bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factors after therapeutic bronchoscopy for tracheo- or bronchoesophageal fistulas: Results from the EpiGETIF registry
Authors: Edme Juliette , Fournier Clément , Lepage Benoit , Zea Obando Ep Chateau Claudia , Cellerin Laurent , Wallyn Frederic , Plat Gavin , Héluain Valentin , Lachkar Samy , Egenod Thomas , Gut Gobert Christophe , Perrot Loic , Lorut Christine , Lefebvre Aurélie , Vergnon Jean Michel , Bourinet Valerian , Roy Pascalin , Legodec Julien , Dutau Hervé , Guibert Nicolas 
Published: November 2024

IntroductionTreatment of malignant tracheo- or bronchoesophageal fistulas (TEF) using therapeutic bronchoscopy (TB) is not standardized and its outcomes are poorly described. This study aimed to analyze the characteristics of patients treated with TB for a TEF and to identify prognostic factors.MethodsWe analyzed data from 96 patients undergoing TB for TEF entered in the EpiGETIF registry between January 2019 and December 2022.ResultsThe mean age was 61.4 years. Median survival after TB was 2.40 months (95% CI 1.81–3.32). Histology was mainly represented by esophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), whereas smoking did (2.17versus3.32 months for non-smokers, p=0.04). Patients with poorperformance status(Eastern Cooperative Oncology Group >2) had shorter survival (1.99versus3.02 months, p=0.04). Sixty nine percent of patients had already received oncologic treatment, with no difference in survival (3.02versus2.21 months for treatment-naive patients, p=0.14). Neither the localization (trachea 61.5%, left main bronchus 34.4%, other 4.1%) nor the size of the fistulas (23% <5 mm, 20% 5–10 mm, 54% >10 mm) impacted survival (p=0.91 and p=0.83, respectively). An airway stent (AS) was placed in 92.7% of patients, mainly self-expanding metallic stents (45%). Patients treated with both an esophageal and AS had a better prognosis than patients treated with an AS alone (2.88versus1.77 months, respectively, p=0.02).ConclusionSurvival of patients treated with TB for a TEF is very poor, and is impacted by smoking, performance status, and the presence of an esophageal stent.
Shorter walk test durations to detect ambulatory oxygen desaturation in interstitial lung disease: an observational cohort study
Authors: Robertson Lucy , Sylvester Karl Peter , Newman Joseph 
Published: November 2024

Introduction6-Minute Walk Test (6MWT) oxygen desaturation is an indication for ambulatory oxygen therapy (AOT) (British Thoracic Society (BTS) SpO2<90%; American Thoracic Society (ATS) SpO2≤ 88%). Shorter walk test durations may be beneficial in remote monitoring or in severe lung disease (ILD), where completing a 6MWT is challenging.MethodsRetrospective routine clinical 6MWT with minute interval SpO2%, lung function and mortality data were collected from patients with ILD. Median lowest SpO2% at different time periods of the 6MWT were compared statistically and prognostically. Patients were classified by Distance-Oxygen-Gender-Age-Physiology (DO-GAP) index.Results274 patient records were analysed. Median SpO2% recorded at 0–1, 1–2, 2–3, 3–4, 4–5 and 5–6 min of the 6MWT were 96%, 93%, 92%, 92%, 91.5% and 91%, respectively (p<0.001). Prognostically, areas under the curve (AUC) for predicting 3-year mortality were significant (p<0.001) and similar for the minimum SpO2% between 0–1, 1–2, 2–3, 3–4, 4–5 and 5–6 min (AUC=0.71, 0.76, 0.77, 0.76, 0.77, 0.76, respectively). 111 patients desaturated to <90% (BTS criteria) during the 6MWT, with the median time to desaturation ranging from 1.5–2.5 min between DO-GAP groups (p=0.01). 94 patients desaturated to ≤88% (ATS criteria) during the 6MWT, with the median time to desaturation ranging from 1.5–2.2 min between DO-GAP groups.ConclusionExertional desaturation manifests during earlier stages of the 6MWT. A 3-minute walk has 87–91% sensitivity in detecting oxygen desaturation requiring AOT, whilst retaining prognostic value. Shorter walk durations can efficiently detect desaturation in ILD, making it more patient-centred and feasible for remote testing.
Early benefit of mepolizumab on small airways in severe asthma: insights from IMPOSE study
Authors: Kotsiou Ourania S. , Kirgou Paraskevi , Siachpazidou Dimitra , Bartziokas Konstantinos , Tourlakopoulos Konstantinos , Malli Foteini , Pinaka Maria , Daniil Zoe , Gourgoulianis Konstantinos I. 
Published: November 2024

