bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Factors Associated With Fast Visual Field Progression in Patients With Ocular Hypertension Based on Unsupervised Machine Learning
Authors: Huang Xiaoqin , Poursoroush Asma , Sun Jian , Boland Michael V. , Johnson Chris A. , Yousefi Siamak 
Published: August 2024

Précis:
We developed unsupervised machine learning models to identify different subtypes of patients with ocular hypertension in terms of visual field (VF) progression and discovered 4 subtypes with different trends of VF worsening. We then identified factors associated with fast VF progression.

Purpose:
To identify ocular hypertension (OHT) subtypes with different trends of visual field (VF) progression based on unsupervised machine learning and to discover factors associated with fast VF progression.

Design:
Cross-sectional and longitudinal study.

Participants:
A total of 3133 eyes of 1568 ocular hypertension treatment study (OHTS) participants with at least 5 follow-up VF tests were included in the study.

Methods:
We used a latent class mixed model (LCMM) to identify OHT subtypes using standard automated perimetry (SAP) mean deviation (MD) trajectories. We characterized the subtypes based on demographic, clinical, ocular, and VF factors at the baseline. We then identified factors driving fast VF progression using generalized estimating equation (GEE) and justified findings qualitatively and quantitatively.

Main Outcome Measure:
Rates of SAP mean deviation (MD) change.

Results:
The LCMM model discovered four clusters (subtypes) of eyes with different trajectories of MD worsening. The number of eyes in clusters were 794 (25%), 1675 (54%), 531 (17%), and 133 (4%). We labeled the clusters as improvers (cluster 1), stables (cluster 2), slow progressors (cluster 3), and fast progressors (cluster 4) based on their mean of MD decline rate, which were 0.08, −0.06, −0.21, and −0.45 dB/year, respectively. Eyes with fast VF progression had higher baseline age, intraocular pressure (IOP), pattern standard deviation (PSD) and refractive error (RE), but lower central corneal thickness (CCT). Fast progression was associated with being male, heart disease history, diabetes history, African American race, and stroke history.

Conclusions:
Unsupervised clustering can objectively identify OHT subtypes including those with fast VF worsening without human expert intervention. Fast VF progression was associated with higher history of stroke, heart disease and diabetes. Fast progressors were more from African American race, males, and had higher incidence of glaucoma conversion. Subtyping can provide guidance for adjusting treatment plans to slow vision loss and improve quality of life of patients with a faster progression course.
Two-Year Results of Gonioscopy-Assisted Transluminal Trabeculotomy in Primary Congenital Glaucoma
Authors: El Sayed Yasmine M. , Aboulhassan Reem M. , Gawdat Ghada I. , Feisal Amanne E. , Elhilali Hala M. 
Published: August 2024

Précis:
Gonioscopy-assisted transluminal trabeculotomy yielded a 45% reduction in intraocular pressure in primary congenital glaucoma, with a success rate of 86.6%. Hyphema was the most common complication. We did not encounter any vision-threatening complications.

Background:
To assess the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and identify the potential prognostic factors for adverse outcomes.

Methods:
This prospective study included patients aged <14 years, presenting with PCG from November 2019 till November 2021. We excluded eyes with hazy cornea, secondary glaucoma, peripheral anterior synechiae ≥90 degrees, and eyes in which the extent of GATT was <270 degrees. Success was defined as a final intraocular pressure (IOP) <18 mm Hg with IOP reduction >20%. Primary outcomes were reduction in IOP and medications, secondary outcomes were complications and correlation of IOP reduction and surgical success with possible risk factors.

Results:
We included 60 eyes of 50 patients aged 1–156 months (mean: 25.5±36.5). A 353±21 degrees incision was created, with 85% achieving a 360-degree incision. There was a significant reduction in IOP and medications at all follow-up intervals up to 2 years, with a mean of 45% IOP reduction. The final success rate was 86.6%, with 76.7% being controlled without medications. There was a significant positive correlation between the preoperative cup-to-disc ratio (CDR) and failure rates (P=0.03) and between the incision extent and the IOP reduction (r=0.4, P=0.001). Hyphema was the most common complication, affecting 33%, and resolved spontaneously in all cases. No vision-threatening complications occurred.

