bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge of Established Conditions List and Associated Policies and Procedures Among Pediatricians and Early Intervention Personnel
Authors: Yadav Asha , Phelps Randall Alan , Squires Jane 
Published: December 2024

ABSTRACT

Objective:
Despite automatic eligibility, many children with medical conditions associated with increased risk of disability do not receive Early Intervention (EI) services. State EI programs have compiled lists of established conditions to facilitate automatic enrollment; yet little is known about professionals' knowledge and utilization of these lists. This study examined the knowledge of these established conditions lists and associated policies and procedures among pediatricians and EI personnel. State initiatives and approaches undertaken to improve familiarity and utilization of the list, along with recommendations for its improvement were examined.

Method:
In this mixed-methods study, self-rated survey data were collected from 193 EI personnel responsible for intake and eligibility evaluations, and 69 pediatricians providing primary care. Follow-up interviews were then conducted with 45 EI personnel and 22 pediatricians. Quantitative data were analyzed using descriptive statistics, and qualitative data underwent thematic analysis.

Results:
Pediatricians rated their knowledge of their state's established conditions list and related policies and procedures lower than EI personnel. Both groups emphasized the significance of the list in referral and eligibility determination but highlighted its underutilization and lack of professional development activities. Consequently, recommendations were made to improve state established conditions lists and their utilization in ensuring direct EI enrollment for eligible children.

Conclusion:
The lack of shared knowledge and utilization of established conditions lists and associated policies and procedures among pediatricians and EI personnel may result in referral failure for eligible children. Addressing this challenge requires improvement in the content and statewide distribution to improve accessibility and usability.
Six-Year Outcome of Lentigo Maligna Treated with “Spaghetti” Technique and Margin Identification by Reflectance Confocal Microscopy
Authors: Le May Océane , Cinotti Elisa , Perrot Jean-Luc , Tognetti Linda , Chauvel Picard Julie 
Published: December 2024

BACKGROUND
Lentigo maligna (LM) and LM melanoma (LMM) present surgical challenges due to their poorly defined boundaries, making it difficult to determine precise peripheral margins. In addition, their preferential localization on the face increases the need to minimize the amount of tissue excised. Striking a balance between reducing the excision size and maintaining oncologic effectiveness is critical in managing LM/LMM. Reflectance Confocal Microscopy (RCM), a noninvasive imaging method that provides cellular-level visualization, could be an ideal tool to define the peripheral margins in the “spaghetti” surgical technique.

OBJECTIVE
This study aimed to evaluate the long-term outcomes of using RCM combined with the “spaghetti” technique for LM/LMM excisions.

MATERIALS AND METHODS
Seventy patients with LM/LMM on the face underwent RCM-guided margin definition followed by the “spaghetti” technique. The sample of patients was the same group of patients included in the authors' 2017 study. The authors subsequently evaluated the effectiveness of the authors' protocol via regular follow-up of the cohort.

RESULTS
A total of 59 LMs and 11 LMMs were included. The mean follow-up time was 6.3 years. The recurrence rate was 5.7%. The authors identified 4 recurrences: 3 of which occurred more than 5 years after the procedure. The recorded mortality was 20%, no deaths were attributed to LM/LMM. The mean margin from lesion to clearance was 2.7 mm.

CONCLUSION
If the authors cluster the 3 principal studies in terms of cohort and follow-up time for LM/LMM treated by Wide local Excision, the recurrence rate is from 5.3% to 5.9%, which is equivalent to the authors'. However, the mean margin excision from lesion is more than 2 times inferior in the authors' protocol (2.7 mm vs 6.7 mm). Therefore, the spaghetti technique with RCM margin identification seems to be an effective method for LM/LMM management.
The Histological Effects of Hyaluronic Acid and Hyaluronidase Injections on Skin: An Experimental Study
Authors: Köken Süleyman , Akşam Ersin , Marşil Rehber , Şimşek Fatma , Başol Tunahan Berk 
Published: December 2024

BACKGROUND
Nonsurgical facial rejuvenation procedures are currently among the most popular areas of plastic, reconstructive, and aesthetic surgery. The goal of this study is to identify the effects of simultaneous hyaluronic acid and hyaluronidase injections into animal skin. This study is the first animal study in the literature showing the effects of hyaluronic acid and hyaluronidase simultaneous injection on skin.

