bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Clinical Decision Support Tool to Improve Cardiac Rehabilitation Referral
Authors: Nowatzke Joseph F. , O’Leary Jared M. , Huang Shi , Wright Adam , Patterson T. Lorraine , Bachmann Justin M. 
Published: November 2024

Purpose:
Inadequate referral to cardiac rehabilitation (CR) is a major barrier to CR participation. We investigated the implementation of a clinical decision support (CDS) tool on improving CR referral for patients hospitalized with acute myocardial infarction (AMI) at an academic medical center.

Methods:
We developed a CDS tool that identified patients admitted with AMI and reminded physicians to refer patients to CR. We used multivariable-adjusted logistic regression to evaluate predictors of CR referral prior to the CDS tool. We then conducted an interrupted time series (ITS) analysis on CR referral rates before and after intervention.

Results:
A total of 1985 patients admitted with acute MI from December 2014 through March 2023 were included. Prior to CDS implementation, 1218 of 1657 patients (74%) were referred to CR. Multivariable-adjusted logistic regression demonstrated that ST-segment elevation myocardial infarction on arrival (OR = 1.70: 95% CI, 1.29-2.23, P < .001) and percutaneous coronary intervention during the hospitalization (OR = 2.25: 95% CI, 1.60-3.15, P < .001) were associated with a higher odds of CR referral. After implementation of the CDS tool, 308 of 328 patients (94%) received CR referrals. An ITS analysis demonstrated that the increase in CR referral from 74-94% after the CDS tool was highly significant (P < .01).

Conclusions:
The implementation of a CDS tool reminding physicians to refer patients with AMI to CR markedly improved CR referral rates at our institution. These findings are important for institutions seeking to improve outcomes in patients with AMI.
Independent and joint effect of central and brachial SBP on incident stroke in hypertensive adults
Authors: Ding Congcong , Cao Tianyu , Cheng Zaihua , Liu Lishun , Chen Zihan , Lu Wenyang , Yu Yaren , Gao Lan , Jiang Chongfei , Song Yun , Li Junpei , Fan Fangfang , Zhang Yan , Li Jianping , Huo Yong , Wang Hong , Wang Xiaobin , Parati Gianfranco , Huang Xiao , Cheng Xiaoshu 
Published: November 2024

Objective:
It is unclear whether central SBP (cSBP) is an independent predictor of stroke above and beyond brachial SBP (bSBP). This study aimed to investigate the difference between cSBP and bSBP in predicting first stroke and the joint effect of cSBP and bSBP on the risk of first stroke in hypertensive adults.

Methods:
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified.

Results:
A total of 8122 hypertensive adults without stroke history were included in this study. cSBP was measured noninvasively using A-Pulse CASPro device. The outcome was first stroke. During a median follow-up of 4.4 years, 579 first strokes were identified. The risk of first stroke increased by the same 16% [hazard ratio: 1.16, 95% confidence interval (95% CI): 1.07–1.26] for per SD increment in both cSBP and bSBP. The differences in areas under the curves, continuous net reclassification indices, and integrated discrimination indices of bSBP and cSBP models for predicting first stroke were 0.003 (95% CI: −0.003, 0.008), 0.007 (95% CI: −0.058, 0.071), and −0.0002 (95% CI: −0.0028, 0.0013), respectively. When cSBP and bSBP were evaluated jointly, participants in the highest tertiles of both cSBP and bSBP had the highest risk of first stroke compared with their counterparts (hazard ratio: 1.59, 95% CI: 1.29–1.96; P-interaction = 0.034). Similar results were found for ischemic stroke and hemorrhagic stroke.

Conclusion:
Although cSBP was not found to be superior to bSBP in predicting first stroke, cSBP and bSBP were jointly associated with the risk of first stroke among hypertensive adults.
Onyx as an adjunctive embolic material for transvenous embolization of cavernous sinus dural arteriovenous fistula after coiling
Authors: Luo Chao-Bao , Lee Chien-Hui , Lo Hsiang-Yun , Chang Feng-Chi , Lin Chung-Jung 
Published: November 2024

Background:
Transvenous coil embolization (TVCE) is a common and effective treatment for cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some patients may experience residual fistulas or worsening visual symptoms after the procedure. This study aimed to compare the effectiveness of transvenous coil and Onyx embolization (TVCOE) with TVCE in treating CSDAVFs.

