bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced multimodal ultrasound for pre-operative assessment of skin tumours: A case series
Authors: Kho Ying Ying , Ooi Chin Chin , Too Chow Wei , Ma Voon Chee , Abu Bakar Rafidah , Lim Chee Yeong , Tang Po Yin , Oh Choon Chiat 
Published: November 2024

Background: Pre-operative assessment of non-melanoma skin cancers via advanced ultrasound techniques may potentially provide additional information to tumour margins and morphology compared to current assessment via dermoscopy or optical coherence tomography. In this case series, the findings of multimodal ultrasonography of non-melanoma skin cancer are described, with histological correlation. Methods: Consecutive patients with clinical suspicion of malignant skin lesions underwent multimodal ultrasonography, comprising B-mode, colour Doppler imaging, superb microvascular imaging, strain elastography, and shear-wave elastography, followed by surgical excision. Images were reviewed by two radiologists. Results: There were 8 female and 3 male patients, whose age ranged from 66 to 98 years. A total of 11 malignant skin tumours (basal cell carcinoma, n = 6; squamous cell carcinoma, n = 5) were reviewed. Tumour depth measured via ultrasound assessment ranged from 1.20 to 7.00 mm (mean ± standard deviation: 4.35 ± 1.99 mm). Tumours were located within dermis (n = 1) and abutting subcutaneous layer (n = 10) sonographically. Where corresponding histological reports for tumour depth were available, ultrasound correlated well with histology. Ultrasound also correctly predicted the deepest layer of involvement for all lesions. The sonographic features observed in all malignant skin tumours (11/11:100%) are solid, hypoechoic, with abundant neovascularity on colour Doppler imaging and superb microvascular imaging, and appeared stiff on strain elastography and shear-wave elastography. In some cases, the microvascular network of intra-tumoural flow were better demonstrated on superb microvascular imaging. Conclusion: Multimodal ultrasound can potentially be a useful and quick adjunctive tool for the pre-operative assessment of skin cancer by delineating the tumour depth and deepest skin layer involvement, ensuring complete excision of tumour.
Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial
Authors: Radford KA , Wright-Hughes A , Thompson E , Clarke DJ , Phillips J , Holmes J , Powers K , Trusson D , Craven K , Watkins C , Bowen A , McKevitt C , Stevens J , Murray JD , O’Connor RJ , Pyne S , Risebro H , Cameron R , Sach TH , Day F , Farrin AJ 
Published: November 2024

Background: Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking. Aims: This study aimed to evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke. Methods: This pragmatic, multicentre, individually randomized controlled trial with embedded economic and process evaluations compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged ⩾ 18 years, in work at stroke onset, hospitalized with new stroke and within 12 weeks of stroke. People not intending to return-to-work were excluded. Participants were randomized (5:4) to individually tailored ESSVR delivered by stroke specialist occupational therapists for up to 12 months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for ⩾ 2 h per week at 12 months. Primary and safety analyses were done in the intention-to-treat population. Results: Between 1 June 2018, and 7 March 2022, 583 participants (Mage 54.1 years (SD 11.0), 69% male) were randomized to ESSVR (n = 324) or UC (n = 259). Primary outcome data were available for 454 (77.9%) participants. Intention-to-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12 months (165/257 (64.2%) ESSVR vs 117/197 (59.4%) UC; adjusted odds ratio 1.12 (95% CI: 0.75–1.68), p = 0.5678). There was some indication that older participants and those with more post-stroke impairment were more likely to benefit from ESSVR (interaction p = 0.0239 and p = 0.0959, respectively). Conclusion: To our knowledge, this is the largest trial of a stroke vocational rehabilitation (VR) intervention ever conducted. We found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12 months post-stroke. Return-to-work (for at least 2 h per week) rates were higher than in previous studies (64.2% ESSVR vs 59.4% UC) at 12 months and more than double that observed in our feasibility trial (26%). Interpretation of findings was limited by a predominantly mild–moderate sample of participants and the COVID-19 pandemic. The pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behavior. These changes influenced our primary outcome and the meaning of work in people’s lives; all pivotal to the context of ESSVR delivery and its mechanisms of action. Data access: Data available on reasonable request. Registration: ISRCTN12464275.
Early-stage hypertension defined by the 2017 ACC/AHA blood pressure guideline carries excessive cardiovascular risk in axial spondyloarthritis patients
Authors: Shi Lin-Hong , So Ho , Lam Steven Ho Man , Li Tena K. , Li Edmund , Szeto Cheuk-Chun , Tam Lai-Shan 
Published: November 2024

