bluuebunny/crossref_metadata_2025_split huggingface dataset:
A machine learning approach for identification of vascular access patency in hemodialysis patients using photoplethysmography: A pilot study
Authors: Yang Po-Kai , Shahmirzadi Danyal , Zhuo Hong-Xu , Chang Chuan-Yu , Tseng Chin-Chung , Yeh Ming-Long , Wang Wen-Fong 
Published: December 2024

Introduction: Vascular access (VA) is essential for patients with hemodialysis, and its dysfunction is a major complication that can reduce quality of life or even threaten life. VA patency is not only difficult to predict on an individual basis, but also challenging to predict in real-time. To overcome this challenge, this study aimed to develop a machine learning approach to predict 6-month primary patency (PP) using photoplethysmography (PPG) signals acquired from the tips of both index fingers. Materials and methods: PPG signals were obtained from hemodialysis patients who received an arteriovenous fistula or an arteriovenous graft as primary VA in a single center from April 2023 to December 2023. With PPG wearables, we propose a method that can efficiently and quickly generate the morphological features of the PPG signal to recognize different groups of patients. For the generated features, an independent sample t-test was used to evaluate their effectiveness for machine learning. Then, two supervised learning algorithms, k-nearest neighbors (kNN) and support vector machine (SVM), are used further to identify VA patency in advance. Results: The study involved 31 patients, of whom 14 had 6-month PP, while 17 did not. Using the kNN algorithm, machine learning classified patients into two groups with 82% precision based on PPG signals, while the SVM algorithm showed a precision of 82%. Conclusions: Our approach can provide reliable classifications for VA patency. It is effective to use the proposed PPG signal features to predict 6-month PP of VA.
Preventing Spinal Cord Injury in Single-Staged Juxtarenal and Thoracoabdominal Endovascular Aortic Aneurysm Repair: An Evaluation of Cerebrospinal Fluid Catheter Drainage
Authors: Walter Corinna , Hirsch Kornelia , Heil Sabine , Taher Fadi , Falkensammer Jürgen , Gustorff Burkhard , Assadian Afshin 
Published: December 2024

Objective: This study offers a retrospective assessment of a single-center experience using cerebrospinal fluid catheters to reduce the risk of perioperative spinal cord injury in patients undergoing single-staged complex endovascular juxtarenal or thoracoabdominal aortic aneurysm repair. Results: A total of 97 patients were included. On average, 70.7%±14.4% of the aortic segment between the left subclavian artery and the aortic bifurcation was covered during the procedures. Of the 53 patients receiving cerebrospinal fluid drainage, 77.4% were prophylactic and 22.6% were in symptomatic patients. The overall spinal cord injury rate was 12.4%, with 8.3% experiencing transient spinal cord injury with immediate improvement after cerebrospinal fluid drainage, and 4.1% of patients suffering permanent spinal cord injury: 2 (2.1%) with minor deficits and 2 (2.1%) with paraplegia. The mean intraoperatively administered heparin dosage was 7500 international units, and an additional intravenous bolus of acetylsalicylic acid was given in 69 cases (71.1%), whereas the cerebrospinal fluid drain was in situ. Conclusions: The evaluation of the employed in-house protocol for single-staged complex endovascular juxtarenal and thoracoabdominal aortic aneurysm repair, focusing on cerebrospinal fluid catheter management in conjunction with necessary anticoagulant and antiplatelet medication, indicated that the use of a cerebrospinal fluid catheter is a feasible approach for spinal cord injury risk reduction in selected high-risk patients. Clinical Impact This study highlights the effectiveness of cerebrospinal fluid drainage (CSFD) in reducing spinal cord injury (SCI) rates from 12.4% to 4.1% during single-staged complex endovascular repair of juxtarenal and thoracoabdominal aortic aneurysms. Implementing CSFD within a standardized protocol achieved a 99.7% target visceral and renal vessel patency without major CSFD-related bleeding complications. These findings emphasize CSFD as a feasible and effective tool for SCI prevention in selected high-risk patients. While supporting on-demand catheter placement, this study underscores the potential of selective prophylactic CSFD use, contributing to safer, evidence-based strategies in managing high-risk aortic repairs.