Methods:
The study included 207 patients with 222 CSDAVFs referred for TVCE, all of whom had complete angiographic follow-up over 9 years. Ninety patients (mean age, 65.3 years) with 97 CSDAVFs underwent TVCOE after coiling. Clinical data, angioarchitecture, and outcomes were retrospectively assessed and compared to 125 CSDAVFs treated with TVCE.

Results:
Key reasons for selecting TVCOE included improvement in immediate complete obliteration (CO) of CSDAVFs (n = 47, 48.5%), presence of cranial nerve palsy (n = 26, 26.8%), residual fistula with persistent pial venous reflux (PVR, n = 22, 22.7%), and redirection of fistula flow to PVR (n = 2, 2.1%). The average volume of Onyx used in TVCOE was 1.7 ml per CSDAVF. The mean coil lengths for TVCOE and TVCE were 143 cm and 228 cm, respectively, with a statistically significant difference (p < 0.05). Immediate digital subtraction angiography showed CO or nearly CO of CSDAVFs in TVCOE and TVCE at rates of 97.9% and 76.8%, respectively, indicating statistical significance in immediate CO (p < 0.05). Transient hemodynamic instability occurred in 81 (90.0%) patients due to Onyx toxicity, and 1 patient (1.1%) experienced hemorrhagic complications during TVCOE.

Conclusion:
The use of a small volume of Onyx as an adjunctive embolic material in TVCOE resulted in reduced coil use and improved immediate CO. This technique is viable for patients with PVR. Aside from the transient hemodynamic instability, periprocedural complications and follow-up angiographic outcomes did not show significant differences between the two groups.
Agitated Depression and the Potential Response to Gama-Amino Butyric Acid Agonist
Authors: Alhau Rawan , Rimawi Motaz , Zubrzycka Izabela , Mahgoub Yassir 
Published: November 2024

Purpose/Background
Agitated depression is a specific variant of depressive disorder characterized by marked psychomotor agitation, including prominent restlessness and pacing, intense anxiety, irritability, and insomnia. These symptoms can be severe, and patients might be at increased risk of suicide. Authors have suggested that agitated depression can worsen with the use of antidepressants but can respond to options such as electroconvulsive therapy (ECT), lithium, anticonvulsants, antipsychotics, and benzodiazepines. Appropriate identification of this variant of depressive disorder is essential for proper treatment, as some of these patients might be labeled as resistant to treatment due to the worsening or lack of response to several antidepressant trials.

Methods/Procedure
Summary of 2 recent cases and literature review on agitated depression symptoms and treatment.

Finding/Results
Our 2 patients presented with symptoms of depressed mood, increased anxiety, irritability, poor sleep, poor appetite, restlessness, rumination, indecisiveness, and psychosis. Both patients had worsening symptoms with the use of various antidepressants but improved with the use of lorazepam and olanzapine. We review literature describing this variant of depressive disorder and its suggested treatment.

Implication/Conclusion
Agitated depression has been poorly characterized in the literature. The criteria suggested by Koukopoulos et al (Acta Psychiatr Scand. 2007;115:50–57) and the provisional criteria for melancholia, as indicated by Mahgoub et al (Front Psychiatry. 2024;15:1372136), might help recognize this variant of depressive disorder. These patients might have a poor response or worsen with the use of antidepressants while responding to options like gamma-amino butyric acid (GABA) agonists, antipsychotics, and ECT.
Rectal foreign body of a cosmetic bottle treated successfully by transanal retrieval: A case report
Authors: Liu Congcong , Li Yuantao 
Published: November 2024

Rationale:
Retained rectal foreign bodies (RFBs) are unusual clinical presentations whose management is challenging for emergency physicians owing to variations in the object types, anorectal anatomy, sacral curvature, insertion times, and local contamination. Here, we present the diagnosis and treatment in 1 case of retained rectal foreign body.

Patient concerns:
A 62-year-old male presented to the emergency department with a cosmetic bottle inserted into the rectum while bathing. He had difficulty defecating and denied any underlying psychiatric illness. Before coming to the hospital, the patient attempted to remove the cosmetic bottle with a screwdriver but failed, causing the cosmetic bottle to penetrate further into the intestinal lumen. The patient felt that the anal bulging was gradually worsening.