Background: Hypertension (HTN) is the most important modifiable risk factor for the development of cardiovascular events (CVEs). Patients with axSpA are also associated with an increased risk of future CVE. Objectives: To ascertain whether baseline early-stage HTN is a predictor of future CVE in addition to inflammation in patients with axial spondyloarthritis (axSpA). Design: A retrospective cohort study. Methods: Patients with axSpA were recruited from 2001 to 2017. Patients with at least 2 years of follow-up and without prior CVE were divided into three groups according to the calculated mean blood pressure (BP) over the first 2-year follow-up period (adjusted mean BP) (⩾140/90, 130–139/80–89, and <130/80 mm Hg). They were followed from baseline until the end of 2020 or the occurrence of a first CVE. Multivariate Cox regression analyses adjusting for baseline and time-varying variables were used to assess the relationship between mean BP and CVE. Results: Out of the 437 patients fulfilling the inclusion criteria, 49 (11.2%) and 132 (30.2%) had an adjusted mean BP ⩾ 140/90 and 130–139/80–89 mm Hg, respectively, and 256 (58.6%) were pre-HTN. After a median follow-up of 12 (7–18) years, 56 (12.8%) CVEs were documented. The incidence rates were 21.4, 14.2, and 5.9 per 1000 patient-years for the three groups, respectively. Baseline adjusted mean BP of 130–139/80–89 mm Hg was independently associated with the occurrence of CVE after adjusting for the baseline covariates as well as time-varying high inflammatory burden. Conclusion: Baseline-defined early-stage HTN carries excessive risk of developing CVE which may be due to untreated inflammatory burden. Early antihypertensive therapy should target this BP level to minimize their future risk of CVE.
Improvement of Glycemia Risk Index and Continuous Glucose Monitoring Metrics During Ramadan Fasting in Type 1 Diabetes: A Real-World Observational Study
Authors: Al Hayek Ayman , Al Dawish Mohamed A. 
Published: November 2024

Background: Managing glycemia during Ramadan is challenging for individuals with type 1 diabetes (T1D) due to prolonged fasting and altered eating patterns. While many are exempt from fasting, some choose to fast, necessitating careful monitoring. The glycemia risk index (GRI) is valuable for assessing glycemic quality and interpreting continuous glucose monitoring (CGM) data to identify individuals needing closer clinical attention. This study investigates the effects of Ramadan fasting on glycemic control in T1D, focusing on GRI and its components for hypoglycemia (CHypo) and hyperglycemia (CHyper). Method: An ambispective study involved 186 individuals with T1D using intermittent scanning CGM (isCGM). Data were retrospectively collected for one month before Ramadan and prospectively during and one month after Ramadan. Clinical, metabolic, and glycemic data were collected, with GRI calculated alongside its components. Results: During Ramadan, GRI improved by 54.6% (from 56.4 to 25.6), CHypo decreased by 60% (from 6 to 2.4), and CHyper dropped by 40.5% (from 21 to 12.5). However, these benefits were temporary, as glycemic measures increased after Ramadan, reflecting a return to pre-Ramadan patterns once normal routines resumed. No participants were admitted for diabetes emergencies during Ramadan. Adolescents and patients on insulin pumps had more favorable outcomes. GRI and its components significantly correlated with other CGM metrics, with these relationships maintained during and after Ramadan. Conclusions: Ramadan fasting significantly improved GRI and its components in individuals with T1D. Incorporating GRI as a novel metric alongside classical CGM metrics could enhance glycemic control, highlighting the need for personalized diabetes management strategies.
The LncRNA PRNCR1 rs13252298 GG genotype is correlated with reducing susceptibility to recurrent spontaneous miscarriage in a southern Chinese population
Authors: Mai Hanran , Ke Junyi , Luo Xilian , Zheng Zilin , Luo Jieyi , Wang Chenlu , Lin Yueling , He Menghua , Qu Yanxia , Xu Yufen , Fu Lanyan , Pi Lei , Zhou Huazhong , Gu Xiaoqiong , Che Di , Zuo Liandong 
Published: November 2024

