bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening major depressive disorder in patients with obstructive sleep apnea using single-lead ECG recording during sleep
Authors: Shaw Vikash , Ngo Quoc Cuong , Pah Nemuel Daniel , Oliveira Guilherme , Khandoker Ahsan Habib , Mahapatra Prasant Kumar , Pankaj Dinesh , Kumar Dinesh K 
Published: November 2024

Objective: A large number of people with obstructive sleep apnea (OSA) also suffer from major depressive disorder (MDD), leading to underdiagnosis due to overlapping symptoms. Polysomnography has been considered to identify MDD. However, limited access to sleep clinics makes this challenging. In this study, we propose a model to detect MDD in people with OSA using an electrocardiogram (ECG) during sleep. Methods: The single-lead ECG data of 32 people with OSA (OSAD-) and 23 with OSA and MDD (OSAD+) were investigated. The first 60 min of their recordings after sleep were segmented into 30-s segments and 13 parameters were extracted: PR, QT, ST, QRS, PP, and RR; mean heart rate; two time-domain HRV parameters: SDNN, RMSSD; and four frequency heart rate variability parameters: LF_power, HF_power, total power, and the ratio of LF_power/HF_power. The mean and standard deviation of these parameters were the input to a support vector machine which was trained to separate OSAD- and OSAD+. Results: The proposed model distinguished between OSAD+ and OSAD- groups with an accuracy of 78.18%, a sensitivity of 73.91%, a specificity of 81.25%, and a precision of 73.91%. Conclusion: This study shows the potential of using only ECG for detecting depression in OSA patients.
Youth and Young Adult Access to Flavored Vaping Products Following a Sales Restriction in New York State: A Mixed Methods Approach
Authors: Henes Amy , Coats Ellen M. , Hein Riley , Nonnemaker James , Cunningham-Rhoads Brian , Brown Elizabeth M. , Farrelly Matthew C. , Fajobi OlaOluwa , Anker Elizabeth , Lee Jennifer 
Published: November 2024

Introduction We examined youth and young adult access to flavored vaping products following New York’s (NY’s) flavored vaping product sales restriction in 2020. Method In 2021, we conducted an online survey (N = 493) and focus groups (N = 33) with NY youth and young adults who vaped in the past year (ages 15–24). We summarize findings and use logistic regression to assess associations with access to flavored vaping products. Results Most youth and young adults who vaped in the past year (64%) had obtained flavored vaping products. Among them, 49% purchased in a store, 47% got them from social sources, and 11% bought online. Focus group participants reported restricted products were available on store shelves or behind the counter. Those under age 21 were less likely to buy flavored vaping products in store than those aged 21–24, but age was unrelated to online purchases. Focus group participants reported websites did not require age verification, or they found ways to circumvent it. Most believed buying flavored vaping products was easy (77%) and had gotten easier or stayed the same in the past year (70%). Discussion Most NY youth and young adults who vaped in the past year obtained flavored vaping products and found it easy to buy them after the statewide sales restriction, suggesting that implementation has not occurred as intended. Findings also raise questions about retailer compliance and highlight enforcement challenges with online purchases. Continued retailer education and enforcement efforts, including for online sales, may help flavored vaping product sales restrictions achieve intended outcomes.
Developing a Carotid Pseudoaneurysm Model in Swine
Authors: Banaskiewicz Karolina , Oliver Alexander A. , Treffalls Rebecca N. , Price Colin , Benike Amy , Dragomir-Daescu Dan , Morrison Jonathan J. 
Published: November 2024

