bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid Artery Stenting during Endovascular treatment of acute ischemic Stroke (CASES) study protocol for a multicenter randomized clinical trial
Authors: Maes Louise , Van Elk Theodora , van der Meij Anne , Roelofs Femke , Bogaerts Kris , Bokkers Reinoud PH , de Borst Gert J , den Hertog Heleen M , Dippel Diederik WJ , François Olivier , Ligot Noémie , Lingsma Hester F , Majoie Charles BLM , Peluso Jo PP , Tancredi Illario , van den Wijngaard Ido R , van der Lugt Aad , Yperzeele Laetitia , Zeebregts Clark J , Nederkoorn Paul J , Lemmens Robin , Uyttenboogaart Maarten 
Published: February 2025

Background: The optimal acute management of patients with acute ischemic stroke and a tandem lesion, defined as intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis or occlusion, remains unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to delayed management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions. Study design: CASES is a phase 3 multicenter prospective randomized open-label blinded endpoint (PROBE) non-inferiority clinical trial. Patients with a computed tomography angiography proven intracranial LVO in the anterior circulation and ipsilateral proximal carotid artery stenosis (⩾50%) or occlusion of presumed atherosclerotic origin will be randomized to either immediate CAS during EVT or to EVT followed by a deferred strategy, which may include carotid endarterectomy (CEA), CAS, or medical management. CASES will be conducted in 27 EVT centers in Belgium and the Netherlands. A total of 600 patients will be included. Study outcomes: The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes include excellent (mRS 0–1) and good (mRS 0–2) functional outcome at 90 days, stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) at 24 h and 5–7 days, recanalization, infarct volume at 24 h, ischemic stroke recurrence, carotid artery re-occlusion, symptomatic intracranial hemorrhage, and mortality. Summary: This study will provide high-quality randomized data on the efficacy and safety of immediate CAS in patients undergoing EVT for acute ischemic stroke due to a tandem lesion. Trial registration: ClinicalTrials.gov NCT06511089; ISRCTN 14956654
Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Large Retrospective Analysis
Authors: Hinton Zoe W. , Kutzer Katherine M. , Morrissette Kali J. , Wu Kevin A. , Krez Alexandra N. , Anastasio Albert T. , Hanselman Andrew E. , Schweitzer Karl M. , Adams Samuel B. , Easley Mark E. , Nunley James A. , Amendola Annunziato 
Published: February 2025

Background: Following insertional Achilles tendinopathy debridement and Haglund prominence resection for Haglund syndrome, patients undergo varying degrees of weightbearing limitation (weightbearing as tolerated [WBAT], partial weightbearing [PWB], touchdown weightbearing [TDWB], and nonweightbearing [NWB]). Given the scarcity of large-scale literature on the topic, the purpose of this study is to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund syndrome. Methods: This was a retrospective cohort study of patients who underwent open surgical management for Haglund syndrome between January 2015 and December 2023 at a single academic institution by fellowship-trained foot and ankle surgeons. Patients were excluded if they underwent concurrent operative management of additional foot pathologies. Patient demographics, comorbidities, surgical techniques, and postoperative weightbearing protocols were recorded. Complications (Achilles tendon rupture, wound breakdown/infection, persistent pain, plantarflexion weakness) and revision rates were compared across weightbearing protocols. Statistical analysis was conducted using R with significance set at P <.05. Results: Three-hundred eighty-seven patients were included (mean age 55.2 years, 66.1% female) with a mean follow-up of 10.1 (range: 0-86.3) months. The most common regimen was NWB (n = 268; 69.3%) followed by TDWB (n = 56; 14.5%), WBAT (n = 54; 14.0%), and PWB (n = 9; 2.3%). There were no significant differences in complications between the weightbearing protocols ( P = .48354). Complications included persistent pain (n = 40; 10.3%), weakness (n = 6; 1.6%), wound breakdown/infection (n = 33; 8.5%), and rupture (n = 1; 0.3%)]. Revision surgery occurred in 1.8% (n = 7). Conclusion: This large cohort study found no significant association between postoperative weightbearing protocols and outcomes following open surgical treatment for Haglund syndrome at a mean follow-up of 10.1 months. This study provides evidence that surgeons can individualize appropriate weightbearing protocols based on patient needs and preferences when treating Haglund syndrome with Achilles debridement and Haglund resection. Level of Evidence: Level III, comparative study.
Health-related quality of life in sarcoidosis patients and the effect of occupational exposures: a cross-sectional study
Authors: Vinnikov Denis , Strizhakov Leonid , Rybina Tatsiana , Babanov Sergey 
Published: February 2025