Diagnoses:
Investigations, a digital rectal examination, and coronal abdominal computed tomography revealed a foreign body stuck in the rectum.

Interventions and outcomes:
After lateral internal sphincterotomy, the cosmetic bottle’s plastic cap was pinched using a towel clamp and rotated slowly. The patient had an uneventful recovery period; the difficult defecation and anal bulging were relieved.

Lessons:
This case proves that lateral internal sphincterotomy can be performed to remove retained rectal foreign bodies if sufficient sphincter relaxation and anal dilatation cannot be achieved with proper anesthesia.
Effect of K-line (−) or (+) on surgical outcomes in cervical ossification of the posterior longitudinal ligament: A systematic and meta-analysis
Authors: Wang Yongping , Chen Xiao , Luo Yuan , Chen Chang , Cui Ran 
Published: November 2024

Background:
To conduct a systematic review and meta-analysis assessing the influence of K-line status on postoperative clinical outcomes in patients with cervical posterior longitudinal ligament ossification (OPLL).

Methods:
We searched PubMed, Embase, OVID, Cochrane Library, and Web of Science databases for English-language literature related to K-line and OPLL up to June 7, 2024. The study underwent rigorous selection, quality assessment, and data extraction, followed by meta-analysis using Review Manager 5.3 and Stata 17.0 software. This study has been registered with the international PROSPERO registry (registration number: CRD42024558578).

Results:
Seventeen articles encompassing 1247 patients were included. The meta-analysis revealed that patients with a positive K-line (K-line (+)) exhibited significantly enhanced Japanese Orthopaedic Association score recovery rate (mean differences [MD] = 19.28, 95% confidence interval [CI]: 12.28–26.28, P < .00001), Japanese Orthopaedic Association score (MD = 1.51, 95% CI: 0.64–2.37, P = .0007), C2-C7 Cobb angle (MD = 6.45, 95% CI: 3.73–9.17, P < .00001), alongside reduced occupation ratio (MD = −7.67, 95% CI: −10.86 to −4.49, P < .00001), C2-C7 sagittal vertical axis (MD = −6.18, 95% CI: −8.36 to −3.99, P < .00001), and neck disability index (MD = −1.85, 95% CI: −3.18 to −0.52, P = .006) at final follow-up compared to those with a negative K-line (K-line (−)). No significant differences were observed in postoperative complication rates (odds ratio = 1.15, 95% CI: 0.41–3.20, P = .79), final follow-up visual analog scale scores (MD = −0.10, 95% CI: −0.80 to 0.59, P = .77), or T1 slope (MD = 2.66, 95% CI: −0.20 to 5.52, P = .07) between the 2 groups.

Conclusion:
A positive preoperative K-line (K-line (+)) is a better predictor of prognosis and is associated with improved clinical outcomes in patients with multi-segmental cervical OPLL compared to a negative K-line (K-line (−)).
Sublingual glyceryl trinitrate given during adenosine sestamibi myocardial perfusion imaging causes apparent transient ischaemic dilation in a propensity-matched analysis
Authors: Rose David S. , Hector Bradley M. , Kannan Shanthi , Lee Joseph C. 
Published: November 2024

Objectives
Administration of sublingual glyceryl trinitrate (GTN) prior to resting radiotracer injection during myocardial perfusion imaging (MPI) has been advocated to aid detection of viable myocardium and increase the extent of reversible perfusion defects. However, GTN is also known to reduce resting left ventricular volume and could thus increase the transient ischaemic dilation (TID) ratio, independently of severe or extensive coronary artery disease. We aimed to determine if GTN administration causes an increase in the TID ratio.

Methods
Causal inference using propensity score matched analysis was used to assess the effect of GTN on TID ratios in subjects undergoing adenosine sestamibi MPI.

Results
From 597 consecutive patients undergoing MPI, we selected a treatment group of 51 who received 400 μg of sublingual GTN before resting sestamibi injection and 51 propensity score matched controls. Mean TID ratios were 1.24 in treated subjects and 1.10 in controls (mean difference 0.15; 95% CI, 0.05–0.25; P = 0.0018). The mean difference in TID ratio fell progressively in each quartile of time elapsed between GTN administration and image acquisition. The proportion with TID ratios equal and greater than an abnormal threshold of 1.39 was 17.6% among the treated and 0% in controls (P = 0.0010). The effect on TID ratio was not restricted to those with moderate-to-severe stress perfusion defects or accompanied by greater reversible perfusion defects.

