bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristic features of late-onset systemic lupus erythematosus: An observational study of data from the Lupus Registry of Nationwide Institutions
Authors: Sakurai Natsuki , Yoshimi Ryusuke , Yajima Nobuyuki , Hidekawa Chiharu , Kunishita Yosuke , Kishimoto Daiga , Sugiyama Yumiko Kawahara , Kojitani Noriko , Suzuki Naoki , Yoshioka Yuji , Komiya Takaaki , Takase-Minegishi Kaoru , Kirino Yohei , Sada Ken-ei , Miyawaki Yoshia , Ichinose Kunihiro , Ohno Shigeru , Kajiyama Hiroshi , Sato Shuzo , Shimojima Yasuhiro , Fujiwara Michio , Nakajima Hideaki 
Published: September 2024

Objective Late-onset systemic lupus erythematosus (LoSLE) is known to possess characteristics different from those of early-onset SLE (EoSLE), thereby making their diagnosis difficult. This study aimed to assess the characteristic features of LoSLE in Japan, a model country with a super-aged society. Methods Data were obtained from the Lupus Registry of Nationwide Institutions, which includes a multicenter cohort of patients with SLE in Japan who satisfied the 1997 American College of Rheumatology revised classification criteria for SLE. Data were compared between patients with LoSLE (≥50 years old at onset) and EoSLE (<50 years old at onset). To identify factors associated with LoSLE, binary logistic regression was used for the multivariate analysis, and missing values were complemented by multiple imputations. We also conducted a sub-analysis for patients diagnosed within 5 years of onset. Results Out of 929 enrolled patients, 34 were excluded owing to a lack of data regarding onset age. Among the 895 remaining patients, 100 had LoSLE, whereas 795 had EoSLE. The male-to-female ratio was significantly higher in the LoSLE group than in the EoSLE group (0.32 vs 0.11, p < 0.001). With respect to SLEDAI components at onset, patients with LoSLE exhibited a higher frequency of myositis (11.9% vs 3.75%, p = 0.031), lower frequency of skin rash (33.3% vs 67.7%, p < 0.001), and lower frequency of alopecia (7.32% vs 24.7%, p = 0.012). No significant differences in overall disease activity at onset were observed between the two groups. Regarding medical history, immunosuppressants were more commonly used in EoSLE. A multivariate analysis revealed that a higher male proportion and a lower proportion of new rash at onset were independent characteristic features of LoSLE. We also identified late onset as an independent risk factor for a high SDI score at enrollment and replicated the result in a sub-analysis for the population with a shorter time since onset. Conclusions We clarified that LoSLE was characterized by a higher male proportion, a lower frequency of skin rash and a tendency to organ damage. Now that the world is faced with aging, our results may be helpful at diagnosis of LoSLE.
Concurrent delayed recurrence of peripheral primitive neuroectodermal tumors in orbital and sellar/suprasellar regions in an older adult
Authors: Yamashita Shota , Yokosawa Michiko , Ono Sadahide , Sugawara Takayuki , Kimura Naoto , Endo Hidenori 
Published: September 2024

Background Peripheral primitive neuroectodermal tumors (pPNETs) are rare and aggressive small round cell tumors, tending to occur in the thoracic and paravertebral soft tissues in children and young adults. This report describes an exceptionally rare case of concurrent delayed recurrence of pPNET in the orbital and sellar/suprasellar regions in an older adult, with a discussion supported by a literature review. Case presentation We report an 82-year-old woman with a history of orbital pPNETs resection at age 62, followed by gamma knife radiosurgery for local recurrence at age 66. She presented left eye pain, left eye protrusion, decreased vision in the right eye, and right homonymous hemianopia. MRI revealed extensive lesions in the left orbital cavity and sellar/suprasellar region, contiguous through the optic canal. The recurrent tumor was treated through a two-stage resection via transcranial and transsphenoidal approaches, which resulted in symptom improvement and a pathologic diagnosis of pPNETs. Conclusion This case highlights a highly rare instance of late-onset orbital pPNETs recurrence in an elderly patient, with evidence suggesting tumor progression into the sellar/suprasellar regions through the optic canal.
Exploring Individualized Follow-up of Gastric Cancer After Radical Surgery Based on pTNM Stage: A Retrospective Cohort Study From China
Authors: Zheng Cheng , Qian Mengyi , Huang Tongmin , Liu Xingchen , Zeng Xiangman , Chen Xiaotong , Shen Yan , Chen Ping , Wu Feng , Gu Lihu 
Published: September 2024