Conclusions:
GATT is a safe and effective procedure in eyes with PCG and clear cornea, including eyes that had previous failed glaucoma surgery. Circumferential GATT is associated with more favorable outcomes, while eyes with a larger CDR are at a higher risk for failure.
Effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy: a multicenter retrospective cohort study of 1621 patients
Authors: Yu Xing , Zhu Ruiying , Zhu Peifeng , Du Yu , Tanu Cheerly , Han Zhenyi , Jiang Neng , Pan Lei , Xie Chaoran , Zhao Qunzi , Wang Yong 
Published: August 2024

Background:
Protecting recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN), a crucial indicator for assessing the quality of thyroid surgery, poses a challenge in endoscopic thyroidectomy. The aim of this study was to investigate the effectiveness and feasibility of nerve real-time monitoring and intermittent monitoring in endoscopic thyroidectomy.

Methods:
In this retrospective cohort study, patients underwent endoscopic thyroidectomy were included, and the characteristics and outcomes of real-time monitoring and intermittent monitoring groups were compared. Thereafter, the outcomes of four surgical types (unilateral lobectomy, total thyroidectomy, unilateral lobectomy + lymph node dissection (LND), and total thyroidectomy + LND) were compared in both groups.

Results:
A total of 1621 patients were enrolled. Compared to intermittent monitoring group, real-time monitoring group significantly shortened operation durations in the four surgical types (30.8±6.1 min vs. 35.7±5.7 min, 54.7±4.4 min vs. 59.1±5.2 min, 39.3±4.6 min vs. 42.0±4.7 min, 59.1±4.9 min vs. 66.0±5.8 min, respectively). As for surgical complications, compared to intermittent monitoring group, real-time monitoring group had lower rates of transient vocal cord paralysis among the four surgical types (0.0 vs. 3.3%, 0.0% vs. 4.0%, 0.8 vs. 3.2%, 2.8 vs. 6.7%, respectively), and lower rates of EBSLN injury (1.1 vs. 4.4%, 0.0 vs. 12.0%, 0.8 vs. 3.8%, 0.9 vs. 4.8%, respectively). Clinicopathologic characteristics and postoperative inflammatory reactions were similarly paralleled in both groups.

Conclusion:
Implementation of real-time monitoring in endoscopic thyroidectomy effectively protects the RLN and EBSLN while shortening operation duration, demonstrating its feasibility and efficacy in enhancing nerve protection and surgical efficiency.
Enhancing nurse practitioner research through reflexivity
Authors: Twist Ida , Montgomery Amy , Moxham Lorna 
Published: August 2024

ABSTRACT
This article highlights the essential role of reflexivity in research, using a qualitative project involving interviews with nurse practitioners during the COVID-19 pandemic as an example. It discusses the potential biases inherent in research, particularly when the researcher's experiences closely align with those of the participants. Drawing on the perspective of a nurse practitioner engaged in both research and health care provision, this article explores the importance of reflexivity in addressing these biases. Examining the lead author's experiences conducting interviews with fellow nurse practitioners, the article illustrates how reflexivity was used, particularly in data collection and analysis, to enhance transparency and minimize subjectivity. By advocating for the integration of reflexivity in qualitative research, this article emphasizes the significance of shared experiences between nurse practitioner researchers and participants in reducing biases and improving research outcomes. It demonstrates how reflexivity contributes to a more authentic and comprehensive methodology, especially when researchers share similar experiences with participants. Furthermore, this article offers practical suggestions to assist nurse practitioners in enhancing reflexivity throughout the research process, thereby contributing to ongoing discussion and strategy development in the field.
Investigation of the relationship between COVID-19 and pancreatic cancer using bioinformatics and systems biology approaches
Authors: Fang Chengxiang , Sun Haiyan , Wen Jing , Wu Xuehu , Wu Qian , Zhai Dongsheng 
Published: August 2024

Background:
The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, poses a huge threat to human health. Pancreatic cancer (PC) is a malignant tumor with high mortality. Research suggests that infection with SARS-CoV-2 may increase disease severity and risk of death in patients with pancreatic cancer, while pancreatic cancer may also increase the likelihood of contracting SARS-CoV-2, but the link is unclear.

