bluuebunny/crossref_metadata_2025_split huggingface dataset:
Causality between Telomere Length and the Risk of Hematologic Malignancies: A Bidirectional Mendelian Randomization Study
Authors: Jiang Guoyun , Cao LingXiao , Wang Yunshan , Li Li , Wang Zie , Zhao Hui , Qiu Yang , Feng Bin 
Published: October 2024

Abstract

Growing evidence indicates a relationship between telomere length (TL) and the stage, prognosis, and treatment responsiveness of hematopoietic malignancies. However, the relationship between TL and the risk of hematologic malignancies remains unclear, considering the vulnerability of observational studies to potential confounding and reverse causation. A two-sample bidirectional Mendelian randomization (MR) analysis was conducted utilizing publicly available genome-wide association study data to assess whether TL was causally associated with the risk of hematologic malignancies. The inverse variance weighted approach was used as the primary assessment approach to evaluate the effects of the causes, augmented by the weighted median and MR-Egger methods. Cochran’s Q test, MR-Egger intercept test, MR-Pleiotropy Residual Sum and Outlier test, and leave-one-out analysis were performed to evaluate sensitivity, heterogeneity, and pleiotropy. According to forward MR estimations, longer TL was related to an increased risk of acute lymphocytic leukemia (OR = 2.690; P = 0.041), chronic lymphocytic leukemia (OR = 2.155; P = 0.005), multiple myeloma (OR = 1.845; P = 0.024), Hodgkin lymphoma (OR = 1.697; P = 0.014), and non–Hodgkin lymphoma (OR = 1.737; P = 0.009). Specific types of non–Hodgkin lymphoma were also associated with TL. The reverse MR results revealed that hematologic malignancies had no effect on TL. This MR analysis revealed an association between longer TL and an increased risk of specific hematologic malignancies, indicating a potential role of TL in risk evaluation and management in hematologic malignancies.

Significance:
In contrast to observational studies, this study uncovered the reliable causal relationships between TL and hematologic malignancies, emphasizing the potential role of telomeres in tumor development. TL maintenance may offer a promising strategy to reduce the risk of hematologic malignancies.
Ablation Strategies for Repeat Procedures in Atrial Fibrillation Recurrences Despite Durable Pulmonary Vein Isolation: The Prospective Randomized ASTRO AF Multicenter Trial
Authors: Schmidt Boris , Bordignon Stefano , Metzner Andreas , Sommer Philipp , Steven Daniel , Dahme Tilmann , Busch Matthias , Tilz Roland Richard , Schaack David , Rillig Andreas , Sohns Christian , Sultan Arian , Weinmann-Emhardt Karolina , Hummel Astrid , Vogler Julia , Fink Thomas , Lueker Jakob , Pott Alexander , Heeger Christian , Chun K.R. Julian 
Published: October 2024

BACKGROUND:
Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.

METHODS:
Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B). The primary end point was freedom from atrial tachyarrhythmias between 91 and 365 days after index ablation. The study was powered for superiority of LAAI compared with low-voltage area.

RESULTS:

Patients (40% women; mean age, 68.8±8 years) with paroxysmal (32%) or persistent atrial fibrillation (68%) were randomized to undergo low-voltage area ablation (n=79) or cryoballoon-guided LAAI (n=82). After a planned interim analysis, enrollment was halted for futility on January 10, 2023. In the LAAI group, 77 of 82 left atrial appendages were successfully isolated with subsequent left atrial appendage closure in 57 patients. Procedure-related complications occurred in 4 (5%) and 11 (13.5%) patients in group A and B, respectively (
P
=0.10). The median follow-up was 367 days (interquartile range, 359–378). The Kaplan-Meier point estimate for freedom from atrial tachyarrhythmias was 51.7% (CI, 40.9%–65.4%) for group A and 55.5% (CI, 44.4%–69.2%;
P
=0.8069) for group B.

