bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individualised cumulative cisplatin dose for locoregionally advanced nasopharyngeal carcinoma patients based on induction chemotherapy response and tumour volume
Authors: Lin Jie-Yi , Lu Zi-Jian , Li Su-Chen , Luo Dong-Hua , Liu Ting , Zhang Wan-Ru , Yang Zhen-Chong , Mo Hao-Yuan , Mai Hai-Qiang , Liu Sai-Lan 
Published: October 2024

Background and objectives: To evaluate the prognostic value of an integrated model consisting of tumour response to induction chemotherapy (IC) and gross tumour volume (GTV) after IC in nasopharyngeal carcinoma (NPC) and elucidate optimal cumulative cisplatin dose (CCD) in concurrent chemoradiotherapy (CCRT) for different subgroups. Design and methods: This retrospective study enrolled 896 patients with NPC diagnosed from 2010 to 2017 receiving IC plus radiotherapy. The primary endpoint was disease-free survival (DFS). Cut-off points for GTV were combined with IC response to develop an integrated model. Propensity score matching (PSM) was used to adjust for potential confounders. Survival outcomes and acute toxicity were compared between the different CCD groups. Results: Unsatisfactory IC response and large GTV after IC were correlated with poor survival outcomes; the AUC increased to 0.668 when these factors were incorporated. The integrated model classified patients into three groups. After PSM, radiotherapy alone and CCRT demonstrated similar efficacy in the low-risk group (complete response (CR)/partial response (PR) and GTV <68 cm3 after IC). In the intermediate-risk group (CR/PR but GTV ⩾68 cm3), CCD of >200 mg/m2 and 101–200 mg/m2 increased the 5-year DFS rates (83.7% vs 81.1% vs 65.3%, p = 0.042). In the high-risk group (stable disease/progressive disease and any GTV), the use of different CCDs did not result in significantly different survival outcomes ( p = 0.793). Additionally, high CCD was significantly associated with increased incidence of grade 1–4 acute toxicity. Conclusion: The integrated model incorporating IC response and GTV after IC demonstrates satisfactory value in risk stratification and the potential to guide individualised decision-making in CCD selection. Balancing toxicity and efficacy, RT alone seems to be the optimal treatment for patients in low-risk groups and 200 mg/m2 might be the optimal dose for intermediate-risk groups. Moreover, increasing CCD does not benefit patients in high-risk groups, and treatment options for these patients require further consideration.
Acute Ischemic Stroke Presenting as Hemiparkinsonism: A Case Report
Authors: Al-Sibahee Essam , Al-Obaidi Mustafa Najah , Al-Sharee Asmaa 
Published: October 2024

Parkinsonism, commonly associated with Parkinson disease (PD), can also arise from other neurodegenerative disorders or non-neurodegenerative causes such as vascular parkinsonism (VP). This case highlights the acute onset of VP following a stroke, contributing to the understanding of VP’s varied presentations and the challenges in its diagnosis. A 54-year-old male with a history of cerebrovascular disease presented with behavioral changes and reduced activity, initially raising the suspicion of a central nervous system infection. Clinical findings included agitation, decreased social interaction, mutism, drooling, immobility, and rigidity. Imaging revealed acute infarction in the left cortical parieto-occipital region, caudate nucleus, and putamen, along with old infarcts, confirming VP. The primary diagnosis was vascular parkinsonism and he was started on anticoagulation therapy and levodopa/carbidopa, which showed minimal improvement over 6 months. This case underscores the importance of considering VP in patients with acute parkinsonian symptoms and a history of cerebrovascular disease. It highlights the necessity for prompt evaluation and management of vascular risk factors to optimize patient outcomes. Additionally, it emphasizes the need for a multidisciplinary approach in treating VP, given the limited efficacy of traditional Parkinson disease medications.
Assessing contrast-induced nephropathy risk in older adults undergoing coronary angiography and intervention: The CV/GFR ratio versus Mehran score
Authors: Nguyen Tan Van , Quang Nhi Tuyet , Liu Weber , Kim Trinh Ngo Thi , Nguyen Tu Ngoc 
Published: October 2024