Abstract

Background
Health-related quality of life (HRQL) in patients with sarcoidosis has been related to treatment, symptoms, organ involvement and disease severity, but little is known about its association with occupation. The aim was to quantify HRQL in occupationally exposed sarcoidosis patients compared to their nonexposed counterparts.

Methods
A total of 221 sarcoidosis patients (median age 49 years, interquartile range (IQR) 37–60 years) with a histologically confirmed diagnosis were recruited from university hospitals and outpatient centers in Belarus, Kazakhstan, and the Russian Federation. General (with SF-8) and specific (with K-BILD) HRQL were compared between patients who were ever exposed to 24 occupational factors and nonexposed patients in adjusted multivariable models.

Results
Work in the office and office equipment (beta − 3.60 (95% confidence interval (CI) -6.91;-0.29)) was significantly associated with a poorer SF-8 physical component score (PCS) independent of sex, whereas exposure to irritant gases was strongly associated with a worse mental component score (MCS), adjusted for sex and smoking beta − 7.11 (95% CI -12.83;-1.39). Irritant gas (beta − 17.2 (95% CI -29.3;-5.1)) and work in the office (beta − 7.9 (95% CI -14.7;-1.0)) were associated with worse K-BILD total scores, while only the latter was associated with breathlessness and activities (BA) scores. Exposure to flour, irritant gas and office work were associated with the psychological (P) domain. Exposure to flour, irritant gas and work in the office could predict chest symptom (CS) scores.

Conclusions
In patients with sarcoidosis and occupational exposure, patients may exhibit worse HRQL, but further research is needed to ascertain the interplay of individual and occupational factors.
Impact and reception of point-of-care ultrasound training across medical education levels
Authors: Meyer Hendrik Leif , Einloft Jonas , Bedenbender Simon , Russ Philipp , Schlicker Nadine , Ganser Andre , Hirsch Martin Christian , Görg Christian , Grgic Ivica 
Published: February 2025

Abstract

Background
Point-of-care ultrasound (POCUS) is a versatile and cost-effective technology that can significantly enhance medical education and clinical practice. This study examines the acceptance of POCUS among medical students and explores strategies to optimize its integration into their training.

Materials and methods
A total of 318 medical students, spanning both preclinical and clinical semesters, participated in seminars that included POCUS demonstrations and hands-on practice. Their perceptions were assessed through a voluntary questionnaire based on the Technology Acceptance Model (TAM), which furthermore explored the ideal timing and potentially suitable subjects for integrating POCUS into the curriculum, with an emphasis on its role in developing clinical skills and supporting decision-making.

Results
Among preclinical students, 60.7% had no prior ultrasound exposure, while 97% of clinical students reported some experience, albeit often limited. Despite the majority of senior students having some ultrasound experience, many lacked confidence in its use. Confidence in sonography skills was generally low across both groups, with 95.9% of preclinical and 79.4% of clinical students expressing a lack of confidence. Importantly, both preclinical and clinical students recognized the high usefulness of POCUS skills and rated the technology as user-friendly, with clinical students perceiving it as slightly easier to use. When asked to identify the most suitable subjects for POCUS training, students most frequently cited anatomy (35.2%) and internal medicine (16.7%). Additionally, a majority of students (57.7%) advocated for POCUS education to begin as early as the first semester.

