bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of microvascular angina pectoris by activating blood circulation to remove blood stasis: A systematic review and meta-analysis
Authors: Yang Ruitong , Bai Zelin , Liang Chao , Qi Feng 
Published: October 2024

Background:
To systematically evaluate the clinical efficacy of using the method of activating blood circulation and removing blood stasis in the treatment of microvascular angina (MVA) based on the meta-analysis method.

Methods:
A comprehensive search of randomized controlled trials on the treatment of MVA using the method of activating blood circulation and removing blood stasis in Chinese and English databases such as China National Knowledge Infrastructure Database, Wanfang Data Knowledge Service Platform, Vipshop Journal Resource Integration Service Platform, PubMed, Cochrane Library, Embase, Web of Science, and CBM was conducted, and the search time limit was from the establishment of each database to February 2023. All retrieved literature was screened, and data extracted according to the specified inclusion and exclusion criteria, and data analysis was completed using Revman 5.4 software.

Results:
Fifteen studies with a total of 1031 patients were finally included, and the results of the meta-analysis showed that the treatment with the method of activating blood circulation and removing blood stasis was more advantageous compared with the group of Western medicine alone. Among them, clinical effect of activating blood circulation and removing blood stasis (relative risk = 1.20, 95% confidence intervals [CI] [1.11, 1.31], P < .0001) and electrocardiographic efficacy (relative risk = 1.32, 95% CI [1.15, 1.51], P < .0001) were more effective, concentration levels of endothelin-1 (standardized mean difference = −2.14, 95% CI [−2.97, −1.31], P < .00001) and high sensitivity C-reactive protein (mean difference = −0.84, 95% CI [−0.93, −0.75], P < .00001) were lower, concentration levels of nitric oxide (standardized mean difference = 0.61, 95% CI [0.33, 0.89], P < .0001) was higher, and ST-segment depression range (mean difference = −0.07, 95% CI [−0.09, −0. 04], P < .00001) was smaller.

Conclusion:
Compared with the treatment with Western medicine alone, the treatment of MVA is more effective by choosing the method of activating blood circulation and removing blood stasis.
Concurrent EGFR mutation and SMARCA4 deficiency in non-small cell lung cancer: A case report and literature review
Authors: Dai Weiping , Li Taidong , Li Yujiao , Chen Chaopeng , Zhang Xiang , Zhou Pingan , Qi Bin 
Published: October 2024

Rationale:
SMARCA4-deficient non-small cell lung cancer (NSCLC) represents a highly aggressive subtype with poor prognosis. While clinical studies have identified common co-mutations in TP53, LRP1B, STK11, KEAP1, and KRAS, actionable driver mutations such as EGFR or ALK are rarely reported in conjunction with SMARCA4 deficiency. This case presents a rare instance of NSCLC featuring both an EGFR exon 21 L858R mutation and SMARCA4 deficiency, highlighting the challenges in treatment and the need for novel therapeutic strategies.

Patient concerns:
A 79-year-old female patient presented with concerns of a lung mass, suspected to be peripheral lung cancer based on diagnostic imaging.

Diagnoses:
Histopathological evaluation confirmed SMARCA4-deficient NSCLC. Molecular genetic analysis further revealed an EGFR exon 21 L858R mutation.

Interventions:
The patient was initially treated with osimertinib, an EGFR tyrosine kinase inhibitor. Upon disease progression, treatment was adjusted to include anlotinib in combination with ongoing osimertinib.

Outcomes:
The initial treatment with osimertinib led to partial remission. However, disease progression necessitated a change in therapy. The combination treatment stabilized the disease temporarily, achieving a stable disease status.

Lessons:
This case underscores the transient efficacy of targeted therapy in SMARCA4-deficient NSCLC with concurrent EGFR mutations. It highlights the need for continuous therapeutic adjustments and emphasizes the importance of further research into effective strategies for treating this complex and challenging subset of NSCLC, as current modalities have limitations in sustained efficacy.
Sarcopenia is associated with worse outcomes in patients with inflammatory bowel disease: insights from US national hospitalization data
Authors: Kohli Isha , Thind Nuhar , Bhalla Akshita , Attri Amitpal , Bhupal Sahiljot Singh , Sohal Aalam , Yang Juliana 
Published: October 2024

Background
Inflammatory bowel disease (IBD) is an inflammatory disorder associated with significant morbidity and mortality. Recent studies have reported sarcopenia as a significant factor affecting the quality of life and outcomes of these patients.