CONCLUSIONS:
The current study did not detect superiority of cryoballoon-guided LAAI over low-voltage area ablation in patients with atrial fibrillation despite durable PVI.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04056390.
Modeling the Dynamics of Social Preparedness with Regional Interactions to Explore Efficient Flood Early Warning Systems
Authors: Kotani Hitomu , Ogawa Wataru , Matsushima Kakuya , Susaki Junichi , Sawada Yohei 
Published: October 2024

Abstract
Flood early warning systems (FEWS) are essential in mitigating flood damage. To optimize their effectiveness, it is important to understand how people respond to warnings and prepare for flooding events. The key factors influencing social preparedness include 1) direct and 2) indirect experiences of floods and 3) trust in warnings. However, existing sociohydrological models do not incorporate all these elements. To include these elements for social preparedness, we propose an idealized model that allows multiple regions to influence one another (i.e., regional interactions). We investigate the dynamics of social preparedness in a society composed of regions with varying infrastructure levels (e.g., levee heights) and explore strategies for developing a socially efficient FEWS. Numerical analyses reveal that in a society that has a region characterized by a low infrastructure level (i.e., a region with frequent floods), regional interactions lead to a pronounced cry wolf effect due to false alarms from other regions, diminishing social preparedness in the low-infrastructure region. These interactions also prevent a warning strategy that optimizes the natural-science-based index (i.e., threat score) from maximizing social efficiency. Conversely, in a society that has a region characterized by a high infrastructure level (i.e., a region with infrequent floods), regional interactions enhance the efficiency of FEWS by improving social preparedness through indirect experiences with floods. These findings suggest that as regional heterogeneity increases, it becomes increasingly vital for forecasters to consider social aspects (e.g., people’s experiences, trust, and interactions) when establishing a socially efficient FEWS. The refined model will be valuable to forecasters in designing effective FEWS in real-world situations.
Social determinants for understanding Muslims’ intentions toward seeking mental health help based on the Theory of Planned Behavior
Authors: Badran Leena , Rizkalla Niveen , Segal Steven P 
Published: October 2024

Background: Many have found that minorities seek help for mental health problems less than the general population. Such findings are surprising considering that minorities experience higher rates of mental health issues compared to the general population. Objectives: Employing the Theory of Planned Behavior (TPB), this study aimed to explore the intentions of Muslims living in California and Israel pertaining seeking mental health help (SMHH). Method and design: A qualitative approach involving semi-structured interviews guided by TPB principles was conducted with 78 participants. Thematic analysis was implemented to identify key themes. Results: Five major themes were identified: 1 – Attitudes: Normalization of SMHH entangled with fear; causes and attributions of mental health disorders; perspectives on treatment. 2 – Subjective norms: Support groups; stigma and social norms. 3 – Perceived behavioral control: Personal and environmental facilitators and barriers. 4 – Intentions: High; conditioned preapproval; and low. 5 – Actual help seeking behavior: Religious figures as first resort; incorporating religious practices, and preference of Muslim therapist. Cultural beliefs, stigma, social support, and religion elements were dominant in the TPB model. Conclusions: The findings underscored the holistic approach among Muslims toward seeking mental help incorporating medical, psychological, social, and spiritual understanding of the mental health condition. This suggests considering social and communal elements in developing interventions, education, and policy for SMHH among Muslims.
Comparable bleeding and inflammation outcomes between heparin-coated and uncoated minimal invasive extracorporeal circuits in isolated coronary artery bypass surgery – A double-blinded randomized control trial
Authors: Jenni Hansjoerg , Kovacic Benjamin , Mihalj Maks , Huber Markus , Rieben Robert , Carrel Thierry , Siepe Matthias , Kadner Alexander , Erdoes Gabor 
Published: October 2024