Effects of Repetitive Transcranial Magnetic Stimulation on Poststroke Hemineglect: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors: Yang Fu-An , Lin Chueh-Ho , Chung Hung-Ning , Kuan Yi-Chun , Escorpizo Reuben , Chen Hung-Chou 
Published: December 2024

Background Although various repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) protocols are used, their comparative effectiveness for treating poststroke hemineglect remains unassessed. Objective To investigate rTMS and TBS effects on clinical outcomes in poststroke hemineglect through a systematic review and network meta-analysis. Methods We searched PubMed, EMBASE, and Cochrane Library databases up to March 7, 2024, for trials on rTMS or TBS in poststroke hemineglect. Included studies involved rTMS or TBS with different protocols, sham, or no stimulation, assessing hemineglect severity or impact. The quality of the included studies was evaluated using the PEDro scale. The network meta-analysis was performed using ShinyNMA (version 1.01). Results We analyzed 13 studies with 309 participants. All studies included participants who had experienced right hemisphere stroke. All included studies had a fair to good quality based on PEDro score evaluation. Protocols included continuous TBS (cTBS), high-frequency rTMS (HF-rTMS), and low-frequency rTMS (LF-rTMS) targeting both contralesional and lesional sites. HF-rTMS on the lesional site significantly improved short-term results on the line bisection test and Catherine Bergego Scale; LF-rTMS on the contralesional site improved short-term line bisection; and cTBS on the contralesional site improved long-term line bisection. No severe adverse events or significant inconsistencies were reported. Conclusions Our findings indicate that HF-rTMS targeting the lesional site is the preferred therapeutic approach for the short-term management of poststroke hemineglect. LF-rTMS directed at the contralesional site is a practical alternative. Moreover, cTBS targeting the contralesional site is a viable option because of its long-term effect.
Longitudinal trend in post-discharge estimated glomerular filtration rate in intensive care survivors
Authors: Glendell Rebecca M , Puxty Kathryn A , Shaw Martin , Sim Malcolm AB , Traynor Jamie P , Mark Patrick B , Andonovic Mark 
Published: December 2024

Background: Acute kidney injury (AKI) within the intensive care unit (ICU) is common but evidence is limited on longer-term renal outcomes. We aimed to model the trend of kidney function in ICU survivors using estimated glomerular filtration rate (eGFR), comparing those with and without AKI, and investigate potential risk factors associated with eGFR decline. Methods: This observational cohort study included all patients aged 16 or older admitted to two general adult ICUs in Scotland between 1st July 2015 and 30th June 2018 who survived to 30 days following hospital discharge. Baseline serum creatinine and subsequent values were used to identify patients with AKI and calculate eGFR following hospital discharge. Mixed effects modelling was used to control for repeated measures and to allow inclusion of several exploratory variables. Results: 3649 patients were included, with 1252 (34%) experiencing in-ICU AKI. Patients were followed up for up to 2000 days with a median 21 eGFR measurements. eGFR declined at a rate of −1.9 ml/min/1.73m2/year ( p-value < 0.001) in the overall ICU survivor cohort. Patients with AKI experienced an accelerated rate of post-ICU eGFR decline of −2.0 ml/min/1.73m2/year compared to a rate of −1.83 ml/min/1.73m2/year in patients who did not experience AKI ( p-value 0.007). Pre-existing diabetes or liver disease and in-ICU vasopressor support were associated with accelerated eGFR decline regardless of AKI experience. Conclusions: ICU survivors experienced a decline in kidney function beyond that which would be expected regardless of in-ICU AKI. Long-term follow-up is warranted in ICU survivors to monitor kidney function and reduce morbidity and mortality.