Methods
We used the National Inpatient Sample 2016–2020 to identify adult patients with IBD. The patients were stratified into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes studied were in-hospital mortality, sepsis, shock, ICU admission, and need for surgery. Multivariate logistic regression analysis was performed.

Results
A total of 1 524 820 IBD hospitalizations were included. Of these, 209 615 (9%) were noted to have sarcopenia. Patients with sarcopenia had a higher incidence of in-hospital mortality (4.2% vs. 1.2%, P < 0.001), ICU admission (6.5% vs. 2.4%, P < 0.001), and need for abdominal surgery (6.5% vs. 3.5%, P < 0.001). After adjusting for confounders, the presence of sarcopenia was associated with higher odds of in-hospital mortality (adjusted odds ratio: 2.83, 95% confidence interval: 2.66–3.02, P < 0.001) and additional worse outcomes.

Conclusion
Our study reports that the presence of sarcopenia was associated with an increased risk of death and the need for abdominal surgery. Preventative measures aimed at improving sarcopenia should be taken to prevent worse outcomes in this patient population.
Fatty liver index as an independent predictor of all-cause and disease-specific mortality
Authors: Zhang Ruixin , Ren Shuhao , Mi Hongfei , Wang Meixia , He Tingjuan , Zhang Renyan , Jiang Wei , Su Chenghao 
Published: October 2024

Purpose:
This study aims to assess the prognostic value of the fatty liver index (FLI), a noninvasive tool for hepatic steatosis assessment, in predicting all-cause and disease-specific mortality.

Methods:
We linked data from the National Health and Nutrition Examination Survey III (1988–1994) with Public-Use Mortality Files, forming a cohort of 11 297 participants with a median follow-up period of 26.25 years. Cox proportional hazards models were used to evaluate the association between FLI and all-cause mortality, while Fine and Gray’s models assessed the relationship between FLI and disease-specific mortality.

Results:
The FLI ≥ 60 was independently associated with an increased risk of all-cause mortality (hazard ratio = 1.24, P < 0.001), as well as mortality from malignant neoplasms (hazard ratio = 1.18, P = 0.048), diabetes (hazard ratio = 2.62, P = 0.001), and cardiovascular diseases (CVDs) (hazard ratio = 1.18, P = 0.018), compared to FLI < 30. No significant associations were found with Alzheimer’s disease, influenza and pneumonia, chronic lower respiratory diseases, or renal disorders. Subgroup analyses indicated that individuals who were females aged 40–60 (hazard ratio = 1.67, P = 0.003), non-overweight (hazard ratio = 1.75, P = 0.007), or without abdominal obesity (hazard ratio = 1.75, P = 0.007) exhibited a stronger association between FLI ≥ 60 and all-cause mortality.

Conclusion:
These findings support the prognostic value of the FLI for predicting mortality from all causes, malignant neoplasms, diabetes, and CVDs. Targeted attention is needed in postmenopausal women, non-overweight, and non-abdominally obese populations.
Advancements in pediatric headache
Authors: Miller Richard N. , Kim Monica E. , Gunduz Muhammed Talha , Aylward Shawn C. 
Published: October 2024

Purpose of review
To provide an update on advancements in pediatric headache.

Recent findings
The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria. Primary stabbing headache pain lasts longer than 3 seconds in over half of patients. Persistent posttraumatic headache or new daily persistent headache have significant overlap in pain character and nonpain-related symptoms with migraine. In a large cohort with continuous headache at first follow-up, 47% reported resolution of their continuous headache and 19.4% had a 50% or greater reduction in frequency with improvements in fluid intake, sleep, not skipping meals, and exercise. There was no correlation with improved lifestyle habits and clinical outcomes despite the overall improvement. Studies noted significant improvement in headache scores with onabotulinum toxin A and incobotulinum toxin A injections with limited side effects. Intranasal sumatriptan without concurrent intravenous therapies found a clinically meaningful decrease in pain score prior to discharge with shorter lengths of stay and lower emergency department costs compared with the those who received intravenous therapies.