Conclusion
This study highlights a significant gap in ultrasound training among medical students, while also underscoring their strong motivation to learn and their positive perception of POCUS as a valuable tool for enhancing clinical skills and decision-making. The findings emphasize that early integration of sonography into the medical curriculum is both highly desired by students and essential for advancing medical education. This is particularly timely and important given the growing role of artificial intelligence in ultrasound technology and the opportunities expected to emerge from this integration.
Cold storage of human precision-cut lung slices in TiProtec preserves cellular composition and transcriptional responses and enables on-demand mechanistic studies
Authors: Melo-Narvaez M. Camila , Gölitz Fee , Jain Eshita , Gote-Schniering Janine , Stoleriu Mircea Gabriel , Bertrams Wilhelm , Schmeck Bernd , Yildirim Ali Önder , Rauen Ursula , Wille Timo , Lehmann Mareike 
Published: February 2025

Abstract

Background
Human precision-cut lung slices (hPCLS) are a unique platform for functional, mechanistic, and drug discovery studies in the field of respiratory research. However, tissue availability, generation, and cultivation time represent important challenges for their usage. Therefore, the present study evaluated the efficacy of a specifically designed tissue preservation solution, TiProtec, complete or in absence (-) of iron chelators, for long-term cold storage of hPCLS.

Methods
hPCLS were generated from peritumor control tissues and stored in DMEM/F-12, TiProtec, or TiProtec (-) for up to 28 days. Viability, metabolic activity, and tissue structure were determined. Moreover, bulk-RNA sequencing was used to study transcriptional changes, regulated signaling pathways, and cellular composition after cold storage. Induction of cold storage-associated senescence was determined by transcriptomics and immunofluorescence (IF). Finally, cold-stored hPCLS were exposed to a fibrotic cocktail and early fibrotic changes were assessed by RT-qPCR and IF.

Results
Here, we found that TiProtec preserves the viability, metabolic activity, transcriptional profile, as well as cellular composition of hPCLS for up to 14 days. Cold storage did not significantly induce cellular senescence in hPCLS. Moreover, TiProtec downregulated pathways associated with cell death, inflammation, and hypoxia while activating pathways protective against oxidative stress. Cold-stored hPCLS remained responsive to fibrotic stimuli and upregulated extracellular matrix-related genes such as fibronectin and collagen 1 as well as alpha-smooth muscle actin, a marker for myofibroblasts.

Conclusions
Optimized long-term cold storage of hPCLS preserves their viability, metabolic activity, transcriptional profile, and cellular composition for up to 14 days, specifically in TiProtec. Finally, our study demonstrated that cold-stored hPCLS can be used for on-demand mechanistic studies relevant for respiratory research.

Graphical Abstract
A machine learning model based on preoperative multiparametric quantitative DWI can effectively predict the survival and recurrence risk of pancreatic ductal adenocarcinoma
Authors: Qu Chao , Zeng Piaoe , Li Changlei , Hu Weiyu , Yang Dongxia , Wang Hangyan , Yuan Huishu , Cao Jingyu , Xiu Dianrong 
Published: February 2025

Abstract

Purpose
To develop a machine learning (ML) model combining preoperative multiparametric diffusion-weighted imaging (DWI) and clinical features to better predict overall survival (OS) and recurrence-free survival (RFS) following radical surgery for pancreatic ductal adenocarcinoma (PDAC).

Materials and methods
A retrospective analysis was conducted on 234 PDAC patients who underwent radical resection at two centers. Among 101 ML models tested for predicting postoperative OS and RFS, the best-performing model was identified based on comprehensive evaluation metrics, including C-index, Brier scores, AUC curves, clinical decision curves, and calibration curves. This model’s risk stratification capability was further validated using Kaplan–Meier survival analysis.

Results
The random survival forest model achieved the highest C-index (0.828/0.723 for OS and 0.781/0.747 for RFS in training/validation cohorts). Incorporating nine key factors—D value, T-stage, ADC-value, postoperative 7th day CA19-9 level, AJCC stage, tumor differentiation, type of operation, tumor location, and age—optimized the model’s predictive accuracy. The model had integrated Brier score below 0.13 and C/D AUC values above 0.85 for both OS and RFS predictions. It also outperformed traditional models in predictive ability and clinical benefit, as shown by clinical decision curves. Calibration curves confirmed good predictive consistency. Using cut-off scores of 16.73/29.05 for OS/RFS, Kaplan–Meier analysis revealed significant prognostic differences between risk groups (p < 0.0001), highlighting the model’s robust risk prediction and stratification capabilities.

Conclusion
The random survival forest model, combining DWI and clinical features, accurately predicts survival and recurrence risk after radical resection of PDAC and effectively stratifies risk to guide clinical treatment.

Critical relevance statement
The construction of 101 ML models based on multiparametric quantitative DWI combined with clinical variables has enhanced the prediction performance for survival and recurrence risks in patients undergoing radical resection for PDAC.

