bluuebunny/crossref_metadata_2025_split huggingface dataset:
Goggle Versus Remote-Camera Video Head Impulse Test Device Comparison
Authors: Janky Kristen L. , Patterson Jessie N. , Vandervelde Casey 
Published: July 2024

Objectives:
This study compared remote versus goggle video head impulse testing (vHIT) outcomes to validate remote-camera vHIT, which is gaining popularity in difficult to test populations.

Design:
Seventeen controls and 10 individuals with vestibular dysfunction participated. Each participant completed remote-camera and goggle vHIT. The main outcome parameters were canal gain, frequency of corrective saccades, and a normal versus abnormal rating.

Results:
Horizontal and vertical canal vHIT gain was significantly lower in the vestibular compared with the control group; remote-camera gains were significantly lower compared with goggle gain for the vestibular group only. The devices categorized control versus vestibular canals identically except for one vertical canal. In the vestibular group, there was not a significant difference in the percentage of compensatory saccades between devices.

Conclusion:
These data provide validation that results obtained with a remote-camera device are similar to those obtained using a standard goggle device.
Refining Field Cancerization: An Institutional Cohort Analysis of Patient Characteristics in a Validation Cohort
Authors: Thomas Sierra I. , Taylor Mitchell A. , Plampton Katherine , Sharma Divya , Samson Kaeli K. , Wysong Ashley , Sutton Adam 
Published: July 2024

BACKGROUND
Field cancerization is poorly defined in dermatology. The author group previously proposed and applied a classification system in an original cohort to risk-stratify patients with field cancerization.

OBJECTIVE
Apply the authors' classification system within a validation cohort.

METHODS
Patients with keratinocyte carcinoma history completed a survey regarding demographic information, medical history, and chemoprevention use. Patients were assigned a field cancerization class, and differences between validation and original cohorts were assessed.

RESULTS
A total of 363 patients were enrolled (mean age 67.4; 61.7% male). After comparing validation and original cohorts, there were differences in age between class II (p = .02) and class IVb (p = .047), and differences in chemoprevention use in class III (p = .04). Similar to the original cohort, the validation cohort was associated with increases in total number of skin cancers in the last year (p < .001), 5 years (p < .001), lifetime (p < .001), years since first skin cancer (p < .001), and chemoprevention use (p < .001). In the validation cohort, there were increases in age (p = .03) and immunocompromised status (p = .04) with increasing class, which were not observed in the original cohort.

CONCLUSION
Differences among field cancerization classes were similar in a validation cohort, further highlighting the importance of class-specific treatment and management.
Switching Vancomycin Monitoring From Trough Concentration to Area Under the Curve Estimation by Bayesian Forecasting: A Short Communication on a Cost-Benefit Study in Resource-Limited Settings
Authors: Telles João Paulo , Coelho Diogenes , Migotto Karen Cristina , Diegues Mariana Suelotto , Leao Erica Rocha , Reghini Rodrigo , Martinez Martos Natalia , Caruso Pedro , França e Silva Ivan Leonardo 
Published: July 2024

Background:
This study was conducted to evaluate the cost-benefit indicators of a vancomycin monitoring protocol based on area under the curve estimation using commercial Bayesian software.

Methods:
This quasi-experimental study included patients who were aged >18 years with a vancomycin prescription for >24 hours. Patients who were terminally ill or those with acute kidney injury (AKI) ≤24 hours were excluded. During the preintervention period, doses were adjusted based on the trough concentration target of 15–20 mg/L, whereas the postintervention period target was 400–500 mg × h/L for the area under the curve. The medical team was responsible for deciding to stop the antimicrobial prescription without influence from the therapeutic drug monitoring team. The main outcomes were the incidence of AKI and length of stay. Cost-benefit simulation was performed after statistical analysis.

Results:
There were 96 patients in the preintervention group and 110 in the postintervention group. The AKI rate decreased from 20% (n = 19) to 6% (n = 6; P = 0.003), whereas the number of vancomycin serum samples decreased from 5 (interquartile range: 2–7) to 2 (interquartile range: 1–3) examinations per patient (P < 0.001). The mean length of hospital stay for patients was 26.19 days after vancomycin prescription, compared with 17.13 days for those without AKI (P = 0.003). At our institution, the decrease in AKI rate and reduced length of stay boosted yearly savings of up to US$ 369,000 for 300 patients receiving vancomycin therapy.