Summary
Newer studies have suggested changes to symptomatology and duration of pediatric headache syndromes. Onabotulinum toxin A and incobotulinum toxin A injections, and emergency department intranasal sumatriptan are well tolerated therapies in pediatric headache.
The Influence of Hospital Physician Integration on Culture of Patient Safety
Authors: Upadhyay Soumya , Chien Lung-Chang 
Published: October 2024

Background
Medical errors are responsible for a large number of deaths every year in the Unites States. Hospitals use various strategies including leadership, staffing, and structural changes to deal with this concerning issue. Hospital physician integration is a structural strategy to possibly improve patient safety. Using the conceptual lens of Donabedian’s Structure Process Outcome model, this study aims to investigate how hospital physician integration affects organizational, management, and communication attributes of patient safety culture.

Methods
A pooled cross sectional study design using the Hospital Survey on Patient Safety Culture, the American Hospital Association data, and Area Health Resource File was used to analyze the relationship between hospital physician integration and organizational and management patient safety culture attributes. The dataset comprised of hospital level data from 2021 and 2022 for patient safety culture and hospital characteristics and contained a final sample of 205 observations. The independent variable was levels of integration across five levels. Three attributes of safety culture were chosen-positive perceptions of communication openness, organizational learning, and hospital management support for patient safety. The control variables were organizational characteristics. Multivariable linear regression was used as the analytic method.

Results
Findings demonstrated a statistically significant correlation between higher level of hospital physician integration and positive perceptions of hospital management support for patient safety. There are 0.063 higher positive perceptions of hospital management support for patient safety for higher levels of integration compared with lower levels of integration (P < 0.05). Perceptions of communication openness and organizational learning did not demonstrate a statistically significant correlation with any level of hospital physician integration.

Conclusions
Hospital physician integration and hospital management support for patient safety were moderately but significantly related. Hospital physician integration allows resources to become available for physician. As physicians take on management roles management of resources and eventually performance can improve, there is a need for future research in this area to examine if integration is a step in the right direction to overcome the challenges of patient safety and if investments in resources and training can be beneficial to safety culture.
Clinical Characteristics and Outcomes of Patients With COVID-19 Treated in Mayo Clinic’s Advanced Care at Home Program
Authors: Gothot Rachel A. , Maniaci Michael J. , Paulson Margaret R. , Dumic Igor , Haney Amy A. , Li Zhuo , Maita Karla C. , Valles Brittane T. , Burger Charles D. 
Published: October 2024

Objectives
Mayo Clinic’s hospital-at-home program, Advanced Care at Home (ACH), launched in 2020. While hospital-at-home literature reported safe and effective care for the general patient population and those with COVID, comparative outcomes between these two groups were unknown. The aim of this retrospective analysis was to compare the outcomes of COVID and non-COVID patients enrolled in ACH and evaluate if COVID patients can be safely treated in this setting.

Methods
Demographics, clinical characteristics, and safety outcomes were retrospectively analyzed to compare COVID and non-COVID patients discharged from ACH between November 2020 and May 2022. Patient characteristics analyzed included severity of illness (SOI) and risk of mortality (ROM), calculated using All Patient Refined Diagnosis Related Groups (APR-DRG). Hospitalization-specific variables included length of stay (LOS), escalation of care, and 30-day readmission rates.

Results
Of 1051 patients, 173 (16%) had COVID, and 878 (84%) were non-COVID patients. The average age in the COVID cohort was 66.6 (15.3) years, compared with 72.2 (14.0) in the non-COVID cohort. Extreme SOI was higher in the COVID group (43.3% versus 17.4%), as was extreme ROM (46.2% versus 16.2%), but LOS was shorter (5.7 versus 7 days). Escalation of care (7.5% in COVID cohort versus 8.4%) and 30-day readmission outcomes (9.2% for COVID patients versus 12.9%) were not statistically different between the groups.

