bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stroke Etiology was associated with Tirofiban Efficacy in Acute Ischemic Stroke Without Endovascular Treatment: A Pre-specified Subgroup Analysis of the TREND Trial
Authors: Qiao Yue , Zhao Min , Wang Jing , Li Sijie , Yang Ting , Wang Pingping , Ji Xunming , Ma Qingfeng , Zhao Wenbo 
Published: February 2025

Background: Different stroke etiologies are associated with varied incidences of early neurological deterioration (END) in patients with acute ischemic stroke (AIS). The TREND trial demonstrated the efficacy of tirofiban in preventing END in patients with AIS. Herein, we conducted a pre-specified subgroup analysis of this trial data to investigate whether stroke etiologies influenced the effects of tirofiban. Methods: We performed a pre-specified subgroup analysis of the TREND trial, including 413 patients with AIS classified into large-artery atherosclerosis (n=114), small-vessel occlusion (n=124), and undetermined etiology (n=175). The primary outcome was the incidence of END4 (defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score by ≥4 points) within 72 hours. Other outcomes included END2 (increase in NIHSS score by ≥2 points), early improvement, functional outcomes at 90 days, and safety profiles. Results: Tirofiban significantly reduced the risk of END4 in patients with large-artery atherosclerosis (4.1% vs. 21.5%; adjusted OR 0.17; 95% CI 0.04–0.78; P=0.023), while no significant differences were observed in small-vessel occlusion (adjusted OR, 0.24; 95% CI, 0.02-2.67; P=0.248) and undetermined etiology (adjusted OR, 0.53; 95% CI, 0.18-1.55; P=0.247) subgroups (P for interaction=0.376). Similar trends were observed for END2, with a significant benefit observed in the large-artery atherosclerosis (adjusted OR 0.24; 95% CI 0.08-0.72; P=0.011). The early improvement rates and 90-day functional outcomes were comparable between the treatment groups across all stroke subtypes. Safety outcomes were similar between antiplatelet therapies in each subgroup. Conclusions: In patients who developed ischemic stroke within 24 hours of symptom onset, there was no evidence of a treatment interaction across stroke etiologies when comparing intravenous tirofiban to oral aspirin for reducing END. However, the absolute risk reduction observed with tirofiban was greatest in patients with large-artery atherosclerosis compared to those with small-vessel occlusion or undetermined etiology.
Synthetic versus conventional MRI for ring-enhancing brain lesions: A pre- and post-contrast comparison
Authors: Dash Sanket , Vyas Sameer , Bhardwaj Nidhi , Singh Paramjeet , Ahuja Chirag K , Ahmad Sarfraj 
Published: February 2025

Purpose Synthetic MRI has potential to significantly reduce MR scan time by reconstructing multiple contrast images from a single acquisition. The aim of this study was to compare the image quality of both pre- and post-contrast synthetic MRI in subjects with ring-enhancing brain lesions with conventional images. Methods 50 patients with radiologically confirmed ring-enhancing brain lesions underwent TSE_MDME sequence before and after gadolinium administration along with conventional MRI sequences. Image quality was compared between synthetic and conventional sequences on a 4-point scale across 5 parameters, that is, grey white matter differentiation, demarcation of caudate nucleus, lentiform nucleus, demarcation of sulci, and SNR. Also, the artefacts, lesion conspicuity, and ability to diagnose on synthetic images were studied. Results Image quality of synthetic MRI was relatively similar across all sequences except for FLAIR. The image quality comparison between synthetic and conventional images showed an agreement in 70.7% of the cases (Weighted Kappa = 0.043, p = <0.001). Artefacts were maximum in synthetic FLAIR sequence (52%). 50% cases showed a discordant enhancement pattern in post contrast synthetic images. Despite a higher occurrence of artefacts in synthetic post contrast images, diagnostic ability was comparable across pre- and post-contrast synthetic and conventional images. Conclusion Synthetic MRI provides comparable diagnostic quality of images with acceptable rate of artefacts in both pre and post contrast sequences. However, needs a careful interpretation especially when diagnosis is heavily relied on the enhancement pattern of lesions.
“Let me hear what you’re needing”: exploring how HIV providers conceptualize patient-provider interactions with people with HIV who use drugs using a harm reduction framework
Authors: Creasy Stephanie L. , Egan James E. , Krier Sarah , Townsend Jessica , Ward Jessica , Hawk Mary , Kay Emma Sophia 
Published: February 2025

