bluuebunny/crossref_metadata_2025_split huggingface dataset:
HAZMAT Technician-level Emergency Response: A Mental Model Framework for Radiological Dispersal Device (RDD) Incidents
Authors: Leek Angela E. , Keren Nir , Blumenthal Daniel , Irwin William , Musolino Stephen 
Published: June 2024

Abstract
This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are conventional explosive devices with radioactive materials incorporated. The objective is to introduce the Expected Mental Model State (EMMS) as a comprehensive evaluation tool for assessing and enhancing the expertise and situational awareness of emergency responders dealing with radiation crises. Through a series of expert focus group sessions using the well-established qualitative methodology of grounded theory, an Expected Mental Model State (EMMS) was developed. The methodology used an influence diagram architecture to conceptually capture and codify key areas relevant to effective emergency response. The research identifies fourteen EMMS key conceptual domains, further elaborated into 301 subtopics, providing a multi-dimensional structure for the proposed mental model framework. Three pivotal notions of mental model emerged within the EMMS framework: Knowledge Topology, Envisioning (Belief), and Response and Operability. These notions were found to align with previous theories of mental models and are vital for understanding how HAZMAT technicians conceptualize and respond to RDD incidents. The study emphasizes the critical role of mental models in enhancing preparedness and effective response strategies during radiation emergencies. The EMMS framework offers a versatile methodology that can be adapted across various kinds of emergency responders and high-risk situations, including the broader Chemical, Biological, Radiological, and Nuclear (CBRN) spectrum. Using this EMMS framework to develop an EMMS Diagnostic Matrix can provide a roadmap for identifying areas for the development of specialized training modules that have the potential to significantly elevate both the quality and efficacy of responder training and preparation.
Emerging alternatives to keratoplasty for corneal endothelial cell dysfunction
Authors: Kaufman Ron , Jun Albert S. 
Published: June 2024

Purpose of reviewWhile effective for treating endothelial dysfunction, keratoplasty has shortcomings including limited access to donor tissue for much of the world. Thus, alternative strategies are under development. This review explores the main advancements achieved in this field during 2022–2023.Recent findingsRecent publications further support the validity of intracameral cultivated allogeneic endothelial cell injection and Descemet stripping only, while emphasizing the benefits of adjunctive Rho-associated kinase inhibitor (ROCKi) therapy. New donor-independent artificial implants, such as EndoArt, show favorable results. Multiple pharmacologic agents, especially ROCKi, show promise as monotherapies, yet none are currently approved for human treatment. Multiple regenerative and genetic therapies are being investigated but all are still in preclinical stages.SummaryA plethora of innovative alternatives to keratoplasty for endothelial disease is in development. Among these, surgical methods are still the mainstay of treatment and closest to clinical application, though further studies to establish their benefits over keratoplasty are needed. Albeit promising, pharmacologic, regenerative, and genetic approaches require validation and are farther from clinical application.
Neuromuscular electrical stimulation, muscle mass, and physical function decline in the early phase after living donor liver transplantation
Authors: Yoshioka Yuji , Oshima Yohei , Sato Susumu , Tamaki Akira , Hamada Ryota , Miyasaka Junsuke , Hata Koichiro , Ito Takashi , Ikeguchi Ryosuke , Hatano Etsuro , Matsuda Shuichi 
Published: June 2024

This study aims to investigate the effects of neuromuscular electrical stimulation (NMES) in addition to conventional early mobilization in the early postoperative period after living donor liver transplantation (LTx) on body composition and physical function. This was a retrospective single-center cohort study. Adult subjects who were admitted for living donor LTx from 2018 to 2023 were included in the analysis. After April 2020, patients underwent 4 weeks of NMES in addition to conventional rehabilitation. The skeletal muscle mass index, body cell mass, and physical function, including the 6-minute walking distance, were assessed before surgery and at discharge, and changes in these outcomes were compared before and after the introduction of NMES. Sixty-one patients were in the NMES group, and 53 patients before the introduction of NMES were in the control group. ANCOVA with etiology, obstructive ventilatory impairment, Child-Pugh classification, and initial body composition value as covariates demonstrated that there was a significantly smaller decline of body cell mass (−2.9±2.7 kg vs. −4.4±2.7 kg, p = 0.01), as well as of the skeletal muscle mass index (−0.78±0.73 kg/m2 vs. −1.29±1.21 kg/m2, p = 0.04), from baseline to discharge in the NMES group than in the control group; thus, the decline after surgery was suppressed in the NMES group. Four weeks of NMES, in addition to conventional rehabilitation in the early period after LTx, may attenuate the deterioration of muscle mass. It is suggested that NMES is an option for developing optimized rehabilitation programs in the acute postoperative period after LTx.
Anti-BCMA CAR-T therapy for multiple myeloma with extramedullary disease: A case report and review of the literature
Authors: Shi Huihui , Zhang Man , Su Yajing , Liu Jingwen , Guo Jiayuan , Liu Mingxin , Ma Qiuling 
Published: June 2024

Introduction:
Multiple myeloma (MM) with extramedullary disease (EMD) is rare in clinical practice, and B cell maturation antigen (BCMA) CAR-T cell therapy is a novel therapy for hematologic malignancies. Very few reports have been published on the effect of CAR-T-cell therapy in MM with EMD. Here, we report a case of MM with extramedullary lesions treated with BCMA CAR-T therapy.