BackgroundSevere eosinophilic asthma adversely affects small airway function, but effective therapeutic options are limited. The IMPOSE trial (NCT05147155) assessed the early and sustained effects of mepolizumab on small airways in patients with severe eosinophilic asthma using Impulse Oscillometry (IOS).MethodsThe study included 130 participants: 40 with uncontrolled severe asthma initiating mepolizumab, 40 with well-controlled severe asthma, and 50 healthy controls. Lung function was assessed with IOS, spirometry, and plethysmography at baseline, and at 1-, 3-, and 6-months post-treatment. Clinical outcomes included asthma control, quality of life, and medication adherence.ResultsSmall airway function significantly improved within one month of mepolizumab initiation, shown by reductions in Fres, indicating decreased small airway resistance undetectable by spirometry. By six months, sustained improvements in FEF25–75%, TLC%, Fres, AX, and R5–20 were evident, accompanied by better asthma control and quality of life scores. Negative correlations between ΔR5 and ΔR5–20 with ΔACT at six months suggested that decreased small airway resistance and heterogeneity correlated with improved asthma control. These benefits were particularly prominent in patients without fixed airway obstruction. Notably, even patients with irreversible airflow limitations saw improvements in small airway dysfunction (SAD), suggesting that mepolizumab may provide benefits despite irreversible airway changes.ConclusionsThis study is the first to demonstrate that mepolizumab has a rapid and sustained therapeutic effect on small airways in severe eosinophilic asthma, as shown by IOS. IOS proves to be a valuable tool for monitoring the effects of biologic treatments on small airway function, revealing insights beyond spirometry.
The sustained increase of cardiovascular risk following COPD exacerbations: meta-analyses of the EXACOS-CV studies
Authors: Nordon Clementine , Simons Sami O , Marshall Jonathan , Müllerová Hana , Pollack Michael , Bengtsson Camilla , Hoti Fabian , Lobier Muriel , Salosensaari Aaro , Santos Ana Cristina , Vogelmeier Claus Franz , Rhodes Kirsty 
Published: November 2024

BackgroundTheEXAcerbations of COPD and their OutcomeS on CardioVascular disease(EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, however with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalizability and improve precision.MethodsStudies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with COPD diagnosis in 2014–2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled HRs (HRp) of risks in post-exacerbation periods (versusperiods outside exacerbations) were obtained through random effects meta-analysis.ResultsTime periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HRp10.22 (95% CI 5.34–19.57) in days 1–7 and HRp1.24 (95% CI 1.09–1.40) in days 181–365. Risks were elevated for 6 months (HRp1.25, 95% CI 1.01–1.55 in days 31–180) and one year (HRp1.48, 95% CI 1.11–1.96 in days 181–365), following a moderate, or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31–180: HRp1.66 (95% CI 1.14–2.42) and HRp1.61 (95% CI 1.28–2.02) following the first, and the second post-diagnosis exacerbation, respectively.ConclusionRisk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.
Allelopathic effects of leaf extracts of Eucalyptus camaldulensis Dehnh. on morphological, physiological, and yield traits of Ethiopian wheat (Triticum durum L.) cultivars
Authors: Andualem Animut Mekuriaw , Aragaw Mersha Wubie , Molla Abiyu Enyew , Tarekegn Zelalem Getnet , Kassa Getinet Masresha 
Published: November 2024

AbstractAllelochemicals released into the soil from the leaves of eucalyptus species affect the growth and physiology of various crops. This study aimed to evaluate the allelopathic effects of aqueous and methanolic leaf extracts from Eucalyptus camaldulensis on three Ethiopian wheat cultivars (Assasa, Mukiye and Ude) of Triticum durum L. It was conducted as a pot experiment, and it utilized four concentrations of the extracts (Control (0%), 10%, 15%, and 20%) in a completely randomized design with three replicates. Results indicated that both extracts inhibited plant growth, biomass, and yield, with the methanolic extract showing stronger inhibitory effects. For instance, a concentration of 20% methanolic leaf extracts decreased chlorophyll fluorescence in the Assasa, Ude, and Mukiye cultivars by 53.97%, 36.36%, and 36.51%, respectively. The growth of both shoots and roots in Assasa, Ude, and Mukiye was significantly reduced at higher concentrations. Increasing concentrations of the extracts led to greater reductions in seedling traits and overall crop yield, with significant impacts observed (p ≤ 0.05). The findings suggest that eucalyptus should not be planted on agricultural land due to its negative impact on crop productivity.
Procalcitonin-guided antibiotic treatment in patients with cancer: a patient-level meta-analysis from randomized controlled trials
Authors: Gregoriano Claudia , Wirz Yannick , Heinsalo Ashley , Annane Djilali , Reinhart Konrad , Bouadma Lila , Christ-Crain Mirjam , Kristoffersen Kristina B. , Damas Pierre , Nobre Vandack , Oliveira Carolina F. , Shehabi Yahya , Stolz Daiana , Verduri Alessia , Mueller Beat , Schuetz Philipp 
Published: November 2024