METHODS
The study included 15 male and 15 female Wistar Albino rats. Four different areas were determined on the backs of the rats: a control area, an area for injection with hyaluronic acid, an area for injection with hyaluronic acid with hyaluronidase, and an area for injection with hyaluronidase only. The experiment was terminated at different times in these groups. After sacrification, the 4 regions were compared with each other under light microscope.

RESULTS
The results of this study demonstrate increases in dermis thickness, collagen density, and extracellular matrix density with injection of hyaluronic acid (81% vs 69.1%, p < .05), and hyaluronidase appears to antagonize these effects (52.5% vs 59.17%, p < .05).

CONCLUSION
Hyaluronic acid injections have positive effects on animal skin, while hyaluronidase can antagonize these effects. When hyaluronic acid and hyaluronidase are injected simultaneously into the animal skin, it is observed that the antagonizing effect of hyaluronidase is dominant from the first moment.
Laser Test Spot Practices Among Dermatologists
Authors: Wang Jennifer Y. , Patel Paras , Kabakova Margaret , Cohen Marc , Jagdeo Jared 
Published: December 2024

BACKGROUND
Laser test spots are a preliminary assessment performed on a small area of the skin to evaluate patients' reaction to laser therapy. Despite their recognized importance, there is a gap in knowledge among dermatologists regarding laser test spot practices.

OBJECTIVE
The authors aim to explore dermatologists' test spot practices.

METHODS
A survey was performed among Association of Academic Cosmetic Dermatology members.

RESULTS
Laser test spot practices varied widely between dermatologists, with 3.0% “always,” 22.7% “frequently,” 54.5% “occasionally,” 16.7% “rarely,” and 3.0% “never” performing test spots. Most dermatologists (59.4%) wait more than 2 weeks before evaluating a test spot. Furthermore, 68.3% of the respondents use the same laser settings for the test spot as they would for the actual treatment. Regarding location, 60.9% of dermatologists perform laser test spots in the same area intended for treatment, while 39.1% choose another inconspicuous area.

CONCLUSION
Establishing definitive protocols for laser test spots may reduce variability in practice and enhance the overall safety and efficacy of laser treatments.
Dose Optimization of Amikacin in the Emergency Department: A Population Pharmacokinetics Simulation Study
Authors: Dia Nada , De Winter Sabrina , Gijsen Matthias , Desmet Stefanie , Vanbrabant Peter , Peetermans Willy , Spriet Isabel , Dreesen Erwin 
Published: December 2024

Background:
In adult patients with sepsis or septic shock admitted to the emergency department, a single intravenous 15 mg/kg amikacin dose provides inadequate pharmacokinetic–pharmacodynamic target attainment at the locally reported minimum inhibitory concentration (MIC) of 2 mg/L and the European Committee on Antimicrobial Susceptibility Testing clinical breakpoint for Enterobacterales of 8 mg/L.

Objectives:
To provide an amikacin dosing strategy with a clinically acceptable probability of target attainment (PTA) for all patients.

Methods:
Stochastic simulations were performed using a two-compartment population pharmacokinetics model of amikacin (NONMEM 7.5). PTA was evaluated for various dosing strategies across a range of virtual patients' body weight, body mass index, serum total protein, serum sodium, fluid balance, and estimated glomerular filtration rate according to the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI), at the locally reported MIC of 2 mg/L and the clinical breakpoint of 8 mg/L. The pharmacokinetic–pharmacodynamic targets were a 24-hour area under the concentration–time curve (AUC24h)/MIC of ≥80 and a 24-hour postdose concentration (C24h) of < 3 mg/L for efficacy and safety, respectively.

Results:
The PTA for the clinical breakpoint of 8 mg/L was <90% with standard 15 mg/kg dosing, across all patient characteristics. A flat 1500-mg dose achieved ≥90% PTA for the entire population at a MIC of 2 mg/L. However, at the clinical breakpoint of 8 mg/L, a flat 3500-mg dose provided ≥90% PTA only when the eGFRCKD-EPI was <96 mL/min/1.73 m2. The C24h was similar for 1500 mg and 15 mg/kg dosing, whereas 3500 mg resulted in a higher C24h.

