bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Large Multilocular Mesothelial Splenic Cyst in Adult: A Rare Case Report
Authors: Somani Kavita , Singh Pretty , Poduval Sujatha 
Published: October 2024

Background: Splenic cysts are uncommon ailments and are incidentally discovered either during imaging procedures or while examining the cause of left upper abdominal pain. The origin of splenic cysts can be either parasitic or non-parasitic. Non-parasitic cysts can be classified as primary or secondary. Primary cysts are also referred to as true, congenital, epidermoid or epithelial cysts. On the other hand, secondary cysts are commonly known as pseudocysts. Splenic cysts are usually asymptomatic and can be found incidentally. Symptoms are usually related to the size of the cyst. Patient may present as local or referred pain, abdominal fullness, local tenderness or symptoms due to compression of the adjacent organs. Case report: We present a case report involving a 56-year-old male patient who was diagnosed with a sizable splenic cyst, initially suspected to be a hydatid cyst. The patient underwent splenectomy, and subsequent microscopic evaluation revealed a diagnosis of a mesothelial cyst, a condition that is considered rare. Conclusion: The clinical history, radiological findings and pathological examination of the cyst are discussed to highlight the diagnostic challenges and management considerations associated with this unusually large mesothelial splenic cyst in adults.
Evaluating heart rate variability by a novel stethoscopic approach to minimise stress in cats
Authors: Chen Chi-Ru , Chang Wei-Tao , Chen Hui-Wen , Wu Huey-Dong , Hsieh Olivia F , Lin Chung-Hui 
Published: October 2024

Objectives Stress associated with manipulation during electrocardiography (ECG) recording in cats potentially limits the assessment of autonomic function through heart rate variability (HRV) in the feline population. This study proposed an alternative, cat friendly, stethoscopic approach to evaluate HRV with an easily acquired vasovagal tonus index (VVTI). Methods The aim of this prospective study was to evaluate whether VVTI derived from heart sound signals could distinguish between relaxed and stimulated states. A total of 29 cats with 56 recordings of heart sound and ECG on 31 occasions were included. In 25 cats in their home environment, a stethoscope connected to a digital recording device was used to record 2 mins of heart sounds twice – with the cats in a relaxed state and immediately after stimulation. The VVTI was calculated from 20, 60 and 120 consecutive beat-to-beat intervals on the heart sound spectrogram (stethoscopic-VVTI 20, 60 and 120), using the natural logarithm of the variance of the intervals based on previous literature. A 2-min ECG recording was obtained at home with the intention of avoiding strict restraint. To demonstrate the feasibility of the stethoscopic approach in a hospital setting, six cats (two of which were also recorded at home) underwent heart sound and ECG recordings during planned veterinary visits. Results Stethoscopic-VVTI 20 (5.43 to 4.79, P = 0.001), 60 (6.20 to 5.18, P <0.001) and 120 (6.24 to 5.60, P = 0.02) all significantly decreased after stimulation, indicating a reduced vasovagal tone as expected. Calculations of stethoscopic-VVTI from different sections of the recording yielded statistically similar results. Stethoscopic-VVTI showed a negative correlation with the corresponding heart rate. Bland–Altman analysis revealed a mean bias for the differences between stethoscopic-VVTI and ECG-VVTI of 0.50 and 1.07 at home and in the hospital, respectively. Conclusions and relevance VVTI can be successfully detected through a stethoscopic approach, serving as a less stressful tool for HRV evaluation in cats during routine auscultation.
Relationship Between High Frequency Component of Heart Rate Variability and Delta EEG Power During Sleep in Women With Irritable Bowel Syndrome Compared to Healthy Women
Authors: Yang Pei-Lin , Kamp Kendra J. , Tu Qian , Chen Li Juen , Cain Kevin , Heitkemper Margaret M. , Burr Robert L. 
Published: October 2024