Abstract
Background
Use of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer.

Methods
Individual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality.

Results
This individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, − 1.77 [95% CI, − 2.74 to − 0.80]; p < 0.001). Regarding safety, there were 72 deaths in 379 patients in the PCT-guided group (19.0%) compared to 91 deaths in 398 participants in the usual care group (22.9%) resulting in an adjusted OR of 0.78 (95% CI, 0.60 to 1.02). A subgroup analysis showed a significant reduction in mortality in patients younger than 70 years (adjusted OR, 0.58 [95% CI, 0.40 to 0.86]).

Conclusion
Result of this individual patient meta-analysis from 15 previous trials suggests that among patients with cancer and suspected or proven respiratory infection or sepsis, use of PCT to guide antibiotic treatment decisions results in reduced antibiotic exposure with a possible reduction in mortality, particularly among younger patients.
Comparison between community-acquired pneumonia and post-obstructive pneumonia associated with endobronchial tumors
Authors: Yu Wenwen , Shi Yubo , Zheng Qingsong , Chen Jianwu , Zhang Xie , Chen Ali , Yu Zhiyang , Zhou Weilong , Lin Li , Zheng Legui , Ye Hua , Li Yunlei 
Published: November 2024

Abstract
Background
Endobronchial tumors can infiltrate the bronchial wall or protrude into the bronchial lumen, causing post-obstructive pneumonia (POP). Differentiating between POP and community-acquired pneumonia (CAP) is challenging due to similar clinical, laboratory, and imaging findings, which can delay the diagnosis and treatment of endobronchial tumors.

Methods
We compared general demographic information, laboratory test results, lung CT images, bronchoscopic observations, pathological findings between the POP group and the CAP group.

Results
(1) The POP group consisted mainly of older individuals (mean age 69 vs. 56 years; P < 0.05), males (93.4% vs. 47.1%; P < 0.05), and smokers (67.2% vs. 14.7%; P < 0.05). Clinical symptoms varied, with chest pain (23.0% vs. 11.8%; P < 0.05) and hemoptysis (26.2% vs. 10.8%; P < 0.05) more prevalent in the POP group. MSCT showed that bronchial wall thickening, bronchial stenosis, occlusion, obstructive emphysema, mucoid impaction, and endobronchial shadows occurred more frequently in POP, while consolidation and exudation shadows were predominant in CAP (P < 0.05). (2) In the POP group, neoplasms were the most frequent bronchoscopic findings (57 cases, 93.44%), especially in the upper lungs. Squamous cell carcinoma was the primary pathological type (52 cases, 85.25%). The average delay in diagnosing endobronchial tumors was 214.8 days. In the POP group, 34 cases (55.74%) had abnormal CT images in the past and did not undergo bronchoscopy, resulting in delayed diagnosis. (3) Factors such as gender, age, bronchial occlusion, stenosis, mucus embolism, and intraluminal shadow were determined to be independent risk factors for endobronchial tumors (P < 0.05 and OR > 1).

Conclusions
Endobronchial tumors combined with POP are easily misdiagnosed as CAP in the early stage. Factors like bronchial occlusion, stenosis, mucus embolism, and intraluminal shadows on MSCT are significant independent risk factors for these tumors, indicating the need for early bronchoscopy.
Exploring the breadth of medicine: 8-year outcomes of a brief clinical summer immersion for premedical students
Authors: Weinlander Eva , Sams Elizabeth , Khemani Sarita , Jamal Armaan , Srinivasan Malathi 
Published: November 2024

Abstract
Background
Exposure to the breadth of healthcare opportunities is crucial to high-school and college students considering a career in medicine. Most programs revolve around research or subspecialties, limiting exposure to the richness within medicine.