Background: Contrast-induced nephropathy is a prevalent cause of hospital-acquired renal insufficiency and increases adverse events in older patients undergoing angiography and percutaneous coronary intervention. The Mehran risk score has been widely used in Vietnam to assess contrast-induced nephropathy risk in patients before coronary angiography and percutaneous coronary intervention. Recently, there has been a shift toward the adoption of simpler risk prediction models, such as the contrast volume-to-glomerular ﬁltration rate ratio. This study aimed to (1) determine the incidence of contrast-induced nephropathy in older patients undergoing coronary angiography and/or percutaneous coronary intervention, and (2) compare the validity of the contrast volume-to-glomerular ﬁltration rate ratio and the Mehran score in predicting contrast-induced nephropathy. Method: This is a prospective cohort study conducted at a hospital in Vietnam from September 2019 to May 2020. Consecutive patients aged ⩾60 years who underwent coronary angiography and/or percutaneous coronary intervention were recruited. The contrast volume-to-glomerular ﬁltration rate ratio and the Mehran score were evaluated for their predictive utility regarding contrast-induced nephropathy risk. The receiver operator characteristic was employed to calculate the area under the curve for both the contrast volume-to-glomerular ﬁltration rate ratio and the Mehran score in predicting contrast-induced nephropathy. Results: The study included 170 participants with a mean age of 70 years and 33.1% were female. Contrast-induced nephropathy was diagnosed in 9.4% of the participants. Participants with contrast-induced nephropathy exhibited a higher prevalence of chronic kidney disease, anemia, and heart failure. There was no significant difference between the area under the curves of the contrast volume-to-glomerular ﬁltration rate ratio (0.79, 95% CI: 0.65–0.92), and the Mehran score (0.65, 95% CI: 0.51–0.82) in predicting contrast-induced nephropathy. Conclusion: Our findings indicate that contrast-induced nephropathy was prevalent among older patients following percutaneous coronary intervention. The contrast volume-to-glomerular ﬁltration rate ratio demonstrated a good prognostic value for predicting contrast-induced nephropathy comparable to that of the Mehran score. Further research is needed to identify optimal cutoff values for the contrast volume-to-glomerular ﬁltration rate ratio in older patients.
Association between lower extremity physical function and physical activity after ischemic stroke: Longitudinal findings from the MOBITEC-Stroke project
Authors: Jäger Christoph , Ryan Michelle , Rommers Nikki , Schär Janine , Weibel Robert , Kressig Reto W , Schmidt-Trucksäss Arno , Engelter Stefan , Peters Nils , Hinrichs Timo , Rössler Roland 
Published: October 2024