Background: Traumatic carotid artery pseudoaneurysms (PSAs) represent a vascular anomaly with potential for serious complications, including stroke. Traditional treatments involve endovascular stenting, which may not be ideally suited to otherwise healthy vessels that have the potential to remodel. Given the limitations of smaller animal models in replicating human vasculature and the need for improved treatment modalities, this study introduces a novel swine model for the creation and evaluation of carotid PSAs. Methods: The PSAs were created from bovine dura and anastomosed in an end-to-side fashion to bilateral carotid arteries. The PSAs were radiologically followed up post-operatively and were harvested at 3 and 10 days for histological analysis. Results: Pseudoaneurysms were successfully created in both animals without intra-operative or immediate post-operative complications. Radiological analysis showed well-perfused PSAs with intra-aneurysmal turbulence, hemodynamically mimicking human carotid artery PSAs. There was no evidence of thrombus or arterial stenosis. Histological examinations revealed thrombus maturation and tight anastomosis of the PSA sac with the native artery. Conclusions: This PSA swine model offers a replicable, cost-effective, and easily implemented tool with the potential to advance carotid PSA management and educational efforts in vascular surgery. Clinical Impact The model presented in this methodology paper allows for a standardized PSA animal model allowing for the standardization of a clinical entity which is frequently heterogenenous in morphology. This can allow for the development of new therapies or provide a ground truth for computer modelling for further in silico study.
Totally Endoscopic Coronary Artery Bypass Graft: Systematic Review and Meta-Analysis of Reconstructed Patient-Level Data
Authors: Zoupas Ioannis , Manaki Vasiliki , Tasoudis Panagiotis T. , Karela Nina-Rafailia , Avgerinos Dimitrios V. , Mylonas Konstantinos S. 
Published: November 2024

Objective: The standard approach for coronary artery bypass grafting is open surgery. Totally endoscopic coronary artery bypass has emerged as an alternative for selected patients. This meta-analysis sought to evaluate clinical outcomes with this emerging technique. Methods: A PRISMA-compliant search was performed up to December 14, 2022, in PubMed (MEDLINE), Scopus, and Cochrane. Time-to-event data were reconstructed using Kaplan–Meier curves from source literature. Results: A total of 2,774 patients with symptomatic coronary artery disease underwent totally endoscopic coronary artery bypass in 18 eligible studies. The mean patient age was 63.2 ± 12.3 years, and 77.5% (95% confidence interval [CI]: 72.2% to 82.4%) of the included patients were males. The mean operative time was 304.2 ± 155 min, whereas the mean internal mammary artery takedown time was 38.3 ± 18.4 min. Of the patients, 4.7% (95% CI: 1.6% to 9.1%) required conversions to open surgery. The 30-day complication rate was 5.9% (95% CI: 1.2% to 13.1%), whereas late complications developed in 4.8% (95% CI: 1.9% to 8.5%) of the patients. Freedom from major adverse cardiac events was 93.4% (95% CI: 85.3% to 94.8%) and 1-year, 5-year, and 10-year survival rates were 95.2%, 83.2%, and 81.7%, respectively. Reintervention was required in 3.3% (95% CI: 2.3% to 4.4%) of the cohort within a mean follow-up of 42.5 ± 27.8 months. Conclusions: Totally endoscopic coronary artery bypass may be a safe and viable alternative for selected patients with coronary artery disease. Long-term follow-up will help define the place of robotic endoscopic treatment in the armamentarium of myocardial revascularization.
Percutaneous recanalization of lower limb chronic total occlusions via tibial artery access using the BeBack™ crossing catheter
Authors: Khaitovitch Boris , Cohen Israel , Gilat Efrat K , Silverberg Daniel , Halak Moshe , Raskin Daniel 
Published: November 2024