Background: In addition to structural interventions such as syringe services and naloxone distribution, harm reduction (HR) is also a relational approach to care encompassing principles such as patient autonomy and pragmatism that can be implemented in healthcare teams to improve outcomes for people with HIV (PWH) who use drugs. Evidence suggests that using a relational HR framework to operationalize care for PWH who use drugs may improve the patient-provider relationship, thus positively impacting HIV outcomes. We previously found that negative attitudes toward people who use drugs are negatively associated with acceptance of HR; however, little is known about how HIV providers conceptualize the patient-provider relationship with PWH who use drugs. Objectives: The aim of this study was to describe the ways healthcare workers (HCWs) characterize interactions with PWH who use drugs and if these characterizations reflect relational HR or missed opportunities to improve the patient-provider relationship. Design: We used a qualitative descriptive design to characterize HCWs’ descriptions of their interactions with PWH who use drugs. Methods: We interviewed providers ( n = 23) working at three HIV clinics in the United States to assess their interactions with patients. Providers included anyone who had worked at their respective clinic for ⩾1 year and who had face-to-face contact with patients (e.g., front desk staff, nurses, physicians, and social workers). Data were coded thematically via Dedoose. Results: We discovered that HCWs characterize positive patient-provider interactions that both reflect HR principles and may not align with the principles of HR. Examples include when patients appear comfortable with and trusting of their provider, when patients feel heard by their provider, and when providers feel they are responsive to patient needs. However, other HCWs described positive interactions as counter to relational HR. Conclusion: HCW descriptions of positive interactions in line with relational HR in their conceptualization of patient-provider interactions with PWH who use drugs have the potential to guide efforts in increasing the acceptability of HR in HIV care. Given evidence showing HR improves outcomes for those who use substances, findings suggest missed opportunities to incorporate relational HR into the patient-provider relationship in HIV primary care settings. Registration: NCT05404750.
Cost-effectiveness of a digital supportive healthcare pathway for type 2 diabetes compared to usual care in Belgium
Authors: Van Wilder Lisa , De Smedt Delphine , Sandra Lieselotte , Vandormael Dorien , Kaes Joyce , Willems Ruben , Trybou Jeroen 
Published: February 2025

Objective To evaluate the cost-effectiveness of a digital supportive healthcare pathway in patients with type 2 diabetes mellitus (T2DM) compared to usual care. Methods An age-dependent Markov model was applied from a healthcare payer perspective projecting results of a clinical trial study over a time horizon of 22 years assuming a continuous implementation of the intervention every year, 24/7. The setting was Flanders (Belgium). One-way and probabilistic sensitivity analyses were performed. Results The hybrid care pathway led to a quality-adjusted life year (QALY) gain of 5.97, while the costs increased with €663,036. This resulted in an incremental cost-effectiveness ratio of €110,989/QALY. With a cost-effectiveness threshold of 45,000€/QALY, the hybrid care pathway was found not cost-effective compared to the usual care trajectory. Sensitivity analyses showed that over 50% of iterations exceeded the threshold, with a cost-effectiveness probability of 13.12% at €45,000/QALY. Conclusions This cost-effectiveness analysis indicates that a hybrid care pathway is unlikely to be a cost-effective approach compared to the standard care trajectory in patients with T2DM. Nevertheless, the exploration of technology-driven healthcare pathways are vital for advancing patient well-being, emphasizing the need for further research to optimize resource utilization and enhance outcomes effectively.
Readmission After Geriatric Inpatient Care: A Narrative Review and a Comparative Analysis
Authors: Willers Carl , Lindqvist Rikard , Dreilich Martin , Fors Stefan , Lindh Mazya Amelie , Nilsson Gunnar H. , Boström Anne-Marie , Naseer Mahwish , Rydwik Elisabeth 
Published: February 2025