Conclusions:
A flat dose is recommended over weight-based dosing. However, selecting a 1500-mg or 3500-mg dose may compromise either efficacy (MIC 2 mg/L) or safety (clinical breakpoint 8 mg/L), posing a dilemma. Clinical validation is warranted.
Calcifying Aponeurotic Fibroma in the Deep Space of the Hand
Authors: Antar Ryan M. , Kidwai M. Sulaiman , Brammer Iris , Zhang Athena , Mantilla-Rivas Esperanza , Hussain Ahmad , Oh Albert K. , Rogers Gary F. 
Published: December 2024

Summary:
Calcifying aponeurotic fibroma is a rare tumor that can involve the upper extremity, but deep hand space involvement is exceptionally uncommon and presents unique diagnostic and treatment challenges. We present a 9-year-old girl with a progressively enlarging mass on the ulnar side of the left palm. Magnetic resonance imaging revealed an ill-defined tumor with fatty infiltration spanning the third and fourth metacarpal spaces, suspicious of an aggressive tumor. The delay in diagnosis, likely stemming from the location in the deep space of the palm and lack of functional impairment, allowed this lesion to become atypically large and expansive. Given the child’s age, a marginal excision was performed with careful preservation of the adjacent tendons, bone, and neurovascular structures. Although long-term monitoring for recurrence is ongoing, the patient had no evidence of recurrence at 1-year follow-up.
Chronic total occlusion of renal artery in symptomatic young patient with resistant hypertension: is a revascularization necessary or redundant?
Authors: Stecko Wojciech , Wańczura Piotr , Wajhajmer Adam , Wiśniowski Mateusz , Aebisher David 
Published: December 2024

Renal artery stenosis (RAS) can be described as a narrowed vessel lumen at least 60% which hemodynamic significance may be subsequently confirmed by the pressure gradient measuring with endovascular methods. Frequency with which a disease appears in a population is 5–10% and its dominant cause is the occurrence of atherosclerotic plaque. Infrequent causes include fibromuscular dysplasia and vasculitis such as Takayasu arteritis. Diagnostic gold standard of RAS is digital subtraction angiography (DSA) with pressure measurements. Nevertheless, Doppler ultrasonography (DUS), magnetic resonance angiography (MRA) and computed tomography angiography (CTA) may also play a key role during diagnostics process. Revascularization of narrowed or occluded vessel consists of percutaneous transluminal angioplasty (PTA) with balloon, drug-coated balloon or stent implantation. Surgical procedures are rare and dedicated only to treatment-resistant cases.
We reported a 19-year-old patient with resistant arterial hypertension, left ventricular hypertrophy and stenosis of the proximal segment of the right renal artery, confirmed in angio-CT examination. Subsequent follow-up endovascular diagnostic procedure after 12 months revealed complete occlusion of renal artery with angiographic features of chronic total occlusion (CTO). Additionally, laboratory tests showed increase of creatinine level, with an estimated eGFR of 32.9 ml/min/1.73 m2. Considering the whole case – history of fibromuscular dysplasia, deterioration of renal function and the presence of resistant hypertension in a young patient – the invasive treatment was decided. Revascularization with paclitaxel-coated balloon was performed leading to renal perfusion improvement and normalization of the creatinine level. The patient was discharged from hospital with significantly reduced doses of antihypertensive drugs.
There are few publications on opening CTOs of renal arteries. The method is rarely used and research in this field should be extended. While routine revascularization is not recommended, in some cases, we should take under consideration that early restoration of normal renal perfusion can bring benefits to the patient both clinical and related to the number of drugs taken and quality of life.
Use of Online Large Language Model Chatbots in Cornea Clinics
Authors: Nichani Prem A. H. , Ong Tone Stephan , AlShaker Sara M. , Teichman Joshua C. , Chan Clara C. 
Published: December 2024

Purpose:
Online large language model (LLM) chatbots have garnered attention for their potential in enhancing efficiency, providing education, and advancing research. This study evaluated the performance of LLM chatbots—Chat Generative Pre-Trained Transformer (ChatGPT), Writesonic, Google Bard, and Bing Chat—in responding to cornea-related scenarios.

