bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perineuromal hydrodissection for acute postamputation pain? An observational study in a time of war
Authors: Dmytriiev Dmytro , Liu Winnie , Barsa Maksym , Khomenko Andreii , Strokan Andreii , Pasquina Paul F , Cohen Steven P 
Published: February 2025

IntroductionThis exploratory study investigates the potential of perineuromal hydrodissection as an adjunct to opioid therapy for postamputation pain, specifically focusing on residual limb and phantom limb pain (PLP). Given the correlations between acute pain and the development of chronic pain, the primary aims were to estimate the effect size of early hydrodissection of scar tissue around residual limb neuroma(s) and to identify the best time frame for treatment.MethodsSeventy-four patients with war-related limb amputations and painful neuromas were included in this observational analysis. Thirty-eight Ukrainian patients with war-related limb amputation and a painful neuroma(s) who underwent hydrodissection and opioid therapy within 6 months of amputation were compared with 36 patients who received opioids alone. Co-primary outcome measures were median reduction from baseline in average residual limb and PLP at 12 weeks. The composite positive outcome was designated as a ≥2-point decrease or 30% reduction in average residual limb and PLP, satisfaction with treatment, and not requiring an increase in analgesics.ResultsHydrodissection as an add-on to opioids resulted in a greater reduction in average residual limb pain at 12 weeks (−2.00±1.00 vs −1.00±1.00; p<0.001) and earlier time periods, but PLP only through 4 weeks. At 12 weeks, Hospital Anxiety and Depression Scale anxiety (10.00±2.00 vs 11.00±1.00; p<0.001) but not depression score was lower in the hydrodissection group. Opioid use in the hydrodissection group significantly declined from 41.32±9.63 to 33.42±8.78 morphine equivalents per day (p=0.001) over the study, but not in the opioid-only group (p=0.20). Differences in 12-week satisfaction rates were not significant.ConclusionsThis exploratory study suggests perineuromal hydrodissection may improve residual limb pain and to a lesser degree phantom limb pain, particularly when implemented early in the course of postamputation pain. The study provides preliminary effect size estimates and identifies acute pain as a potential characteristic of patients who may respond more favorably to this intervention. Randomized controlled trials are needed to confirm these findings and control for the confounding variables identified.
Gender‐Specific Effects on Quality of Life and Physical Activity After Pulmonary Vein Isolation: A Secondary Analysis of a Randomized Controlled Trial
Authors: Meretz Daniel , Seifert Martin , Haase-Fielitz Anja , Georgi Christian , Bannehr Marwin , Moeller Viviane , Minden Hans-Heinrich , Meininghaus Dirk Große , Janßen Gerhard , Butter Christian 
Published: February 2025

Background: Gender differences exist in atrial fibrillation (AF) regarding epidemiology, mechanisms, management, and outcomes. There are limited data regarding gender‐specific outcomes after pulmonary vein isolation (PVI) including AF recurrence, physical activity, and health‐related quality of life.Methods: In this secondary analysis of a randomized controlled trial (BE‐ACTION study: investigating 200 patients with paroxysmal or persistent AF undergoing PVI), a gender‐specific analysis of the primary endpoint (recurrence of atrial arrhythmia > 30s, additional ablation procedure, or new onset of antiarrhythmic drugs) was performed. Quality of life was assessed using the AFEQT and SF‐36 questionnaires, while physical activity was measured via step counts recorded at baseline, 6 months, and 12 months. The Mann–Whitney U test and Fisher exact test were used to compare continuous and categorical variables, respectively.Results: 33.5% were women. Women and men were comparable in demographics, comorbidities, and steps per day before and after PVI. There was no statistically significant difference in the primary composite endpoint between women (37.3%) and men (25.6%) (p = 0.085). Before PVI, women had lower quality of life scores than men (median AFEQT scores: 43.5 points [25th to 75th percentiles 25.9–63.9] vs. 62.0 points [47.2–76.4], respectively, p < 0.001) as well as in the physical (40.22 points [33.98–46.69] vs. 46.30 points [39.21–51.60], p = 0.002) and mental domains (42.33 points [27.34–51.59] vs. 49.59 points [36.02–55.64], p = 0.001) of the SF‐36 questionnaire. The overall improvement in the quality of life was significant for both men and women (p < 0.001). Using AFEQT, women exhibited lower quality of life scores compared to men at 6 months post‐PVI (p = 0.001); however, this difference was no longer statistically significant at 12 months (p = 0.077).Conclusion: These data emphasize the importance of AF recurrence after PVI and motivate future research to explore the causes and clinical consequences of a gender gap in quality of life in women after PVI.Trial Registration: BE‐ACTION Study ClinicalTrials.gov identifier: DRKS00012914
A Before–After Study With a Novel Educational Tool for Reducing Non–Heart‐Beating Donation Hesitancy in High Schools
Authors: Terzoni Stefano , Milani Sara , Lusignani Maura , Ruta Federico , Ricci Cristian , Ferrara Paolo , Turrioni Tania 
Published: February 2025