Case presentation:
A 66-year-old female patient presented to our hospital with an enlarged left maxillary gingiva.

Diagnosis:
Diagnosis of indolent MM stage III (DS staging) and stage III (ISS and R ISS) with extramedullary lesions.

Intervention:
The patient underwent a clinical trial of humanized anti-BCMA CAR T cell therapy.

Results:
Symptoms improved; left gingival hyperplasia and swelling resolved; left buccal mass resolved; and neck and submandibular masses resolved. Pathological examination of the exfoliated masses showed necrotic tissue.

Conclusion:
MM with extramedullary lesions often has limited treatment options, and traditional chemotherapy methods are ineffective; however, BCMA CAR-T cell therapy can significantly improve the symptoms of extramedullary lesions in MM.
The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis
Authors: Cheng Min , He Mei , Ning Liping , Gan Haoyue , Liu Qin , Liu Hangcheng , Shi Feifei , Luo Ying 
Published: June 2024

Background:
Frailty has been identified as a risk factor for adverse outcomes in older adults with diabetes. This study aimed to investigate the impact of frailty on the prognosis of older adults with diabetes through a systematic review and meta-analysis, with the goal of offering insights for clinical decision-making.

Methods:
PubMed, Web of Science, Embase, Cochrane were systematically searched from inception to September 10th, 2023. Reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. The primary outcomes of this study were mortality, hospitalization and disability, and the secondary outcomes were diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia) and urolithiasis.

Results:
A total of 14 studies were included in this study, with low risk of bias and moderate to good quality. The results showed that frailty increased the risk of mortality (HR 1.91, 95% CI 1.55–2.35, P < .001), hospitalization (HR 2.19, 95% CI 1.53–3.13, P < .001), and disability in older adults with diabetes (HR 3.84, 95% CI 2.35–6.28, P < .001). In addition, frailty was associated with diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia), urolithiasis.

Conclusions:
Frailty is an important predictor of adverse outcomes, such as mortality, hospitalization, and disability in older adults with diabetes. Accurate assessment of the frailty in older adults with diabetes can help improve the adverse outcomes of patients.
Effectiveness and safety of Chaihu-Shugan-San for treating depression based on clinical cases: An updated systematic review and meta-analysis
Authors: Zhang Xiaohang , Zhao Qiulong , Wang Yang , Mao Yaqing , Sun Yue , Bian Xiaokun 
Published: June 2024

Background:
Chaihu-Shugan-San (CSS), a Traditional Chinese Medicine formula, has been widely used for treating depression since the Ming Dynasty, as recorded in Jingyue Quanshu, but its effectiveness and safety lack comprehensive and objective evaluation. Based on our meta-analysis, we aimed to adequately evaluate the efficacy and risk of CSS by considering the latest clinical literature.

Methods:
Multiple databases, including PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang, were used to collect clinical data. The quality of the included clinical studies was assessed using the Cochrane Risk of Bias Tool, and the data were meta-analyzed using Review Manager 5.0 and Stata 17. The data were obtained from a genome-wide association study, and Mendelian randomization (MR) was performed using R Software 4.3.2 with the TwoSampleMR and MR Pleiotropy RESidual Sum and Outlier packages.

Results:
A total of 15 studies with 1034 patients and 6 antidepressant drugs were included in this work. Meta-analyses revealed that drug combinations of CSS and antidepressants significantly improved depressive symptoms (weighted mean difference = −4.21; 95% confidence interval [CI]: −5.62–−2.81), increased the effective rate (odds ratio [OR] = 3.82; 95% CI: 2.44–6.83), and reduced side effects (OR = −3.55; 95% CI: −5.66–−1.43) compared with antidepressant monotherapy. Additionally, compared with antidepressant monotherapy, CSS alone exhibited fewer side effects (95% CI:−9.25–−6.95). Like antidepressants, CSS also improved depressive symptoms (weighted mean difference = −0.05; 95% CI: −0.63–−0.52) and increased the effective rate (OR = 1.07; 95% CI: 0.52–2.20). Additionally, MR was used to evaluate the safety of traditional antidepressants, as there was a causal association between amitriptyline and body mass index.