Objectives The study aims to evaluate the safety and efficacy of the BeBack™ crossing catheter for percutaneous recanalization of lower limb chronic total occlusions (CTO) via tibial artery access in patients with chronic limb-threatening ischemia (CLTI). Methods This single-center, retrospective study included 21 patients who underwent 22 limb recanalization procedures between May 2021 and April 2024. The BeBack™ catheter was utilized after traditional methods of recanalization failed. Patients aged 18 years or older with peripheral artery disease (PAD) and treated exclusively through the tibialis anterior artery were included. Data on demographics, occlusion characteristics, procedural details, and outcomes were collected from hospital records. Procedural success was defined as achieving less than 30% residual stenosis and an improvement in the ankle-brachial index (ABI) by at least 0.2 within 24 h. Results The median patient age was 77 years (IQR 73–81.5), with the majority being male (71%). Technical success was achieved in 95% of cases (21/22), and procedural success was achieved in 91% (20/22) cases. The device was primarily used for re-entry (77%), with a minority of cases (23%) where it was used as a crossing device. The most frequently treated artery was the superficial femoral artery (95%). One procedural failure was noted due to an inability to traverse a heavily calcified occlusion. Complications included one case of intra-procedural acute thrombosis, which was resolved, and one instance of post-procedural pulmonary edema, treated with diuretics. No reinterventions or amputations were required during the 30-day follow-up, although there were three mortalities (14%). Conclusions The BeBack™ crossing catheter demonstrated high technical success and a low complication rate for recanalizing lower limb CTOs via a single tibial artery access. These findings suggest that the BeBack™ catheter could be an effective and safe option for managing complex CTOs, particularly when traditional approaches are not feasible. Further prospective studies are needed to validate these results and compare them with other crossing and re-entry devices.
International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis
Authors: Brakel Benjamin A , Rebchuk Alexander D , Ospel Johanna , Chen Yimin , Heran Manraj KS , Goyal Mayank , Hill Michael D , Miao Zhongrong , Huo Xiaochuan , Sacco Simona , Yaghi Shadi , Mai Ton Duy , Thomalla Götz , Boulouis Grégoire , Yamagami Hiroshi , Hu Wei , Nagel Simon , Puetz Volker , Kristoffersen Espen Saxhaug , Demeestere Jelle , Qiu Zhongming , Abdalkader Mohamad , Al Kasab Sami , Siegler James E , Strbian Daniel , Fischer Urs , Coutinho Jonathan , Munckhof Anita , Aguiar de Sousa Diana , Campbell Bruce CV , Raymond Jean , Ji Xunming , Saposnik Gustavo , Nguyen Thanh N , Field Thalia S 
Published: November 2024

Background: Cerebral venous thrombosis (CVT) accounts for 0.5–1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known. Aims: Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT. Methods: A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT. Results: The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT ( p < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as “never indicated” throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography. Conclusion: Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.
Evaluation of virtual training delivery for health information systems implementation in Canada: A qualitative study
Authors: Karsan Inaara , Hasan Hafsa , Jeyakumar Tharshini , Ambata-Villaneuva Sharon , Fur Katharine , Hanley Ivanka , McClure Sarah , Omar Maram , Sheriff Tamee , Wiljer David 
Published: November 2024

Introduction: As health information systems (HIS) become a critical part of patient care, it is crucial to build an effective education strategy that facilitates the adoption and sustained use of these systems. The COVID-19 pandemic (2019–2023) has contributed to the rapid shift in virtual education and training for healthcare staff. Objective: We sought to evaluate the efficacy and long-term sustainability of virtual training for using a HIS by examining opportunities and challenges. Method: An exploratory, multimethods study was conducted with staff who had taken part in a virtual HIS training program as part of the clinical transformation journey at a large academic health science center in Canada. The study was guided by the Accelerating the Learning Cycle framework. Data were collected through pre- and post-training surveys, as well as semi-structured interviews. An iterative, inductive, constant comparative analysis approach, outlined by Braun and Clarke, was taken to thematically analyse the data. Results: Of the 33 participants in this study, 13 were educational champions, and 20 were end-users. The pre- and post-training surveys yielded a total of 1479 responses in both groups. Three prominent themes emerged from this study: (1) fostering dynamic facilitation techniques to cultivate an inclusive culture and adapt to diverse learning needs; (2) integrating practical learning activities that contribute to knowledge retention; and (3) ensuring training resources are accessible and consistent for an optimal training experience. Conclusion: As HIS continue to be part of the transformation of the healthcare ecosystem, education is vital in preparing healthcare providers to perform their clinical tasks and effectively use these technologies. Findings from this study can be used to inform the development of virtual training that is inclusive and addresses the needs of care providers.
A Case of Moyamoya Vasculopathy Presenting as Simultaneous Ischemic and Hemorrhagic Strokes
Authors: Zhong Wayne , Mehta Amit , Haberli Nicholas , Elmashad Ahmed , Forman Rachel , Kim Jennifer 
Published: November 2024