Background: Non–heart‐beating donors have great potential for organ donation, which still needs to be used. Young adults aged 18–30 years are often hesitant to donate their organs; high schools are ideal places for education aimed at fostering donations, but effective strategies still need to be developed in the literature.Objective: To build an educational intervention targeted at high school students aged 18+, also developing dedicated tools.Materials and Methods: A before–after study on a non‐randomized sample of students from eight schools of two campuses in Northern Italy. A questionnaire was built and validated (Cronbach’s alpha, exploratory factor analysis). An educational interactive game was created to involve the students.Results: One hundred and eighty‐seven students were enrolled (M = 108 = 57.75%, F = 67 = 35.8%, nonbinary = 5 = 2.7%, nonresponders n = 7 = 3.75%). The questionnaire proved valid and reliable (alpha = 0.889, all factor loadings above Stevens’ cutoff). Intention to donate raised significantly from 33.0% to 42.6% (p < 0.05); so did knowledge about non–heart‐beating donations. There was a significant increase in those who would have wanted to ask such questions to healthcare personnel (p < 0.001) (n = 87, 47.3% vs. n = 84, 70.59%, p < 0.05). The main reasons for not expressing the willingness to donate were “it’s too early in my life,” lack of information, and fear that the organs could be stolen or sold.Conclusion: This educational game proved engaging; the questionnaire was successfully validated and can be used in future studies on education about organ donation.
Extrachromosomal DNA dynamics contribute to intratumoural receptor tyrosine kinase genetic heterogeneity and drug resistance in gastric cancer
Authors: Kanayama Kazuki , Imai Hiroshi , Hashizume Ryotaro , Matsuda Chise , Usugi Eri , Hirokawa Yoshifumi S. , Watanabe Masatoshi 
Published: February 2025

Abstract
Chromosomal instability in gastric cancer cells is associated with the amplification of oncogenes that encode receptor tyrosine kinases (RTKs), such as HER2 and FGFR2; such gene amplification varies from cell to cell and manifests as genetic heterogeneity within tumours. The intratumoural genetic heterogeneity of RTK gene amplification causes heterogeneity in RTK protein expression, which has been suggested to be associated with therapeutic resistance to RTK inhibitors; however, the underlying mechanism is not fully understood. Here, we show that extrachromosomal DNA (ecDNA) causes intratumoural genetic heterogeneity in RTKs and drug resistance due to diverse dynamic changes. We analysed the dynamics of FGFR2 and MYC ecDNA in a gastric cancer cell line after single-cell cloning. Similar to those in parental cells, the copy numbers of FGFR2 and MYC in subclones differed significantly between cells, indicating intraclonal genetic heterogeneity. Furthermore, the ecDNA composition differed between subclones, which affected FGFR2 protein expression and drug sensitivity. Interestingly, clone cells that were resistant to the FGFR2 inhibitor AZD4547 presented diverse changes in ecDNA, including chimeric ecDNA, large ecDNA and increased ecDNA numbers; these changes were associated with high expression and rephosphorylation of FGFR2. Conversely, when resistant clone cells were cultured under conditions that excluded AZD4547, the ecDNA status became similar to that of the original clone cells, and the inhibitory effect on cell growth was restored. Implications: Our results show that dynamic quantitative and qualitative changes in ecDNA can drive the intratumoural genetic heterogeneity of RTKs and resistance to RTK inhibitors.
Atrial Fibrillation Treatment Pathway in the Emergency Department Reduces Median 30‐Day Health Service Charges
Authors: Mahmood Rafat , Armbruster Tiffany , Jin Wanting , Choudhury Allysha , Rosman Lindsey , Mazzella Anthony J. , Li Quefeng , Biese Kevin , Stearns Sally C. , Gehi Anil K. 
Published: February 2025