Objective To explore the relationship between the high frequency (HF) heart rate variability (HRV) and electroencephalogram (EEG) delta band power in women with irritable bowel syndrome (IBS) versus healthy control women. Materials and Methods Twenty women with IBS and twenty healthy controls were studied over three consecutive nights using polysomnography in a sleep laboratory. To avoid the first night effect, only second-night data were analyzed. Power spectral analysis was applied to HRV and EEG recordings. The linear system coherence/phase analysis assessed the relationship between normalized HF power of HRV and normalized delta band power of EEG during the first four NREM-REM sleep cycles. Results Women with IBS exhibited a significantly higher percentage of NREM sleep, higher normalized HF, lower normalized low frequency (LF) and decreased LF/HF ratio of HRV in the first four NREM-REM sleep cycles compared to controls. Additionally, their normalized delta band power was significantly lower in these sleep cycles and over the whole night. The phase shift between HF and delta band power was significantly longer in the IBS group. While the coherence between normalized HF and normalized delta band power was lower in the IBS group, the difference was not statistically significant. Conclusions The coherence/phase analysis showed a dysregulated interaction between autonomic and central nervous systems in women with IBS, manifested by increased lag time between cardiac and EEG delta band power compared to healthy controls. Whether this dysregulation contributes to the pathophysiology of IBS remains to be determined.
Teledermoscopic triage of melanoma-suspicious skin lesions is safe: A retrospective comparative diagnostic accuracy study with multiple assessors
Authors: Nervil Gustav Gede , Ternov Niels Kvorning , Lorentzen Henrik , Kromann Charles , Ingvar Åsa , Nielsen Kari , Tolsgaard Martin , Vestergaard Tine , Hölmich Lisbet Rosenkrantz 
Published: October 2024

Background The rising incidence of melanoma and the high number of benign lesions excised due to diagnostic uncertainty highlight the need for effective patient triage. This study assesses the safety and accuracy of teledermoscopic triage on a high-prevalence case set with pre-triaged, challenging, melanoma-suspicious lesions. Methods Five dermatologists independently reviewed 250 retrospectively extracted patient cases. Teledermoscopy assessments were simulated for panels of 1, 2, 3 and 5 assessors using two distinct consensus strategies, Caution Protocol and Majority Vote, and the sensitivity and specificity of the patient triages were calculated. Results Triage by a single teledermatologist showed a sensitivity of 92.3% and a specificity of 58.7%. Sensitivity improved with the number of assessors, particularly when using the Caution Protocol, though with a considerable drop in specificity. The Majority Vote showed a more balanced improvement in sensitivity and specificity. Safety analyses indicated that diagnostic accuracy decreased with poor image quality and increased case difficulty. Discussion Expert teledermoscopic triage of melanocytic skin lesions is highly sensitive and lowers the need for unnecessary excision procedures by half while dismissing as few as 0.4% (95% confidence interval 0–0.6%) of melanomas, even when applied to a high-prevalence pre-triaged subpopulation. Implementation of safety procedures increases accuracy. Using multiple teledermatologists increases sensitivity but at the cost of specificity unless a Majority Vote consensus strategy is applied. Future teledermoscopy guidelines should encompass safety procedures and protocols for disagreement between assessors.
Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system
Authors: Simcoe Kathleen , Stainbrook J Alacia , Chazin Kate T , Schnelle Elaina , Wagner Liliana , Hooper Madison , Juárez A Pablo , Warren Zachary 
Published: October 2024

Despite the clear efficacy and appeal of naturalistic developmental behavioral interventions for families of young children, they are often difficult for families to access due to the limited availability of trained service providers. In recent years, telehealth has emerged as an effective tool for overcoming issues related to access, especially in rural and underserved communities. However, while telehealth offers a strategy to connect with families, it does not address the limited availability of trained providers. In this article, we provide an overview of a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while building the capacity of early intervention providers. Through this model, expert consultants connect to caregivers and providers via telehealth to provide information and coaching over a limited series of visits. Collectively, child, caregiver, and provider outcomes support the effectiveness, acceptability, and feasibility of this model while demonstrating that services can be provided successfully to diverse participants. Lay abstract Many families seek access to evidence-based therapy to support their child’s learning. Naturalistic developmental behavioral intervention is a set of practices that use a child’s natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention–based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.
Exploring perceived helpfulness of health services in men and women with dementia and care partners: A cross-sectional analysis
Authors: Arsenault-Lapierre Geneviève , Rodriguez Duarte Maria Alejandra , Rojas-Rozo Laura , Jeon Yun-Hee , Hevink Maud , Ciułkowicz Marta , Szczesniak Dorota , Rait Greta , Robinson Louise , Wilcock Jane , Poole Marie , McAiney Carrie , Doucet Shelley , Luke Alison , Reid Amy E. , Vedel Isabelle 
Published: October 2024