Conclusions:
Even in resource-limited settings, a commercial Bayesian forecasting–based protocol for vancomycin is important for determining cost-benefit outcomes.
Unmatched. What’s Next? Is a Preliminary Year of Residency or Research Fellowship Better for Reapplicants to Plastic Surgery?
Authors: George Robert E. , Bay Caroline C. , Thornton Sarah M. , Zhong Tammy , Feeley Lauren P. , Schappe Alyssa M. , Dingle Aaron M. , Poore Samuel O. 
Published: July 2024

Background:
Plastic and reconstructive surgery is one of the most competitive residency programs, and given the increased number of applicants for a relatively fixed number of positions, successfully matching is a challenge. Match rates have declined since 2018, with a match rate of ~55% in 2022. Two common options before reapplying are a preliminary year of residency (preliminary year) or a research fellowship. This study investigated which option is more beneficial for reapplicants seeking a successful match.

Methods:
This retrospective study included all applicants to an integrated plastic and reconstructive surgery residency from 2015 to 2023. Two cohorts based on reapplication strategy (research fellowship or preliminary year) were created. Demographic, applicant, and match data were collected. Pearson chi-squared, Fisher exact, and Wilcoxon rank sum testing were performed.

Results:
In total, 125 reapplicants were included. Seventy-one (56.8%) reapplicants pursued a preliminary year, and 29 (23.2%) completed a research fellowship. Research fellowship reapplicants had a greater mean number of first author publications (8.8 versus 3.2, P < 0.001), non-first author publications (11.3 versus 5.9, P = 0.021), poster presentations (9.7 versus 6.0, P = 0.028), and oral presentations (11.8 versus 6.4, P < 0.001). Research fellowship reapplicants were more likely to match into plastic and reconstructive surgery (PRS) than preliminary year reapplicants, with 72.4% (n = 21) of research fellowship reapplicants matching into PRS compared with 39.4% (n = 28) of preliminary year reapplicants (P = 0.003).

Conclusions:
Research fellowship reapplicants demonstrated greater research productivity and were almost twice as likely to match into PRS compared with preliminary reapplicants.
Taurine-conjugated bile acids and their link to hepatic S1PR2 play a significant role in hepatitis C–related liver disease
Authors: Ali Rabab O. , Haddad James A. , Quinn Gabriella M. , Zhang Grace Y. , Townsend Elizabeth , Scheuing Lisa , Hill Kareen L. , Menkart Matthew , Oringher Jenna L. , Umarova Regina , Rampertaap Shakuntala , Rosenzweig Sergio D. , Koh Christopher , Levy Elliot B. , Kleiner David E. , Etzion Ohad , Heller Theo 
Published: July 2024

Background:
Bile acids mediate gut-liver cross-talk through bile acid receptors. Serum, hepatic, and microbial bile acid metabolism was evaluated in HCV-compensated chronic liver disease.

Methods:
Patients underwent liver biopsy; portal and peripheral blood were obtained before (HCVi), and 6 months after sustained virologic response (SVR), splenic blood was obtained only after SVR. The fecal microbiome and liver transcriptome were evaluated using RNA-Seq. Twenty-four bile acids were measured in serum, summed as free, taurine-conjugated bile acids (Tau-BAs), and glycine-conjugated bile acids.

Results:
Compared to SVR, HCVi showed elevated conjugated bile acids, predominantly Tau-BA, compounded in HCVi cirrhosis. In the liver, transcription of bile acids uptake, synthesis, and conjugation was decreased with increased hepatic spillover into systemic circulation in HCVi. There was no difference in the transcription of microbial bile acid metabolizing genes in HCVi. Despite an overall decrease, Tau-BA remained elevated in SVR cirrhosis, mainly in splenic circulation. Only conjugated bile acids, predominantly Tau-BA, correlated with serum proinflammatory markers and hepatic proinflammatory pathways, including NLRP3 and NFKB. Among hepatic bile acid receptors, disease-associated conjugated bile acids showed the strongest association with hepatic spingosine-1-phosphate receptor 2 (S1PR2).