Conclusion:
This analysis demonstrated that compared with traditional antidepressants, CSS combined with antidepressants was more effective and safer for treating depressed patients. MR showed that a causal relationship may exist between amitriptyline and body mass index. Therefore, clinicians should carefully consider the advantages and potential drawbacks of Traditional Chinese Medicine and classic drugs to serve patients better.
Neutrophil to lymphocyte ratio as a prognostic marker for cardiovascular outcomes in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis
Authors: Ul Hussain Hassan , Kumar Kanwal Ashok , Zahid Marium , Husban Burney Muhammad , Khan Zayeema , Asif Muqaddus , Rehan Syeda Tayyaba , Ahmad Cheema Huzaifa , Swed Sarya , Yasmin Farah , Ullah Waqas , Alraies M. Chadi 
Published: June 2024

Background:
Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR’s efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).

Methods:
Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072).

Results:
A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93–4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00–1.14), (RR = 3.32; 95% CI = 2.57–4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04–3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06–10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17–1.46), long-term MACE (RR = 2.92; 95% CI = 2.16–3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40–0.79) in patients with high NLR compared to those with a low NLR.

Conclusion:
NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI.
A cross-sectional study of university students’ awareness, knowledge, and attitudes on organ donation and transplantation in Northern Cyprus
Authors: Bayraktar Necmi , Bayraktar Ümmü 
Published: June 2024

Background:
Understanding the knowledge and attitudes of university students regarding organ transplantation and donation is crucial, as these students can significantly influence public opinion and behavior. This study aims to assess the knowledge and attitudes of North Cyprus University students towards organ transplantation and donation.

Methods:
A cross-sectional study was conducted with 400 students from Northern Cyprus University, divided into medical and social science faculties. A structured questionnaire was utilized to assess their knowledge and attitudes towards organ transplantation and donation. Descriptive statistics, Chi-square tests, and effect size calculations were employed for data analysis.

Results:
Among the 400 students, 27% demonstrated sufficient knowledge of organ transplantation, and 62.7% had positive views on organ donation. Willingness to donate was expressed by 37% as living donors and 64% as deceased donors. There were no significant differences in knowledge and attitudes between medical and social science students. Factors such as sex, marital status, faculty, and contact with individuals with end-stage organ failure did not significantly influence the knowledge and attitudes.

Conclusions:
This study highlights the necessity for educational interventions and awareness campaigns to improve understanding and attitudes towards organ donation among Northern Cyprus University students. Incorporating organ donation education into university curricula, providing accurate online information, addressing misconceptions, and promoting awareness of donation centers and transplant hospitals are essential steps to mitigate organ shortages. Public engagement should be encouraged to foster a supportive environment for organ donation.
Hydromorphone combined with ropivacaine for erector spinae plane block in patients undergoing modified radical mastectomy: A prospective randomized controlled trial
Authors: Cao Xue , Bao Malian , Ma Yuhua , Ren Jie , Ma Weiwei , Bao Yongli , Ma Changfei , Sui Xin , Nie Yongzhen 
Published: June 2024

Background:
Combining hydromorphone with ropivacaine in ultrasound-guided erector spinae plane blocks enhances postoperative analgesia and reduces interleukin-6 expression in breast surgery patients.

Methods:
In this study, breast cancer patients undergoing modified radical mastectomy were randomized into 3 groups for anesthesia (30 patients in each group): standard general (group C), Erector Spinae Plane Block (ESPB) with ropivacaine (group R), and ESPB with ropivacaine plus hydromorphone (group HR). Diagnosis: Breast cancer patients. Postsurgery, pain levels, IL-6, anesthetic doses, additional analgesia needs, and recovery milestones were compared to evaluate the efficacy of the ESPB enhancements.

Results:
The 3 groups were not significantly different in baseline characteristics, operation time, number of cases with postoperative nausea, and serum IL-6 concentrations at T1 (the time of being returned to the ward after surgery). At T2 (at 6:00 in the next morning after surgery), the serum IL-6 concentration in group HR was significantly lower than that in groups R and C (P < .05); the intraoperative doses of remifentanil, sufentanil, and propofol were significantly lower in groups HR and R than those in group C (P < .05); Groups HR and R had significantly lower visual analog scale scores at T3 (4 hours postoperatively), T4 (12 hours postoperatively), and T5 (24 hours postoperatively) than those in group C (P < .05); the proportions of patients receiving postoperative remedial analgesia were significantly lower in groups HR and R than in group C (P < .05); groups HR and R had significantly lower proportions of patients with postoperative nausea than group C (P < .05); the time to the first anal exhaust and the time to the first ambulation after surgery were significantly shorter in groups HR and R than those in group C (P < .05).