Introduction: The aim of this study was to examine the association of sex/gender and other factors with the perceived helpfulness of the diagnostic process and post-diagnostic services by persons with dementia and care partners. Methods: We conducted secondary cross-sectional analysis of surveys from the ‘Cognisance’ project. Sex/gender and other factors (e.g., demographic variables, help seeking behaviours, healthcare professional consulted) of persons with dementia and care partners from four countries were considered. Main outcomes were perceived helpfulness of diagnostic process and post-diagnostic services. We conducted descriptive and multivariate analyses. Results: Compared to men, more women with dementia perceived post-diagnostic services as helpful though not statistically significant. Sex/gender was not associated with perceived helpfulness of diagnostic process and post-diagnostic services among care partners. Satisfaction with and awareness of services were associated with perceived helpfulness among care partners. Discussion: These findings underscore the necessity for sex/gender-based research to enhance dementia care and for tailored interventions.
Plasma-derived Exosomal miR-25-3p and miR-23b-3p as Predictors of Response to Chemoradiotherapy in Esophageal Squamous Cell Carcinoma
Authors: Jing Zhao , Guo Zhen , Zhang Chuanfeng 
Published: October 2024

Background Exosomal miRNAs have emerged as promising biomarkers for cancer. However, little is known about the role of exosomal miRNAs in the response prediction of esophageal squamous cell carcinoma (ESCC) patients treated with chemoradiotherapy (CRT). Methods In this prospective study, 40 ESCC patients treated by CRT were enrolled from January 2021 to June 2022. Exosomes were isolated from plasma through EXODUS platform. We used small RNA sequencing in 14 samples of ESCC patients (7 responders, 7 non-responders) and the selected exosomal miRNAs were further validated in the extended cohort of 40 ESCC patients by quantitative real-time polymerase chain reaction (qRT-PCR). Results In the discovery phase, we identified five significantly differentially expressed exosomal miRNAs from miRNA sequencing data between the responder and non-responder patients. In the extended groups of responders (n = 27) and non-responders (n = 13), only miR-23b-3p ( p = 0.035, AUC = 0.708) and miR-25-3p ( p < 0.001, AUC = 0.932) were confirmed to have the predictive ability to distinguish non-responders from responders. The patients with low levels of miR-25-3p had a significantly shorter progression-free survival (PFS) than those with high levels ( p = 0.035). Multivariate Cox regression analysis revealed that miR-25-3p may serve as an independent predictive biomarker of PFS in ESCC patients received CRT. Conclusion Exosomal miR-25-3p and miR-23b-3p serve as promising biomarkers for predicting the early effectiveness of CRT in locally advanced ESCC patients, whereas miR-25-3p is a novel prognostic marker for ESCC. However, further larger prospective studies are needed to confirm their utility for individualized treatment decision in ESCC.
Hepaticogastrostomy versus hepaticogastrostomy with antegrade stenting for malignant biliary obstruction: a systematic review and meta-analysis
Authors: Paraskevopoulos Panagiotis , Obeidat Mahmoud , Bednárik Dániel , Martinekova Petrana , Veres Dániel Sándor , Faluhelyi Nándor , Mikó Alexandra , Mátrai Péter , Hegyi Péter , Erőss Bálint 
Published: October 2024