Objective Minimally invasive extracorporeal circulation has been shown to be non-inferior or even superior to conventional cardiopulmonary bypass circuits in isolated coronary artery bypass grafting, but there is little evidence whether the addition of a heparin-coated circuit can further reduce the inflammatory response and amount of bleeding in these patients. Methods A single-center randomized control trial enrolled 49 adult patients scheduled to undergo isolated coronary artery bypass grafting with minimally invasive extracorporeal circulation (MiECC) between January 2015 and December 2018. Patients were randomized 1:1 to either the heparin-coated circuit group, or the uncoated (control) circuit group. The primary outcome was chest tube output 18 h after weaning from MiECC, and secondary outcomes included inflammatory (TNF-α, IL-6, IL-8, IL-10) and complement (C3a, C4d, C5a, sC5b-9) biomarkers, platelet count and function (D2D, TAT, SDC1, PF4), number of transfused blood products, and 30-day survival. Results Patients were randomized to undergo myocardial revascularization using heparin-coated circuits ( n = 25), and to the uncoated MiECC circuit ( n = 24), with comparable baseline demographics. No significant difference was observed in chest tube output and for all secondary outcomes. IL-6 and IL-8 were increased from baseline at 18 h after weaning (effect size 0.29 and 0.05, respectively) and sC5b-9 was lower (effect size 0.11) in the heparin-coated than in the uncoated MiECC, although not significantly different. Conclusions Compared with an uncoated MiECC circuit, heparin-coated MiECC circuit was not associated with a reduction in postoperative bleeding, transfusion, inflammation, complement activation, and platelet biomarkers, following isolated coronary artery bypass grafting.
A pragmatic approach to selecting a grading system for clinical practice recommendations in palliative care
Authors: Voznyuk Sasha , Carter Rachel Z , Ridley Julia 
Published: October 2024

Background: The limited palliative care evidence base is poorly amenable to existing grading schemes utilized in guidelines. Many recommendations are based on expert consensus or clinical practice standards, which are often considered ‘low-quality’ evidence. Reinforcing provider hesitancy in translating recommendations to practice has implications for patient care. Aim: To rationalize the selection of an appropriate grading system for rating evidence to support recommendations made in palliative care clinical practice guidelines. Design: Review of the methodology sections of international palliative care guidelines published in English identified five grading systems comparison: Grading of Recommendations, Assessment, Development and Evaluations (GRADE); the Scottish Intercollegiate Guidelines Network (SIGN); Infectious Diseases Society of America-European Society for Medical Oncology (IDSA-ESMO); Confidence in the Evidence from Reviews of Qualitative research (CERQual) and the National Service Framework for Long Term Conditions (NSF-LTC). Results: There is heterogeneity among grading systems used in published palliative care or terminal symptom management guidelines. GRADE has been increasingly adopted for its methodological rigour and inter-guideline consistency with other medical associations. CERQual has the potential to support recommendations informed by qualitative evidence, but its role in clinical guidelines is less defined. The IDSA-ESMO system has an intuitive typology with the ability to categorize tiers of lower-quality evidence. Conclusions: It is challenging to apply commonly used grading systems to the palliative care evidence base, which often lacks robust randomized controlled trials (RCTs). Adoption of IDSA-ESMO offers a feasible and practical alternative for lower-resourced guideline developers and palliative clinicians without a prerequisite for methodological expertise.
The beneficial effect of probiotics as an adjuvant treatment in childhood drug resistant epilepsy: A prospective pilot study
Authors: El-Sharkawy Ossama Salah , El-Rashidy Omnia Fathy , Elagouza Iman Ali Abdelhamid , Nassar Bassant A , Taha Sara I 
Published: October 2024