Background Moyamoya disease (MMD) is a rare pathological state characterized by progressive stenosis of the terminal portion of the internal carotid arteries (ICA). Complications include both ischemic and hemorrhagic strokes, for which there is no curative treatment for MMD. Early diagnosis with surgical intervention is vital for there is no definitive treatment. Due to the bimodal age distribution, moyamoya should be considered for patients presenting with stroke and supraclinoid ICA vasculopathy. Case We present a case of a 23-year-old female who presented with left arm weakness and sudden onset thunderclap headache. Upon further questioning, it was revealed that the patient had started an estrogen-containing birth control two weeks prior to presentation. Neuroimaging at our tertiary care center demonstrated simultaneous ischemic and hemorrhagic strokes in the bilateral hemispheres associated with vasculopathy seen in both invasive and noninvasive cerebrovascular imaging. She was diagnosed with idiopathic moyamoya disease since her serum and cerebrospinal fluid studies did not reveal any obvious precipitators to suggest moyamoya syndrome (MMS). Conclusion There were no obvious precipitating factors identified in the extensive workup for this patient. Therefore, further secondary prevention is difficult for this otherwise young and healthy individual. While there is data to support the use of antiplatelet medications for the prevention of ischemic stroke secondary to intracranial atherosclerotic disease, there are no clear guidelines for the treatment of MMD that simultaneously causes ischemic and hemorrhagic stroke. Further research on the pathophysiology and treatment modalities for MMD are needed to guide clinicians in treating this complex disease.
TNF-α Regulated Bidirectional Interaction Between Bone Marrow Mesenchymal Stem Cells and Articular Chondrocytes
Authors: Huang Yu , Zuo Fengqiong , Wu Jue , Wu Shaoping 
Published: November 2024

Background Articular chondrocytes (ACs) secrete a variety of extracellular matrix components to maintain the functions of articular cartilage. Degeneration of ACs leads to the degeneration of articular cartilage and consequently to osteoarthritis. The secretion of bone marrow mesenchymal stem cells (BMSCs) is capable of protecting ACs from degeneration, and thus BMSCs are widely applied to treat osteoarthritis. Objective This study aims to explore whether BMSCs and ACs will affect the functions of each other through their secretions in the context of osteoarthritis. Design BMSCs and ACs isolated from rabbits were identified using flow cytometry and immunocytochemistry. Conditioned medium of BMSCs and ACs treated with 0, 5, 10, 20, and 40 ng/ml of tumor necrosis factor-alpha (TNF-α) were collected and used to treat ACs and BMSCs, respectively. The viabilities of ACs and BMSCs treated with condition medium were assessed using a Cell Count Kit-8 (CCK-8) kit. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR), immunoblotting, and enzyme-linked immunosorbent assay (ELISA) methods were employed to evaluate the relative expression levels of genes and proteins, as well as the cytokine concentrations in the supernatant. Results Immunofluorescence and flow cytometry results indicated that the purity of isolated cells exceeded 95%. CCK-8 analysis showed that 6 hours of treatment with a conditioned medium did not affect the viability of BMSCs and ACs. However, treatment for 12 hours or longer significantly increased the viability of BMSCs ( p < 0.05) and significantly decreased the viability of ACs ( p < 0.01). RT-qPCR results demonstrated that the relative expression levels of Runx2 (1.15-3.91), Alp (1.06-2.84), TNF (BMSCs: 0.94-2.54; ACs: 1.03-2.64), IL6 (BMSCs: 0.98-2.78; ACs: 0.96-3.71), IL17A (BMSCs: 1.08-5.91; ACs: 0.90-4.20), and IL10 (BMSCs: 0.93-2.82; ACs: 0.89-2.25) genes in conditioned medium-treated BMSCs and ACs were dose-dependently elevated ( p < 0.001) by TNF-α treatment. Immunoblotting analysis revealed that the expression levels of RUNX2 (0.53-0.86) and ALP (0.49-0.85) proteins were also dose-dependently elevated ( p < 0.001) by TNF-α treatment. ELISA results showed similar TNF-α dose-dependent increases ( p < 0.001) in the supernatant concentrations of pro-inflammatory cytokines TNF-α (BMSCs: 36.90 ± 0.75 to 199.38 pg/ml; ACs: 29.76 to 293.99 pg/ml), interleukin (IL)-6 (BMSCs: 4.96-48.24 pg/ml; ACs: 6.12-38.15 pg/ml), IL-17 (BMSCs: 3.06-28.99 pg/ml; ACs: 3.08-28.51 pg/ml), as well as the anti-inflammatory cytokine IL-10 (BMSCs: 6.34-65.02 pg/ml; ACs: 5.30-34.85 pg/ml). Conclusion Together, these results indicate a TNF-α-regulated bidirectional interaction between BMSCs and ACs, deepening our understanding of the pathogenesis of osteoarthritis and aiding in its prevention and treatment.
Meniscus Injury Induces Patellofemoral Osteoarthritis Development Mediated by Synovitis and Gait Kinematics: A Preclinical Study
Authors: Nakahata Akihiro , Ito Akira , Nakahara Ryo , Kuroki Hiroshi 
Published: November 2024