Background: Readmission can be be related to the work of several stakeholders involved in the care of individuals throughout the community, including, for example, primary care and social care providers. A narrative review was performed to assess definitions and frequency of readmission for older adults found in previous research. In addition, a dataset for a cohort of older adults in Stockholm, Sweden, was used to quantify how different definitions of readmission affect frequency. Materials and Methods: The review was based on pre-specified search criteria within PubMed and Embase databases. All studies based on a cohort of older adults with a primary objective to assess readmission to inpatient care, were included for the assessment of readmission criteria. The dataset was based on a cohort of older adults treated at a geriatric department in Stockholm during 2016. Estimations of readmission were performed with the most common criteria found in the narrative review. Results: The narrative review showed that definitions of readmission included predominantly time-based criteria, either alone or combined with additional criteria such as medical condition or readmitting department. Frequency of readmission based on different definitions varied substantially; a 14-day time interval implied a rate of 8.0% whilst a 30-day interval—more commonly used—rendered a rate of 12.6%. The density of readmissions per day was higher during the first weeks after discharge, and then dropped continuously. Conclusion: Transparency on definitions is imperative in studies that include rates of readmission. The levels of readmission rates are highly dependent on the study population and its context. Furthermore, the actual value of readmission monitoring is dependent on what purpose it is supposed to fulfill, and it is essential to put it into context of all relevant stakeholders including, for example, the primary care providers and different social care providers throughout the community.
Prenatal Dental Visits, Perceived Benefits of Oral Health, and Preterm Birth Outcome, 2009–2021
Authors: Lee H. , Hong N. , Janevic T. 
Published: February 2025

Background: Previous studies have demonstrated a significant association between maternal oral health and pregnancy complications, including preterm birth (<37 wk). However, research on the impact of dental care utilization during pregnancy on these outcomes has produced both positive and negative results. Objective: The current study investigated the association between preterm birth and dental care utilization, focusing on dental visits for cleaning during pregnancy as well as the perceived benefits of oral health during pregnancy. Methods: This secondary data analysis cross-sectional study used data from the Pregnancy Risk Assessment Monitoring System in the United States from 2009 to 2021. Descriptive and multivariate logistic regression analyses were performed to examine the association between dental variables and preterm birth. Results: The study included 399,847 women with a recent single live birth, representing 21,218,114 women across 48 states and New York City. After adjusting for factors such as race and ethnicity, age, marital status, medical insurance type, education level, adequacy of prenatal care, and other medical variables associated with preterm birth, women who had dental visits for cleaning during pregnancy had a lower odds of preterm birth (adjusted odds ratio [aOR] = 0.90, 95% confidence interval [CI] [0.86, 0.93], P < 0.001) compared with those who did not. A significant association between prenatal dental cleaning and reduced preterm birth was observed only among women who perceived the benefits of oral health during pregnancy (aOR = 0.93, 95% CI [0.88, 0.97], P = 0.002) and among non-Hispanic White women (aOR = 0.88, 95% CI [0.83, 0.93], P < 0.001). Conclusion: This study revealed an inverse relationship between dental cleaning visits during pregnancy and preterm birth outcomes, notably among women who recognized the benefits of oral health and among non-Hispanic White women. The results emphasize the significance of dental visits and the perception of oral health benefits during pregnancy. Knowledge Transfer Statement: The study demonstrated an inverse association between dental visits for cleaning during pregnancy and preterm birth outcomes, with this relationship being significant among women who perceived the benefits of oral health during pregnancy and among non-Hispanic White women. These findings suggest that both the dental visits and the perception of oral health benefits may be important factors linked to preterm birth outcomes, with potential racial and ethnic variations. Policy makers and clinicians could integrate oral health care and prenatal oral health education into prenatal care as essential components of primary health care to improve both oral and overall health outcomes for women.
Transcriptomic analysis offers deep insights into the Increased Grain Length 1 (IGL1) regulation of grain length
Authors: Sang Liran , Xu Ending , Liu Yan , Hu Tiange , Yang Mengqi , Niu Jiayu , Lu Chong , Zhou Yi , Sun Yifei , Zhai Zhaoyu , Abdulmajid Dina , Zhang Peijiang , Wang Qianqian , La Honggui , Zou Yu 
Published: February 2025

Abstract

Background
Although great progress has been made in recent years in identifying novel genes or natural alleles for rice yield improvement, the molecular mechanisms of how these genes/natural alleles regulate yield-associated traits, such as grain length and 1000-grain weight, remain largely unclear. An in-depth understanding of the roles of these genes/natural alleles in controlling yield traits become a necessity to ultimately increase rice yield via novel molecular techniques, such as gene editing.