Conclusions:
Enhanced expression of hepatic S1PR2 in HCVi and HCVi-cirrhosis and strong associations of S1PR2 with Tau-BAs suggest pathological relevance of Tau-BA-hepatic S1PR2 signaling in chronic liver disease. These findings have therapeutic implications in chronic liver diseases.
Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) associated with Paracentral Acute Middle Maculopathy (PAMM) and Cilioretinal Artery Occlusion (CILRAO): multimodal imaging of a newly described clinical association.
Authors: Coletto Andrea , Serafino Sonia , Marica Valentina , Olivieri Chiara , Marolo Paola , Parisi Guglielmo , Reibaldi Michele , Borrelli Enrico 
Published: July 2024

Purpose:
To report multimodal imaging features of a novel association of non-arteritic anterior ischemic optic neuropathy (NAION), paracentral acute middle maculopathy (PAMM), and cilioretinal artery occlusion (CILRAO).

Methods:
A 74-year-old male patient presented complaining of an acute subjective decline in visual acuity in the right eye over the previous days. This patient underwent a comprehensive ophthalmological assessment, including multimodal retinal imaging and visual field test.

Results:
The eye examination revealed yellowish optic disc edema in the right eye with peripapillary hemorrhages and a whitish lesion extending from the temporal margin of the optic nerve head towards the macula. Multimodal imaging confirmed the diagnosis of NAION in the right eye. Notably, the structural B-scan and en face OCT images revealed hyperreflective areas in the inner and mid retinal layers, indicating an association with CILRAO and PAMM.

Conclusion:
We herein describe the clinical findings of a previously unreported association among NAION, CILRAO and PAMM.
Persistent opioid use after hospital admission due to trauma: a population-based cohort study
Authors: Gong Jiayi , Beyene Kebede , Yan Chan Amy Hai , Frampton Chris , Jones Peter 
Published: July 2024

Abstract
Persistent opioid use (POU) is a common marker of harm related to opioid use after trauma. This study determined the incidence and risk factors for POU after hospitalisation due to trauma in New Zealand, among opioid-naïve patients. This was a population-based, retrospective cohort study, using linked data, involving all trauma patients of any age admitted to all NZ hospitals between 2007 and 2019. We included all patients who received opioids after discharge and were considered opioid naïve, defined as not having received opioids or not having a prior diagnosis of opioid-use disorder up to 365 days preceding the discharge date. The primary outcome was the incidence of POU defined as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify independent risk factors for POU. A total of 177,200 patients were included in this study. Of these, 15.3% (n = 27,060) developed POU based on criteria used for the primary analysis, with sensitivity analyses showing POU incidence ranging from 14.3% to 0.8%. The opioid exposure risk factors associated with POU included switching between different opioids (adjusted odds ratio [aOR] 2.62; 95% confidence interval [CI] 2.51-2.73), prescribed multiple opioids (vs codeine, aOR 1.44; 95% CI 1.37-1.53), slow-release opioid formulations (aOR 1.32; 95% CI 1.26-1.39), and dispensed higher total doses of on the initial discharge prescription (aOR 1.26; 95% CI 1.20-1.33). Overall, 1 in 7 opioid-naïve patients who were exposed to opioids after trauma developed POU. Our findings highlight clinicians should be aware of these factors when continuing opioids on discharge.
A Multidisciplinary Approach to Increase Dysphagia Compliance in Stroke Patients
Authors: Serber Stacy L. , Wachtel Noah , Fox Madison , Petrushonis Corrine 
Published: July 2024

