bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase I/III Clinical Trial to Evaluate the Safety and Efficacy of a New Botulinum Toxin (HU-014) Versus OnabotulinumtoxinA in Subjects With Moderate-to-Severe Crow's Feet Lines
Authors: Han Hye Sung , Yoo Kwang Ho , Lee Ji Su , Huh Chang-Hun , Kwon Soon-Hyo , Lee Yang Won , Kim Beom Joon 
Published: April 2021

BACKGROUND
HU-014, a newly introduced botulinum toxin type A, has not been investigated for its efficacy and safety in crow's feet line (CFL) treatment.

OBJECTIVE
Here, we compared the efficacy and safety of HU-014 and onabotulinumtoxinA in CFL treatment.

METHODS
This was a randomized, double-blind, active drug–controlled, multicenter, 16-week, Phase I/III study designed to determine the noninferiority of HU-014 compared with onabotulinumtoxinA in moderate-to-severe CFL treatment. In the Phase III study, 290 subjects were randomized at a 1:1 ratio to receive a single treatment of HU-014 or onabotulinumtoxinA. The primary endpoint was the proportion of subjects achieving Grade 0 or 1 in the facial wrinkle scale on maximum smile at Week 4.

RESULTS
The primary endpoint was achieved by 72% of the subjects with HU-014 and onabotulinumtoxinA treatments, supporting the noninferiority of HU-014 compared with onabotulinumtoxinA. All secondary efficacy outcomes were achieved by the subjects. The 2 groups showed no significant differences in the safety analysis.

CONCLUSION
HU-014 has noninferior efficacy and safety compared with onabotulinumtoxinA in the treatment of CFL.
Predictive Model for Quality of Life in Patients 1 Year After First Stroke
Authors: Kim Sung Reul , Yoo Sung-Hee , Kim Hye Young , Kim Gye-Gyoung 
Published: April 2021

Background
Because the recurrence rate of stroke increases 1 year after its initial occurrence, it is important to predict quality of life at this stage, although most functions are likely recovered.

Objectives
We aimed to construct and verify a model of quality of life in patients 1 year post stroke by considering their characteristics at the time of the stroke based on the Wilson and Cleary model and previous literature.

Methods
Participants comprised 288 patients who had experienced their first ischemic stroke and were enrolled in 3 regional stroke centers in South Korea. Data were analyzed using path analysis to identify a model of patients' quality of life 1 year post stroke.

Results
Age, National Institutes of Health Stroke Scale score, the modified Rankin Scale score, and anxiety had a direct effect on quality of life, whereas type D personality and social support had an indirect effect. Type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety explained 32.9% of the total variance in quality of life.

Conclusions
When predicting quality of life in a patient 1 year after a stroke, it is important to consider variables such as type D personality, age, National Institutes of Health Stroke Scale score, social support, the modified Rankin Scale score, and anxiety at the time of the first stroke. Interventions to improve the quality of life of patients with stroke should consider these factors.
“No One Told Me About This Part”: What Breastfeeding Women Want and Need to Support Their Physical Health
Authors: Snyder Kailey , Peterson Julie , Bargstadt-Wilson Kari 
Published: April 2021

Background:
Breastfeeding women struggle to achieve recommendations of obtaining 150 minutes of moderate activity per week or more. Pelvic floor dysfunction may be hindering postpartum physical activity. However, the severity and type of dysfunction remain poorly understood.

Objective:
This study had the following objectives: (1) to determine the severity of symptoms of pelvic floor dysfunction among breastfeeding women, with a secondary objective (1a) to determine whether this varied on the basis of exclusive breastfeeding versus supplementation of solids foods and/or formula and (2) to determine what breastfeeding women perceive they need in a physical activity intervention and (2a) how their activity levels change from before to after pregnancy.

Study Design:
This was a concurrent embedded mixed-methods cross-sectional survey.

Methods:
A survey consisting of demographic questions, physical activity experiences, the Pelvic Floor Distress Inventory (PFDI-20), and open-ended questions was disseminated to currently breastfeeding mothers.

Results:
Survey findings conclude that breastfeeding women are primarily sedentary or engage in light physical activity and experience greater symptom severity related to urinary incontinence than anal or pelvic organ prolapse distress. Symptoms are not influenced by breastfeeding exclusivity. Many women are hindered from being active by time constraints associated with feeding their infant. Women would like a combination of in-person/online pelvic floor and general exercise resources.

