bluuebunny/crossref_metadata_2025_split huggingface dataset:
“I know when to stop”: sentinels and counterstrategies against drowsy driving in narcolepsy and idiopathic hypersomnia
Authors: Beguin Elsa , Maranci Jean Baptiste , Leu-Semenescu Smaranda , Dodet Pauline , Gales Ana , Oudiette Delphine , Andrillon Thomas , Arnulf Isabelle 
Published: August 2024

Abstract

Study Objectives
To collect prodromal symptoms experienced by participants with narcolepsy and idiopathic hypersomnia (considered “hypersomnolence experts”) prior to drowsy driving and counterstrategies used to maintain alertness.

Methods
Systematic, face-to-face interview (using a semi-structured questionnaire), including clinical measures, frequency of car accidents/near misses, and symptoms experienced before impending drowsy driving episodes and counterstrategies.

Results
Among 61 participants (32 with narcolepsy, 29 with idiopathic hypersomnia; 56 drivers), 61% of drivers had at least one lifetime accident/near miss. They had a higher sleepiness score (14 ± 4 vs. 11 ± 5, p &lt; .04) than those without an accident/near miss, but no other differences in demographics, driving experience, medical conditions, symptoms, sleep tests, and treatment. All but three participants experienced prodromal symptoms of drowsy driving, which included postural and motor changes (86.9%: axial hypotonia—e.g. eyelid droop, stereotyped movements), cognitive impairment (53.3%: automatic steering, difficulty concentrating/shifting, dissociation, mind wandering, dreaming), sensory (65%: paresthesia, pain, stiffness, heaviness, blunted perceptions such as a flat dashboard with loss of 3D, illusions and hallucinations), and autonomic symptoms (10%, altered heart/breath rate, penile erection). Counterstrategies included self-stimulation from external sources (pain, cold air, music, drinks, and driving with bare feet), motor changes (upright posture and movements), and surprise (sudden braking).

Conclusions
Drowsy driving symptoms can result from “local” NREM, entry in N1 sleep, and hybrid wake/REM sleep states. These rich qualitative insights from participants with narcolepsy and idiopathic hypersomnia, as well as sophisticated counterstrategies, can be gathered to reduce the crash risk in this population, but also in inexperienced healthy drivers.
Closed-loop auditory stimulation targeting alpha and theta oscillations during rapid eye movement sleep induces phase-dependent power and frequency changes
Authors: Jaramillo Valeria , Hebron Henry , Wong Sara , Atzori Giuseppe , Bartsch Ullrich , Dijk Derk-Jan , Violante Ines R 
Published: August 2024

Abstract

Study Objectives
Alpha and theta oscillations characterize the waking human electroencephalogram (EEG) and can be modulated by closed-loop auditory stimulation (CLAS). These oscillations also occur during rapid eye movement (REM) sleep, but their function here remains elusive. CLAS represents a promising tool to pinpoint how these brain oscillations contribute to brain function in humans. Here we investigate whether CLAS can modulate alpha and theta oscillations during REM sleep in a phase-dependent manner.

Methods
We recorded high-density EEG during an extended overnight sleep period in 18 healthy young adults. Auditory stimulation was delivered during both phasic and tonic REM sleep in alternating 6-second ON and 6-second OFF windows. During the ON windows, stimuli were phase-locked to four orthogonal phases of ongoing alpha or theta oscillations detected in a frontal electrode.

Results
The phases of ongoing alpha and theta oscillations were targeted with high accuracy during REM sleep. Alpha and theta CLAS induced phase-dependent changes in power and frequency at the target location. Frequency-specific effects were observed for alpha trough (speeding up) and rising (slowing down) and theta trough (speeding up) conditions. CLAS-induced phase-dependent changes were observed during both REM sleep substages, even though auditory evoked potentials were very much reduced in phasic compared to tonic REM sleep.