Conclusions
There is evidence of a cause-and-effect relationship between administering GTN before resting sestamibi injection and increased TID ratio on MPI. This may be a source of misleading false positive TID findings.
Prevalence and Predictors of the Unmet Supportive Needs of Patients With Cancer in Oman
Authors: Al Qadire Mohammad , Abdelrahman Hanan , Al Sabei Sulaiman , Aljezawi Ma’en , Al Omari Omar , Al Salmi Nasser , Al Awaisi Huda , Aljezawi Hala 
Published: November 2024

Background
Unmet supportive needs are directly correlated with more frequent psychological distress, reduced quality of life, and low patient satisfaction with healthcare and indirectly connected with low compliance with treatment and increased care-related costs.

Objective
To assess the spectrum of unmet needs among patients with cancer in Oman and identify predictors of these needs and their relationship with psychological distress and symptom burden.

Method
A descriptive, correlational study design was used, involving 551 patients with cancer from 2 major healthcare facilities in Muscat, Oman. Data on patients’ unmet needs were collected between January and June 2023 using the Supportive Care Needs Survey Short-Form 34.

Results
Participants had a mean age of 45.8 (SD, 15.6) years, with female patients comprising 65.5% of the sample. Breast cancer was the most prevalent type of cancer. The mean unmet need score was 31.0/100 (SD, 20.1). Statistical analysis revealed significant predictors of unmet needs, including marital status, treatment type, performance status, symptom interference, and psychological distress, with the regression model explaining 26% of the variance in unmet needs.

Conclusions
Healthcare providers must regularly assess supportive needs, recognizing that they may vary across populations and are influenced by cultural factors. Additionally, individuals identified as having characteristics that predict higher levels of need should receive focused and prioritized supportive care.

Implications for Practice
By adopting regular tailored assessments that address the comprehensive supportive needs of patients with cancer, clinicians can significantly enhance patients’ quality of life and optimize treatment outcomes.
Long-Term Moderating Effect of Resilience Capacity on the Impact of Stressful Life Events on Depressive Symptoms After 6 Years in Outpatients With Depression and/or Anxiety
Authors: Chen Yi-Xin , Lin Shih-Hsien , Chen Po See , Lu Tsung-Hua , Huang Huei-Lin , Lee I Hui 
Published: November 2024

Abstract
Previous cross-sectional studies have utilized scales to explore potential indications of the moderating effect of resilience on the relationship between stressful life events (SLEs) and mental health. However, there remains a notable dearth of psychometrically driven models in longitudinal resilience research, especially concerning the prognosis of individuals with affective disorders and/or anxiety. This study aimed to investigate whether baseline resilience capacity, measured by the Connor-Davidson Resilience Scale, could mitigate the impact of SLEs on depressive symptoms assessed using the Beck Depression Inventory-II among 66 outpatients with depression and/or anxiety disorders during a follow-up period ranging from 4–8 years. Hierarchical linear regression analysis revealed that baseline resilience capacity significantly moderated the effect of SLEs on depressive symptoms at the end point, but neither SLEs nor baseline resilience capacity was significantly correlated with depressive symptoms at the end point after controlling for potential confounders. Patients with higher levels of baseline resilience capacity showed fewer depressive symptoms in response to SLEs. These findings underscore the potential of resilience capacity as a promising target for therapeutic interventions.
A Review of Stereotactic Body Radiotherapy in the Management of Gastrointestinal Malignancies
Authors: Hollis Emily , Nganga David W. , Yanagihara Ted K. 
Published: November 2024

Abstract
In this review, we explore the role of stereotactic body radiotherapy (SBRT) and other advanced radiotherapy techniques in the treatment of gastrointestinal malignancies, which primarily involves primary and secondary liver cancers and pancreatic cancers. The review examines radiotherapy in both curative and palliative settings, emphasizing the evolution of SBRT and hypofractionation as alternatives to conventional radiotherapy. We review the recent literature evaluating radiotherapy in the management of unresectable, borderline resectable, and metastatic pancreatic cancer, highlighting recent advances in radiotherapy techniques that aim to improve local control, reduce toxicity, and increase resectability in appropriate patients. For primary liver cancers (hepatocellular carcinoma and cholangiocarcinoma), SBRT has emerged as a potential noninvasive alternative to surgery, particularly in patients with unresectable tumors or those awaiting liver transplantation. The review also provides insights into ongoing clinical trials, comparative studies between SBRT and other local therapies such as radiofrequency ablation, and the use of radiotherapy in managing liver metastases from various primary cancers. Throughout, we emphasize limitations in the available literature and highlight areas of ongoing and future investigation.
Advances in Stereotactic Body Radiation Therapy for Lung Cancer
Authors: Lee Katie N. , Owen Dawn 
Published: November 2024

