bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers of Ukrainian refugees and migrants in accessing German healthcare
Authors: Davitian Karina , Noack Peter , Eckstein Katharina , Hübner Jutta , Ahmadi Emadaldin 
Published: September 2024

Abstract
Background
This study focused on Ukrainian refugees and migrants, a population that, with an ongoing war, is expected to grow in Germany. Over 1 million Ukrainians with exceptional legal status and access to public insurance in Germany significantly burden governmental services, especially German healthcare. It is thus essential to facilitate their integration into the healthcare system and ensure its proper usage. Identifying the obstacles Ukrainian refugees and migrants encounter while accessing healthcare services is crucial to ease their integration.

Methods
A qualitative study was conducted from February 2023 to April 2023. Thirty semi-structured interviews were performed with Ukrainian migrants and refugees. The interviews were transcribed verbatim, organized, and categorized. Thematic analysis was performed to identify barriers related to the use of German healthcare services. To assess possible differences in the experiences of Ukrainian refugees and migrants, the responses of these two groups for each topic were analysed separately.

Results
Ukrainian migrants and refugees experience similar barriers while accessing German healthcare services. Predominantly, language barriers and a lack of understanding of the German healthcare system posed the main barriers in both groups. Additionally, structural challenges, such as differences in referral processes, appointment scheduling, and consultation duration, presented further challenges.

Conclusion
This research study emphasizes the importance of addressing cultural and structural barriers to improve healthcare accessibility and utilization for Ukrainian refugees and migrants in Germany to better facilitate their integration into the healthcare system.
Application of microvascular ultrasound-assisted thyroid imaging report and data system in thyroid nodule risk stratification
Authors: Ma Guangrong , Chen Libin , Wang Yong , Luo Zhiyan , Zeng Yiqing , Wang Xue , Shi Zhan , Zhang Tao , Hong Yurong , Huang Pintong 
Published: September 2024

Abstract
Objectives
To establish superb microvascular imaging (SMI) based thyroid imaging reporting and data system (SMI TI-RADS) for risk stratification of malignancy in thyroid nodules.

Methods
In total, 471 patients, comprising 643 thyroid nodules, who received conventional ultrasound (US), SMI, and a final diagnosis were extensively analyzed. A qualitative assessment of US features of the nodules was performed followed by univariable and multivariable logistic regression analyses, leading to the construction of the SMI TI-RADS, which was further verified using internal and external validation cohorts.

Results
Among the stand-alone US, predictive factors were the shape and margins of the nodules, echogenicity and echogenic foci, vascularity, extrathyroidal extension, ring-SMI patterns, penetrating vascularity, flow-signal enlarged, and vascularity area ratio. SMI TI-RADS depicted an enhanced area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI: 0.92, 0.96; p < 0.001 relative to other stratification systems), a 79% biopsy yield of malignancy (BYM, 189/240 nodules), and a 21% unnecessary biopsy rate (UBR, 51/240 nodules). In the verification cohorts, we demonstrated AUCs, malignancy biopsy yields, and unnecessary biopsy rates of 0.88 (95% CI: 0.83, 0.94), 79% (59/75 nodules), and 21% (16/75 nodules) for the internal cohort, respectively, and 0.91 (95% CI: 0.85, 0.96), 72% (31/43 nodules), and 28% (12/43 nodules) for the external cohort, respectively.

Conclusion
SMI TI-RADS was found to be superior in diagnostic sensitivity, specificity, and efficiency than existing TI-RADSs, showing better stratification of the malignancy risk, and thus decreasing the rate of unnecessary needle biopsy.

Critical relevance statement
To develop an imaging and data system based on conventional US and SMI features for stratifying the malignancy risk in thyroid nodules.

Key Points

SMI features could improve thyroid nodule risk stratification.

SMI TI-RADS showed superior diagnostic efficiency and accuracy for biopsy guidance.

SMI TI-RADS can provide better guidance for clinical diagnosis and treatment of thyroid nodules.

Graphical Abstract
Detecting and characterizing creeping fat in Crohn’s disease: agreement between intestinal ultrasound and computed tomography enterography
Authors: Zhou Mengyuan , Niu Zihan , Ma Li , Li Wenbo , Xiao Mengsu , He Yudi , Qin Jing , Jiang Yuxin , Liu Wei , Zhu Qingli 
Published: September 2024

Abstract
Objectives
Creeping fat (CF) is associated with stricture formation in Crohn’s disease (CD). This study evaluated the feasibility of intestinal ultrasound (IUS) for semiquantitative analysis of CF and compared the agreement between IUS and computed tomography enterography (CTE).