Methods:
Prompts covering clinic administration, patient counselling, treatment algorithms, surgical management, and research were devised. Responses from LLMs were assessed by 3 fellowship-trained cornea specialists, blinded to the LLM used, using a standardized rubric evaluating accuracy, comprehension, compassion, professionalism, humanness, comprehensiveness, and overall quality. In addition, 12 readability metrics were used to further evaluate responses. Scores were averaged and ranked; subgroup analyses were performed to identify the best-performing LLM for each rubric criterion.

Results:
Sixty-six responses were generated from 11 prompts. ChatGPT outperformed the other LLMs across all rubric criteria, scoring an overall response score of 3.35 ± 0.42 (83.8%). However, Google Bard excelled in readability, leading in 75% of the metrics assessed. Importantly, no responses were found to pose risks to patients, ensuring the safety and reliability of the information provided.

Conclusions:
ChatGPT demonstrated superior accuracy and comprehensiveness in responding to cornea-related prompts, whereas Google Bard stood out for its readability. The study highlights the potential of LLMs in streamlining various clinical, administrative, and research tasks in ophthalmology. Future research should incorporate patient feedback and ongoing data collection to monitor LLM performance over time. Despite their promise, LLMs should be used with caution, necessitating continuous oversight by medical professionals and standardized evaluations to ensure patient safety and maximize benefits.
Tumor budding is an independent adverse prognostic factor of pancreatic ductal adenocarcinoma patients treated by resection after preoperative chemoradiotherapy
Authors: Hayasaki Aoi , Mizuno Shugo , Usui Miki , Kaluba Benson , Komatsubara Haruna , Sakamoto Tatsuya , Maeda Koki , Shinkai Toru , Noguchi Daisuke , Ito Takahiro , Gyoten Kazuyuki , Iizawa Yusuke , Fujii Takehiro , Tanemura Akihiro , Murata Yasuhiro , Kuriyama Naohisa , Watanabe Masatoshi , Uchida Katsunori , Kishiwada Masashi 
Published: December 2024

Abstract

Objectives
To examine the significance of tumor budding as a prognostic factor of resected pancreatic ductal adenocarcinoma (PDAC) specimens after preoperative chemoradiotherapy (CRT).

Methods
Among 162 PDAC patients who underwent pancreatectomy after gemcitabine and S1-based CRT from 2012 to 2019, 131 were evaluated for tumor budding. Tumor buds were counted at the invasive front, where the degree of budding was the greatest (hematoxylin and eosin staining, ×20 magnification). Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared between the patients without tumor budding (non-TB group) and those with tumor buddings (TB group). Multivariate Cox proportional hazards analysis was conducted to examine the significance of tumor budding as a prognostic factor.

Results
OS, DSS, and RFS (median survival time) of the non-TB group were significantly longer than those of the TB group (OS: 50.7 vs. 27.5 months, P = 0.014. DSS: 63.3 vs. 33.0 months, P = 0.014. RFS: 20.3 vs. 11.3 months, P = 0.028). Multivariate analysis identified adjuvant chemotherapy (P = 0.003) as a favorable prognostic factor of OS and tumor budding (P = 0.023) as an adverse prognostic factor of DSS.

Conclusions
This study revealed that the presence of tumor budding was an independent adverse prognostic factor in PDAC patients resected after gemcitabine and S1-based CRT.
Prostate cancer in people with HIV
Authors: Sigel Keith , Yu Ryan , Chiao Elizabeth , Deshmukh Ashish , Leapman Michael S. 
Published: December 2024

Purpose of review
Prostate cancer burden has been rising among people with HIV (PWH), yet it remains understudied in the context of HIV infection. The objective of this review article is to summarize contemporary information on the burden, risk, and outcomes of prostate cancer for people living with HIV.

Recent findings
Despite a lower apparent incidence of prostate cancer in early studies for PWH compared to uninfected persons, this malignancy is now likely to be the most common tumor for US PWH. Tumor characteristics and stage appear to have limited differences by HIV status. The optimal approach to early detection of prostate cancer remains controversial, and there are little HIV-specific data surrounding screening. Prostate cancer outcomes may have been worse for PWH in the early antiretroviral era but may have improved in more recent years.