Background: Combining antegrade stenting (AGS) and hepaticogastrostomy (HGS) is an increasingly used endoscopic ultrasound-guided intervention when stenting by endoscopic retrograde cholangiopancreatography is impossible. Objectives: We comprehensively assessed the benefits and downsides of combined AGS and HGS (HGS procedure with AGS, HGAS). Data sources and methods: From 788 HGS and 295 HGAS cases, a random-effects meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases were searched for studies on HGS with or without AGS from inception until May 2024. The odds ratio (OR) and pooled rates were used for single and two-arm comparisons with 95% confidence intervals (CI). Results: From 26 eligible studies. The pooled technical and clinical success was 94% (CI: 92%–96%) and 88% (CI: 84%–91%) for HGS and 89% (CI: 83%–93%) and 94% (CI: 89%–97%) for HGAS, respectively. Pooled OR of HGAS and HGS showed an OR = 0.38 (CI: 0.07–2.00) for technical success and an OR = 1.02 (CI: 0.50–2.06) for clinical success. The pooled adverse event rates were 20% (CI: 16%–25%) for HGS and 14% (CI: 9%–20%) for HGAS, whereas pooled OR showed an OR = 1.09 (CI: 0.30–3.94). For re-intervention, an OR = 0.37 (CI: 0.27–0.52) was found. Time to stent dysfunction increased, HGAS 333 (CI: 280–Not reached) and HGS 209 (CI: 120–325) with no change in overall survival HGS 117 (CI: 94–147) and 140 (CI: 105–170). Conclusion: The use of HGAS appears to increase clinical success and reduce the need for re-intervention. Overall adverse event rates were similar but bile leakage prevalence was decreased. Time to stent dysfunction seems to increase with no change in overall survival. Trial registration: Our protocol was prospectively registered with PROSPERO (CRD42024509412).
Long-term analysis of infections and associated risk factors in patients with multiple sclerosis treated with ocrelizumab: pooled analysis of 13 interventional clinical trials
Authors: Derfuss Tobias , Bermel Robert , Lin Chien-Ju , Hauser Stephen L. , Kappos Ludwig , Vollmer Timothy , Comi Giancarlo , Giovannoni Gavin , Hartung Hans-Peter , Weber Martin S. , Wang Jianmei , Jessop Nikki , Chognot Cathy , Craveiro Licinio , Bar-Or Amit 
Published: October 2024

Background: Patients with multiple sclerosis (PwMS) have an increased risk of infections. Objectives: To characterize incidence, clinical characteristics, outcomes and risk factors of infections, and serious infections (SIs) in ocrelizumab (OCR)-treated PwMS. Design: Post-hoc analysis of pooled data from 6155 patients in 13 clinical trials. Methods: Descriptive analyses of clinical characteristics and outcomes were reported over ⩽14 years. A Poisson Generalized Estimating Equation model was constructed to examine risk factors in a subgroup of patients with longer exposure to OCR ( n = 2092). Results: Over a median (max) treatment period of 3.7 (13.9) years, 420/6155 patients (6.8%) experienced 583 SIs, excluding coronavirus disease 2019. Incidence rates in relapsing multiple sclerosis (RMS; 1.50 per 100 patient years [95% confidence interval (CI): 1.34–1.68]) and progressive multiple sclerosis (PMS; 3.70 [95% CI: 3.27–4.17]) remained stable over this period. Lower respiratory tract, urinary tract, abdominal and gastrointestinal, and skin infections were the most commonly reported SIs. Most SIs (~90%) resolved, and treatment with OCR was continued in >80% of cases. The presence of 1 or ⩾2 comorbidities (rate ratio = 1.66, 2.73, respectively), recent relapse activity (2.06), and Expanded Disability Status Scale (EDSS) score ⩾6.0 (2.02) were significant risk factors for SIs in patients with RMS treated over a median (max) period of 8.3 (11.2) years. In patients with primary PMS treated over a median (max) period of 7.1 (11.8) years, an EDSS score ⩾6.0 was associated with the greatest risk of SIs, a 4-fold increase (rate ratio, 4.31), followed by abnormal immunoglobulin (Ig)M levels (1.89), the presence of ⩾2 comorbidities (1.80), and having overweight/obesity (1.46). Time on OCR and abnormal IgG levels were not significantly associated with an increased SI risk. Conclusion: Continuous long-term treatment with OCR is associated with a manageable infection risk profile. Optimal disease control and addressing modifiable risk factors may reduce the risk of infections.
Thrombectomy for patients with a large infarct core: a study-level meta-analysis with trial sequential analysis
Authors: Jhou Hong-Jie , Yang Li-Yu , Chen Po-Huang , Lee Cho-Hao 
Published: October 2024