Methods:
This study investigated the transcriptional profiles of COVID-19 and PC patients, along with their respective healthy controls, using bioinformatics and systems biology approaches to uncover the molecular mechanisms linking the 2 diseases. Specifically, gene expression data for COVID-19 and PC patients were obtained from the Gene Expression Omnibus datasets, and common differentially expressed genes (DEGs) were identified. Gene ontology and pathway enrichment analyses were performed on the common DEGs to elucidate the regulatory relationships between the diseases. Additionally, hub genes were identified by constructing a protein–protein interaction network from the shared DEGs. Using these hub genes, we conducted regulatory network analyses of microRNA/transcription factors-genes relationships, and predicted potential drugs for treating COVID-19 and PC.

Results:
A total of 1722 and 2979 DEGs were identified from the transcriptome data of PC (GSE119794) and COVID-19 (GSE196822), respectively. Among these, 236 common DEGs were found between COVID-19 and PC based on protein–protein interaction analysis. Functional enrichment analysis indicated that these shared DEGs were involved in pathways related to viral genome replication and tumorigenesis. Additionally, 10 hub genes, including extra spindle pole bodies like 1, holliday junction recognition protein, marker of proliferation Ki-67, kinesin family member 4A, cyclin-dependent kinase 1, topoisomerase II alpha, cyclin B2, ubiquitin-conjugating enzyme E2 C, aurora kinase B, and targeting protein for Xklp2, were identified. Regulatory network analysis revealed 42 transcription factors and 23 microRNAs as transcriptional regulatory signals. Importantly, lucanthone, etoposide, troglitazone, resveratrol, calcitriol, ciclopirox, dasatinib, enterolactone, methotrexate, and irinotecan emerged as potential therapeutic agents against both COVID-19 and PC.

Conclusion:
This study unveils potential shared pathogenic mechanisms between PC and COVID-19, offering novel insights for future research and therapeutic strategies for the treatment of PC and SARS-CoV-2 infection.
Emphasis on the importance of comprehensive clinical and genetic analysis – spinal muscular atrophy combined with phenylketonuria: A case report
Authors: Ma Kai , Wang Dong , Hu Wandong , Wang Jie , Yu Chunmei , Cui Zhenqiong , Liu Fangfang 
Published: August 2024

Rationale:
Both spinal muscular atrophy (SMA) and Phenylketonuria (PKU) are caused by biallelic pathogenic mutations. However, there has been no report on case who suffering from both diseases simultaneously. SMA mainly affects the motor function while PKU may have an impact on both the intelligence and motor function. But if only 1 disease is treated while neglecting the other, the treatment effect will be compromised. Here, for the first time, we report a case from China diagnosed with both these diseases and treated properly.

Patient concerns:
A boy was admitted to the Children’s Hospital Affiliated to Shandong University (Jinan, China) due to “limb weakness for 19 months” when he was 22 months old. Considering that the child’s motor function development is delayed, we made a comprehensive examinations including inherited metabolic diseases and found a significantly increase of phenylalanine concentration in the blood which indicating PKU. Combined with his typical clinical manifestations of SMA, target capture sequencing followed by Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) technologies were used for genetic confirmation.

Diagnoses:
SMA and PKU was confirmed.

Interventions:
The child was treated with risdiplam and low phenylalanine formula immediately when he was diagnosed with both SMA and PKU.

Outcomes:
The child showed remarkable improvement in motor function and significant decrease of blood phenylalanine concentration after treatment.