Results
In this study, the roles of IGL1, which was previously identified through a map-based cloning approach, in the regulation of grain length were investigated by overexpressing and knocking out it in the Nipponbare genetic background. Overexpression and knockout of IGL1 (the resulting transgenic lines were hereafter designated IGL1-OE and IGL1-CR lines, respectively) led to elongation and shortening of grains, respectively. To further elucidate the molecular mechanisms behind the IGL1 action, young panicles from IGL1-OE and IGL1-CR lines were subjected to mRNA sequencing. The results showed that both overexpression and knockout of IGL1 all resulted in a large number of upregulated and downregulated differentially expression genes (DEGs) relative to wild-type NPB control lines. A total of 984 DEGs overlapped between upregulated DEGs from IGL1-OE and downregulated DEGs from IGL1-CR; 1146 DEGs were common to downregulated DEGs from IGL1-OE and upregulated DEGs from IGL1-CR. GO term and KEGG pathway analysis revealed that IGL1-upregulated DEGs were associated with extracellular region, protein ubiquitination, cell-wall modification, BR signaling, cell cycle, etc.; by comparison, the IGL1-downregulated DEGs were connected with extracellular region, response to wounding, flavonoid biosynthesis, jasmonic-acid signaling, glucose/sucrose metabolism, etc. Some phytohormone-associated genes (like OsYUCCA4, OsPIN10b, OsBAK1, and OsDLT), TF genes (like OsMADS1 and OsGASR9), grain length-regulating genes (like An-1, GS9, OsIQD14, and TGW2) showed significant upregulation or downregulation in IGL1-OE or IGL1-CR.

Conclusion
Our result clearly demonstrated that IGL1 is an important regulator of grain length, and has profound impacts on genome-wide gene expression, suggesting that it may work together with certain TFs. Overexpression or knockout of IGL1 appears to cause complex expression changes of genes associated with phytohormones, TFs, grain length-regulating factors, which ultimately brings about the grain elongation.
Minimising the usage of desflurane only by education and removal of the vaporisers – a before-and-after-trial
Authors: Lehmann Ferdinand , Mader Johannes , Koch Christian , Markmann Melanie , Leicht Dominik , Sander Michael 
Published: February 2025

Abstract

Background
By exceeding planetary environmental boundaries, multiple global crises have become imminent in the 21st century. The healthcare system is a contributor to the climate crisis, accounting for approximately 5% of greenhouse gas emissions in Western countries. In anaesthetic clinics, desflurane, a highly potent greenhouse gas and volatile anaesthetic with no compelling indications, accounts for up to two thirds of total emissions. Its use can be drastically reduced using simple measures. In the present study, we investigated whether a relevant and timely reduction in use could be achieved by dismounting desflurane vaporisers and providing information to the team without restricting its use.

Methods
The study was conducted in a German university hospital with approximately 1250 beds, over a 12-month period between 2021 and 2022, with a comparison to the corresponding periods of the previous years up to 2017. The interventions were, first, the removal of desflurane vaporisers, and second, staff education on the climate impact of volatile anaesthetics. The primary outcome variable was the reduction of hypnotic-related emissions in CO2 equivalents per anaesthetic procedure.

Results
Prospective data collection and interventions were conducted from 28 March 2021 to 27 March 2022. The amount of CO2 equivalent emissions per procedure in the form of volatile anaesthetics was reduced by 86% compared with the year before the interventions (p < 0.001). Interestingly, there was already a 52.1% reduction in the year before the procedure (p < 0.001). There were no significant changes in the use of sevoflurane or propofol. Hypnotic-related costs decreased by €14,549, whereas extubation time did not change significantly.

Conclusions
Removal of desflurane vaporisers and staff training can quickly and significantly reduce the emissions of an anaesthesia department in a large German teaching hospital. This may also reduce the costs.