Background: The effectiveness and safety of endovascular treatment compared with medical management alone regarding outcomes for patients with a large infarct core remain uncertain. Objectives: To juxtapose the clinical outcomes of thrombectomy versus the best medical care in patients with a large infarct core. Design: Systematic review and meta-analysis. Data sources and methods: We conducted searches in PubMed, Cochrane, and Embase for articles published up until November 8, 2023. Randomized trials were selected for inclusion if they encompassed patients with large vessel occlusion and sizable strokes receiving thrombectomy. The primary outcome was functional outcomes at 3 months after pooling data using random-effects modeling. Safety outcomes included mortality at 3 months, symptomatic intracranial hemorrhage (SICH), and decompressive craniectomy. We performed a trial sequential analysis to balance type I and II errors. Results: From 904 citations, we identified six randomized trials, involving a cohort of 1897 patients with a large ischemic region. Of these, 953 individuals underwent endovascular thrombectomy. At 3 months, thrombectomy was significantly correlated with better neurological prognosis, as evidenced by the increased odds of good functional outcomes (odds ratio (OR), 2.90; 95% confidence interval (CI), 2.08–4.05) and favorable functional outcomes (OR, 2.40; 95% CI, 1.86–3.09). Mortality rates did not demonstrably diminish as a consequence of the endovascular management (OR, 0.78; 95% CI, 0.58–1.06). However, the incidence of SICH was greater in the thrombectomy group compared to those with only medical treatment (5.5% vs 3.2%; OR, 1.77; 95% CI, 1.11–2.83). The application of trial sequential analysis yielded definitive evidence regarding favorable function outcomes and a shift in the distribution of modified Rankin scale scores at 3 months; however, others remained inconclusive. Conclusion: The results from most of the included trials display consistency. Meta-analysis of these six randomized trials offers high-quality evidence that thrombectomy significantly mitigates disability in patients with a large infarction, while also increasing the risk of SICH. Trial registration: PROSPERO, CRD42023480359.
Is the Frequency of a Targeted Neuromuscular Training Program a Factor in Modifying Knee Joint Loading During Typical Netball Landing Tasks?
Authors: Boey Desmond , Joseph Ranald , Lee Marcus 
Published: October 2024

Background:Unplanned sidestep cutting and forward single-leg jump-landing contribute to non-contact anterior cruciate ligament (ACL) injuries in netball. Neuromuscular training programs (NMTPs) have shown promising results in reducing injury risk in certain populations when compliance is high. Compliance is easier to achieve when NMTPs are effective yet require minimal time for completion.Hypothesis:Once- and thrice-weekly intervention groups would be equally effective in reducing knee abduction and internal rotation moments during forward single-leg jump landing and unplanned sidestep cutting.Study Design:Randomized controlled trial.Level of Evidence:Level 3.Methods:External peak knee abduction and peak knee internal rotation moments during unplanned sidestep cutting and forward single-leg jump-landing were assessed pre- and post-intervention for 17 elite-level female netballers assigned randomly to either a once-weekly or thrice-weekly group. Regular netball training continued throughout the intervention, which lasted 6 weeks (30 minutes/session). One-way analysis of covariance (α = 0.05) was utilized to compare post-intervention peak knee abduction and peak knee internal rotation moments between groups, controlling for pre-intervention knee moments during the forward single-leg jump-landing and unplanned sidestep cut. Paired t tests were used to examine within-group changes in knee moments pre- versus post-intervention.Results:For unplanned sidestep cuts on the right leg, both groups differed significantly, with the once-weekly group displaying a decrease in peak knee internal rotation moments [ F(1,14) = 5.23; P = 0.04] whereas the thrice-weekly group did not. No other significant group interactions were found.Conclusion:A condensed NMTP with targeted exercises, performed once-weekly as part of regular training, shows potential to reduce peak knee internal rotation moments that are injurious to the ACL during unplanned sidestep cutting in adult female netballers.Clinical Relevance:A once-weekly targeted NMTP would pose minimal disruption to a high-performing athlete’s training schedule and likely increase compliance to ensure the success of the NMTP.