Conclusion:
A large proportion of breastfeeding women are sedentary or engaging only in light activity. Furthermore, breastfeeding women report urinary incontinence symptoms and these symptoms are not influenced by breastfeeding exclusivity. Breastfeeding women desire increased education and resources to support their physical activity.
Optimizing defibrillation during cardiac arrest
Authors: Babini Giovanni , Ruggeri Laura , Ristagno Giuseppe 
Published: April 2021

Purpose of review
Current cardiac arrest guidelines are based on a fixed, time-based defibrillation strategy. Rhythm analysis and shock delivery (if indicated) are repeated every 2 min requiring cyclical interruptions of chest compressions. This approach has several downsides, such as the need to temporarily stop cardiopulmonary resuscitation (CPR) for a variable amount of time, thus reducing myocardial perfusion and decreasing the chance of successful defibrillation. A tailored defibrillation strategy should identify treatment priority for each patient, that is chest compressions (CCS) or defibrillation, minimize CCs interruptions, speed up the delivery of early effective defibrillation and reduce the number of ineffective shocks.

Recent findings
Real-time ECG analysis (using adaptive filters, new algorithms robust to chest compressions artifacts and shock-advisory algorithms) is an effective strategy to correctly identify heart rhythm during CPR and reduce the hands-off time preceding a shock. Similarly, ventricular fibrillation waveform analysis, that is amplitude spectrum area (AMSA) represents a well established approach to reserve defibrillation in patients with high chance of shock success and postpone it when ventricular fibrillation termination is unlikely. Both approaches demonstrated valuable results in improving cardiac arrest outcomes in experimental and observational study.

Summary
Real-time ECG analysis and AMSA have the potential to predict ventricular fibrillation termination, return of spontaneous circulation and even survival, with discretely high confidence. Prospective studies are now necessary to validate these new approaches in the clinical scenario.
Effect of Laser-assisted Subepithelial Keratectomy with Mitomycin C on Corneal Optical Density Measured with Confocal Microscopy
Authors: Cañadas Pilar , Garcia-Gonzalez Montserrat , Gros-Otero Juan , Rodriguez-Perez Isabel , Cañones-Zafra Rafael , Teus Miguel A. 
Published: April 2021

SIGNIFICANCE
The development of confocal microscopy allows one to obtain high-resolution corneal images like its optical density. Some studies have evaluated the optical density with Scheimpflug cameras in the early post-operative period after photorefractive keratectomy, but no studies have evaluated the long-term evolution of optical density after surface ablation when mitomycin C is used.

PURPOSE
This work aimed to study the changes in corneal optical density measured with confocal microscopy in eyes treated with laser-assisted subepithelial keratectomy (LASEK) and intraoperative mitomycin C (MMC) to correct myopia.

METHODS
A study of 24 consecutive myopic eyes that underwent LASEK with 0.02% MMC and a control group of 24 healthy nontreated eyes was performed. Optical density was measured using the images by the confocal microscopy of the Heidelberg Retina Tomograph II with the Rostock Cornea Module. An analysis of confocal microscopy images was performed using the ImageJ software to obtain the optical density, in gray-scale units (GSU). The optical density of the stromal bed was evaluated 3 months, 15 months, and 3 years after surgery and was compared with the optical density at the equivalent depth of the stroma in controls.

RESULTS
The mean values of optical density for the LASEK group were 81.7 ± 9.7, 78.6 ± 11.7, and 73.6 ± 18.7 GSU at 3 months, 15 months, and 3 years, respectively, and it was 61.8 ± 8.2 GSU for the control group. A statistically higher optical density 3 and 15 months after LASEK with MMC was found compared with controls (P < .001). No significant difference was found in optical density at 3 years post-operatively.

CONCLUSIONS
Our study suggests that, after LASEK with MMC, the anterior corneal stroma has a higher optical density at 3 and 15 months post-operatively, which gradually returns to normal values 3 years after surgery.
Community Health Improvement Plans: An Analysis of Approaches Used by Local Health Departments
Authors: Carroll Leslie D. , Wetherill Marianna S. , Teasdale Thomas A. , Salvatore Alicia L. 
Published: April 2021

Context:
The Public Health Accreditation Board requires accredited local health departments (LHDs) to complete community health improvement plans (CHIPs). Evidence suggests that participatory planning frameworks, cross-sector collaboration, social determinants of health (SDOHs), and steering organizations are integral to effective public health planning. However, little is known about the degree to which LHDs incorporate these aspects during the CHIP process.

Objectives:
To describe the use of planning methods, SDOHs, cross-sector partnerships, and steering organizations during the CHIP development process among nationally accredited LHDs and to identify whether LHD jurisdictional size or region is associated with differences in use.

Design:
The most recent CHIPs from 93% of all nationally accredited LHDs (n = 195) were qualitatively reviewed and numerically coded for each of the planning components to calculate frequency and degree of use. Differences in use of each component by LHDs' jurisdictional size and region were tested using the chi-square test.

Main Outcome Measure:
Use of CHIP planning frameworks, SDOH inclusion, cross-sector partnerships, and steering organizations.