Antioxidant Properties of Virgin Coconut Oil and its Cytotoxicity Towards Human Keratinocytes
Authors: Zainodin Elly Liyana , Rashidi Nur Fatihah , Abdul Mutalib Haliza , Ishak Bashirah , Ghazali Ahmad Rohi 
Published: December 2024

Background Virgin Coconut Oil (VCO) is rich in medium-chain fatty acids and bioactive constituents such as vitamin E and polyphenols, rendering it an appealing natural ingredient for medicinal and cosmeceutical skin applications. Its use on the skin warrants cytotoxicity assessment to ensure safety and efficacy. This study evaluated VCO's antioxidant properties and its cytotoxicity in human keratinocytes (HaCaT). Methods Fatty acid composition was analyzed using gas chromatography with a flame ionization detector (GC-FID). The antioxidant potential of serial doses of VCO (45%, 22.5%, 11.3%, 5.6% and 2.8%) was assessed by 2,2-Diphenyl-1- picrylhydrazyl (DPPH) and ferric-reducing/antioxidant power (FRAP) assays. Cytotoxicity was determined using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on human keratinocytes. Results GC-FID analysis revealed lauric acid as the predominant fatty acid, accounting for 46.4% of the total composition. VCO exhibited dose-dependent antioxidant activity in the DPPH assay, with statistically significant differences across concentrations (F (4, 320) = 143.2, P < .0001) and compared to positive control Trolox (F(1, 320) = 13,201, P < .0001). The FRAP assay showed a statistically significant difference in ascorbic acid equivalent antioxidant capacity (AEAC) among various concentrations (F(4, 35) = 17.65, P = .02). A dose-dependent decrease in HaCaT cell viability was observed with IC50 identified at 17.8% v/v. VCO was mildly cytotoxic to HaCaT at 11.3% v/v (74.36 + 5.41% cell viability). One-way ANOVA showed significant differences across concentration groups (F(5, 150) = 69.68, P < .0001). Tukey's post-hoc indicated significant differences from the negative control ( P < .0001) and between the pairwise groups of 11.3% and 22.5% v/v ( P = .0001). Conclusion VCO possesses antioxidant properties, but future formulation and application for skin may consider using an optimal concentration below 11.3% v/v.
Current status and management of peri-implantitis: A systematic review
Authors: Acar Buket , Guncu Guliz N. 
Published: December 2024

Aim: To systematically review the literature on the surgical and non-surgical methods for managing peri-implantitis. Materials and methods: An electronic search for randomised controlled trials published between 2019 and 2023 in the English language was performed with the Medline/PubMed database according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The specific search terms were “periimplantitis”, “non-surgical treatment”, “surgical treatment” and combinations of these terms. Results: The initial search yielded 2,704 relevant articles. Most of these articles were excluded based on publication type and year. At this stage, only two articles were excluded from the study because they were not written in English. Of the remaining 98 articles, seven were eliminated because the full text could not be accessed, and the others were excluded because their study topics and types were not within the scope of this review. Six out of the 51 studies, whose full texts were assessed for eligibility, were further excluded. Finally, 45 articles that met the inclusion criteria of this review were evaluated. Conclusion: Personalised and evidence-based approaches in the treatment of peri-implantitis are at the forefront in achieving the long-term success of peri-implantitis therapy. Further evidence is needed for the outcomes of surgical or non-surgical peri-implantitis treatment methods applied alone or with adjunctive therapies.