Background:Patients with gastric cancer (GC) who underwent radical surgery require long-term follow-up (usually 5 years). The purpose of this study was to explore individualized follow-up strategies for patients with GC.Methods:This is a retrospective cohort study that established a clinicopathologic database of patients who underwent gastrectomy from January 2010 to December 2020 at Ningbo No. 2 Hospital. Follow-up was performed until March 2023. The rate of new-onset recurrence of patients with GC was explored annually according to different pTNM stages, defining a recurrence rate of less than 1% as adequate follow-up time.Results:Of the 1606 patients who were eligible, the total number of patients who completed the 5- and 10-year follow-up was 1107 and 586, respectively. A total of 444 cases were diagnosed with recurrence. The recurrence rate for stage IA patients was consistently less than 1% during the follow-up time. The adequate follow-up time (the rate of new-onset recurrence less than 1%) was 5 years for stage IB and IIA patients, and 8 years for stage IIB and IIIA patients, respectively. In contrast, stage IIIB patients were always at risk of recurrence during the follow-up time (>1%). Time to a new recurrence rate for stage IIIC patients was 6 years.Conclusion:Among patients who underwent radical gastrectomy, the rate of new-onset recurrence varied among patients with different pTNM stages. This study suggests that the follow-up of GC can be individualized and refer to pTNM stage.
Recovery of Phenolic Compounds from Citrus Peel Through Solid Phase Extraction and QuEChERS as Clean-up Methods
Authors: Anticona Mayra , Lopez-Malo Daniel , Frigola Ana , Blesa Jesus , Esteve Maria Jose 
Published: September 2024

Introduction Citrus peel, one of the main byproducts of the food industry, is an important source of phenolic compounds with preventive and protective effects. The analysis of these compounds has been widely described, however, information on the purification methods of the extracts is limited. Objective The objective of the present study is to determine the purification method that favors the obtaining of phenolic compounds from citrus peel extracts. Methods Oranges ( C. sinensis) and mandarins ( C. reticulata) were purchased from a local supermarket (Valencia, Spain). The peels were separated manually and cut into pieces of 25 mm2. An ultrasound-assisted extraction was performed (30 min, 400 W, < 40 °C). Purification by Solid Phase Extraction (SPE) was carried out using cartridges with 200 mg of C18. The QuEChERS procedure was performed using 2 ml DisQUE™ Tubes. The profile of phenolic compounds was analyzed by HPLC-UV. Results The major compounds in the samples were narirutin and hesperidin. Differences were determined according to both purification methods (p < 0.05). Hesperidin was higher in orange peel samples (2229 µg/g FW), while the highest amount of narirutin was obtained in tangerine peel (440 µg/g FW). Conclusion The sample purification methods are selective. The QuEChERS method showed a greater recovery of phenolic acids and quercetin. The content of phenolic acids was higher in mandarin peel samples.
Analyzing and evaluating the prevalence and metabolic profile of lean NAFLD compared to obese NAFLD: a systemic review and meta-analysis
Authors: Fatima Hareer , Sohail Rangwala Hussain , Mustafa Muhammad Saqlain , Shafique Muhammad Ashir , Abbas Syed Raza , Sohail Rangwala Burhanuddin 
Published: September 2024

Background: Non-alcoholic fatty liver disease (NAFLD) is a common liver condition affecting 25%–40% of the worldwide population. NAFLD is traditionally related to obesity and metabolic disorders. NAFLD can also affect non-obese individuals, termed “lean NAFLD” (LN), who exhibit a paradoxical combination of physical leanness and metabolic obesity. Factors contributing to LN remain unclear, necessitating further research. This analysis aims to understand LN’s prevalence and metabolic characteristics compared to obese NAFLD (ON) populations. Methods: This meta-analysis searched various databases until August 1, 2023. Inclusion criteria involved observational studies comparing LN with overweight/obese NAFLD. Data extraction included baseline characteristics, disease occurrence, metabolic profile, and clinical parameters—statistical analysis employed calculating risk ratios (RR) and standard mean differences. Results: Twenty-five studies were analyzed. LN is associated with lower prevalence in both NAFLD (RR 0.27, 95% confidence interval (CI) 0.14–0.52, p = <0.0001) and total (RR 0.27, 95% CI 0.15–0.51, p < 0.0001) population. LN had lower diabetes mellitus (RR 0.78, 95% CI 0.71–0.87, p < 0.00001), dyslipidemia (RR 0.87, 95% CI 0.79–0.95, p = 0.002), hypertension (RR 0.80, 95% CI 0.74–0.87, p < 0.00001), and metabolic syndrome (RR 0.45, 95% CI 0.31–0.64, p < 0.00001) compared to those with ON. The LN group’s lipid profile, blood pressure, and other clinical parameters were favorable compared to ON. Conclusion: The prevalence of NAFLD among lean and non-lean individuals varies by region. Our analysis revealed that LN is associated with lower metabolic diseases, fasting blood sugar, blood pressure, and a more favorable lipid profile compared to ON.
Comparing Access to Engaging Hill-Sachs Lesions Between the Modified Posterior Deltoid Split Approach and Standard Deltopectoral Approach for Bone Grafting
Authors: Bond Elizabeth C. , Bryniarski Anna R. , Udoh Imoh , Wittstein Jocelyn R. , Lau Brian C. , Taylor Dean C. , Dickens Jonathan F. 
Published: September 2024

Background: Hill-Sachs lesions are common after shoulder instability, and treatment options vary but include remplissage or implantation of structural bone graft. Large Hill-Sachs lesions not addressed by remplissage are challenging to manage and may frequently require an open surgical approach for bone filling treatment options. The optimal approach to maximize visualization of the humeral head during these procedures remains unclear. Purpose/Hypothesis: The purpose of this study was to compare the area of the humeral head accessed using a modified posterior deltoid split approach versus a standard deltopectoral approach without surgical dislocation, with particular attention to access of engaging Hill-Sachs lesions for the purpose of bone grafting in the setting of anterior shoulder instability. It was hypothesized that both approaches would provide equal access to a simulated Hill-Sachs lesion. Study Design: Controlled laboratory study. Methods: Four human cadaveric shoulders were mounted in the beach-chair position. The modified posterior deltoid split approach and nonextensile deltopectoral approaches were performed. A typical Hill-Sachs lesion was simulated on the humeri. The percentage of the total surface area of the humeral head that was accessed, including access to the simulated Hill-Sachs lesion, was mapped using 3-dimensional digitizing software. Results: The deltopectoral approach provided 45% ± 15.2% access (range, 24% to 58%) to the humeral head versus 22.2% ± 6.1% (range, 17% to 30%) for the modified posterior deltoid split approach ( P = .057). The modified posterior deltoid split approach enabled 100% access of the simulated Hill-Sachs lesion compared with 0% for the nonextensile deltopectoral approach. The angle of access to the articular surface was direct and perpendicular with the modified posterior deltoid split approach. Conclusion: The overall surface area of the humeral head accessed via the modified posterior deltoid split approach was less compared with the deltopectoral approach; however, the entire area of a typical Hill-Sachs lesion was able to be accessed from the modified posterior deltoid split approach, whereas this area was not well visualized from the standard deltopectoral approach. Clinical Relevance: The modified posterior deltoid split approach provided sufficient access to the humeral head for the purposes of grafting an engaging Hill-Sachs lesion in the setting of anterior shoulder instability.
Setting Up Medical Devices at Home: Easing the Patient’s Human Factors’ Burden by Creating A Great User Experience
Authors: Moll Robert 
Published: September 2024