Results:
One-half of LHDs (53%) reported use of Mobilizing for Action through Planning and Partnerships, but nearly one-fourth of LHDs did not use any planning framework. LHDs with a large jurisdictional size (>500 000) were significantly more likely to include SDOHs to a high degree than LHDs with mid- (100 000-499 999) to small- (<99 999) jurisdictional size (P < .01). Similarly, large LHDs were more likely to include cross-sector partners except for the category community members, which were rarely (10%) included. Mid-sized LHDs were more likely to lead the CHIP steering committee (61%) than small (29%) and large (9%) LHDs (P < .01). Differences in use of the 4 components by region were less significant.

Conclusions:
Jurisdictional size, rather than region, was more strongly associated with LHD approaches to CHIP development. More studies are needed to determine how differences influence CHIP implementation and impact.
The Governance of Helmet Safety to Prevent Traumatic Brain Injury in the Caribbean
Authors: Rolle Myron L. , Garba Deen L. , Wesley Alexander , Teasley Damian E. , Warner Tyler , Odewade Niyi , Ekedede Magnus 
Published: April 2021

Background:
The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions.

Methods:
We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40.

Results:
Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8.

Conclusion:
Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.
Pulmonary Artery Size Measurements: A Comparison Study Between Electrocardiogram-Gated and Nonelectrocardiogram-Gated Computed Tomography
Authors: Li Danyan , Tang Xin , Zhu Yinsu , Wei Yongyue , Mu Dan 
Published: April 2021

Objectives
The aim of this study was to determine the difference and correlation in pulmonary artery (PA) size when measured from the electrocardiogram (ECG)–gated computed tomography (CT) and non–ECG-gated CT.

Methods
In the retrospective study, 279 patients who underwent both ECG-gated CT and non–ECG-gated CT were enrolled. Maximum and minimum diameters of main pulmonary artery (MPA), right pulmonary artery (RPA), and ascending aorta (AAO) were measured, whereas mean diameters of MPA and RPA were obtained. The same PA size parameters were also measured on non–ECG-gated CT.

Results
There was a significant difference in maximum and minimum PA diameters between ECG-gated CT and non-ECG-gated CT, whereas mean PA diameters showed no statistically difference. The PA parameters showed a strong positive correlation between these 2 examinations.

Conclusions
The PA size was different between ECG-gated CT and non–ECG-gated CT, whereas the PA size parameters on non–ECG-gated CT could be used to predict those with ECG-gated CT, which allow for confident prediction of pulmonary hypertension and guide further surgical intervention.
Validation of Second-Generation Motion-Correction Software for Computed Tomography Coronary Angiography With Novel Quantitative Approach
Authors: Goldberg Ari , Adams William H. , Thomsen Brian , Ashraf Usman , Vasilopoulos Vasilios 
Published: April 2021

Introduction
Computed tomography of the coronary arteries (CTCA) is an important diagnostic tool. However, motion degradation is sometimes a challenge to interpretation and quantification, particularly with elevated heart rates. Here, a novel quantitative method is presented as part of an evaluation of one particular motion correction algorithm.

Methods
Computed tomography of the coronary arteries scans from 49 patients, with heart rates of >70 bpm, were identified with motion artifacts in multiple coronary segments. At these foci (196), an objective measure of motion degradation, defined here by cross-section eccentricity, was determined before and after image processing with second-generation GE SnapShot Freeze software (SSF-2.0). In addition, a subjective scoring was applied by an expert cardiothoracic radiologist both before and after processing.

Results
An overall decrease in vessel eccentricity strongly correlated (P < 0.001) with processing of the images by motion-correction software. A concurrent overall increase in subjective vessel clarity correlated (P < 0.001) with application of the software as well.

Conclusions
A novel quantitative method (and subjective analysis) for evaluation of CTCA motion has been described and applied to validation of SSF-2.0 motion-correction software. Both the technique and software demonstrate promise for robust clinical utility in CTCA evaluation.
Optimizing Identification of Power Injectable Ports on the Scout Images for Multidetector Computed Tomography Procedures
Authors: Schwartz Fides R. , Iliffe Kevin S. , Somers Andrew , Stone Brittney , Jaffe Tracy A. , Solomon Justin , Hurwitz Koweek Lynne M. 
Published: April 2021

Objective
The objective of this study was to assess the impact of tube voltage and image display on the identification of power ports features on anterior-posterior scout images to inform optimal workflow for multidetector computed tomography (MDCT) examinations.

Materials and Methods
Four ports, representing variable material composition (titanium/silicone), shapes, and computed tomography (CT) markings, were imaged on an adult anthropomorphic chest phantom using a dual-source MDCT at variable peak tube voltages (80, 100, 120, 150, and Sn150 kVp). Images were reviewed at variable image display setting by 5 blinded readers to assess port features of material composition, shape, and text markings as well as overall preferred image quality.