Self-Assessment Techniques in Clinical Studies in Public Universities in Anambra State: Benefits and Alignment With Supervisors Evaluation as Perceived by Medical Students
Authors: Ezeugo Nneka Chinyere , Eleje Lydia Ijeoma , Obiasor Gideon Ebuka , Mbelede Njideka Gertrude , Osonwa Kalu Eke , Metu Ifeoma Clementina , Eleje George Uchenna 
Published: December 2024

OBJECTIVES This research explores the perceptions of medical students regarding self-assessment techniques in clinical studies at public universities in Anambra State, Nigeria. Specifically, it investigates the benefits of these techniques and their perceived alignment with formal evaluations conducted by supervisors. METHODS Utilizing a descriptive cross-sectional study design, data were collected from 273 consenting medical students through an online questionnaire. The questionnaire was developed to capture students’ demographics, experiences with self-assessment, and perceptions of its benefits in relation to supervisor evaluations. RESULTS Results indicate a balanced representation of gender among respondents, with the majority falling within the 21‒25 years’ age range, and nearly equal participation from students at the 500 and 600 levels across two institution types, Federal and State. The findings reveal a positive alignment between students’ perception of self-assessments and formal evaluations, with no significant discrepancies observed between institutions or levels of study. Additionally, participants widely perceive self-assessment as beneficial for enhancing confidence, identifying learning gaps, fostering professional growth, and improving communication skills. Furthermore, students from both institutions and across different levels of study report similar perceived benefits from engaging in self-assessment practices. CONCLUSIONS There is a strong alignment between medical students’ perceptions of self-assessments and formal evaluations, with no significant differences found across institutions or stages of study. Overall, self-assessment was viewed as valuable for boosting confidence, identifying areas for improvement, supporting professional development, and enhancing communication skills. Further exploration of students’ perspectives will offer valuable insights for educators to design effective learning strategies and promote lifelong learning habits among medical students.
Noninferiority of Copper Dressings Compared to Negative Pressure Wound Therapy in Diabetic Foot – An RCT Study
Authors: Melamed Eyal A. , Dabbah Jihad , Roth Tohar , Borkow Gadi , Pinzur Michael S. 
Published: December 2024

Category: Diabetes; Other Introduction/Purpose: Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper OxideDressings (COD) in the management of diabetic foot wounds (DFW). Methods: A Randomized controlled trial (RCT) lasting three months with 46 Diabetic Foot Wounds (DFW), recovering from infectious episodes that necessitated debridement or partial foot amputation. Patients in whom the wound was stable with resolution of the infection and in whom NPWT was indicated were enrolled in the study: 23 patients in the COD arm and 23 in the control NPWT arm. NPWT was succeeded by Aquacell extra or Granuflex dressings for up to 3 months. The primary endpoint was wound size reduction, assessed by an artificial intelligence program. The study was set as a non-inferiority study with a 20% margin. Secondary endpoints were convenience to the patient and caregiver, and pain, were assessed by visual analog score (VAS); application time (minutes), and calculated cost. Results: Twenty-three patients participated in the study in each arm. Seven patients dropped from the study in the NPWT arm and one in the COD group. The initial wound area was 19.9±4.36 and 14.1±2.32 cm2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). COD therapy was more convenient for the patients - VAS was 8.44 vs. 5.33; (p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007) and less painful (1.15 vs. 2.19; p=0.67) compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p< 0.001). The cost of COD was calculated to be 84% less than NPWT treatment. Conclusion: This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.