As ubiquitous as smartphones, apps, and related devices are these days, it’s still not always an easy process for a user to get comfortable with a new product. This is particularly true in the setup process of a new medical device, smartphone and companion app system. Such systems can be complex, and portions of the target population may not be well-versed in using smartphones and apps. A user’s lack of experience is something that we regularly see in the process of designing and developing medical device interfaces that are used by patients at home. This puts extra pressure on developers/manufacturers to get the setup process right, otherwise the end user will not be able to use the device at all. How can developers/manufacturers ease the burden of a patient setting up a system at home? By paying close attention to steps like unboxing a device, providing a quick reference card, making app download easy, and onboarding the user, we can lessen the burden patients face, achieve a great user experience, and facilitate the beginning of an adherent relationship between the patient and the device.
Comparing the Clinical Outcomes of Percutaneous Cheilectomy to Open Cheilectomy With Moberg Osteotomy for the Treatment of Hallux Rigidus
Authors: DiGiovanni Grace M. , El Masry Seif , Mizher Rami , Jones Agnes , Johnson A. Holly , Ellis Scott J. , Conti Matthew S. 
Published: September 2024

Background: Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion. However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System. Methods: A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected. Results: The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity ( P = .015, .011, .001, respectively). No significant difference was identified in the reoperation rate. Conclusion: Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC. Level of Evidence: Level III, retrospective review.
Changes in multimorbidity among hospitalized adults in the US
Authors: Loyd Christine , Picken Lauren , Sanders Richelle , Zhang Yue , Kennedy Richard E. , Brown Cynthia J. 
Published: September 2024

Objective This investigation examines burden of comorbidity measured by the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) among inpatients based on age, sex, and race. Methods Cross-sectional analysis of 2012-2018 US NIS datasets. Participants were inpatients 55y+. ICD-9/10 codes for admitting diagnoses were used to calculate disease burden using the CCI and ECI. Unweighted mean CCI and ECI scores were compared across demographic variables. Results An increase in mean CCI and ECI scores across age, sex, and races (p<.001) was identified. Compared to the youngest age group (55-59y), all age groups had higher mean CCI and ECI adjusting for time (p<.001). Increases were greatest in older age groups until age 80-84 for CCI and 85-89 for ECI. The female group had lower CCI adjusting for time (p<.001) compared to males. There was no difference between sex groups in mean ECI (p=.409). Compared with the White group, all other race groups had higher mean CCI adjusting for time (p<.001). Black inpatients had the highest CCI followed by Native American inpatients. Findings were similar for ECI, but with no difference between Hispanic and White groups (p=.434). Conclusions Growing multimorbidity burden among adult inpatients across age, sex, and race supports the continued need for programs for preventing and reducing multimorbidity, especially among communities that experience health inequity including older, Black, and Native American patients.
Prevalence and Risk Factors for Fecal Incontinence in Post-Menopausal Women in India
Authors: Sridhar Shriya , Jain Mayank 
Published: September 2024

Aim The aim of this study was to determine the prevalence of fecal incontinence (FI) in post-menopausal women and its risk factors. Methods This cross-sectional study was carried out from May 2022 to May 2023. All women in the post-menopausal age group attending outpatient services were given a simple questionnaire to assess the presence of FI and likely risk factors. Results A total of 728 women formed the study group (median age 58, range 45-84 years). FI was reported by 10.1 % of respondents. Women with FI were significantly more likely to have vaginal delivery ( P < .0001), presence of one or more comorbid diseases ( P = .0001), previous abdominal surgery ( P = .01), and diarrheal stools ( P = .0009). The odds of developing FI were highest for vaginal delivery, followed by the presence of co-morbid diseases. Conclusion The prevalence of FI was 10.1%. History of vaginal delivery, previous abdominopelvic surgery, diarrheal stools, and comorbid diseases were significantly associated with FI.
Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments
Authors: Liengswangwong Wijittra , Siriwannabhorn Ranchana , Leela-Amornsin Sittichok , Yuksen Chaiyaporn , Sanguanwit Pitsucha , Duangsri Chonthicha , Kusonkhum Nusara , Saelim Parnthap 
Published: September 2024

Abstract
Introduction
Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabetes increases infection and sepsis risk, making management complex. Various scores of screening tools, such as Modified Early Warning Score (MEWS), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment Score (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE II), are used to predict the severity or mortality rate of disease. Our study aimed to compare the effectiveness and optimal cutoff points of these scores. We focused on the early prediction of septic shock in patients with diabetes in the Emergency Department (ED).