Background: Stroke often results in physical impairments. Physical activity is crucial for rehabilitation, enhancing mobility, strength, and overall health. This study examines the association between Timed Up-and-Go (TUG) test performance and changes in physical activity to improve lower extremity physical function. Methods: The MOBITEC-Stroke Cohort Study (“Recovery of mobility function and life-space mobility after ischemic stroke”) included patients with a first incidence of stroke. Data assessed 3 and 12 months after stroke were used for analysis. Linear regression model adjusted for age, sex, instrumental activities of daily living, Falls Efficacy Scale-International, modified Ranking Scale, and National Institutes of Health Stroke Scale-score was used to examine the relationship between lower extremity physical function (i.e., TUG) and change in physical activity (i.e., minutes of physical activity measured with a wrist-worn accelerometer over 1 week). Results: Longitudinal data of 49 patients (65% male, mean age 71.2 (SD: 10.4) years) were analyzed. Mean daily physical activity was 291.6 (SD: 96.2) min at 3 months and 298.9 (SD: 94.4) min at 12 months, with a change from 3 to 12 months of 7.3 min (95% CI: −9.4 to 24.0; p = 0.394) post-stroke. We observed significant relationships between the baseline TUG performance and the change in total physical activity over 9 months ( p = 0.011) and between the change of TUG performance over time and the change in total physical activity ( p = 0.022). Conclusion: Our findings indicate that better initial lower extremity physical function and higher improvements in function over time are associated with a greater increase in physical activity levels after stroke. This suggests that interventions aimed at maintaining and improving lower extremity physical function may positively affect physical activity levels.
Bridging the gap: Leveraging telemedicine and IT infrastructure to connect outpatient oncology practices with specialized expert teams in the management of rare tumors
Authors: Kasprzak Julia , Goering Timothy , Berger-Thürmel Karin , Kratzer Vanessa , Prompinit Wuthichai , Wichert Sven P. , Leutner Simon , Langermann Norbert , von Bergwelt-Baildon Michael , Heinemann Volker , Algül Hana , Zünkeler Martin , Nasseh Daniel ,   on behalf of the TARGET Group *
Published: October 2024

Objectives The treatment of rare tumors often necessitates the involvement of highly specialized teams, typically based in larger medical centers or university hospitals, which are often lacking in rural areas. The German TARGET (the Trans-sectoral Personalized Care Concept for Patients with Rare Cancers) project aims to improve the network between outpatient oncology practices and more centralized expert teams via telemedicine. Methods The primary work involved conceptualizing the implementation of project requirements based on feedback from various TARGET project teams, and ultimately, the method of implementation using the software CentraXX. Key requirements included the utilization of an electronic health record (EHR), incorporating appropriate access mediums such as smartphones, and utilizing user-specific certificates to ensure secure and tailored access. The implementation considered technical aspects, data protection regulations, and the need for user-friendly interfaces, particularly for older patients with cancer with limited technological proficiency. Results The results detail the successful implementation of the project requirements using CentraXX, which facilitated the implementation of an EHR, access mediums (patient app), and browser access for outpatient doctors, addressing the project's technical, security, and usability needs. Conclusion This article presents an overview of the requirements associated with the TARGET project and outlines how they were met in terms of the IT infrastructure. By focusing on the IT implementation rather than the medical trial results, this work aims to provide valuable insights and guidance for similar projects seeking to improve telemedicine networks and digital information exchange in the context of rare cancer treatment.
A step-by-step roadmap for the development and deployment of an electronic health record sidecar application that tracks patient outcomes: The RA PRO dashboard
Authors: Schmajuk Gabriela , Nasrallah Catherine , Berrean Beth , Prugh Jonathan , Wilson Cherish , Hamblin Alicia , Young Cammie , Jacobsohn Lindsay , Kay Julia , Li Jing , Kersey Emma , Subash Meera , Murray Sara , Yazdany Jinoos 
Published: October 2024

Objective Despite interest in optimizing the electronic health record (EHR) to facilitate chronic disease care for conditions like rheumatoid arthritis (RA), progress in this area has been slow. EHR sidecar applications offer one solution, but little guidance exists to facilitate their successful development, deployment, and maintenance in the healthcare setting. We aimed to provide a roadmap for how to develop and deploy an EHR sidecar application based on our experience building a new EHR-integrated, patient-facing visualization tool that displayed disease outcomes to RA patients during a clinical visit (the “RA PRO dashboard”) in a large academic health center. Methods We describe the technical design and implementation of the RA PRO dashboard; report clinic workflow adaptations to incorporate this new technology; and discuss the resources required and challenges encountered in maintaining this application. Results The RA PRO dashboard required extensive human-centered design work, regulatory approvals, software development, user testing, integration with Epic-based workflows, and maintenance. Key requirements were prioritized based on the anticipated effects on usefulness and ease of use. Implementation science strategies were used to improve use of the dashboard in clinic and included education for patients, staff, and clinicians; reports of actual use of the dashboard and data quality; and regular meetings between the research team and clinicians to discuss and address barriers to use. Conclusion Successful development and deployment of an EHR-integrated application are resource-intensive and require technical, operational, and educational innovations. The roadmap presented in this study can serve as a resource for future developers.
A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022
Authors: Conyer Ryan T. , Cleary Emmett J. , Wang Allen S. , Boos Alex M. , Crowe Matthew M. , Economopoulos Kostas J. , Krych Aaron J. , Levy Bruce A. , Hevesi Mario 
Published: October 2024

Background: The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. Purposes: To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. Results: A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 ( P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 ( P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 ( P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. Conclusion: There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.
Effect of a Preoperative Subacromial Epinephrine Injection on Visualization During Shoulder Arthroscopic Surgery: A Randomized Controlled Trial
Authors: Feinstein Shawn , Svetgoff Reese A. , Harmon Jordan , Siahaan Jacob , Ngo Daniel H. , Fullick Robert K. , Flores Steven E. , Shupe Paul G. , Gregory Bonnie P. , Gregory James M. 
Published: October 2024

Background: The addition of epinephrine to arthroscopic irrigation fluid has been shown to improve surgeon-rated visual clarity during shoulder arthroscopic surgery. Subacromial injections of epinephrine are also used for this purpose. Purpose/Hypothesis: To assess the influence of a preoperative subacromial epinephrine injection on surgeon visualization during subacromial shoulder arthroscopic surgery. It was hypothesized that the epinephrine injection would improve surgeon-rated visual clarity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A double-blind randomized controlled trial including adult patients undergoing shoulder arthroscopic surgery in the beach-chair position requiring visualization of the subacromial space was performed. Patients in the epinephrine group (n = 30) received a preoperative subacromial injection of bupivacaine and epinephrine, and those in the control group (n = 30) received a preoperative subacromial injection of bupivacaine. Epinephrine was added to the first 10 L of arthroscopic irrigation fluid in all patients. The primary outcome was surgeon-rated visual clarity throughout the procedure that was recorded at the end of the procedure using a visual analog scale (VAS) scored from 0 (worst) to 10 (best). Secondary outcomes included an increase in pump pressure during the procedure, total operative time, and the intraoperative use of blood pressure–modulating medications. Results: Rotator cuff repair was performed in 88.3% of patients (25/30 epinephrine; 28/30 control), with multiple procedures performed in 85.0% of patients (23/30 epinephrine; 27/30 control). The VAS score for visual clarity was slightly better in the epinephrine group compared with the control group, although the difference was neither statistically nor clinically significant (8.3 ± 1.4 vs 7.5 ± 1.8, respectively; P = .09). There was no difference between the epinephrine and control groups in the need for an increase in pump pressure to improve visualization (8/30 [26.7%] vs 7/30 [23.3%], respectively; P > .99), total operative time (62.0 ± 19.4 vs 64.0 ± 30.1 minutes, respectively; P = .90), or the intraoperative use of blood pressure–modulating medications (20/30 [66.7%] vs 17/30 [56.7%], respectively; P = .60). There were no perioperative adverse events in either group. Conclusion: The addition of a subacromial epinephrine injection before shoulder arthroscopic surgery resulted in a small improvement in visual clarity that was neither statistically nor clinically significant, with no adverse effects reported in this study. Registration: NCT05244525 (ClinicalTrials.gov)
Complications and Radiographic Outcomes of Tibial Tubercle Osteotomy at Minimum 5-Year Follow-up
Authors: Yalcin Sercan , Seals Karrington , Joo Peter , Fulkerson John P. , Farrow Lutul D. 
Published: October 2024

