones.

Results
The mean concentrations of Cu, Pb, and Fe were 0.124, 0.117, and 1.42 mg/m3, respectively. Pb exceeded TLV-TWA. Welders showed significantly lower pulmonary function compared to the control group (p < 0.05).

Conclusions
Prolonged exposure to welding fumes significantly reduces pulmonary function, necessitating preventive measures.
Shexiang Baoxin Pills alleviate doxorubicin-induced cardiotoxicity via the reactive oxygen species-mediated AKT/Bcl-2 pathway
Authors: Wang Shudan , Chen Mingcai , Qian Yi , Chen Xiaohan , Xu Weifeng 
Published: December 2024

Background:
Shexiang Baoxin Pill (SBP) is a classical Chinese medicine that improves endothelial function and antioxidant and inflammatory responses. It may also alleviate doxorubicin (DOX)-induced cardiotoxicity. The aim of this study is to explore the potential influence and molecular mechanisms of SBP in DOX-induced cardiotoxicity using network pharmacology.

Methods:
We established control, SBP, DOX, and DOX + SBP groups to evaluate cell function using a Cell Counting Kit-8 assay, reactive oxygen species (ROS) measurement, cell cycle analysis, and apoptosis assessment. Network pharmacology was employed to predict potential targets and pathways of SBP in DOX-induced cardiotoxicity; the predictions were validated using protein blotting assays.

Results:
SBP (2.5 mg/L) significantly mitigated DOX-induced cardiotoxicity. DOX elevated ROS levels, induced phosphorylation of the AKT pathway, and altered the expression of apoptosis-related proteins Bcl-2 and Bax. SBP attenuated the impact of DOX on cardiomyocytes. Network pharmacology identified 10 candidate targets.

Conclusion:
SBP ameliorates DOX-induced cardiomyocyte apoptosis by activating the ROS-mediated AKT/Bcl-2 signaling pathway.
Evaluation of endoscopic retrograde cholangiopancreatography in Turkish children
Authors: Çirkin Gül , Akarsu Mesut , Öztürk Yesim , İyilikçi Leyla , Güler Yunus , Gülpinar Aydin Özlem 
Published: December 2024

Background:
This study aimed to evaluate the indications, efficacy, and safety of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients at a single center in Turkey between 2017 and 2021.

Methods:
A retrospective review was conducted on 50 children (mean age, 12.7 years; range, 1–18 years) who underwent 65 ERCP procedures. Data collected included patient demographics, indications for ERCP, procedural details, success rates, and complications. All procedures were performed using therapeutic duodenoscopes under conscious sedation administered by an anesthesiologist.

Results:
The primary indications for ERCP were biliary tract issues, including choledocholithiasis (52.3%) and chronic pancreatitis (18.5%). The overall cannulation success rate was 92.3%. Multiple therapeutic interventions, such as sphincterotomies and stent placements, were often required. The most common complication was post-ERCP pancreatitis, observed in 6.1% of cases, all of which were moderate. No fatalities or serious anesthesia-related adverse events were reported.

Conclusion:
ERCP is an effective and safe therapeutic procedure in pediatric patients when performed in collaboration with adult gastroenterologists, despite technical challenges such as the lack of pediatric-specific duodenoscopes. The findings highlight the need for specialized pediatric ERCP equipment and suggest that centralized ERCP facilities could enhance patient outcomes in Turkey.
Exploring phenotypic and genotypic diversity among methicillin-resistant, vancomycin-resistant, and sensitive Staphylococcus aureus
Authors: Bakeer Walid , Gaafar Marwa , El-Gendy Ahmed O. , El Badry M. A. , Alblwi Noaf Abdullah N. , Selim Heba M. R. M. , Alharbi Nada K. , Bendary Mahmoud M. 
Published: December 2024

Background:
Methicillin-Resistant Staphylococcus aureus (MRSA) is a global concern owing to the increasing prevalence of multidrug-resistant (MDR) strains. Vancomycin has been the primary treatment for MRSA; however, Vancomycin-resistant strains are being increasingly reported worldwide. Therefore, comparative studies are essential to support antimicrobial stewardship and improving clinical management. Ultimately, the findings from this study are expected to inform treatment strategies and guide public health interventions effectively.

Material and methods:
This study investigated the prevalence, antimicrobial resistance, and virulence characteristics of Vancomycin-sensitive S. aureus (VSSA) and Vancomycin-resistant S. aureus (VRSA) within MRSA strains. By employing a combination of phenotypic methods, such as antimicrobial susceptibility testing, and genotypic techniques, including molecular typing and identification of virulence genes, we obtained comprehensive insights into VRSA and VSSA profiles.

Results:
Of 250 clinical samples, 62 (24.8%) were S. aureus and 27 (43.5%) were identified as MRSA. All MRSA isolates exhibited MDR patterns. Most MRSA strains were VSSA (20/27, 74.1%), while 7 (25.9%) were VRSA. The VRSA isolates showed more antimicrobial resistance than VSSA isolates; however, the VRSA isolates had less virulence than VSSA isolates. Linezolid was the most effective treatment, with a 3.7% resistance rate. A higher percentage of biofilm-producing MRSA (96.3%) was confirmed by both phenotypic and genotypic methods. All isolates, except one VRSA, showed multi-virulence patterns (harbored more than 3 virulence genes). High diversity and low clonality (D-value = 0.99) were found in both VSSA and VRSA. Based on our correlation findings, the emergence of vancomycin resistance could modify the association between antimicrobial resistance and virulence, potentially affecting the pathogenic profile of these strains. The study also revealed complex interactions among host factors (including age and gender), sample origin, antimicrobial resistance, biofilm production, and virulence genes.