Background: LncRNAs play diverse roles and participate in various biological processes within the human body. It has been frequently reported that they are involved in the occurrence and development of recurrent spontaneous miscarriage. PRNCR1, a crucial player in several types of cancers, may also have implications for recurrent spontaneous miscarriage risk. However, the correlation between PRNCR1 rs13252298 A > G polymorphism and this risk remains unclear. In summary, we conducted the following experiments to investigate the association between the PRNCR1 polymorphic site rs13252298 and susceptibility to recurrent spontaneous miscarriage. Method: Our research included 695 healthy controls and 413 patients with recurrent spontaneous miscarriage from southern China. Genotyping was performed using the TaqMan method. Result: Our findings revealed that there is a relationship between PRNCR1 rs13252298 A > G polymorphism and lower susceptibility to recurrent spontaneous miscarriage (AG and AA: adjusted OR = 0.794, 95% CI = 0.527–1.196, p = 0.2696; GG and AA: adjusted OR = 0.705, 95% CI = 0.542–0.917, p = 0.0092; dominant model: adjusted OR = 0.722, 95% CI = 0.563–0.926, p = 0.0104; recessive model: adjusted OR = 0.949, 95% CI = 0.644–1.398, p = 0.7912). Conclusion: The results of our study demonstrate that the PRNCR1 rs13252298 A > G allele may contribute to a decreased risk of recurrent spontaneous miscarriage. The rs13252298 polymorphism could potentially serve as a biomarker for detecting recurrent spontaneous miscarriage risk and aiding prevention efforts.
Automatic segmentation of extensor carpi ulnaris tendon and detection of tendinosis with convolutional neural networks
Authors: Hämäläinen Mathias , Sormaala Markus , Kaseva Tuomas , Salli Eero , Savolainen Sauli , Kangasniemi Marko 
Published: November 2024

Background Extensor Carpi Ulnaris (ECU) tendinosis, a frequent cause of chronic wrist pain, requires prompt diagnosis to prevent disability. This study demonstrates the use of convolutional neural networks (CNNs) for automated detection and segmentation of the ECU tendon and tendinosis in 2D axial wrist MRI. Purpose To develop a CNN for the automated detection of ECU tendon and automatic delineation of tendinosis in 2D wrist MRI. The study serves as a proof-of-concept, demonstrating the feasibility of automating the segmentation of musculoskeletal structures in wrist MRI and offering an efficient solution for detecting tendinosis. Material and Methods In a retrospective analysis of 1081 patients undergoing wrist MRI imaging, 46 patients exhibited tendinosis. Two deep learning-based methods for segmenting the ECU tendon and T2 hyperintense lesions indicative of tendinosis from 2D axial wrist MRI series were developed and compared in this study. Both methods were trained and evaluated over all 46 patients using Dice score as the main evaluation metric. Results The mean ECU tendon segmentation Dice score ranged from 0.61 to 0.64 (± 0.27 to 0.31). Tendinosis detection yielded a Dice score of 0.38 for both the threshold method (±0.19) and the CNN (±0.22). A Dice score > 0.50 indicated successful detection, with our methods achieving a detection rate of 72–76%. Conclusion The developed CNN effectively detected and segmented the ECU tendon in 2D MRI series. Tendinosis was detected with comparable accuracy using both signal intensity thresholding and the trained CNN method.
Evaluating the Scope of Services and Monetary Impact of Charity Medical Clinics in North Texas
Authors: Mills Logan G. , Newsom Barbara , Lewis Abigail , Pottorff Alexandra , Wallace Wu Ashley , Castro Erika , Morgan Kelsi , Wu Lawrence , Tran Bau P. , Lake Katherine , Guirguis Mina , Wagner James M. , Gimpel Nora , Kindratt Tiffany B. 
Published: November 2024