Objective
We conducted a program evaluation of the Stanford Clinical Summer Internship (CSI) 2-week program, to understand learner viewpoints around CSI program utility, and to assess long term impact. We assess viewpoints by learner level (high school versus college) and participation mode (in-person versus virtual).

Methods
In 2016 we launched a two-week premedical internship, incorporating AAMC core competencies. In 2022 and 2023, we surveyed past participants, collecting demographic data and evaluating/comparing CSI’s impact on educational and career paths, future preferences in healthcare careers, and influential factors of matriculation for high-school and college participants.

Results
Of 411 past participants, 42% responded (n = 173). We found minimal significant differences between high school and college students. The primary reason for joining was exploring a career in health professions. Notably, 82% acknowledged Stanford-CSI broadened their medical perspectives, 79% gained clarity on healthcare professionals' daily life, 79% heightened their interest in healthcare careers, 71% enhanced their resumes, and 72% learned valuable clinical skills. In-person participants reported developing more friendships (agree/strongly agree: 60% vs 35%, unpaired t-test: p = 0.01), while virtual participants reported having more interest in research careers (40% vs 68%, p = 0.01). Amongst high school matriculants (n = 133), 46% are now in college and 4% in medical or nursing school. Amongst collegiate matriculants (n = 40), 89% have graduated and 11% are now in graduate or medical school. All respondents believed Stanford-CSI was a worthwhile investment of time and resources, with nearly all reporting subsequent increased interest in medicine.

Conclusions
Stanford-CSI's summer internship gives premedical students real-world medical profession exposure and fosters meaningful connections. Our findings and teaching framework can guide similar program developments, supporting future medical education initiatives.
Large language models improve clinical decision making of medical students through patient simulation and structured feedback: a randomized controlled trial
Authors: Brügge Emilia , Ricchizzi Sarah , Arenbeck Malin , Keller Marius Niklas , Schur Lina , Stummer Walter , Holling Markus , Lu Max Hao , Darici Dogus 
Published: November 2024

Abstract
Background
Clinical decision-making (CDM) refers to physicians’ ability to gather, evaluate, and interpret relevant diagnostic information. An integral component of CDM is the medical history conversation, traditionally practiced on real or simulated patients. In this study, we explored the potential of using Large Language Models (LLM) to simulate patient-doctor interactions and provide structured feedback.

Methods
We developed AI prompts to simulate patients with different symptoms, engaging in realistic medical history conversations. In our double-blind randomized design, the control group participated in simulated medical history conversations with AI patients (control group), while the intervention group, in addition to simulated conversations, also received AI-generated feedback on their performances (feedback group). We examined the influence of feedback based on their CDM performance, which was evaluated by two raters (ICC = 0.924) using the Clinical Reasoning Indicator – History Taking Inventory (CRI-HTI). The data was analyzed using an ANOVA for repeated measures.

Results
Our final sample included 21 medical students (agemean = 22.10 years, semestermean = 4, 14 females). At baseline, the feedback group (mean = 3.28 ± 0.09 [standard deviation]) and the control group (3.21 ± 0.08) achieved similar CRI-HTI scores, indicating successful randomization. After only four training sessions, the feedback group (3.60 ± 0.13) outperformed the control group (3.02 ± 0.12), F (1,18) = 4.44, p = .049 with a strong effect size, partial η2 = 0.198. Specifically, the feedback group showed improvements in the subdomains of CDM of creating context (p = .046) and securing information (p = .018), while their ability to focus questions did not improve significantly (p = .265).

Conclusion
The results suggest that AI-simulated medical history conversations can support CDM training, especially when combined with structured feedback. Such training format may serve as a cost-effective supplement to existing training methods, better preparing students for real medical history conversations.
Exploring the educational journey: perspectives of ethnic minority GP-trainees in Dutch GP-specialty training - a qualitative interview study
Authors: van Moppes N.M , Nasori M. , Jorissen A.C. , van Es J.M. , Bont J. , Visser M.R.M. , van den Muijsenbergh M.E.T.C. 
Published: November 2024

Abstract
Background
Previous research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students’ and trainees’ outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees’ experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education.
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Research question
We aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment.

Method
We conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open and axial coding, followed by generating, reviewing, and defining themes. For a structured analysis of encountered microaggressions, we adopted Sue's Taxonomy of Microaggressions.

Results
All fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training.

Conclusion
Ethnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias.