bluuebunny/crossref_metadata_2025_split huggingface dataset:
Back on track – digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study
Authors: Boy Katharina , May Susann , Labinsky Hannah , Morf Harriet , Heinze Martin , Leipe Jan , Kuhn Sebastian , Schett Georg , Knitza Johannes , Muehlensiepen Felix 
Published: September 2024

AbstractNon-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.
Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas
Authors: Schuettfort Victor M. , Graf Rebecca R. , Vetterlein Malte W. , Ludwig Tim A. , Gild Philipp , Marks Phillip , Soave Armin , Dahlem Roland , Fisch Margit , Riechardt Silke 
Published: September 2024

Abstract
Introduction
Urethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery.

Methods
A retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires.

Results
Among 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8).

Discussion
Our study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention.
Changing times: trends in risk classification, tumor upstaging, and positive surgical margins after radical prostatectomy - results from a contemporary National Cancer Database study
Authors: Freitas Pedro F. S. , Blachman-Braun Ruben , Soodana-Prakash Nachiketh , Williams Adam D. , Ritch Chad R. , Punnen Sanoj , Gonzalgo Mark L. , Parekh Dipen , Nahar Bruno 
Published: September 2024

Abstract
Purpose
Recent advancements in screening, prostate MRI, robotic surgery, and active surveillance have influenced the profile of patients undergoing radical prostatectomy (RP). We sought to examine their impact on trends in clinicodemographic, risk classification, and adverse pathology in men undergoing surgery.

Methods
We queried the National Cancer Database for clinicodemographic, risk group, and pathology data in men undergoing upfront RP between 2006 and 2020. Patients were categorized by NCCN risk groups, and trends were assessed among 2006–2010, 2011–2015, and 2016–2020 periods. Endpoints included rates of pT3, positive surgical margins (PSM), pathologic upstaging, and Gleason grade group (GG) upgrading.

Results
610,762 patients were included. There were significant increases in African Americans (9.8–14.1%), comorbidities (2.1–5.2% with Charlson scores > 1), and robot-assisted RP (78–84%). Over the three time periods, high-risk cases increased from 15 to 20 to 27%, and intermediate-risk from 54 to 51 to 60%. Overall rates of pT3 rose from 20 to 38%, and PSM from 20 to 27% (p < 0.001). Pathologic upstaging increased in low (6–15%), intermediate (20–33%), and high-risk groups (42–58%) –p < 0.001. Gleason upgrading rose in low-risk (45–59%, p < 0.001), with slight reductions in the intermediate and high-risk groups.

Conclusions
Recent trends in RP indicate a shift towards more advanced disease, evidenced by increasing rates of pT3, PSM, and pathologic upstaging across all NCCN risk groups. These findings emphasize the need for a careful balance in applying fascia and nerve-sparing techniques to avoid compromising oncological safety.
Assessing diastolic function using CMR as an alternative to echocardiography: age- and gender-related normal reference values
Authors: Cirener Lilly Charlotte , Körperich Hermann , Barth Peter , Racolta Anca , Piran Misagh , Burchert Wolfgang , Weber Oliver M. , Eckstein Jan 
Published: September 2024

Abstract
Background
Impaired diastolic function is associated with a variety of diseases such as myocarditis or dilated cardiomyopathy. Currently, echocardiography is the standard method for assessing diastolic function. Recently, it has been postulated that cardiovascular magnetic resonance (CMR) is an at least equivalent or superior alternative to echocardiography. To assess CMR-based age- and gender-dependent diastolic functional normal reference values, pulmonary venous and transmitral blood-flow parameters were examined in heart-healthy test persons.

Methods and results
Flow-sensitive phase-contrast CMR imaging was performed in the right upper pulmonary vein (RUPV) and at the level of the mitral valve (MV) in 183 healthy subjects (age 10–70 years; 97 women, 86 men). The data was distributed as evenly as possible across all groups. Strong age-dependence was observed for PV S/D; r = 0.718, p < 0.001 (Pearson product–moment correlation) and for transmitral MV E/A; ρ = −0.736, p < 0.001 (Spearman’s Rho correlation). Moderate age-dependence was found for PV slope D-wave; r = 0.394, p < 0.001. Except for MV slope E-wave (male −292 cm/s2 interquartile range (IQR) {−338; −243} vs. female −319 ± 82 cm/s2; p = 0.047), no gender-related differences were observed. In a subgroup (N = 100), CMR data were compared with echocardiographic data. Strong correlation was found between CMR and echocardiography for PV S/D; r = 0.545, p < 0.001 and MV E/A; ρ = 0.692, p < 0.001.

Conclusion
Diastolic functional parameters change with age, while gender-differences are small. CMR and echocardiography showed similar PV S/D and MV E/A ratios, making CMR a promising alternative for assessing diastolic function.

Graphical abstract
Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability
Authors: Nakasa Tomoyuki , Ikuta Yasunari , Kawabata Shingo , Sakurai Satoru , Moriwaki Dan , Ishibashi Saori , Silan Asyumaredha Asril , Adachi Nobuo 
Published: September 2024

Abstract
Purpose
Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair.

Materials and methods
Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries.

Results
The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries.

Conclusions
Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries.

Evidence level
Level III
Hidradenitis suppurativa and female infertility: a pilot study conducted amongst 110 dermatological patients
Authors: Medianfar Cecilia Egede , Kursawe Larsen Christoffer , Saunte Sara Karoline , Saunte Ditte Marie Louise , Jemec Gregor Borut Ernst , Andersen Rune Kjærsgaard 
Published: September 2024

AbstractHidradenitis suppurativa (HS) is a chronic inflammatory skin disease with severe consequences on quality of life. One aspect of this is that HS has been linked to an increased risk of infertility, but as data is still limited, it is not known if the association reflects causality. We performed a cross-sectional study of 161 female participants included at Zealand University Hospital, Roskilde, Denmark. Data regarding basic demographics, infertility, pregnancies, sexual function, and known factors with impact on fertility was collected. Logistic regressions were performed to analyze the association between HS and infertility, adjusting for factors that influence fertility. The study population consisted of 55 patients with HS, 55 patients with other dermatological diseases (ODD), and 51 healthy controls (HC). The HS group had a higher BMI, lower sexual function, and a higher tobacco use. We found no significant difference between the three groups in terms of whether they had children, the number of children they had, infertility, or whether they had received fertility treatments. The logistic analyses found no correlation between HS and infertility, and adjusting for factors affecting infertility did not alter this result. This study did not find a significant difference in infertility between patients with HS compared to those with ODD or HC. This result was not affected by adjustments for other factors known to influence fertility. Interestingly, the lower sexual function in the HS group did not appear to influence their desire or ability to conceive.
Age and sex differences in outpatient antipsychotic prescriptions for schizophrenia: a claims data study
Authors: Ramin Tabea , Peter Jens-Uwe , Schneider Michael , Heinze Martin , Riedel Oliver , Langbein Sophie Hanna , Haug Ulrike , Zolk Oliver 
Published: September 2024

AbstractMost studies on antipsychotic efficacy and safety, including sex differences, focus on young schizophrenia patients. However, with an aging population, the number of older schizophrenia patients is increasing. This group faces challenges due to varying treatment responses and higher risks of adverse reactions, and guidelines often lack specific recommendations due to insufficient trials. Therefore, we investigated how age and sex influence antipsychotic prescribing practices in schizophrenia using the German Pharmacoepidemiological Research Database (GePaRD). We included patients diagnosed with schizophrenia (ICD-10 code F20.X) who had been prescribed at least one antipsychotic on an outpatient basis in at least two consecutive quarters in 2020, analyzing prescription data for 49,681 patients. Key findings include a notable preference for second-generation antipsychotics (SGAs) across all age groups, especially in younger patients, possibly due to their perceived better tolerability and efficacy. Treatment intensity with SGAs (expressed as the defined daily doses of SGAs per patient in 2020) initially increased with age, peaked among 35- to 44-year-olds, and then decreased, with the lowest treatment intensity in patients aged 65 years and older. The prescription patterns of specific SGAs and first-generation antipsychotics varied across age groups, highlighting the complexity of treatment decisions in schizophrenia management. Sex differences in prescription frequency and treatment intensity were also observed. The basic recommendation of the guideline to consider sex and age when prescribing antipsychotics therefore appears to be followed. Whether this prescribing practice is really optimal for older male and female schizophrenia patients, however, still needs to be proven in clinical trials.
A new activity model for biotite and its application
Authors: Dachs Edgar , Benisek Artur 
Published: September 2024

AbstractA new activity model for biotite is formulated in the system K2O-FeO-MgO-Al2O3-SiO2-H2O-TiO2-O2 (KFMASHTO), which extends that for the KFMASH system by introducing a titanium-biotite and a ferric-biotite end-member (tbio: K(TiMg2)[(O)2(AlSi3)O10] and fbio: K(Fe3+Mg2)[(OH)2(Al2Si2)O10]), as well as a pyrophyllite end-member (pyp: Al2[(OH)2Si4O10]) that accounts for the presence of octahedral excess-Al in natural biotites. Phonon calculations applying density functional theory (DFT) using the software Castep yielded the standard entropies of tbio and fbio as Sotbio = 328.06 J/(mol·K) and Sofbio = 301.69 J/(mol·K), and their heat capacity functions. From experimental phase-equilibrium data, the enthalpy of formation value of tbio was constrained as $$\Delta {H}_{f,tbio}^{o}$$

Δ

H

f
,
t
b
i
o

o

= −6124.68 ± 3.33 kJ/mol. Natural data were used to derive $$\Delta {H}_{f,fbio}^{o}$$

Δ

H

f
,
f
b
i
o

o

= −5935.3 ± 6.6 kJ/mol. The single-defect DFT method was applied to parameterize important macroscopic mixing properties (macro-W’s) involving tbio and pyp end-members in the model (fbio was treated ideal). Castep-derived microscopic interaction energies (micro-w’s) are presented herein for KFMASH-biotite. The octahedral same-site (M1) Mg–Al mixing micro-w (wMgAl(M1)), the same-site tetrahedral Si-Al mixing parameter (wSiAl(T1)) and the related cross-site term are: wMgAl(M1) = 82.5 kJ/mol, wSiAl(T1) = 95.6 kJ/mol (two T1-sites) and $${w}_{MgAlAlSi(M1T1)}=$$

w

M
g
A
l
A
l
S
i
(
M
1
T
1
)

=

175.1 kJ/mol. The linear combination of these micro-w’s gives a macroscopic Wphleas = 18.8 kJ/mol, that is not transferable to other mineral groups. Micro w’s for Mg-Fe mixing in biotite (wMgFe(M1), wMgFe(M2),$${w}_{MgMgFeFe(M1M2)}$$

w

M
g
M
g
F
e
F
e
(
M
1
M
2
)

), are all close to ideality. The biotite activity model of this study is thus a first example of next-generation activity models that use DFT- and thus physically based micro-w’s and reassembled macro-W’s for petrological calculations. Test calculations on 5 samples from low- to high-grade metamorphic environments covering metapelite to greywacke bulk-compositions using Perple_X suite of programs illustrate the performance of the new biotite activity model. Computed mineral-chemistries are in all cases in better agreement with measured compositions than resulting from published activity models of biotite.
Prevalence of relevant early complications during the first 24 h on a normal ward in patients following PACU care after medium and major surgery: a monocentric retrospective observational study
Authors: Wurth Anouk , Hackert Thilo , Böckler Dittmar , Feisst Manuel , Haag Sabine , Weigand Markus A. , Brenner Thorsten , Schmoch Thomas 
Published: September 2024

Abstract
Purpose
Even today, it remains a challenge for healthcare professionals to decide whether a clinically stable patient who is recovering from uncomplicated medium or major surgery would benefit from a postoperative intensive care unit (ICU) admission, or whether they would be at least as adequately cared for by a few hours of monitoring in the post-operative care unit (PACU).

Methods
In this monocentric retrospective observational study, all adult patients who (I) underwent medium or major surgery between 1 January 1 2014 and 31 December 2018 at the Heidelberg University Surgical Center, and (II) were monitored for 1–12 h in the PACU, and then (III) transferred to a normal ward (NW) immediately thereafter were included. At the end of the PACU stay, each patient was cleared by both a surgeon and an anesthesiologist to be transferred to a NW. The first objective of this study was to determine the prevalence of relevant early complications (RECs) within the first 24 h on a normal ward. The secondary objective was to determine the prevalence of RECs in the subgroup of included patients who underwent partial pancreaticoduodenectomy.