Methods
In this retrospective study, we recruited consecutive CD patients who underwent IUS and CTE. CF wrapping angle was analyzed on the most affected bowel segment and was independently evaluated by IUS and CTE. We evaluated the wrapping angle of CF in the cross- and vertical sections of the diseased bowel. CF wrapping angle was divided into < 180° and ≥ 180°. IUS performance was assessed using CTE as a reference standard, and IUS interobserver consistency was evaluated.

Results
We enrolled 96 patients. CTE showed that CF wrapping angle was < 180° in 35 patients and ≥ 180° in 61 patients. We excluded three cases in which the observation positions were inconsistent between the IUS and CTE. Excellent agreement was shown between US and CTE (82/93, 88.2%). The eleven remaining cases showed inconsistencies mostly in the terminal ileum (n = 5) and small intestine (n = 4). Total agreement between IUS observers was 89.6% (86/96, κ = 0.839, p = 0.000), with perfect agreement for the ileocecal and colonic segments (35/37, 94.6% and 20/21, 95.2%, respectively) and moderate agreement for small intestinal segments (16/21, 76.2%).

Conclusions
IUS could be of value and complementary to CTE for assessing CF, particularly in patients with affected terminal ileum and colon. IUS is a non-invasive technique for monitoring CD patients.

Critical relevance statement
In our study, excellent agreement was shown between intestinal US observers as well as between US and CT enterography (CTE) for assessing creeping fat (CF), which showed that ultrasound could be of value and complementary to CTE.

Key Points

Creeping fat (CF) is a potential therapeutic target in Crohn’s disease.

Excellent agreement was shown between US and CT Enterography (CTE) for assessing CF.

Ultrasound could be complementary to CTE for assessing CF.

Graphical Abstract
The immunoglobulin M-degrading enzyme of Streptococcus suis (IdeSsuis) leads to long-lasting inhibition of the activation of porcine IgM-secreting B cells
Authors: Breitfelder Annika Katharina , Schrödl Wieland , Baums Christoph Georg , Alber Gottfried , Müller Uwe 
Published: September 2024

AbstractStreptococcus suis(S. suis) is one of the most important porcine pathogens, causing severe pathologies such as meningitis or polyarthritis. It is also a very successful colonizer of mucosal surfaces. The IgM-degrading enzyme ofS. suis(IdeSsuis) specifically cleaves porcine IgM, which results in complement evasion. On the basis of our previous finding that IdeSsuisalso cleaves the IgM B cell receptor in vitro, we verified IgM B cell receptor cleavage ex vivo in whole regional lymph nodes and investigated the working hypothesis that this IgM B cell receptor cleavage results in a long-lasting impaired B cell function. The number of IgM-secreting cells was determined via ELISpot analysis after porcine peripheral blood mononuclear cells had initially been treated with different recombinantS. suisproteins and subsequently stimulated with interleukin-2 and the toll-like receptor 7/8 ligand R848. Compared with treatment with medium or recombinant muramidase-released protein, treatment with rIdeSsuisbut also with a cleavage-deficient variant led to a reduction in the number of IgM-secreting cells as well as the level of secreted IgM. Flow cytometry analysis confirmed that the IgM B cell receptor was cleaved only by rIdeSsuis,and the receptor recovered to pretreatment levels on day 2 after treatment. Flow cytometry analysis of B and T cells incubated with fluorescein-labelled recombinant proteins revealed that different rIdeSsuisvariants bind specifically to B cells, most prominently the cleavage-deficient variant. Our results indicate that in vitro interference of rIdeSsuiswith the IgM B cell receptor results in long-lasting impaired IgM secretion by B cells after toll-like receptor activation. Further studies are warranted to prove that the modulation of B cell function by IdeSsuiscould play a role in vivo.
Impact of airway closure and lung collapse on inhaled nitric oxide effect in acute lung injury: an experimental study
Authors: Pellegrini Mariangela , Sousa Mayson L. A. , Dubo Sebastian , Menga Luca S. , Hsing Vanessa , Post Martin , Brochard Laurent J. 
Published: September 2024