ABSTRACT

BACKGROUND: The objective was to optimize conditions that increase dysphagia compliance after stroke—a measure recognized by The Joint Commission in designating institutions as primary or comprehensive stroke centers and by the American Heart Association that promotes stroke treatment adherence and bestows achievement and quality awards. Failure to meet stroke measures, including medication documentation, may produce poor patient outcomes that directly affect consumer confidence and choice of treatment facility. Stroke patient care requires multidisciplinary team collaboration to manage multiple factors; variations in practice create fallouts that need correction, the absence of which jeopardizes standards for maintaining stroke center designation. PURPOSE: Aims were to determine the nature of dysphagia fallouts in our quaternary academic teaching hospital, assess multidisciplinary workflows and barriers to success, and develop strategies to enhance dysphagia compliance. DESCRIPTION: We used a multidisciplinary approach using James Reason's Swiss cheese model to examine compliance. The clinical nurse specialist interviewed physicians, advanced practice providers, pharmacists, speech-language pathologists (SLPs), nurses, and informaticists to ascertain discipline-specific success barriers, targeting top issues for each discipline to develop solutions. Unit educators unified their dysphagia reduction strategies; physicians, pharmacists, and informaticists collaborated to clarify standardized medication route orders and to increase electronic health record swallow screen visibility to multidisciplinary users; and SLPs adjusted workflow and documentation. EVALUATION: Outcomes included reinforcing correct nursing charting, pharmacy oral-to-feeding tube conversion order revision, optimization of delivery and awareness of medication routes, electronic health record system enhancements, and SLPs aligning documentation with nursing medication administration. The multidisciplinary approach proved successful and increased dysphagia compliance by 9.6% (P = .001). These outcomes contributed to a successful The Joint Commission survey, redesignation as a comprehensive stroke center, and American Heart Association Gold Plus achievement award.
Unveiling the prognostic role of blood inflammatory indexes in a retrospective cohort of patients undergoing liver resection for intrahepatic cholangiocarcinoma
Authors: Milana Flavio , Polidoro Michela A. , Soldani Cristiana , Franceschini Barbara , Famularo Simone , Di Tommaso Luca , Terracciano Luigi M. , Lleo Ana , Donadon Matteo , Torzilli Guido 
Published: July 2024

Background:
Systemic inflammation is relevant in intrahepatic cholangiocarcinoma (iCCA), but controversial results exist on the prognostic role of inflammatory indexes and their correlation with tumor microenvironment. The authors aimed to explore the biological and prognostic values of these indexes.

Materials and methods:
A retrospective cohort study involving iCCA patients who underwent hepatic resection between 2010 and 2021 was conducted. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and clinic-pathological factors were recorded. Immune-cell subpopulations, isolated from surgical specimens, were analyzed by flow cytometry. NLR and LMR cut-offs were calculated by X-Tile software. Linear regression, Kaplan–Meier, and Cox regression analyses were conducted.

Results:
A total of 101 iCCA patients were considered. NLR ≥3.83 and LMR <2.28 correlated with worse survival. Patients were divided into groups: 67 (66.3%) in the low-risk and 34 (33.7%) in the high-risk (having at least one worse prognostic ratio). The 5-year overall survival was 49.8 and 18.9% for low- and high-risk groups, respectively (P=0.003). An elevated CA19-9 in the high-risk group gives 2.148 HR (95% CI: 1.060–4.349) of mortality and 2.182 HR (95% CI: 1.206–3.948) of disease recurrence. Flow cytometry analysis of 20 surgical specimens highlighted that NLR was associated with tumor-derived NLR (P=0.026) and LMR with tumor-infiltrating lymphocytes (P=0.002). In a subset of five high-risk vs five low-risk patients, T-cell evaluation showed a higher prevalence of CD4+ compared to CD8+ cells in the high-risk group (78.5 vs. 21.5%, P<0.0001). Conversely, low-risk patients demonstrated a noteworthy infiltration of CD8+ cells compared to the high-risk group (21.5 vs. 48.7%, P=0.037).

Conclusions:
The combination of blood inflammatory indexes determined two survival-risk profiles. The correlation between the blood scores and the iCCA microenvironment suggests a link between immune-cell infiltration and the risk group. These findings open the possibility of patient stratification with the chance to identify subgroups suitable for dedicated follow-up and targeted immuno-chemotherapy protocols.
Epithelioid trophoblastic tumor with lung metastasis: A case report and literature review
Authors: Li Jing , Du Zhenwu , Xu Tianmin , Li Chenhong , Ba Shumin , Zhu He 
Published: July 2024

Rationale:
Epithelioid trophoblastic tumor (ETT) is an extremely rare variant of gestational trophoblastic neoplasms (GTNs). The biological behavior and therapeutic schedule of ETT remains to be defined which frequently poses diagnostic and therapeutic challenges. Although ETT is a relatively indolent malignancy tumor, the therapeutic efficacy and survival rate decrease significantly when presented with metastases. The lung is the most common site of ETT metastasis.