Conclusion:
Hydromorphone combined with ropivacaine for ESPB achieved a greater postoperative analgesic effect for patients receiving MRM under general anesthesia. The combined analgesia caused fewer adverse reactions and inhibited the expression level of the inflammatory factor IL-6 more effectively, thereby facilitating postoperative recovery. ESPB using hydromorphone with ropivacaine improved pain control post-MRM, reduced adverse effects, and more effectively suppressed IL-6, enhancing recovery.
A concept analysis of ageism from older adults’ perspective: a hybrid model
Authors: Goudarzian Amir Hossein , Abdi Kamel , Taebi Mozhgan , Sayahi Somaye , Wibisono Ahmad Hasyim , Allen Kelly A. , Yaghoobzadeh Ameneh 
Published: June 2024

Introduction:
Iran follows global trends with a growing aging population. To better understand ageism in Iranian context, the present study explores the concept using a hybrid model with both inductive and deductive approaches.

Methods:
A hybrid concept analysis model was used to further define the concept of ageism. In the first step, databases such as PubMed, Web of Knowledge, Science Direct, and Google Scholar were searched for studies up until August 2019. Key terms used in the search included “ageism”, “stereotype”, “discrimination”, “age”, “aging” “old”, and “elder”. Subsequently, semi-structured interviews were conducted with 10 community-dwelling older adults chosen through purposive sampling.

Results:
Data from the theoretical and fieldwork phases presented a definition of ageism: “Ageism engrained into older adults (no other age groups) is associated with personal, psycho-social, economic, and especially cultural factors that impose an acceptance of limitations based on chronological age or being perceived as old”.

Conclusion:
Ageism is a multi-faceted experience composed of psycho-social, economic, and cultural dimensions. While the present study has further clarified ageism, more research is needed, particularly in relation to diverse cultural contexts.
Neurofibromatosis to neoplasia transition: a rare case report of spindle cell malignant peripheral nerve sheath tumor with literature review
Authors: Abdallah Adam M. , Odat Ramez M. , Hanifa Hamdah , Shakhatreh Zaid , Sharqiah Qosay M. , Daoud Suleiman 
Published: June 2024

Introduction and importance:
Malignant peripheral nerve sheath tumor (MPNST) is a rare and aggressive soft tissue malignant tumor. MPNST in the spinal canal is rarely seen except in cases of neurofibromatosis type 1. However, a long-segment extradural spinal malignant spindle cell neoplasm has not been reported in the current literature.

Case presentation:
We present the first reported case of spinal malignant spindle cell neoplasm extended along the spine. The detected lesion is responsible for compressing various segments of the spinal cord, causing thinning of the cord and secondary stenosis of the spinal canal, leading to a condition known as multisegment compression myelopathy.

Clinical discussion:
MPNSTs are typically detected late due to nonspecific symptoms, with a higher incidence in extremities and a notable occurrence in unusual locations. Diagnosis relies on MRI and histopathology, with S_100 positivity as a neural marker. MPNSTs can arise from neurofibromas or Schwann cells, with a significant portion resulting from TP53 mutations or secondary to radiation exposure.

Conclusion:
This case stands out due to its unique presentation, characterized by a predominantly spindle cell morphology with certain epithelioid features. It is imperative to recognize this condition for an accurate diagnosis, emphasizing the spindle cell-type MPNST and highlighting its exceptionally poor prognosis.
Infection-associated hemophagocytic lymphohistiocytosis: a case report
Authors: Chand Abhimanyu , Malbul Kiran , Thapa Ashish , Shrestha Merry , Bhandari Santosh Bikram , Adhikari Prabhat 
Published: June 2024

Introduction:
Hemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory disorder characterized by fever, cytopenia, splenomegaly, and hemophagocytosis. Without prompt treatment, HLH can rapidly progress to life-threatening multiorgan failure. The authors present a case of occult HLH with severe bicytopenia and organ dysfunction requiring intensive care.

Case presentation:
A 20-year-old male presented with fever, cough, and constitutional symptoms. He developed hypoxia, elevated transaminases, and bicytopenia. Despite transfusions, platelet counts remained critically low. With high suspicion for HLH, head computed tomography and bone marrow biopsy was although panned but couldn’t be performed due to resource less settings. And with suspicion for HLH treatment with high-dose dexamethasone was initiated as counts improved.

Clinical course:
The patient required mechanical ventilation for pulmonary infiltrates. He exhibited seizure activity and epistaxis related to coagulopathy. On hospital day 9, he was successfully extubated as counts normalized. He was discharged from the intensive care unit once stable.

Conclusion:
This case illustrates a delayed diagnosis of HLH masquerading as a fever of unknown origin. HLH should be urgently considered in patients with unexplained cytopenia, organ dysfunction, and systemic inflammation. Early treatment with immunotherapy can be lifesaving, whereas delays may precipitate irreversible end-organ damage.