Introduction/Objectives: The cost of medical services is a major barrier to healthcare accessibility for underserved populations in the United States. Community charity medical clinics help address this disparity by providing free or reduced-cost care for the medically underinsured; however, their economic and public health contributions are unknown. The objective of this study was to evaluate the scope of services and monetary impact of 4 community charity medical clinics in North Texas, with one of the largest medically underinsured populations in the United States. Methods: A cross-sectional study was conducted using electronic health records from 4 clinics serving adults and children in North Texas. Encounters from June 1 to December 31, 2018 completed by with sufficient documentation to assign a level of service were reviewed. There were 3942 encounters identified and 2148 (54.5%) audited. Centers for Medicare and Medicaid Services Evaluation and Management Standards were used to identify level of service provided for each encounter, and their subsequent value was determined based on CMS fee-for-service schedules at the time service was provided. Common conditions managed during these encounters were identified using ICD-10 codes documented with each encounter. Results: The most prevalent diagnoses encountered were hypertension, diabetes, hyperlipidemia, and major depressive disorder. We estimate the total value of services and medications provided for 1 year is between $840 278.30 to $845 737.41. Conclusions: The charity clinics in North Texas provide a significant economic impact through a high level of charity care and a broad scope of services for a vulnerable patient population. The results may be used in the development and implementation of future services to meet the needs of the medically underinsured.
Melatonin ameliorates age-related sarcopenia by inhibiting fibrogenic conversion of satellite cell
Authors: Zhu Guo-Zheng , Zhao Kai , Li Hong-Zhou , Wu Di-Zheng , Chen Yun-Biao , Han Dong , Gao Jia-Wen , Chen Xing-Yu , Yu Yong-Peng , Huang Zhi-Wei , Tu Chen , Zhong Zhao-Ming 
Published: November 2024

AbstractThe fibrogenic conversion of satellite cells contributes to the atrophy and fibrosis of skeletal muscle, playing a significant role in the pathogenesis of age-related sarcopenia. Melatonin, a hormone secreted by the pineal gland, exhibits anti-aging and anti-fibrotic effects in various conditions. However, the effect of melatonin on satellite cell fate and age-related sarcopenia remains under-explored. Here, we report that melatonin treatment mitigated the loss of muscle mass and strength in aged mice, replenished the satellite cell pool and curtailed muscle fibrosis. When primary SCs were cultured in vitro and subjected to aging induction via d-galactose, they exhibited a diminished myogenic potential and a conversion from myogenic to fibrogenic lineage. Notably, melatonin treatment effectively restored the myogenic potential and inhibited this lineage conversion. Furthermore, melatonin attenuated the expression of the fibrogenic cytokine, transforming growth factor-β1, and reduced the phosphorylation of its downstream targets Smad2/3 both in vivo and in vitro. In summary, our findings show melatonin's capacity to counteract muscle decline and inhibit fibrogenic conversion in aging SCs and highlight its potential therapeutic value for age-related sarcopenia.
Graphical Abstract
Biphasic cartilage repair implant versus microfracture in the treatment of focal chondral and osteochondral lesions of the knee: a prospective, multi-center, randomized clinical trial
Authors: Tseng Tzu-Hao , Chen Chao-Ping , Jiang Ching-Chuan , Weng Pei-Wei , Chan Yi-Sheng , Hsu Horng-Chaung , Chiang Hongsen 
Published: November 2024

Abstract
Background
Autologous minced cartilage is a method for cartilage defect repair, and our study focuses on a newly developed biphasic cylindrical osteochondral construct designed for use in human knees. We aimed to compare its clinical effectiveness and safety with microfracture, the commonly utilized reparative treatment for knee chondral or osteochondral defects.

Materials and methods
Conducted as a prospective multicenter, randomized controlled, non-inferiority trial across nine hospitals, the study involved 92 patients with International Cartilage Repair Society (ICRS) grade 3 to 4 chondral or osteochondral lesions on femoral condyles. Patients were evenly randomized to receive either the biphasic cartilage-repair implant (BiCRI) or microfracture. Functional outcomes and safety assessments were conducted at postoperative intervals of 6 weeks and 3, 6, and 12 months. Primary and secondary endpoints included International Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation Form score improvement, the grade distribution in the IKDC 2000 Knee Examination Form, and various assessments, such as the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scales (VASs) for pain, MRI findings, and arthroscopic findings at 12 months.