Methods
We conducted a retrospective cohort study to collect data on patients with diabetes. We collected prediction factors and MEWS, SOFA, SAPS II and APACHE II scores to predict septic shock in these patients. We determined the optimal cutoff points for each score. Subsequently, we compared the identified scores with the gold standard for diagnosing septic shock by applying the Sepsis-3 criteria.

Results
Systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), Glasgow Coma Scale (GCS), pH, and lactate concentrations were significant predictors of septic shock (p < 0.001). The SOFA score performed well in predicting septic shock in patients with diabetes. The area under the receiver operating characteristics (ROC) curve for the SOFA score was 0.866 for detection within 48 h and 0.840 for detection after 2 h of admission to the ED, with the optimal cutoff score of ≥ 6.

Conclusion
SBP, SpO2, GCS, pH, and lactate concentrations are crucial for the early prediction of septic shock in patients with diabetes. The SOFA score is a superior predictor for the onset of septic shock in patients with diabetes compared with MEWS, SAPS II, and APACHE II scores. Specifically, a cutoff of ≥ 6 in the SOFA score demonstrates high accuracy in predicting shock within 48 h post-ED visit and as early as 2 h after ED admission.
The use of nonpharmacological interventions for chronic pain treatment in community-dwelling older adults with a certified need for care
Authors: Koios Daniela , Kuhnert Ronny , Dräger Dagmar , Wenzel Arlett , Kreutz Reinhold , Budnick Andrea 
Published: September 2024

Abstract
Background
Chronic pain is a major health issue and rapid population ageing exacerbates the burden to health systems in countries like Germany. Nonpharmacological interventions (NPIs) are essential in pain care and the prioritization of active NPIs is emphasized in guidelines. This paper examines the utilization of NPIs for chronic pain management in community-dwelling older adults with a certified need of care in Berlin, Germany.

Methods
Cross-sectional data was collected through standardized face-to-face surveys with older adults (≥65 years), using validated instruments (e.g., Brief Pain Inventory), and structured lists for NPI utilization. Categorization into active and passive NPIs was performed through a literature-based, iterative process by an interdisciplinary team. For not normally distributed data, non-parametric tests were used as appropriate. Logistic regression was conducted for multivariate analysis.

Results
In total, 250 participants were included in this analysis (aged 65-104, x̅ = 81.8, 68.8% female). Most (92%) use NPIs for chronic pain management: 85.6% use active NPIs, 50.4% active movement and only 5.6% use solely passive approaches. Most common NPIs are distraction, thermotherapy/compresses, and physiotherapy. The odds of utilizing physiotherapy are three times higher for those with high educational status when compared to those with low education while those with low educational status had higher odds of using thermotherapy/compresses.

Conclusions
In our sample, most community-dwelling older adults with a certified need of care use active NPIs for chronic pain management with about half using active movement approaches. Considering the high vulnerability of this population, physiotherapy (in the form of therapeutic exercise) is a particularly appropriate intervention, and it was the third most frequent NPI in our sample. However, there is a social gradient in the utilization of physiotherapy for chronic pain management which might be rooted in issues around awareness, appeal, and access to such measures. It is important to take socioeconomic differences into account when planning the care for older chronic pain patients but also when designing research or user-friendly guidelines for this target group.

Trial registration
Ethical approval from the Ethics Committee of Charité - Universitätsmedizin Berlin (EA1/368/14) and study registration with the Central Study Register (ZSR no. 20009093).