Background: One of the most common long-term neurological disorders affecting children is epilepsy. Even with effective antiseizure medications, one-third of epileptic patients develop drug-resistant epilepsy (DRE). Numerous treatments have been offered to these DRE patients, though with varying degrees of effectiveness. Objectives: This study aimed to evaluate the effectiveness of probiotics in improving the quality of life (QoL) and lowering the severity and frequency of epileptic episodes in DRE patients. As well as to assess the anti-inflammatory effects of probiotics. Methods: DRE patients were daily supplemented with one probiotic for 4 months. During these 4 months, patients continued their routine anti-epileptics with no change in the doses. Before and following the 4-month trial, patients had their QoL evaluated using the validated Arabic version of QoL in epilepsy-31 inventory (QoLIE-31) questionnaire, an electroencephalogram (EEG) examination, and serum soluble CD14 (sCD14) evaluation by ELISA. Results: Of the 21 DRE patients who completed the study, 42.9% achieved the therapeutic goal, which was a ≥50% reduction in seizures. After probiotic, there was a significant increase in time elapsed since the last seizure ( p = 0.001) and a decrease in seizure duration ( p = 0.038), frequency ( p = 0.002), and severity by Chalfont Seizure Severity Score ( p < 0.001), as compared to pre-probiotic data. Moreover, there was a significant decrease in serum levels of sCD14 ( p < 0.001) and a significant improvement in QoL ( p < 0.05). Conclusion: Probiotics may be used as a DRE adjuvant treatment. They can lessen the number and severity of seizures, alleviate the associated inflammation, and enhance the QoL for DRE patients.
Fitness to stand trial: 415 consecutive defendants assessed by a New Zealand forensic psychiatry service
Authors: Wakefield Amber , Every-Palmer Susanna , Foulds James A 
Published: October 2024

Background New Zealand defendants found unfit to stand trial following a Court-ordered forensic mental health assessment cannot be detained in prison and must either be released, or made subject to a mental health or intellectual disability order. There is increasing awareness of the need to identify these people and protect their rights. Methods Retrospective audit of 8 years of Court-ordered health assessor reports addressing fitness to stand trial prepared by a New Zealand regional forensic mental health service with a catchment area of around 850,000. Results Between 2014 and 2022, Courts referred 415 defendants for assessment of fitness to stand trial. The number of reports requested increased by 20% between 2014 and 2022. Report subjects were 81% male and had a median age of 31. Commonest primary diagnoses were psychotic disorders (37%), intellectual disability (13%) and acquired neurocognitive disorders (15%). Few people with foetal alcohol spectrum disorder were identified. Despite the increase in assessments, the number of defendants considered unfit by report writers remained stable over time. Conclusion The increasing number of referrals for assessment of fitness to stand trial has resourcing implications for forensic mental health services.
The inferior sacral iliac line as a horizontal reference plane in paediatric pelvic radiographs
Authors: Berault Thomas J , Wyatt John M , Olsen Aaron A , Mantooth Clark , Balazs George C , Goldman Ashton H , Rocchi Vanna J 
Published: October 2024

Background: While often used, Hilgenreiner’s line may not always be a reliable reference plane following triple innominate pelvic osteotomy or trauma to the triradiate cartilage. The inferior sacral-iliac line is a horizontal line connecting the sclerotic corners of the inferior sacral-iliac joints. This is a consistent landmark in the ossifying infant pelvis as well as the fully developed adult pelvis. The goal of this study was to determine if there is a difference in measurements between the inferior sacral-iliac line and Hilgenreiner’s line in order to identify an alternative horizontal reference plane. Methods: 3 reviewers (fellowship-trained paediatric orthopaedic surgeon, junior orthopaedic resident, senior orthopaedic resident) reviewed 100 paediatric non-osteotomized pelvises. The difference between Hilgenreiner’s line and the inferior sacral-iliac line were measured and reported. Measurements were repeated a minimum of 48 hours apart, resulting in 600 comparisons between Hilgenreiner’s line and the inferior sacral-iliac line. The standard error of measurement was calculated to assess the variation in measurements between each individual observer and the group as a whole. Results: The mean standard error of measurement between Hilgenreiner’s line and the inferior sacral-iliac line was 0.44° (95% CI, ± 0.86). Reviewers 1–3 demonstrated a mean standard error of measurement of 0.38, 0.28, and 0.35 (95% CI, ± 0.74, 0.55, and 0.86) respectively. There was no statistically significant difference between reviewers ( p > 0.05). Intra-observer reliability for reviewers 1, 2, and 3 was 0.64 (0.47–0.76), 0.75 (0.63–0.83), and 0.54 (0.32–0.69) respectively, with an inter-observer reliability of 0.42 (0.20–0.60) degrees. Conclusions: In this proof-of-concept study, the inferior sacral-iliac line was found to be an appropriate alternative to Hilgenreiner’s line that is easily identifiable for all levels of orthopaedic training. Future inferior sacral-iliac line studies should demonstrate the reliability of multiple acetabular measurements, both pre- and post-osteotomy.
Outcomes and Cost-Effectiveness of Hospital Outpatient Versus Ambulatory Surgery Center Lumbar Decompression Surgery
Authors: Rana Parimal , Brennan Jane , Johnson Andrea , Patton Chad M. , Turcotte Justin J. 
Published: October 2024