Abstract
Background
Efficacy of inhaled therapy such as Nitric Oxide (iNO) during mechanical ventilation may depend on airway patency. We hypothesized that airway closure and lung collapse, countered by positive end-expiratory pressure (PEEP), influence iNO efficacy. This could support the role of an adequate PEEP titration for inhalation therapy. The main aim of this study was to assess the effect of iNO with PEEP set above or below the airway opening pressure (AOP) generated by airway closure, on hemodynamics and gas exchange in swine models of acute respiratory distress syndrome. Fourteen pigs randomly underwent either bilateral or asymmetrical two-hit model of lung injury. Airway closure and lung collapse were measured with electrical impedance tomography as well as ventilation/perfusion ratio (V/Q). After AOP detection, the effect of iNO (10ppm) was studied with PEEP set randomly above or below regional AOP. Respiratory mechanics, hemodynamics, and gas-exchange were recorded.

Results
All pigs presented airway closure (AOP > 0.5cmH2O) after injury. In bilateral injury, iNO was associated with an improved mean pulmonary pressure from 49 ± 8 to 42 ± 7mmHg; (p = 0.003), and ventilation/perfusion matching, caused by a reduction in pixels with low V/Q and shunt from 16%[IQR:13–19] to 9%[IQR:4–12] (p = 0.03) only at PEEP set above AOP. iNO had no effect on hemodynamics or gas exchange for PEEP below AOP (low V/Q 25%[IQR:16–30] to 23%[IQR:14–27]; p = 0.68). In asymmetrical injury, iNO improved pulmonary hemodynamics and ventilation/perfusion matching independently from the PEEP set. iNO was associated with improved oxygenation in all cases.

Conclusions
In an animal model of bilateral lung injury, PEEP level relative to AOP markedly influences iNO efficacy on pulmonary hemodynamics and ventilation/perfusion match, independently of oxygenation.
Exploring innovative strides in radiolabeled nanoparticle progress for multimodality cancer imaging and theranostic applications
Authors: Najdian Atena , Beiki Davood , Abbasi Milad , Gholamrezanezhad Ali , Ahmadzadehfar Hojjat , Amani Ali Mohammad , Ardestani Mehdi Shafiee , Assadi Majid 
Published: September 2024

AbstractMultimodal imaging unfolds as an innovative approach that synergistically employs a spectrum of imaging techniques either simultaneously or sequentially. The integration of computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and optical imaging (OI) results in a comprehensive and complementary understanding of complex biological processes. This innovative approach combines the strengths of each method and overcoming their individual limitations. By harmoniously blending data from these modalities, it significantly improves the accuracy of cancer diagnosis and aids in treatment decision-making processes. Nanoparticles possess a high potential for facile functionalization with radioactive isotopes and a wide array of contrast agents. This strategic modification serves to augment signal amplification, significantly enhance image sensitivity, and elevate contrast indices. Such tailored nanoparticles constructs exhibit a promising avenue for advancing imaging modalities in both preclinical and clinical setting. Furthermore, nanoparticles function as a unified nanoplatform for the co-localization of imaging agents and therapeutic payloads, thereby optimizing the efficiency of cancer management strategies. Consequently, radiolabeled nanoparticles exhibit substantial potential in driving forward the realms of multimodal imaging and theranostic applications. This review discusses the potential applications of molecular imaging in cancer diagnosis, the utilization of nanotechnology-based radiolabeled materials in multimodal imaging and theranostic applications, as well as recent advancements in this field. It also highlights challenges including cytotoxicity and regulatory compliance, essential considerations for effective clinical translation of nanoradiopharmaceuticals in multimodal imaging and theranostic applications.
Graphical Abstract
Do mobile applications foster sustainable mobility? Evidence from a field experiment
Authors: Goetz Alexander , Marinica Ioana , Mayr Harald , Mosetti Luca , Schubert Renate 
Published: September 2024

AbstractMobile applications hold promise to foster sustainable mobility behavior, but evaluations of their effectiveness are subject to a number of empirical challenges. We conduct a randomized controlled trial with three distinctive features: unobtrusive tracking of the control group, limited sample attrition, and a representative sample. In our study, 410 participants track their mobility behavior over a 5 week period. After 1 week, the treatment group engages with the user interface of the “Swiss Climate Challenge App”. The user interface combines information on individual $$\hbox {CO}_2$$

CO
2

emissions with gamification features. We find a treatment effect that implies a $$9.8\%$$