Trial registration
The trial was registered with the German Clinical Trials Register, identifier DRKS00024973 on 12/04/2021.
A longitudinal study of the subjective birth experience and the relationship to mental health
Authors: Märthesheimer Sarah , Hagenbeck Carsten , Helbig Martina , Balan Percy , Fehm Tanja , Schaal Nora K. 
Published: February 2025

Abstract

Background
A satisfying birth experience has positive effects on the well-being of mother and child. The birth experience depends on subjective expectations and objective birth parameters, and the view of birth can also change over time. However, it is still unclear how birth anxiety and mode of birth affect the different dimensions of the birth experience in the first months after childbirth.

Methods
In this prospective longitudinal study, 307 first-time mothers, planning to give birth vaginally, were assessed for fear of childbirth at approximately 34 weeks of gestation and for obstetric information. Postpartum birth experience and psychological stress was evaluated 2 days, 6 weeks and 6 months postpartum using the validated Childbirth Experience Questionnaire which comprises the four dimensions emotional experience, participation, professional support and coping possibilities, and a visual analogue scale for a global birth judgement, supplemented by the Edinburgh postpartum depression scale and the Impact of Event Scale.

Results
The individual dimensions of the birth experience changed differently within the first six months. Mixed factorial ANOVAs identified a main effect of fear of childbirth for all four dimensions of the birth experience and the global birth judgment. Mode of birth influenced the dimension participation and the global judgement. For emotional experience, a complex interplay between fear of birth, birth mode and time was revealed. Correlation analyses showed significant associations between the birth experience and the psychological distress symptoms resulting from childbirth.

Conclusions
Prepartum fear of childbirth affects all dimensions of the subjective birth experience, even after six months. Birth mode, on the other hand, only affects the global birth judgement and participation. The stable correlations between the different dimensions of the birth experience and maternal mental health highlight the importance of the birth experience for clinical practise.

Trail registration
Registered in the German Clinical Trials Register (“DRKS”) (No. DRKS00022177) on 22 June 2020 (https://drks.de/search/en/trial/DRKS00022177).
Early versus delayed mobilisation for non-surgically treated proximal humerus fractures: a systematic review and meta-analysis of randomised trials
Authors: Challoumas Dimitris , Minhas Haroon , Bagni Stephanie , Millar Neal 
Published: February 2025

Abstract

Background
Proximal humerus fractures (PHFs) are among the commonest bony injuries and the majority of them can be managed non-surgically. The aim of our systematic review and meta-analysis was to compare the effectiveness and safety of early versus delayed mobilisation in conservatively treated PHFs.

Methods
A literature search was performed in Medline, EMBASE and clinicaltrials.gov in Januray 2025 aiming to identify all randomised controlled trials (RCTs) comparing early versus delayed (conventional) mobilisation as part of the non-surgical management of PHFs. Primary outcomes were patient-reported function and pain at short-term (3 months), mid-term (6 months) and long-term (12 months) follow-up, and secondary outcomes included secondary fracture displacement and total complications. Meta-analyses produced mean differences (MDs) or standardised MDs (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE tool. Recommendations for clinical practice were given only based on results of high or moderate certainty of evidence.

Results
Six (6) RCTs were included that compared early mobilisation (EM; within one week from injury) to delayed mobilisation (DM; after 3 or 4 weeks of immobilisation) with a total of 470 patients with PHFs. There were no differences in patient-reported function (combined or Constant score) or pain between the EM and DM groups at any follow-up time points except for a significant difference in combined function scores favouring EM [SMD 0.4 CI (0.1,0.7), P = 0.006] at 3 months follow-up. There were no significant differences in the incidence of secondary fracture displacement and total complications in the two groups [OR 3.5 CI (0.7,18.2), P > 0.05, and OR 1.2 CI (0.5,2.9), P > 0.05, respectively]. All results were based on moderate or high strength of evidence. The most significant limitations of our study were the small number of pooled studies and inability to perform subgroup analyses for specific fracture types.

Conclusions
Our meta-analysis of RCTs showed that commencement of mobilisation within one week from injury for non-surgically managed PHFs is safe and may confer short-term functional benefits compared to delayed mobilisation.