Study Design Retrospective Chart Review. Objectives Outpatient spinal surgeries in Ambulatory Surgery Centers (ASCs) have gained traction due to their potential cost efficiencies and improved perioperative processes. This study aims to compare the cost-effectiveness and patient outcomes of lumbar laminectomies performed in hospital settings vs ASCs. Methods A retrospective analysis was conducted on 771 patients who underwent 1 or 2-level outpatient laminectomy between 2019 and 2023. Patient demographics, 90-day and one-year clinical and patient-reported outcomes (PROs), and one-year episode of care costs were evaluated. A one-year cost-effectiveness analysis was performed using the EQ-5D to measure quality-adjusted life years (QALYs). Results ASC patients demonstrated lower body mass index and American Society of Anesthesiologists (ASA) scores, with a higher prevalence of 1-level laminectomies compared to hospital patients. ASC-based laminectomy was associated with lower initial surgery cost and one-year episode of care costs ($5662 ± 4748 vs $10229 ± 9202, P < 0.001), with similar rates of complications and postoperative resource utilization. These trends remained after controlling for patient demographics, comorbidities, and number of levels treated. In patients completing baseline and 1-year EQ-5D scores, ASC-based laminectomy was over twice as cost-effective as hospital procedures ($64873/QALY gained vs $152630). Conclusions The findings support the safety and one-year cost effectiveness of ASCs for appropriately selected patient populations undergoing lumbar laminectomy. Additional studies are needed to replicate these findings across institutions, and to assess the cost effectiveness of ASC-based laminectomy beyond one-year postoperatively.
Potential Sampling Errors in Stability Studies Due to Dead Volume in Closed System Transfer Devices
Authors: Closset Mélanie , Colsoul Maire-Lise , Bihin Benoît , Hecq Jean-Daniel , Odou Pascal , Galanti Laurence 
Published: October 2024

Background: Closed system transfer devices (CSTD) help to reduce the exposure of healthcare professionals to hazardous drugs. They may be used in stability studies conducted on anticancer drugs. During a stability study about polyolefin bags of gemcitabine, Tevadaptor® device was suspected of causing a bias in the evaluation of the concentrations of the first aliquots extracted from the bags. Objective: The objectives are to determine whether the use of a CSTD to prepare a drug solution and to withdraw it from a bag can interfere on the measured concentration compared to the expected one and to suggest hypothesis to explain the phenomenon. Method: In the first experiment, three polyolefin bags of gemcitabine (5.4 mg/mL) were prepared under aseptic conditions using the Tevadaptor Luer Lock Adaptor®. The day of preparation, five aliquots of 3.8 ml each were sequentially withdrawn from each polyolefin bag using the same device. After one day, a new aliquot was withdrawn from each bag. In the second experiment, three polyolefin bags of gemcitabine (5.4 mg/ml) were prepared under aseptic conditions using a needle. One aliquot was extracted using a needle after the preparation from each bag, and another aliquot was extracted after one day. The concentrations of all aliquots were measured by liquid chromatography coupled to a photodiode array detector during the same run. Results and discussion: The concentrations of the first aliquots extracted on day zero from the polyolefin bags using the Tevadaptor Luer Lock Adaptor® exhibit an overestimation of 26% ([95%CI: 23%-29%] P<0.001) compared to the others. Overestimation is not found for subsequent aliquots, or while using a needle to bypass the Tevadaptor® device. Conclusion: This case highlights the bias that may arise when using CSTDs in stability studies. They should be used with comprehensive understanding of their technical specifications.