9.8
%

reduction in emissions caused by access to the mobile application. While we lack the statistical power to exclude a zero average effect, we find statistically significant emission reductions in the second half of the intervention period, among subjects in medium population density areas, and among men. Our findings suggest that mobile applications could generate considerable net benefits, but larger studies will be needed for validation.
Noise suppression in photon-counting computed tomography using unsupervised Poisson flow generative models
Authors: Hein Dennis , Holmin Staffan , Szczykutowicz Timothy , Maltz Jonathan S. , Danielsson Mats , Wang Ge , Persson Mats 
Published: September 2024

AbstractDeep learning (DL) has proven to be important for computed tomography (CT) image denoising. However, such models are usually trained under supervision, requiring paired data that may be difficult to obtain in practice. Diffusion models offer unsupervised means of solving a wide range of inverse problems via posterior sampling. In particular, using the estimated unconditional score function of the prior distribution, obtained via unsupervised learning, one can sample from the desired posterior via hijacking and regularization. However, due to the iterative solvers used, the number of function evaluations (NFE) required may be orders of magnitudes larger than for single-step samplers. In this paper, we present a novel image denoising technique for photon-counting CT by extending the unsupervised approach to inverse problem solving to the case of Poisson flow generative models (PFGM)++. By hijacking and regularizing the sampling process we obtain a single-step sampler, that is NFE = 1. Our proposed method incorporates posterior sampling using diffusion models as a special case. We demonstrate that the added robustness afforded by the PFGM++ framework yields significant performance gains. Our results indicate competitive performance compared to popular supervised, including state-of-the-art diffusion-style models with NFE = 1 (consistency models), unsupervised, and non-DL-based image denoising techniques, on clinical low-dose CT data and clinical images from a prototype photon-counting CT system developed by GE HealthCare.
Comparison of different cementing techniques for cement penetration under tibial component in total knee arthroplasty: a retrospective observational study
Authors: Okuno Yu , Nagira Keita , Ishida Koji , Kanaya Haruhisa , Hayashi Ikuta , Enokida Makoto , Nagashima Hideki 
Published: September 2024

Abstract
Purpose
This study aimed to investigate the differences in cement penetration between cementing techniques in total knee arthroplasty (TKA).

Materials and methods
We retrospectively evaluated knee undergone TKA at our hospital for both preoperative and postoperative computed tomographic (CT) evaluations. Cementing was performed with hand mixing and hand packing (HM group) and with vacuum mixing and cement gun use (VM group). We measured the area under the tibial baseplate (sclerotic and nonsclerotic sides) and compared the mean and maximum depths of cement penetration at each area.

Results
Of the 44 knees evaluated, 20 and 24 knees were in the HM and VM groups, respectively. At the center of the sclerotic side, the mean penetration depths (2.0 ± 0.7 and 2.5 ± 0.7 mm, p = 0.02) and the maximum penetration depths (4.0 ± 0.9 and 5.0 ± 1.6 mm, p = 0.02) were significantly deeper in the VM group than in the HM group. The correlation between preoperative Hounsfield unit values and mean penetration were r = –0.617 (p < 0.01) and –0.373 (p = 0.01) in the HM and VM groups, respectively.

Conclusion
The cementing technique of vacuum mixing and using a cement gun allowed for deeper cement penetration compared with the hand mixing and hand packing technique, even in bone sclerotic sites.
The rare association of congenital glaucoma, giant melanocytic nevus, alopecia, and hypospadias in an Egyptian child with neurofibromatosis type 1: a case report
Authors: Sadek Abdelrahim A. , Aladawy Mohammed A. , Mansour Tarek M. M. , Sayed Khulood M. , Khang Rin , Abdelkreem Elsayed 
Published: September 2024

Abstract
Background
Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder that commonly involves skin, nerves, and skeletal system with increased neoplastic predisposition. This disease has been rarely associated with multiple congenital anomalies. Herein, we describe an Egyptian child with NF1 and coexistent bilateral congenital glaucoma, giant congenital melanocytic nevi (GCMN), alopecia, and hypospadias.