Lessons:
To our knowledge, this is the first reported case of SMA combined with PKU. This case expands our understanding of diagnosis for synchronous SMA and PKU and highlights the importance of comprehensive examinations and the utilizing of various genetic testing methods to make an accurate diagnosis of genetic diseases, which may help avoiding the progressive damage caused by certain genetic disease with insidious clinical symptoms.
Risks and benefits of anti-TNF therapy for ulcerative colitis in a patient with autoimmune hepatitis-related cirrhosis: Case report
Authors: Dutra Renata de Medeiros , Pinto Fernanda Patrícia Jeronymo , Craveiro Marcela Maria Silvino , Baima Julio Pinheiro , Saad-Hossne Rogerio , Romeiro Fernando Gomes , Sassaki Ligia Yukie 
Published: August 2024

Rationale:
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by continuous inflammation of the colonic mucosa. Autoimmune hepatitis (AIH) is a chronic liver disease characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis, and favorable response to immunosuppression. An association between IBD and AIH is uncommon, and experts have suggested that in patients with overlapping IBD and AIH, the anti-tumor necrosis factor agents can be used. Therefore, this study reports a rare case of a patient with liver cirrhosis due to AIH and UC refractory to conventional treatment and discusses the risks and benefits of using anti-tumor necrosis factor in both conditions.

Patient concerns:
A 28-year-old female presented with symptoms of diarrhea, abdominal pain, asthenia, and inappetence, accompanied by abdominal collateral circulation, anemia, alteration of liver enzymes, and elevation of C-reactive protein levels.

Diagnoses:
The patient underwent a liver biopsy, which was consistent with liver cirrhosis due to AIH. Colonoscopy showed an inflammatory process throughout the colon, compatible with moderately active UC.

Interventions:
The patient received mesalazine, azathioprine, and corticotherapy, with no control of the inflammatory process. Faced with refractoriness to drug treatment and side effects of corticosteroids with an increased risk of severe infection due to cirrhosis, we opted to use infliximab for the treatment of UC. The patient presented with a clinical response and infliximab therapy was maintained.

Outcomes:
Eight months after starting infliximab therapy, the patient developed pneumonia with complications from disseminated intravascular coagulation and died.

Lessons subsections:
AIH is a rare cause of elevated transaminase levels in patients with UC. The best treatment to control the 2 conditions should be evaluated with vigilance for the side effects of medications, mainly infections, especially in patients with cirrhosis.
Physicians’ knowledge, attitudes, and practices regarding fibromyalgia: A systematic review and meta-analysis of cross-sectional studies
Authors: Agarwal Arnav , Emary Peter C. , Gallo Lucas , Oparin Yvgeniy , Shin Sae Ha , Fitzcharles Mary-Ann , Adachi Jonathan D. , Cooper Matthew D. , Craigie Samantha , Rai Arjun , Wang Li , Couban Rachel J. , Busse Jason W. 
Published: August 2024

Background:
The diagnosis, etiology, and optimal management of fibromyalgia remains contentious. This uncertainty may result in variability in clinical management. We conducted a systematic review and meta-analysis of cross-sectional studies examining physicians’ knowledge, attitudes, and practices regarding fibromyalgia.

Methods:
We searched MEDLINE, Embase, and PubMed from inception to February 2023 for cross-sectional surveys evaluating physicians’ attitudes toward, and management of, fibromyalgia. Pairs of independent reviewers conducted article screening, data extraction, and risk of bias assessment in duplicate. We used random-effects meta-analysis to pool proportions for items reported by more than one study and the Grading of Recommendations Assessment, Development, and Evaluation approach to summarize the certainty of evidence.

Results:
Of 864 citations, 21 studies (8904 participants) were eligible for review. Most physicians endorsed fibromyalgia as a distinct clinical entity (84%; 95% confidence interval [CI], 74–92), and half (51%; 95% CI, 40–62) considered fibromyalgia a psychosocial condition. Knowledge of formal diagnostic criteria for fibromyalgia was more likely among rheumatologists (69%, 95% CI, 45–89) versus general practitioners (38%, 95% CI, 24–54) (P = .04). Symptom relief was endorsed as the primary management goal by most physicians (73%, 95% CI, 52–90). Exercise, physiotherapy, antidepressants, nonsteroidal anti-inflammatory drugs, and non-opioid analgesics were most endorsed for management of fibromyalgia, but with wide variability between surveys. Opioids and most complementary and alternative interventions (e.g., homeopathy, chiropractic, and massage) received limited endorsement.