Objective To investigate whether meniscal injury leads to the development of patellofemoral (PF) osteoarthritis (PFOA) and to explore how synovitis and gait kinematics mediate this relationship. Methods Fifty-four male Wistar rats (12 weeks old) were randomly assigned to the control, sham, or destabilized medial meniscus (DMM) groups. The rats were subjected to gait analysis to assess the kinematic changes at 2, 4, and 8 weeks postoperatively. Subsequently, the rats were euthanized, and their right knees were harvested for histological analysis. Results: The Osteoarthritis Research Society International (OARSI) and modified Mankin (MM) scores in the DMM group were significantly higher than those in the control and sham groups at week 2 and significantly higher than those in the control group at week 4. The OARSI and MM scores in the sham group were significantly higher than those in the control group at weeks 2 and 4. The association between the DMM and OARSI scores was significantly mediated by the synovitis score and knee flexion angle at foot contact (proportion mediated: 58% and 10%, respectively). The association between the sham and OARSI scores was significantly mediated by the synovitis score and knee flexion angle (proportion mediated: 24% and 24%, respectively). Conclusions: DMM surgery induced articular cartilage damage in the PF joint. Synovitis and the knee flexion angle significantly mediated the association between DMM or sham surgery and PFOA development.
Coin Test: A Complementary Examination for Assessing Upper Extremity Function in Cervical Myelopathy
Authors: Li Xudong J. , Labaran Lawal , Talla Vishal , Donato Zach , Lesevic Milos , Wang Benjamin , Shen Francis , Shimer Adam , Lockey Stephen , Singla Anuj , Russell Shawn , Novicoff Wendy , Jin Li 
Published: November 2024

Study Design A prospective observational study. Objectives To explore the potential utility of the Coin Test as a valuable tool for assessing and diagnosing cervical spondylotic myelopathy (CSM). Methods In the first cohort, 36 patients with balance issues were assessed for CSM using the new Coin Test. In the second cohort, the Coin Test and mJOA scores were compared in 36 CSM patients before and 6 weeks after surgery. Results Among the 36 patients with balance problems who failed tandem gait test, 15 out of 16 (94%) CSM patients failed the Coin Test. The other 20 patients (56%) without CSM completed the Coin Test successfully but failed the tandem gait test for various reasons. The Coin Test demonstrated high specificity (100%) and sensitivity (94%) for diagnosing CSM in patients who failed tandem gait test. In the second cohort, the mJOA score improved significantly from 12 to 15 6 weeks postoperatively, and the Coin Test completion time decreased from 29.5 seconds to 16.4 seconds postoperatively ( P < 0.0001). Higher mJOA scores correlate with better performance (shorter time) on the Coin Test, both at baseline and 6 weeks post-surgery. Conclusion The Coin Test is a useful tool for evaluating hand fine motor and sensory function in CSM patients with high specificity. It also can serve as a tool for assessing surgical outcomes in patients with CSM.