Abstract
Stereotactic body radiation therapy (SBRT) delivers curative-intent radiation to patients with early-stage non-small cell lung cancer and inoperable thoracic lesions. With improved techniques in tumor delineation, motion management, and delivery of radiation treatments, the therapeutic window within the thorax is able to be maximized. Ongoing technological advances enable highly targeted ablative radiation therapy while sparing adjacent sensitive organs at risk. Further applications of SBRT with combinatorial immunotherapy, the usage of particle therapy, and for patients with more advanced stages of lung cancer and other histologies mark exciting possibilities for the role of SBRT within the thorax.
Technical and Quality Considerations for Stereotactic Radiation Treatment Techniques
Authors: Covington Elizabeth L. , Popple Richard A. 
Published: November 2024

Abstract
Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT), collectively termed SRS-SBRT, are advanced treatment modalities delivering high doses of radiation in a single treatment or condensed treatment phase. Due to the small margins and steep dose gradient used in SRS-SBRT, the technical and safety considerations are more stringent than traditional radiation therapy and may include more advanced simulation, patient immobilization, treatment planning, and treatment delivery techniques. Respiratory motion management and intrafraction motion monitoring are often used during SRS-SBRT to ensure treatments are robust to both internal organ motion and patient movement during treatment. To ensure optimal treatment quality, SRS-SBRT programs should use multidisciplinary coordination of care to ensure patient-specific treatment strategies are used for optimal patient outcomes. Quality and safety considerations are presented, including peer review and external validation, for optimizing quality and adhering to national guidelines for stereotactic techniques.
Contrast-Enhanced Ultrasound Compared With Hepatobiliary Agent MRI for Differentiation of Focal Nodular Hyperplasia and Hepatic Adenoma: A Prospective Trial
Authors: Swensson Jordan , McCrate Mary , Halappa Vivek Gowdra , Stethen Taylor , Akisik Fatih 
Published: November 2024

Abstract
Magnetic resonance imaging (MRI) may be time-consuming, expensive, or poorly tolerated by patients with liver lesions. This is a prospective clinical trial designed to evaluate if contrast-enhanced ultrasound (CEUS) can be used to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) with similar accuracy compared with hepatobiliary agent MRI.
Institutional review board approval was obtained (1805450097), and the trial was registered with ClinicalTrials.gov (NCT03652636). From 2018 through 2023, 40 patients who had lesions consistent with FNH or HCA on HBA-MRI underwent 1-time prospective CEUS of up to 2 hepatic lesions. Sonographic images obtained before and after intravenous administration of 2 mL sulfur hexafluoride lipid-type A microspheres (Lumason) per lesion totaling 59 lesions (27 FNHs/32 HCAs). Two blinded radiologists provided a diagnosis of FNH or HCA.
Thirty-eight female and 2 male patients (age 36.7 ± 9.9) were scanned. Radiologists provided diagnosis of FNH or HCA with respective sensitivity (66.7/64.0%), specificity (71.9/90.6%), and accuracy (69.5/78.0%). For 38 lesions greater than or equal to 2 cm in size (17 FNHs/21 HCAs), readers had sensitivity (70.6/84.2%), specificity (70.6/84.2%), and accuracy (81.5/86.8%). Interobserver agreement for all lesions was fair (κ = 0.34), whereas agreement for lesions 2 cm or larger was substantial (κ = 0.67).
Contrast-enhanced ultrasound can differentiate FNH from HCA with accuracy approaching that of hepatobiliary agent MRI for lesions 2 cm or greater. Interobserver agreement is improved with larger lesions. CEUS may have utility as an alternate diagnostic tool for FNH/HCA, especially in patients who cannot or do not desire to undergo MRI.