Summary
Prostate cancer is an increasingly common clinical issue for PWH. Lower than expected incidence rates in the early ART-era may be increasing, and oncologic outcomes may also be improving. Treatment tolerability is still a key question for this patient group. Given the clinical and biological complexity of chronic HIV infection, strategies for both early detection and treatment will need continued evaluation specifically in the setting of HIV.
Risk of Malignancy Related to Ixekizumab in Patients With Psoriatic Arthritis or Axial Spondyloarthropathy
Authors: Maneiro José Ramón , Carmona Julia , Mera Antonio , Pérez-Pampín Eva 
Published: December 2024

Background
We aimed to estimate the risk of malignancy associated with ixekizumab in randomized controlled trials (RCTs) and long-term extension studies (LTEs) in patients with rheumatological indications.

Methods
A systematic review of the literature up to June 2024 was performed to analyze the risk of malignancy associated with ixekizumab use in patients with psoriatic arthritis and axial spondyloarthritis. The primary endpoint was overall malignancy risk in RCTs and LTEs. Meta-analyses of RCTs were performed when at least 3 studies had comparable outcome measures using Peto odds ratios. For LTEs, meta-analyses were performed using random-effects computing incidence rates (IRs) per 100 patient-years.

Results
Twelve articles, 4 LTEs and 8 pooled analyses, were included. Meta-analyses of RCTs for malignancy risk at week 24 showed a Peto odds ratio of 0.45 (0.11–1.86), with an I
2 of 43.0%. When stratified according to the comparator, heterogeneity decreased. Malignancy risk comparing ixekizumab with placebo was 1.43 (0.18–11.53), with an I
2 of 39.6%. Malignancy risk comparing ixekizumab with adalimumab was 0.11 (0.01–0.77), with an I
2 of 0%. At week 52, the IR of all malignancies with ixekizumab was 0.31 (0.07–0.72), with an I
2 of 18.9%. At 156 weeks, the IR of all malignancies with ixekizumab was 0.58 (0.29–0.96), with an I
2 of 0%.

Conclusion
Ixekizumab appears to confer a low malignancy risk in patients treated for rheumatological indications. Patients with psoriatic arthritis and axial spondyloarthritis appeared to be at similar risk, except for those with nonmelanoma skin cancer.
Association Between Quantitative Sialoscintigraphy and Antibody Profiles in Patients With Sjögren or Sicca Syndrome
Authors: Chuang Tzyy-Ling , Koo Malcolm , Lee Yi-Min , Tung Chien-Hsueh , Wang Yuh-Feng 
Published: December 2024

Purpose
This study analyzed the association between anti-Ro/SSA and anti-La/SSB antibody levels with quantitative and visual sialoscintigraphy patterns in patients suspected of having Sjögren or sicca syndrome.

Patients and Methods
Medical records of patients who underwent sialoscintigraphy between April 2020 and May 2022 were reviewed. Associations between antibody levels and sialoscintigraphy parameters were evaluated using linear regression. Receiver operating characteristic curve analysis was used to identify antibody cutoff values for predicting flat-type patterns and the risk of Sjögren or sicca syndrome.

Results
Of the 170 patients (mean age, 56.6 years; 78.8% female), 95.3% had dry mouth and eyes, 30% experienced polyarthralgia, and 66.5% were prescribed hydroxychloroquine. The most common sialoscintigraphy finding was the median-type time-activity curve (TAC) pattern. Anti-Ro/SSA and anti-La/SSB levels were significantly correlated with maximum accumulation or maximum secretion in the salivary glands. Receiver operating characteristic analysis for anti-Ro/SSA predicting a flat-type TAC pattern showed an area under the curve (AUC) of 0.659 to 0.780, with specificity between 82.1% and 86.3% for antibody levels greater than 85.2 units. Anti-Ro/SSA levels greater than 49.75 units predicted a higher risk of Sjögren or sicca syndrome, with an AUC of 0.622 and 83.9% specificity. Anti-La/SSB levels had no significant predictive value, with an AUC of 0.554.

Conclusions
Anti-Ro/SSA levels greater than 85.2 units were strong predictors of flat-type TAC patterns, indicating near-total salivary gland dysfunction and supporting their diagnostic utility in Sjögren or sicca syndrome.