Results
Material composition was correctly identified for all ports by all readers across all kilovoltage-peak settings. The identification by shape was more reliable than CT markers for all but one of the ports. CT marker identification was up to 80% for titanium ports at window level settings optimized for metal (window width, 200; window center, −150) and at a soft tissue setting (window width, 400; window center, 40) for silicone ports. Interreader agreement for best image quality per kilovoltage-peak setting was moderate to substantial for 3 ports (k = 0.5–0.62) but only fair for 1 port (k = 0.27). The highest overall rank for image quality was given unanimously to Sn150 kVp for imaging titanium ports and 100 kVp for silicone ports.

Conclusions
Power port identification on MDCT scout images can be optimized with modification of MDCT scout acquisition and display settings based on the main port material.
Magnetic Resonance Imaging Evaluation of Ectopic Pregnancy: A Value-Added Review
Authors: Gopireddy Dheeraj Reddy , Le Rebecca , Virarkar Mayur Kundan , Freels Parker D. , Hubickey Joana , Kee-Sampson Joanna , Lall Chandana 
Published: April 2021

Abstract
Ectopic pregnancy (EP) is a known cause of maternal mortality and may be misdiagnosed in up to 50% of pregnant female individuals (Ann Emerg Med. 1996;28(1):10–17). Magnetic resonance imaging, with its superior soft tissue resolution, is a valuable alternative diagnostic modality to diagnose EP when transvaginal ultrasound results are inconclusive. Although an extrauterine gestational sac is the most specific finding, there are other key MRI findings that can aid in diagnosing EP. As availability of MRI access in the emergency department setting increases across the nation, its utility in women with a positive pregnancy test has also increased. Specific MRI findings that are diagnostic of EP include absence of intrauterine pregnancy, adnexal mass separate from the ovary, and hemoperitoneum. In addition, intrauterine ectopic locations, especially intramural, cornual, and cervical pregnancies, can be diagnosed with increased accuracy with the help of MRI. Magnetic resonance imaging is also useful in excluding potential mimics of EP, including adnexal cysts, ovarian neoplasms, and fibroids. In summary, providing an accurate diagnosis and determining the precise location of an EP, which is supported by the use of MRI, is imperative for guiding a patient's treatment to prevent a potentially fatal outcome.
Computed Tomography–Derived Fractional Flow Reserve in Patients With Chronic Coronary Syndrome: A Real-World Cohort Study
Authors: Kvist Thomas Vedel , Nørgaard Bjarne Linde , Bøtker Hans Erik , Mathiassen Ole Norling , Grove Erik Lerkevang , Parner Erik , Jensen Jesper Møller 
Published: April 2021

Objective
This study aimed to investigate the outcome of computed tomography (CT) angiography with optional CT-derived fractional flow reserve (FFRCT) of intermediate-range coronary artery disease in non-emergent patients referred on a suspicion of chronic coronary syndrome.

Methods
Patients were classified as high risk and low-intermediate risk according to the presence of typical angina or either atypical or nonangina chest pain. Outcome was assessed as the cumulative incidence proportion of a composite end point of unstable angina pectoris, unplanned revascularization, nonfatal myocardial infarction, and all-cause mortality.

Results
The study included 743 patients. Mean follow-up was 2.2 (range, 0.1–2.5) years. Low-intermediate–risk and high-risk patients who had invasive coronary angiography deferred had comparable proportions of adverse events (1.4% vs 2.6% [P = 0.27]). Adverse events in high-risk patients with FFRCT >0.80 was 3.3% versus 1.4% in patients where no additional testing was performed (P = 0.79).

Conclusions
Computed tomography–derived fractional flow reserve >0.8 conveys an excellent prognosis. Computed tomography angiography with optional FFRCT allows for the safe cancellation of invasive coronary angiography in high-risk patients.
Verification of Duodenobiliary Reflux With SPECT/CT Imaging
Authors: Zhao Meixin , Zhang Weifang 
Published: April 2021

Abstract
Duodenobiliary reflux is believed to be 1 of the causes of recurrent bacterial cholangitis. We reported a 65-year-old woman with intermittent epigastric pain for 20 years. She was diagnosed with cholelithiasis in the past, and she still had recurrent abdominal pain after the stone was removed. The patient was suspected of having duodenobiliary reflux and received duodenobiliary reflux imaging. After oral administration of 700 mL water containing 5 mCi 99mTc-DTPA, SPECT/CT images of the abdomen were acquired. Abnormal radioactivity was seen in the common bile duct, indicating the presence of duodenobiliary reflux.