Optimizing Total Ankle Arthroplasty Analysis: A Comprehensive Assessment of Alignment and Patient-Reported Outcome Measures via Weight-Bearing CT
Authors: Felipe Albarrán Carlos , Ignacio Escudero Mario , Felipe Muñoz Carlos , Birman Eddie , Letelier Hugo , Chaparro Felipe , Carcuro Giovanni , Jose Pellegrini Manuel 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Osteoarthritis (OA) of the tibiotalar joint is associated with a high degree of morbidity, comparable to the final stages of renal and heart failure. The incidence of OA in the tibiotalar joint is as high as 47.7 per 100,000 inhabitants, most of whom will require surgical intervention to improve their quality of life. To date, there is scarce literature on the alignment in Total Ankle Arthroplasty (TAA) and its implications for patient-reported outcome measures (PROMs). Furthermore, no evidence has yet analyzed the association between alignment assessed with weight-bearing CT (WB-CT) and PROMs. Methods: A prospective cohort study was conducted, including all TAAs performed between 2015 and 2023, with a minimum follow-up of 12 months and a WB-CT taken within the first 12 months postoperatively. Revision TAAs, those lost to follow-up, and cases lacking WB-CT in the first 12 months were excluded. The anterior distal tibial angle (ADTA) and medial distal tibial angle (MDTA) were assessed with WB-CT, along with the internal rotational angle of the talar component. TAAs exhibiting an ADTA or MDTA with angles outside the range of normality were considered to have misaligned prostheses. The PROMs were assessed in the preoperative scenario and again at 2 months, 6 months, 1-year and 2-year post-surgery. The association between alignment and PROMs was evaluated using the Mann-Whitney test, while the association between the internal rotation of the talar component and PROMs was analyzed with the Spearman test. Statistical significance was set at p=0.05. Results: 74 TAAs were included. No statistically significant difference was found between correctly aligned and misaligned prostheses in the ADTA or MDTA and PROMs. However, the internal rotation angle of the talar component showed a statistically significant association with both the vitality component (p = 0.01, rho = -0.52) and the physical function component (p < 0.01, rho = 0.60) of the SF-36 score. Meanwhile, the VAS, AOFAS, FAAM, FAOS, and SMFA showed no statistical association. Conclusion: In our cohort of patients with TAA, coronal or sagittal misalignment, as assessed with WB-CT, shows no association with PROMs. It's worth mentioning that PROMs are subjective, multifactorial measures that should be interpreted with caution, and the importance of achieving correct alignment should not be minimized. Although internal rotation of the talar component is associated with better PROMs, to date, no cutoff value has been described, and further efforts should be made to elucidate the optimum internal rotation of the talar component.
Outcomes Following Early Weight Bearing in Syndesmotic Injuries: A Randomized Controlled Trial
Authors: Khaleel Mubinah , Durante Elizabeth C. , Hawkins Sam , Della Rocca Gregory J. , Stannard James P. , Crist Brett D. , Schweser Kyle M. 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Syndesmotic injuries occur in 10% of ankle fractures. Restoration and maintenance of the distal tibiofibular stability is crucial. The literature regarding time to weight bearing is scarce, with the majority recommending greater than 6 weeks of non-weight bearing. No studies examine whether early weight bearing as tolerated is safe in syndesmotic injuries, and current early weight bearing studies after ankle fractures typically exclude syndesmotic injuries. Purpose: The purpose of this randomized controlled trial is to measure differences between early weight bearing at 2 weeks and delayed weight bearing at 6 weeks in terms of outcomes, hardware failure, and loss of reduction at 1 year. Methods: All rotational ankle fractures in patients over 18 were enrolled preoperatively. Only those who received syndesmotic fixation were randomized post-operatively to early vs delayed weight bearing. No fracture types were excluded. All syndesmotic fixation utilized suture buttons. A total of 39 patients were enrolled. Primary outcome was maintenance of reduction at 1 year comparing post-operative and 1 year CT scan of both ankles. Secondary outcomes included pain scores, surgical experience (SSQ-8), AAOS Foot and Ankle, range of motion, and complications. Data was analyzed using unpaired t-test and Fishers exact. Statistical significance was set at p < 0.05. Results: 16 patients were randomized to early weight bearing and 23 patients to delayed. The early weight bearing group had a significantly higher pain score (4.69 ± 2.84 vs 2.87 ± 2.31, p = 0.039) at the baseline 2 week visit. At 1 year, dorsiflexion in the early weight bearing group was significantly higher (14.2° ± 3.97° vs 7.71° ± 4.46°) than the delayed group (p = 0.017). There was no significant difference in syndesmotic malreduction, loss of reduction, pain scores, PROs, development of arthritis or complication rates at any other timepoint. Conclusion: Early weight bearing is safe following syndesmotic fixation in ankle fractures, at least in those receiving suture button fixation.