Patient concerns:
A 39-year-old female patient presented with irregular vaginal bleeding and slight distention pain in lower abdomen.

Diagnoses:
The patient was diagnosed ETT with lung metastasis after surgery and immunohistochemical staining.

Interventions:
A total abdominal hysterectomy plus bilateral salpingectomy and histopathology were performed. The patient received 3 cycles of etoposide, methotrexate, actinomycin-D/etoposide, cisplatin (EMA/EP) regimen chemotherapy after surgery. Due to the presence of lung metastasis, she received pulmonary lesion resection and another cycle of postoperative chemotherapy.

Outcomes:
The patients showed a good response to treatment initially. However, the patient did not complete the full initial treatment for family reasons and had signs of recurrence after 2.5 months. The serum β-hCG level gradually elevated and the lung imaging showed that the lesion area gradually expanded. After 15 months of follow-up, the patient declined further treatment due to a lack of presenting symptoms.

Lessons:
The diagnosis of ETT should be taken into consideration in patients with abnormal vaginal bleeding and low levels of β-hCG. Patients with metastatic disease should be treated with complete surgical resection and intensive combination chemotherapy to maximize the opportunity for cure. Targeted biological agents might be potential therapeutic strategies for chemotherapy-resistant or recurrent patients.
Efficacy and safety of BaitouWeng decoction for ulcerative colitis: A meta-analysis of randomized and controlled trials
Authors: Xie Qian , Yu Wenlong , He Yuancong , Deng Guocheng , Yang Hongyan , Chen Jiarou , Liang Jianlong , Zeng Xuxin , Guo Jialiang , Ma Rong 
Published: July 2024

Background:
To systematically evaluate the therapeutic effect of BaitouWeng Decoction in patients with ulcerative colitis (UC), evaluate its safety and effectiveness, and provide a reference for clinical medication.

Methods:
The research literature on the treatment of UC with BaitouWeng Decoction was searched in databases such as China National Knowledge Infrastructure, Wanfang Data, VIP database for Chinese Technical Periodicals, Chinese BioMedical Literature Database, and PubMed. The literature was screened by setting inclusion and exclusion criteria, strictly following the inclusion and exclusion criteria, and following the search strategy for literature screening, data extraction, and methodological quality evaluation. According to the Cochrane System Evaluation Manual, methodological quality evaluation was conducted on the included studies using the bias risk assessment tool for randomized controlled trials. For meta-analysis, Review Manager software was used.

Results:
A total of 24 articles were included, including 2131 patients. Meta-analysis showed that compared with conventional Western medicine, BaitouWeng Decoction can significantly improve the effective rate (odds ratio = 5.10, 95% confidence interval [CI] [3.74–6.96], P < .00001), reduce the traditional Chinese medicine syndrome score (mean difference [MD] = −4.23, 95% CI [−5.17–−3.30], P < .00001), Baron endoscopic score (MD = −0.68, 95% CI [−0.78–−0.58], P < .00001), and intestinal lesion activity score (MD = −2.29, 95% CI [−1.15–−1.03], P < .00001); improve serum factors and reduce serum tumor necrosis factor α levels (MD = −16.84, 95% CI [−19.92–−13.76], P < .00001), serum interleukin-8 levels (MD = −10.41, 95% CI [−10.87–−9.95], P < .00001), and increased serum interleukin-10 levels (MD = 4.96, 95% CI [2.76–7.16], P < .00001).

Conclusion:
BaitouWeng Decoction has good efficacy and safety in treating UC. BaitouWeng Decoction improved the symptoms of colitis injury and inhibited inflammatory response. However, more rigorously designed randomized controlled trials with blinding, concealment, and placebo controls should be conducted on Baitouweng decoction to generate higher quality evidence and longer-term studies on sustained benefits are needed.
Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke
Authors: Choi Jong-Bae , Cho Kyung-In 
Published: July 2024

Background:
This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke.

Methods:
This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl–Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen–Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation.

Results:
In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01).

Conclusion:
The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.