Key Points

This study first develops DWI-based radiological–clinical ML models predicting PDAC prognosis.

Among 101 models, RFS is the best and outperforms other traditional models.

Multiparametric DWI is the key prognostic predictor, with model interpretations through SurvSHAP.

Graphical Abstract
Multi-stakeholder collaboration framework for post-harvest loss reduction: the case of tomato value chain in Iringa and Morogoro regional in Tanzania
Authors: Izdori Fides John , Mkwambisi David , Karuaihe Selma Tuemumunu , Papargyropoulou Effie 
Published: February 2025

Abstract
Globally, one-third of the food produced for human consumption globally is wasted, a figure projected to rise with increased food production. Collaborative efforts across food supply chains can mitigate post-harvest losses, playing a crucial role in enhancing food security. However, frameworks for multi-stakeholder collaborations remain underdeveloped, particularly in developing countries. We address this gap by focusing on the case study of tomato food supply chain in Tanzania. Using value chain analysis with farmers, traders, and transporters in the Iringa and Morogoro regions, findings reveal that 28% of post-harvest losses stem from climate and weather conditions, followed by limited market knowledge (12.5%) and inadequate storage facilities (11%). The results further show that only a small proportion of the tomato is transported to the market due to bad roads and there is limited number of processing industries, exacerbating the issue. Farmers have no knowledge as to how much they will produce or where they will sell in the next season. Building on these findings, the study revises Bhattacharya and Fayezi’s (Ind Mark Manag 93: 328–343, 2021) framework to propose a tailored multi-stakeholder collaboration framework for the Tanzania food supply chain context. This framework aims to empower smallholder farmers to reduce losses and increase incomes while fostering sustainable collaborations applicable to other value chains and regions.
Preparing to deliver a stepped wedge cluster-randomised trial to test the effectiveness of daily symptom tracking integrated into electronic health records for managing rheumatoid arthritis: a mixed-methods feasibility trial
Authors: Druce Katie L. , Masood Yumna , Chadwick Helen , Skyrme Sarah , Griffiths-Jones Deb , Bravo Santisteban Ramiro D. , Bower Peter , Firth Jill , Sharp Charlotte A. , Armitage Christopher J. , Dowding Dawn , McBeth John , Sanders Caroline , Dixon William G. , van der Veer Sabine N. ,   on behalf of the REMORA team
Published: February 2025

Abstract

Background
We sought to assess the feasibility of a stepped-wedge cluster-randomised trial testing the effectiveness of a complex mHealth intervention called REMORA: a co-designed smartphone app enabling daily, weekly and monthly symptom tracking integrated into electronic health records for people with rheumatoid arthritis (RA).

Methods
We conducted a mixed-methods feasibility trial using a convergent approach with some explanatory sequential elements. Patients were eligible to take part if they were older than ≥18 years of age, had (suspected) RA or undifferentiated inflammatory arthritis, and consented to take part from two outpatient departments. We analysed quantitative app and electronic health record data descriptively. We analysed qualitative data from interviews and clinic observations thematically. We assessed four feasibility domains: recruitment and consent (target: 15 patients per site), intervention uptake (≥70% of recruited participants completed on-boarding, i.e., registered with the app and submitted at least one symptom report), intervention adherence (>50% daily symptom reports provided), and measuring disease activity as the primary outcome (scores available for ≥80% of people with a follow-up clinic visit). Due to time constraints, we only recruited patients to the intervention group, leaving us unable to test the logistics of randomising sites in accordance with the trial’s cluster stepped wedge design.

Results
Of 130 people screened, 52 consented. Of those, 32 (62%) completed on-boarding. On-boarded participants provided symptom data on 2384/3771 (63%) of possible days. Among the 48 people who had ≥1 follow-up appointment, at least one disease activity scored was obtained for 46 (96%) of them. Factors related to intervention uptake formed the biggest threat to trial feasibility, including lack of clarity of communication and guidance, access to technology, and personal challenges (e.g., being busy or unwell).

Conclusion
We found that delivering a trial to test the effectiveness of integrated symptom tracking in rheumatology outpatient settings was feasible. The future REMORA trial will contribute to the much-needed evidence base for the impact of integrated symptom tracking on care delivery and patient outcomes, including decision-making, patient experience, disease activity, and symptom burden.