Conclusions
Despite higher SOI and ROM, COVID patients had shorter LOS with outcomes that were not statistically different from non-COVID patients. COVID patients can be safely and efficiently cared for in ACH.
Older Adult Misuse of Over-the-Counter Medications: Effectiveness of a Novel Pharmacy-Based Intervention to Improve Patient Safety
Authors: Gilson Aaron M. , Chladek Jason S. , Stone Jamie A. , Watterson Taylor L. , Lehnbom Elin C. , Hoffins Emily L. , Berbakov Maria E. , Moon Jukrin , Jacobson Nora A. , Holden Richard J. , Gangnon Ronald E. , Walbrandt Pigarelli Denise L. , Welch Lauren L. , Portillo Edward C. , Shiyanbola Olayinka O. , Gollhardt Joel , Walker Kenneth , Chui Michelle A. 
Published: October 2024

Objectives
Older adults’ (ages ≥65) inappropriate over-the-counter medications (OTC) use is prevalent, comprising Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Given that pharmacies sell many OTCs, structurally redesigning pharmacy aisles for improving patient safety (Senior Safe) was conceived to mitigate older adult OTC misuse, using Stop Signs and Behind-the-Counter Signs for high-risk OTCs. This study determined whether Senior Safe reduced high-risk OTCs misuse, while secondarily evaluating misuse changes for all OTCs.

Methods
A randomized controlled trial design matched and randomly allocated 20 health system community pharmacies to control or intervention groups. All 288 study participants completed an OTC choice task in which they chose a hypothetical symptom scenario (pain, sleep, cough/cold/allergy), selected an OTC, and described how they would use it at symptom onset and if symptoms persisted or worsened. Reported OTC use was evaluated for each misuse type. Intervention and control sites were compared for each misuse type using multivariate modeling.

Results
For high-risk OTCs, Drug-Age and Drug-Drug misuse were more likely in control sites (OR = 2.752, P = 0.004; OR = 6.199, P = 0.003, respectively), whereas Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. For all OTCs, only Drug-Age misuse was more likely for control sites (OR = 5.120, P = 0.001). Adults aged 85+ years had the greatest likelihood of all misuse types.

Conclusions
Results demonstrated that older adults frequently reported multiple misuse types, highlighting safety concerns. Senior Safe reduced high-risk OTC misuse, especially for older adults younger than 85 years. Cumulatively, these findings provide insights into practice recommendations supported through regulatory guidance.
Hypoxia-Inducible Factor-1α Potentiates Multiterritory Perforator Flap Survival by Augmenting Vascular Endothelial Growth Factor Expression in the Choke II Zone
Authors: Zeng Xiuan , Xie Yunfei , Guo Tao , Gao Zhenyang , Wang Kejing , Yang Qibing , Li Meng 
Published: October 2024

Background
Hypoxia-inducible factor-1α (HIF-1α), regulated by prolyl hydroxylase, plays a central role in tissue adaptation to ischemia. This study investigates the impact of HIF-1α on angiogenesis in the Choke II zone of multiterritory perforator flaps.

Methods
Ninety male Wistar rats were allocated into 3 groups, with 30 rats in each group: the dimethyloxalylglycine (DMOG) group, the 3-(5-hydroxymethyl-2-furyl)-1-benzylindazole (YC-1) group, and the normal saline (NS) group. All rats underwent multiterritory perforator flap surgeries on their dorsal side. Subsequently, they received intraperitoneal injections of DMOG (40 mg/kg), YC-1 (10 mg/kg), and normal saline on postoperative days 1, 2, and 3, respectively. After treatment, angiogenesis in the Choke II zone of the flap on day 7 was observed through transillumination tests and lead oxide/gelatin x-ray angiography. Histological features were determined using hematoxylin and eosin staining, and the expression of HIF-1α and vascular endothelial growth factor (VEGF) in the Choke II region of the flap was assessed via immunohistochemistry and western blotting.

Results
Compared to the YC-1 and NS groups, the DMOG group exhibited significant angiogenesis, resulting in a denser vascular network in the Choke II zone of the flap. The DMOG group showed significantly higher microvessel density in the Choke II zone than the YC-1 and NS groups (7.10 ± 0.99 vs 24.30 ± 3.65; 14.30 ± 2.40 vs 24.30 ± 3.65, both P<0.05). Additionally, the DMOG group demonstrated higher expression of VEGF and HIF-1α in the flaps than the other groups (P < 0.05).