Conclusion:
There is moderate certainty evidence to suggest that physicians are divided regarding whether fibromyalgia is a biomedical or psychosocial disorder. Physicians typically prioritize symptom relief as the primary goal of management, and often endorse management with exercise, non-opioid analgesics, nonsteroidal anti-inflammatory drugs, antidepressants, and physiotherapy (moderate to high certainty evidence); however, important practice variation exists.
Role of Bacillus coagulans (Heyndrickxia coagulans)BCP92 in managing irritable bowel syndrome: A randomized, double-blind, multicenter, placebo-controlled clinical trial
Authors: Shaikh Sohel S. , Kumar Sanjay 
Published: August 2024

Background:
Irritable bowel syndrome (IBS) is a major global healthcare burden that requires effective and well-tolerated intervention. This study aimed to investigate the effectiveness and safety of Bacillus coagulans BCP92, a probiotic, in managing IBS symptoms.

Methods:
This randomized controlled trial included 100 participants who strictly adhered to the protocol. Various parameters such as IBS severity, digestive symptom frequency, gastrointestinal symptom frequency, stool consistency, interleukin-6 levels, stress relief, and anxiety levels were evaluated over 12 weeks.

Results:

B. coagulans BCP92 significantly improved IBS severity (P < .001), and gastrointestinal symptom frequency (P < .001) compared with that in the control group. The stool consistency significantly improved (P < .001). Mental stress relief was remarkable (P = .001), differentiating the test and control groups. No significant change in interleukin-6 levels was observed; however, the safety assessment revealed an excellent profile with no reported severe adverse events.

Conclusion:

B. coagulans BCP92 is one of the most promising therapeutic options for the management of IBS because it has shown significant efficacy in alleviating symptoms among patients suffering from this condition, resulting in improved stool consistency changes in addition to improving overall mental well-being for its users, thereby foreseeing the elimination of any potential side effects experienced during the implementation of this approach strategy within our health care system, thereby improving patient outcomes and leading to individualization of treatment plans among all individuals diagnosed with this disease entity who may have symptoms, including abdominal pain or discomfort associated with changes in bowel habits.
Neuroendocrine carcinoma of the gallbladder: A case report and literature review
Authors: Yao Xiaofei , Wu Kangze , Lu Baochun , Lin Feizhuan 
Published: August 2024

Rationale:
Neuroendocrine neoplasms (NENs) originating from neuroendocrine cells occur in the thyroid, respiratory, and digestive systems, with Gallbladder Neuroendocrine Carcinoma (GB-NEC) accounting for only 0.5% of all NENs and 2.1% of gallbladder cancers. Due to its rarity, little is known about GB-NEC’s clinical presentation and treatment.

Patient concerns:
We report a case of a 52-year-old male presenting with acute upper right abdominal pain, leading to further investigation.

Diagnoses:
Initial diagnostic workup, including abdominal ultrasound and contrast-enhanced CT, suggested gallbladder malignancy. Post-surgical pathology confirmed GB-NEC, with immunohistochemistry supporting the diagnosis.

Interventions:
The patient underwent radical cholecystectomy, followed by etoposide plus cisplatin chemotherapy. After disease progression indicated by CT, the patient received additional cycles of chemotherapy with cisplatin and irinotecan, plus targeted therapy with anlotinib and immunotherapy with paimiplimab.

Outcomes:
The patient showed a partial response to initial treatment. Subsequent liver biopsy confirmed NEC, consistent with small cell carcinoma. With continued treatment, the patient maintains a good survival status.

Lessons:
GB-NEC is associated with poor prognosis, emphasizing the importance of early detection and multimodal treatment strategies. Our case underlines the potential benefit of a comprehensive treatment plan, including aggressive surgery and chemotherapy, with further research needed to standardize treatment for this rare condition.