Results
A total of 10,273 patients were included in this study. The prevalence of RECs was 0.50% (confidence interval [CI] 0.40–0.60%), with the median length of stay in the PACU before the patient’s first transfer to a NW being 285 min (interquartile range 210–360 min). In the subgroup of patients who underwent partial pancreaticoduodenectomy (n = 740), REC prevalence was 1.1% (CI = 0.55–2.12%).

Conclusion
Based on a medical case-by-case assessment, it is possible to select patients who after a PACU stay of only up to 12 h have a low risk of emergency readmission to an ICU within the 24 h following the transfer to the NW. Continued research will be needed to further improve transfer decisions in such low-risk subgroups.
Shiga toxin-producing Escherichia coli infection as a precipitating factor for atypical hemolytic-uremic syndrome
Authors: Mortari Gabriele , Bigatti Carolina , Gaffi Giulia Proietti , Lionetti Barbara , Angeletti Andrea , Matarese Simona , Verrina Enrico Eugenio , Caridi Gianluca , Lugani Francesca , Vellone Valerio Gaetano , Chiarenza Decimo Silvio , La Porta Edoardo 
Published: September 2024

Abstract
Background
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy characterized by intravascular hemolysis. It can be classified as either typical, primarily caused by Shiga toxin-producing Escherichia coli (STEC) infection, or as atypical HUS (aHUS), which results from uncontrolled complement activation.

Methods
We report the case of a 9-year-old boy with aHUS due to compound heterozygous complement factor H-related genes (CFHR) 1/3 and CFHR1–CFHR4 deletions, leading to the development of anti-complement factor H (CFH) autoantibodies. The patient presented nephrological and neurological thrombotic microangiopathy with STEC positivity. Additionally, we provide an extensive literature review of aHUS cases initially classified as typical.

Results
A total of 11 patients were included, 73% of whom were pediatric. Kidney replacement therapy was required in 73% of patients. The recurrence rate was 55%. All cases were found positive for pathological variants of the complement system genes. The most commonly implicated gene was CFH, while the CFHR genes were involved in 36% of cases, although none exhibited anti-CFH autoantibodies. Anti-complement therapy was administered in 54% of cases, and none of the patients who received it early progressed to kidney failure.

Conclusions
STEC infection does not exclude aHUS diagnosis, and early use of anti-complement therapy might be reasonable in life-threatening conditions. Genetic testing can be helpful in patients with atypical presentations and can confirm the necessity of prolonged anti-complement therapy.

Graphical Abstract
Forecasting thermal stress for sports tourists at the 2026 FIFA World Cup
Authors: Craig Christopher , Karabas Ismail 
Published: September 2024

AbstractThis study explores thermal stress conditions (i.e. heat, humidity, sunlight exposure) sports tourists can expect when attending the 2026 FIFA World Cup. Sports tourism’s growth is driven by international mega-events like FIFA World Cups and Olympic Games. With planning ongoing for the 2026 FIFA World Cup football (soccer) tournament, what remains unstudied are the heat conditions spectators can expect at the 16 host stadiums in the United States, Mexico, and Canada. The inquiry is important considering (1) the tournament is taking place in warm-weather months of June and July, (2) thermal stress contributes to heat-related illnesses like heat stroke, and (3) many destination-bound tourists will be at elevated risk to heat. Accordingly, we report historical and forecasted thermal stress levels documenting expected conditions at each host stadium. Notably, forecasts indicate worsening thermal stress compared to long-term means, providing support for the study’s methodology. Practical implications and limitations are provided.
Stratified equatorial flows in cylindrical coordinates with surface tension
Authors: Gheorghe Cristina , Stan Andrei 
Published: September 2024

AbstractThis paper considers a mathematical model of steady flows of an inviscid and incompressible fluid moving in the azimuthal direction. The water density varies with depth and the waves are propagating under the force of gravity, over a flat bed and with a free surface, on which acts a force of surface tension. Our solution pertains to large scale equatorial dynamics of a fluid with free surface expressed in cylindrical coordinates. We also prove a regularity result for the free surface.