Conclusions
In summary, HIF-1α enhances the expression of VEGF, promoting angiogenesis in the Choke II zone of the multiterritory perforator flap, thus increasing the survival area.
The Efficacy of Naso-Alveolar Molding on Premaxilla Pushback and Dentoalveolar Changes in Patients With Bilateral Cleft Lip and Palate
Authors: Bangun Kristaninta , Tania Vika , Kreshanti Prasetyanugraheni , Pancawati Julieta , Mihardjanti Marini , Halim Jessica , Cendrick Windy 
Published: October 2024

Objective:
To evaluate the extent of naso-alveolar molding (NAM) in pushing the premaxilla posteriorly in patients with bilateral cleft lip and palate (BCLP).

Background:
Naso-alveolar molding application in cleft lip and palate cases bridges the cleft gap and increases nasal tip projection. In BCLP, NAM potentially mobilizes the premaxilla posteriorly to allow tension-free primary lip closure. However, some patients with BCLP with NAM history still necessitate osteotomy during labioplasty, questioning the efficacy of NAM for BCLP management.

Methods:
This single-center retrospective study was conducted using medical records of nonsyndromic patients with BCLP. Twenty-six patients with BCLP were enrolled over a 5-year period with a history of NAM application before primary labioplasty. The changes in premaxilla width (P), anterior arch width (A), posterior arch width (R), and anteroposterior projection of the premaxilla (P’-A’) were statistically analyzed at 2 time points: (1) at the start of NAM application (T1) and (2) after completion of NAM before surgery (T2).

Results:
The average age at NAM initiation was 46.2 ± 40.4 days, and the average duration of NAM usage was 125.14 ± 62.94 days. A and P-A showed significant differences between T1 and T2 (P < 0.0001), whereas the rest did not show significant differences in value following NAM application (P > 0.05). Naso-alveolar molding successfully pushed back the premaxilla portion about 4.68 ± 2.83 mm on average.

Conclusion:
Naso-alveolar molding can push back the premaxillary protrusion up to 5 mm, which can serve as a cutoff point for the consideration of combined modalities. Prenatal diagnosis, counseling, and cleft education should be the benchmark in cleft centers to improve overall patient outcomes.
Does PERM1 Regulate Systolic Cardiac Function? A Game of Numbers
Authors: Zaitsev Alexey V. , Sreedevi Karthi , Goode Brianna , Warren Junco S. 
Published: October 2024

AbstractWe and others demonstrated that PERM1 is a positive regulator of mitochondrial bioenergetics in the heart. However, discrepant results have emerged with regard to whether PERM1 loss-of-function affect cardiac contractility. In order to exclude the possibility that the reported negative results can be due to insufficient power of statistical test, we conducted a more robust echocardiography (Echo) analysis by increasing the sample size. We usedPerm1-KO and their respective wildtype (WT) littermates, which were destined to tissue harvest. This yielded 84 WT mice and 88Perm1-KO mice. We analyzed Echo-derived parameters of left ventricular (LV) systolic function. At the end of the study, ejection fraction (EF) was 65.43 ± 7.13 in WT vs. 53.98 ± 8.80 in Perm1-KO yielding p < 0.00000000000000004. Other parameters which reached statistically significant difference between WT andPerm1-KO (at p < 0.05) included LV fractional shortening (FS), LV diastolic and systolic diameters, LV anterior and posterior systolic wall thickness, LV posterior wall systolic thickening, stroke volume, and cardiac output (CO). Retrospectively, a p value < 0.05 was consistently achieved in assessment of EF only after average N per group reached 13. Larger minimal N per group were required for other parameters. Of interest, in both groups there were no correlation between EF% and CO. At the same time, in both groups EF strongly inversely correlated with LV diastolic diameter. This led us to a speculation that low EF may be in part compensated by an increased LV circumference, for the purpose of maintaining invariant CO. Indeed, the intergroup difference in CO (6%) was much smaller than the intergroup difference in EF (18%). We conclude that PERM1 does regulate cardiac mechanics. Changes caused by constitutivePerm1-KO can be conceptualized as reduced contractility partially compensated by increased LV circumference. This study underscores the importance of sufficiently large sample size for detecting significant differences in Echo data.