Trial registration
This feasibility trial was registered at https://www.isrctn.com/ on 23-Jan-2023 (ISRCTN21226438).
Developing and standardizing a tool to assess the health education needs of diabetic patients at Jazan Armed Forces Hospital
Authors: Abdelwahid Hassan A. , Dahlan Hesham M. , Mojemamy Gassem M. , Al-Harbi Turki J. , Indarkiri Nouf Y. , Tourkmani Ayla M. 
Published: February 2025

Abstract

Background
Determining the health educational needs of people living with diabetes is essential in developing patient-centered, structured health education programs that aim to improve the outcome of diabetes care.

Objectives
To develop a tool for the identification of the health education needs of individuals living with diabetes in the Jazan Armed Forces Hospital (JAFH) and to standardize the questionnaire through the assessment of its reliability and validity.

Methods
A cross-sectional design was used in the present work, which included 303 participants living with diabetes. The researchers and an expert panel in family medicine and endocrinology created a comprehensive and mutually exhaustive questionnaire covering every potential area of health education needs. It included a 15-item section with questions on a 5-point Likert scale for determining the participants’ needs for health education. Cronbach’s alpha was used to determine the Likert scale’s reliability. Exploratory factor analysis was used to determine the Likert scale’s construct validity.

Results
The total number of males was 123 (40.6%) and that of females was 180 (59.4%). Their mean ages were 55.9 ± 12.9, ranging from 18 to 94 years. The reliability of the 15-item Likert scale was 83%, and it increased to 90% when the redundant items (n = 5) were eliminated. The test had an 86% test–retest reliability when repeated. Also, the final 10-item Likert scale has significant face, content, and construct validity. Two components with eigenvalues over 1 (generic knowledge about diabetes, and diabetes and travel) could be extracted out of the 10-item Likert scale.

Conclusion
The final 10-item Likert scale offers a good degree of validity and reliability for determining the health education needs of individuals living with diabetes. The two Likert scale components (general information on diabetes, and diabetes and travel) and their contributing items were identified from the questionnaire, which is standardized and helpful in both practice and research, in order to ascertain patients' needs and develop structured health education programs. The component “General information about diabetes” exhibited significant associations with the following items: diabetes risk factors and prevention; common oral agents for treating hypoglycemia; HbA1c (glycosylated hemoglobin) and normal blood glucose levels; and acute problems related to diabetes, such as hypoglycemia and diabetic ketoacidosis. On the other hand, diabetes and fasting; chronic complications of diabetes; and the significance of the yearly eye screening were the Likert scale items that contributed more to Component 2 (diabetes and travel).
Anatomical observation of adult cadavers comparing with CT images about peri-pancreatic fascia and fascial space
Authors: Zhou Xiaobo , Huang Hefeng , Zhu Gaoyong , He Zhenhua 
Published: February 2025

Abstract

Objective
To compare the anatomical relationship between the peri-pancreatic fascia and fascia space on the abdominal CT images and those observed in adult embalmed cadaver specimens.

Materials and methods
A total of 556 patients clinically diagnosed with acute pancreatitis were recruited, and the imaging characteristics of peri-pancreatic structures on the abdominal CT scans were summarized. Ten embalmed adult cadaver specimens were selected for abdominal dissection to clarify the corresponding relationship between the peri-pancreatic fascia and fascia space on abdominal CT images and cadaver specimens.

Results
The anterior pancreatic fascia, posterior pancreatic fascia and anterior renal fascia could be observed simultaneously on the abdominal CT images of patients with acute pancreatitis and embalmed adult cadaver specimens. Bilateral anterior renal fascia was continuously connected. The pancreatic fascial space located in front of the pancreatic parenchyma was known as the anterior pancreatic space, and the pancreatic fascial space located behind the pancreatic parenchyma was considered as the posterior pancreatic space. The fusion fascial space existed between the posterior pancreatic fascia and the anterior renal fascia.

Conclusion
The peri-pancreatic fascia and fascial space can be observed on the abdominal CT mages of a minority of patients (4 percent) with acute pancreatitis, which correspond with anatomical relationship of embalmed adult cadaver specimens.