Background
The economic burden of atrial fibrillation (AF) continues to increase. AF treatment pathways have been shown to reduce avoidable admissions, but the effects on health care costs are not understood. This study sought to assess the impact of an AF treatment pathway on health service charges and emergency department (ED) discharge rates.

Methods
An AF treatment pathway was implemented at 7 hospital EDs in North Carolina between 2017 and 2020. Thirty‐day health service charges were calculated for ED visits, hospitalizations, and outpatient clinic appointments. A quasi‐experimental design was used to assess changes in health service charges and ED discharge rates following implementation of the AF treatment pathway. Adjusted quantile and negative binomial regressions were used to analyze changes in median 30‐day health service charges and discharge rates from the ED, respectively.

Results

Among 12 504 patients that met eligibility for study inclusion (preperiod: n=3893; postperiod: n=8611), implementation of the AF treatment pathway significantly reduced 30‐day health service charges (preperiod: $11 922; postperiod: $9219;
P
<0.001). In adjusted models, implementation of the AF treatment pathway was associated with an $834 decrease in median 30‐day health service charges (95% CI, −$1630 to $−37;
P
=0.04). Additionally, the adjusted predicted probability of ED discharge increased from 65.3% to 70.0% after the AF treatment pathway implementation, a 4.7 percentage point increase (95% CI, 1.4–8.0;
P
<0.001).

Conclusions
The implementation of an AF treatment pathway in the ED was associated with a decrease in median 30‐day health service charges and an increase in ED discharge rate for patients presenting with AF.
Exact nonlinear state estimation
Authors: Chipilski Hristo G. 
Published: February 2025

Abstract
The majority of data assimilation (DA) methods in the geosciences are based on Gaussian assumptions. While such approximations facilitate efficient algorithms, they cause analysis biases and subsequent forecast degradations. Non-parametric, particle-based DA algorithms have superior accuracy, but their application to high-dimensional models still poses operational challenges. Drawing inspiration from recent advances in the fields of measure transport and generative artificial intelligence, this paper develops a new estimation-theoretic framework which can incorporate general invertible transformations in a principled way. Specifically, a Conjugate Transform Filter (CTF) is derived and shown to extend the celebrated Kalman filter to a much broader class of non-Gaussian distributions. The new filter has several desirable properties, such as its ability to preserve statistical relationships in the prior state and converge to highly accurate observations. An ensemble approximation of the new filtering framework is also presented and validated through idealized examples. The numerical demonstrations feature bounded quantities with non-Gaussian distributions, which is a typical challenge in Earth system models. Results suggest that the greatest benefits from the new filtering framework occur when the observation errors are small relative to the forecast uncertainty and when state variables exhibit strong nonlinear dependencies.
Development and external validation of Global Leadership Initiative on Malnutrition-dictated nomograms predicting long-term mortality in hospitalized patients with cirrhosis
Authors: Liu Qing , He Yumei , Yang Fang , Guo Gaoyue , Yang Wanting , Wu Liping , Sun Chao 
Published: February 2025