Background: Tibial tubercle osteotomy (TTO) is a commonly utilized surgery in the treatment of patellofemoral instability and chondrosis. A number of case series studies have reported on the mid- and long-term outcomes with varying complication rates. Purpose: To report the incidence of major complications after TTO and the rate of progression of knee osteoarthritis at midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent primary TTO between January 1, 2010 and December 31, 2015, and who had ≥5 years of clinical follow-up data were included. Patient demographics and clinical and radiographic outcomes were recorded. Risk factors for complications were identified using multivariate logistic regression analysis. Results: A total of 72 patients were included. The mean follow-up period was 104.8 months (range, 67-138 months). The overall complication rate was 38.9% (28/72 patients), and the incidence of major complications was 6.9%. Univariate logistic regression analysis revealed that patients with a history of smoking were more likely to experience a complication (odds ratio = 4.33 [95% CI, 1.29-14.53]; P = .02). Multivariate analysis with TTO as the main predictor indicated that complication rates were not affected by TTO procedure (TTO vs TTO+other), number of screws, or distalization. There was also no difference between anteromedialization and medialization TTO techniques. The rate of patients with Kellgren-Lawrence grade 3 to 4 increased from 12.0% preoperatively to 23.9% at the final follow-up. New osteophyte formation was detected in 5.8% of patients on anteroposterior radiographs and in 9.1% of patients on lateral radiographs. Conclusion: In the current study, TTO was found to have a major complication rate of 6.9% at midterm follow-up. Smoking was a risk factor for major complications. Only 11.9% of patients had progression in tibiofemoral osteoarthritis at midterm follow-up.
Effect of Electrical Stimulation of Lingual Nerve on Xerostomia: A Randomized Controlled Trial
Authors: Xu K. , Ma S. , Jia S. , Chen L. , Wei J. , Liu Q. , Tian M. , Ji Z. , Dong Y. , Wang X. , Tay F.R , Zhang T. , Jiao K. , Niu L. 
Published: October 2024

Introduction: Xerostomia is a subjective sensation of dry mouth affecting millions of people worldwide. Current management has limitations, often causing side effects. This study aims to investigate whether electrical stimulation of the lingual nerve could offer effective relief for xerostomia sufferers. Methods: Eligible participants were randomly assigned (1:1) to either the experimental or sham group, receiving electrical stimulation of the lingual nerve (n = 24) or sham stimulation (n = 23) for 12 wk. The primary outcome is the changes in xerostomia score using a 100-mm visual analog scale throughout the therapy. Participants assessed their dryness and assigned corresponding scores, with lower scores indicating more severe dry mouth. Secondary outcomes included remission rate in dry mouth frequency, changes in stimulated/unstimulated salivary flow rate (SSFR/USFR), and changes in Oral Health Impact Profile–14 (OHIP-14) questionnaire scores, where higher scores indicate greater impact on oral quality of life. Results: At week 12, the electrical stimulation group showed greater improvement in xerostomia score compared to the sham group, with a mean between-group difference of 13.8 (95% confidence interval [CI], 10.0–17.6). The therapeutic effect of electrical stimulation was also confirmed by secondary outcomes. The remission rate of dry mouth was higher at 12 wk in the electrical stimulation group (61.9% [95% CI, 40.9%–79.3%] vs. 28.6% [95% CI, 13.8%–50.0%]). Participants in the electrical stimulation group also experienced a greater increase in USFR, with a mean difference of 14.5 (6.1–23.0) μL/min. Moreover, they exhibited significant improvement in OHIP-14 score after 12 wk of therapy, with a mean between-group difference of −10.0 (–13.9 to −6.2). No significant difference was observed between the 2 groups for SSFR (P = 0.702). Conclusions: Electric stimulation offers promise as a noninvasive, nonpharmacological strategy for the management of xerostomia. Further research is needed to understand its long-term effectiveness, optimal parameters, and underlying mechanisms. Knowledge Transfer Statement: The study confirmed that electrical stimulation of the lingual nerve is a promising noninvasive and nonpharmacological modality for relief of xerostomia.