Case presentation
A 2.5-year-old boy presented with developmental delay, back swelling, and multiple congenital anomalies. His father and two sisters were known to have NF1. The child was diagnosed with bilateral primary congenital glaucoma at the age of 3.5 months and underwent trabeculectomy with mitomycin C therapy. Examination at the age of 5 months revealed marked hypotonia, multiple GCMN, scanty café-au-lait macules, left upper eyelid plexiform neuroma and trichomegaly, hypertrichosis of left eyebrow, hypertelorism, depressed nasal bridge, left frontal scalp alopecia, and distal penile hypospadias. At the age of 8 months, brain imaging depicted a markedly dilated left lateral ventricle, and he underwent ventriculoperitoneal shunt surgery. The child developed back swelling at the age of 2.5 years, and a spinal magnetic resonance image showed bilateral multiple spinal neurofibromas in the paraspinal region with intraspinal extensions. A whole exome sequencing identified a heterozygous missense variant NM_001042492.3:c.1466A > G (NP_001035957.1:p.Tyr489Cys) in NF1 gene.

Conclusions
The present case report adds to the knowledge of the phenotypic spectrum and variability of NF1 by reporting the association of multiple unusual congenital anomalies. Importantly, such congenital anomalies could be the first presenting features in patients with NF1 since cafe´-au-lait macules and other typical diagnostic criteria may not be apparent in the neonatal period and early infancy. Accordingly, NF1 should be considered in newborns with congenital glaucoma, GCMN, scalp alopecia, and hypospadias.
Thyroid function evaluation in pediatric nephrotic syndrome: a study in a developing country
Authors: Omar Omneya Magdy , Fathi Hanan Mohamed , Merzabani Sara Salah El , Raafat Shaymaa 
Published: September 2024

Abstract
Background
In steroid-resistant nephrotic syndrome (SRNS), protracted proteinuria leads to the loss of thyroxine-binding proteins resulting in low thyroid hormones and in damage renal tubules and exhausts the thyroid reserve. This study aimed to assess thyroid function in those patients with SRNS and steroid-sensitive nephrotic syndrome (SSNS). A comparative cross-sectional study evaluated the thyroid status of 50 children with an equal age- and sex-matched SSNS, and controls were enrolled in this study. Demographic data, clinical examination, renal profile, and thyroid function tests were conducted for them.

Results
Subclinical non-autoimmune hypothyroidism was significantly prevalent in 54% of SRNS patients and 12% of SSNS patients (p < 0.001). No cases of overt hypothyroidism were detected. Albumin and protein/creatinine ratio emerged as significant independent factors influencing subclinical hypothyroidism with odds ratio (OR) 0.624, 95% CI (0.425–0.916), and 1.315 OR (1.315) and 95% CI (1.035–1.672), respectively.

Conclusion
Subclinical non-autoimmune hypothyroidism among patients with SRNS might occur, especially with protracted proteinuria necessitating regular screening of thyroid function in this cohort.
MSCT enterography score for prediction of disease severity in patients with active ulcerative colitis
Authors: Ali Rasha Mostafa Mohamed , Soliman Mirna Sami , Shehab Hany , Hashem Mohamed Bassam , Al-Sharif Aya M. , Safwat Merit , Elnafrawy Marwa Shaker Abd Elfattah 
Published: September 2024

Abstract
Background
Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease (IBD). It is characterized by diffuse inflammatory process of the bowel mucosa with a relapsing course. The precise evaluation of UC severity is pivotal in the therapeutic decision-making. Modified Mayo score is consistently used for the evaluation of the disease activity which depends on the patient’s symptoms as well as the colonoscopic findings. The aim of this study is to assess the role of the CT enterography (CTE) scoring system in the evaluation of the disease severity in ulcerative colitis. From October 2022 to July 2023, 66 patients with known ulcerative colitis patients at time of disease activity were referred from the inflammatory bowel disease unit for radiological assessment by CTE. CT images were analyzed to determine the anatomical location of the affected bowel segments, mucosal thickening and hyperenhancement as well as the extra-enteric involvement. Correlation with the modified Mayo score was established.

Results
Our results showed a statistical significant correlation between modified Mayo score and CTE with a P value of 0.000. The correlation coefficient is r = 0.964. The cut-off value of the optimal CTE score to predict mild and moderate UC was 7.5 with 0.996 area under the ROC curve, 92%sensitivity and 100% specificity. The cut-off value of the optimal CTE score to predict moderate and severe UC was 10.5 with 0.983 area under the ROC curve, 90.6% sensitivity and 100% specificity.

Conclusions
CTE is a reliable diagnostic method in the systematic assessment of the disease severity of active ulcerative colitis. CTE score shows a strong proportionate correlation with modified Mayo score. The aggravation of the course of the disease increased the CTE score. CTE scoring system can help plan the therapeutic strategy and predict prognosis.