Objectives Global Leadership Initiative on Malnutrition (GLIM) criteria have gradually accounted for the mainstay evaluating nutritional status. We sought to establish GLIM-dictated nomograms with other prognostic factors influencing long-term mortality and externally validate their predictive performance in decompensated cirrhosis. Methods The derivation cohort comprised 301 patients presenting with cirrhosis-associated acute insults, while the validation cohort encompassed 101 subjects from another tertiary hospital. Two nomograms were constructed to predict the 1-year all-cause mortality by integrating the GLIM criteria. The study population was stratified into low-, moderate- and high-risk mortality groups according to aforesaid proposed models. Results Adjusting Child-Turcotte-Pugh classification (Nomo#1) or Model for End-stage Liver Disease-Sodium score (Nomo#2) separately, the GLIM criteria were independently associated with 1-year mortality in the multivariate Cox regression analysis (Nomo#1 hazard ratio (HR) = 3.139, p < 0.001; Nomo#2 HR = 3.456, p < 0.001). The C-index and time AUC for Nomo#1 and Nomo#2 performed significantly better than those of the GLIM criteria or conventional scoring systems alone. The survival rate of the low-risk group was significantly higher than those of the moderate- or high-risk groups (Nomo#1: 95% vs 65.8% vs 33.3%, p < 0.001; Nomo#2: 94.3% vs 64.5% vs 25%, p < 0.001). Furthermore, our proposed models exhibited moderate prediction accuracy and may identify malnourished patients with poor survival conditions in the external validation cohort. Conclusion GLIM criteria-defined malnutrition negatively impacted long-term mortality in the context of decompensated cirrhosis. Our established nomograms may predict survival status with sufficient discriminatory ability, alongside good consistency and clinical benefits, supporting their effectiveness in daily practice.
All in the family: A collective case study of family influence on siblings’ experiences and outcomes in organized youth sport
Authors: Osai Keith V. , Dorsch Travis E. , Bradford Kay , Whiteman Shawn , Blazo Jordan A. , Downey Haylee 
Published: February 2025

The influence of families on siblings’ experiences and outcomes has been well documented outside of sport, with research dedicated to topics such as socialization, relationship quality, adjustment, resource dilution, and behavioral genetics. While these associations are understood in reference to the immediate family context, sibling dynamics are less understood in the context of youth sport. This is important because sport represents the most common extracurricular activity in which siblings participate together. Guided by family systems theory, Dorsch and colleagues’ (2022) integrated model of the youth sport system, and a social constructivist epistemology, the present study was designed to understand the interactions that take place across multiple family relationships and how these relationships impact siblings’ experiences and outcomes in organized youth sport. Twelve intact families, each consisting of two parents and two siblings, who were engaged in organized youth sport in the United States, participated in individual, semi-structured interviews. More than nine hours of interviews were conducted across these 48 participants.Three researchers engaged in the coding process, which informed the creation of case narratives for each of the 12 families. Interpretation of the case narratives led to the development of nine general themes regarding sibling relationships in youth sport. Of note, a unique pathway of influence was also recognized, wherein parents expressed support for their children’s pursuit of their own niche/identity in youth sport. Future theoretically informed research should be designed to investigate specific individual, dyadic, and family processes that influence sibling experiences and outcomes in youth sport, offering further insight into the complex and dynamic interactions that occur within and across families.
Buttock ischemia in adults with femoral venoarterial-extracorporeal membranoxygenation – A single center experience
Authors: Scriba Verena , Loeschhorn-Becker Ralf , Motekallemi Arash , Lotz Christopher , Lepper Philipp M , Torje Iuliu E , Feth Maximilian , Rolfes Caroline B , Muellenbach Ralf M , Ajouri Jonas 
Published: February 2025