Results
Out of the initial participants, 47 in the BiCRI group and 45 in the microfracture group completed the follow-up. At 12 months, the mean change in IKDC total score was 25.56 ± 18.48 for BiCRI and 27.51 ± 23.65 for microfracture. The 95% confidence interval (CI) for the score difference (BiCRI minus microfracture) was − 6.95, exceeding the non-inferiority margin of − 12. Secondary endpoints indicated comparable functional outcomes, and arthroscopic findings demonstrated more fully regenerated cartilage in the BiCRI group.

Conclusion
Based on the IKDC 2000 Subjective Knee Evaluation Form score, BiCRI proved non-inferior to microfracture at 12 months. Short-term functional outcomes were comparable to those with microfracture, while arthroscopic findings showed more complete cartilage regeneration in the BiCRI group. Consequently, BiCRI emerges as a viable alternative for treating chondral or osteochondral defects.

Level of evidence

Level 2, multi-center, randomized clinical trial.
Trial registration: Name of the registry: ClinicalTrials.gov. Trial registration number: NCT01477008. Date of registration: 11/14/2011. URL of trial registry record: clinicaltrials.gov/study/NCT01477008
The potential role of exercise in mitigating fertility toxicity associated with immune checkpoint inhibitors (ICIs) in cancer patients
Authors: Jamrasi Parivash , Tazi Mia , Zulkifli Nur Afiqah , Bae Jun Hyun , Song Wook 
Published: November 2024

AbstractOver the last decade, therapeutic advances in cancer immunotherapy have rapidly progressed, leading to an expansion of clinical trials and the development of novel immune checkpoint inhibitors (ICIs) and combination treatments. While ICIs offer substantial clinical benefits, they are also associated with various side effects, notably concerning endocrine function and potential gonadal damage following the initiation of immunotherapy. Exercise has demonstrated promise in enhancing treatment efficacy, including symptom reduction in cancer patients. Research has also established the benefits of exercise in managing fertility and reproductive health. However, there is limited data on the effectiveness of exercise in mitigating fertility-related side effects specifically in patients undergoing ICIs therapy. Given that a significant number of cancer patients are of reproductive age, it is crucial to address potential sexual side effects and offer fertility preservation options. Ensuring that patients are well-informed and supported in their reproductive health decisions is vital. This review reports the prevalence of immune-related adverse effects linked to fertility in cancer patients undergoing ICIs, explores the potential mechanisms by which ICIs may impact reproductive health, and emphasizes the role of exercise in mitigating these adverse effects.
Graphical Abstract
Coronary Artery Disease Empowerment Scale (CADES): Persian translation and psychometric properties
Authors: Jalali Amir , Naghibzadeh Amirhossein , Rostami Mojgan , Ahmadi Yasin , Khodamorovati Mahbod , Vatandost Salam , Darvishi Niloufar , Moradi Khalil 
Published: November 2024

Abstract
Introduction
Coronary artery disease (CAD) is a leading cause of global mortality and a prevalent health issue in Iran. Assessing the empowerment of CAD patients during treatment and care is essential. However, no scale is available to measure empowerment in CAD patients in Iran. Therefore, this study aimed to evaluate the validity and reliability of the Persian version of the "Coronary Artery Disease Empowerment Scale" (CADES).

Method
This methodological and cross-sectional study was conducted on patients with CAD from June 2022 to April 2023 in Kermanshah City, Iran. The scale was translated using the forward–backward translation method. Construct validity was examined using Exploratory Factor Analysis (EFA) with 190 samples and Confirmatory Factor Analysis (CFA) with 344 samples, both selected through convenience sampling. Internal consistency was assessed using Cronbach's alpha coefficient, and reliability was evaluated using the test–retest method. SPSS version 27 and LISREL version 8 software were utilized for data analysis.

Results
The EFA and CFA results confirmed the instrument with three factors and 25 items. The model's main indicators in factor analysis were all above 0.9, indicating a good fit for the model. The Pearson correlation coefficient between the items and subscales with the main scale showed a direct and significant relationship. Additionally, Cronbach's alpha coefficient (0.813) and test–retest reliability (0.763) confirmed the reliability of the Persian version of the CADES.

Discussion
The study's results suggest that the Persian version of CADES is both practical and acceptable for evaluating the empowerment of CAD patients. This tool can be relied upon as a valid and reliable method for assessing these patients' empowerment.