Conclusion:
This study highlights the alarming spread of MRSA and VRSA, which show significant resistance and virulence.
Novel mutation in KCNJ2 gene causes long QT interval syndrome type 7 and learning disability: A case report
Authors: Zhang Hua-yong , Zhang Yong 
Published: December 2024

Rationale:
Long QT interval syndrome type 7 (LQT7) is a rare hereditary multisystem disorder characterized by a classic triad of ventricular arrhythmias with QT interval prolongation, periodic paralysis, and distinctive skeletal and facial features. The Kir2.1 protein is encoded by the KCNJ2 gene, which has been associated with LQT7.

Patient concerns:
We report an 8-year-old boy who presented with frequent premature ventricular contraction with QRS electrical alternans, QT interval prolongation, bidirectional ventricular tachycardia, and learning disability with poor school performance. Gene sequencing revealed a novel missense mutation in the KCNJ2 gene (c.224 C>A, p.Thr75Lys).

Diagnoses:
The patient was diagnosed as LQT7 and a learning disability.

Interventions:
During the follow-up period, the ventricular arrhythmias were difficult to treat with β-blocker. Due to the frequent premature ventricular contraction and bidirectional ventricular tachycardia, radiofrequency catheter ablation was tried but failed.

Outcomes:
An implantable cardioverter-defibrillator was recommended due to the recurrent syncope, but the boy’s legal guardian rejected the recommendation, opting to continue his treatment in another hospital.

Lessons:
Clinical management is mostly focused on reducing adverse cardiac events. As a first option, β-blockers are often chosen as treatments for LQT7 patients, but there is no clear evidence for their effectiveness in preventing fatal arrhythmias. If the drug treatment is not effective, radiofrequency catheter ablation can be considered. However, it may be difficult to target accurately the right spot, and the attempt of the radiofrequency catheter ablation failed. Therefore, after ineffective medical treatment, implantable cardioverter-defibrillator implantation could be an option for patients with life-threatening cardiac events.
High-grade B-cell lymphoma manifested as peripheral nerve injury: A case report
Authors: Luo Han , Li Shanshan , Liu Bo 
Published: December 2024

Rationale:
High-grade B-cell lymphoma is highly malignant and progresses rapidly, often being at the intermediate or advanced stage with poor prognosis when detected. This disease involves the central nervous system in 9% to 45% of cases, while peripheral nerve injury is relatively rare.

Patient concerns:
A 42-year-old male was admitted to the hospital due to recurrent peripheral facial paralysis lasting for 8 months and weakness in both lower extremities lasting for 1 month. No other symptoms and signs were apparent.

Diagnoses:
Fluorescence in situ hybridization showed the following results: IgH/Bcl2 t(14:18)(q32;q21) chromosomal translocation: negative; Bc16 gene translocation: positive; and Myc(8;q24) chromosomal translocation: positive. The clonal gene rearrangement test for B-cell lymphoma was positive, and the clonal gene rearrangement test for T-cell lymphoma was negative.The patient was diagnosed with high-grade B-cell lymphoma.

Interventions:
The treatment plan included chemotherapy, targeted drug therapy, biological therapy, immunotherapy, etc.

Outcomes:
The patient who was followed up for 1 and 3 years had stable conditions and was able to take care of himself, with an mRS score of 1. Five years after the initial diagnosis, the patient experienced recurrence and systemic metastasis of high-grade B-cell lymphoma, ultimately dying from multiple organ failure.

Lessons:
Lymphoma manifests mainly as progressive impairment of multiple cranial nerves or recurrent alternating peripheral nerve injury complicated with elevated protein concentrations in cerebrospinal fluid; it can be easily misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy. Performing lymph node biopsy for high-grade B-cell lymphoma as early as possible helps detect lymphoma in the early stage.
Validity and Reliability of the Videoconference-Based Berg Balance Scale in Stroke Survivors: The Tele-Berg Balance Scale
Authors: da Costa Aline Barbosa , Freire Bruno , da Silva Tayara Gaspar , Michaelsen Stella Maris 
Published: December 2024

Background and Purpose:
Telerehabilitation represents an alternative for individuals who have difficulty accessing services to receive care. Therefore, telerehabilitation measures must be studied for their reliability and validity. This study evaluated the validity and reliability of the videoconference-based Berg Balance Scale assessment in stroke survivors.

Methods:
Thirty-one stroke survivors were assessed. Rater A conducted in-person and remote assessments via videoconferencing at 2 different times (test-retest), and rater B conducted an assessment using the second recording made remotely. The validity and agreement between the in-person and remote assessments were analyzed using the Pearson’s correlation coefficient and the Bland-Altman plots limits of agreement (LoA), respectively. Test-retest and inter-rater reliability were analyzed using the intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI), and individual item reliability was assessed by weighted Kappa. The standard error of measurement and minimal detectable change were computed. Cronbach’s alpha was used for the analysis of internal consistency, and the ceiling effect was investigated.

Results:
In-person and remote assessments showed a strong positive correlation (r = 0.96) and less than a 1-point difference between the 2 assessments. Both the test-retest (ICC = 0.96; 95% CI, 0.93-0.98) and inter-rater (ICC = 0.93; 95% CI, 0.87-0.97) reliability were excellent. The standard error of measurement and minimal detectable change were 1.8 and 5.1 points, respectively. Results showed adequate internal consistency and no ceiling effect.

Discussion and Conclusions:
The Tele-Berg demonstrated validity, excellent test-retest and inter-rater reliability, low measurement error, adequate internal consistency, and lack of ceiling effect. These findings suggest that the Tele-Berg is comparable to in-person Berg Balance Scale in stroke survivors.

Video abstract available for more insights from the authors (see Supplemental Digital Content, available at: http://links.lww.com/JNPT/A509).