Introduction Femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as an ultima ratio to maintain circulation in patients with refractory cardiorespiratory failure, but is also associated with vascular and ischemic complications. Buttock ischemia appears to be an underreported complication in these patients. Methods: In this retrospective single-center case series over a five-year period, all patients who received femoral VA-ECMO and survived for more than 24 hours were screened for buttock ischemia. Buttock ischemia was diagnosed using a two-step approach, which involved identifying characteristic skin lesions and CT scans suggesting hypoperfusion of the ipsilateral internal iliac artery. Results Over the five-year period, 264 patients were assessed for buttock ischemia, which occurred in seven patients, with an average annual incidence of 2.7%. Unilateral buttock ischemia was observed in six patients, while bilateral buttock ischemia was seen in one patient and led to multiple surgeries in three patients. The CT scans showed that, in all cases, the arterial ECMO cannula covered the origin of the internal iliac artery and revealed additional bilateral atherosclerotic lesions in the iliac arteries. Conclusion Buttock ischemia is a rare and not fully understood complication of femoral VA-ECMO but may lead to clinically significant sequelae. Widespread knowledge and awareness are therefore important to recognize buttock ischemia, followed by individualized strategies for selecting and positioning the arterial cannula.
Priorities for post-stroke aphasia service development: Prioritisation phase of an experience-based co-design study
Authors: Anemaat Lisa , Palmer Victoria J , Copland David A , Binge Geoffrey , Druery Kent , Druery Julia , Mainstone Kathryn , Aisthorpe Bruce , Wallace Sarah J 
Published: February 2025

Objective Post-stroke aphasia (language impairment) has a devastating impact on quality of life and people with aphasia experience long-term unmet needs. A shared understanding of the experiences underpinning these unmet needs is required to identify priorities for improvement. Establishing priorities for meaningful service improvement requires involvement of service users and providers. Therefore, this research aimed to: (1) collaboratively identify priorities for aphasia service improvement according to people with aphasia, significant others, speech pathologists, and (2) co-design a plan for service development and improvement. Design Prioritisation phase of an experience-based co-design project. Online surveys were used to prioritise ideas ( n = 773). Three multi-stakeholder consensus groups were held to shortlist top priorities. Design principles were applied during three consecutive co-design workshops, to develop a concept design targeting the top priority. Participants, setting People with aphasia ( n = 41), significant others ( n = 35) and speech pathologists ( n = 75) across 26 health and hospital sites in remote, regional, and metropolitan Queensland, Australia. Results Consensus was established on seven priorities: (1) chart alert system for aphasia, (2) training for healthcare providers in ways to support communication, (3) care that is tailored to the individual, (4) consistent care, (5) equitable access to care, (6) intensive communication therapy options, and (7) mental health service options. A concept design (implementation strategy) was created for the top priority. Conclusions Multi-stakeholder consensus was gained on seven priorities. Development, implementation, and evaluation of the co-designed concept plan for the top priority may decrease miscommunication in hospital settings and enhance experiences of people with aphasia communicating with healthcare providers.
The spiritual care intervention “In dialogue with your life story”: Results of a longitudinal study on palliative clients’ spiritual wellbeing
Authors: Liefbroer Anke I. , Foppen Annemarie , Wierstra Iris R. , Nagel Ineke 
Published: February 2025

Background: Spiritual care is important for palliative care, but the evidence base for spiritual care provision is low. Aim: To investigate the course over time of clients’ spiritual wellbeing who participated in the spiritual care intervention “In dialogue with your life story.” Design: The intervention consisted of six individual sessions between client and chaplain of various faiths. A longitudinal study was conducted pre- and post-intervention, and a follow-up approximately 10 weeks after post-intervention. Spiritual wellbeing was measured using the EORTC QLQ-SWB32 and NEIS, and symptoms of anxiety and depression as secondary outcome measure using the HADS. Latent growth modeling was used to investigate changes in outcome measures over time. Setting/Participants: Adult clients receiving home-based, palliative care were eligible to participate in this study. Results: A total of 75 clients and 33 chaplains participated. On the four EORTC QLQ-SWQ32-subscales, a significant increase was found over time on “relationship with self,” “relationship with others,” and ‘“existential wellbeing” (linear trends). “Relationship with someone or something greater” significantly increased over time but decreased 10 weeks post-intervention (quadratic trend). On the two NEIS-subscales, ego-integrity significantly increased over time (linear trend), while despair significantly decreased (quadratic trend). On the two HADS-subscales, symptoms of anxiety significantly decreased over time (linear trend). No significant change was found for depressive symptoms. Conclusions: We provided first empirical evidence for an increase in clients’ spiritual wellbeing after enrollment in the spiritual care intervention “In dialogue with your life story.” Future research using control conditions is needed to investigate its causal effect.