Conclusions
This study provides evidence that faster REM sleep rhythms can be modulated by CLAS in a phase-dependent manner. This offers a new approach to investigating how modulation of REM sleep oscillations affects the contribution of this vigilance state to brain function.
IGF signaling pathway in bone and cartilage development, homeostasis, and disease
Authors: Ruan Xinyi , Jin Xiuhui , Sun Fuju , Pi Jiashun , Jinghu Yihan , Lin Xinyi , Zhang Nenghua , Chen Guiqian 
Published: August 2024

AbstractThe skeleton plays a fundamental role in the maintenance of organ function and daily activities. The insulin‐like growth factor (IGF) family is a group of polypeptide substances with a pronounced role in osteoblast differentiation, bone development, and metabolism. Disturbance of the IGFs and the IGF signaling pathway is inextricably linked with assorted developmental defects, growth irregularities, and jeopardized skeletal structure. Recent findings have illustrated the significance of the action of the IGF signaling pathway via growth factors and receptors and its interactions with dissimilar signaling pathways (Wnt/β‐catenin, BMP, TGF‐β, and Hh/PTH signaling pathways) in promoting the growth, survival, and differentiation of osteoblasts. IGF signaling also exhibits profound influences on cartilage and bone development and skeletal homeostasis via versatile cell–cell interactions in an autocrine, paracrine, and endocrine manner systemically and locally. Our review summarizes the role and regulatory function as well as a potentially integrated gene network of the IGF signaling pathway with other signaling pathways in bone and cartilage development and skeletal homeostasis, which in turn provides an enlightening insight into visualizing bright molecular targets to be eligible for designing effective drugs to handle bone diseases and maladies, such as osteoporosis, osteoarthritis, and dwarfism.
Anterior Column Release
Authors: Pressman Elliot , Monsour Molly , Goldman Hannah , Kumar Jay I. , Noureldine Mohammad Hassan A. , Alikhani Puya 
Published: August 2024

Study Design:
Retrospective review.

Objective:
We sought to characterize complications associated with anterior column release (ACR).

Summary of Background Data:
Correction of positive sagittal imbalance was traditionally completed with anterior column grafts or posterior osteotomies. ACR is a minimally invasive technique for addressing sagittal plane deformity by restoring lumbar lordosis.

Methods:
We conducted a retrospective review of consecutive patients who underwent ACR in a prospectively kept database at a tertiary care academic center from January 2012 to December 2018. The prespecified complications were hardware failure (rod fracture, hardware loosening, or screw fracture), proximal junctional kyphosis, ipsilateral thigh numbness, ipsilateral femoral nerve weakness, arterial injury requiring blood transfusion, bowel injury, and abdominal pseudohernia.

Results:
Thirty-eight patients were identified. Thirty-five patients had ACR at L3-4, 1 had ACR at L4-5, and 1 patient had ACR at L2-3 and L3-4. Eighteen patients (47.4%) had one of the prespecified complications (10 patients had multiple). Ten patients developed hardware failure (26.3%); 8 patients (21.1%) had rod fracture, 4 (10.5%) had screw fracture, and 1 (2.6%) had screw loosening. At discharge, rates of ipsilateral thigh numbness (37.8%) and hip flexor (37.8%)/quadriceps weakness (29.7%) were the highest. At follow-up, 6 patients (16.2%) had ipsilateral anterolateral thigh numbness, 5 (13.5%) suffered from ipsilateral hip flexion weakness, and 3 patients (5.4%) from ipsilateral quadriceps weakness. Arterial injury occurred in 1 patient (2.7%). Abdominal pseudohernia occurred in 1 patient (2.7%). There were no bowel injuries observed.

Conclusions:
ACR is associated with a higher than initially anticipated risk of neurological complications, hardware failure, and proximal junctional kyphosis.
Brief Communication: Treatment Outcomes for Advanced Melanoma of Unknown Primary Compared With Melanoma With Known Primary
Authors: Persa Oana-Diana , Hassel Jessical Cecile , Steeb Theresa , Erdmann Michael , Karimi Bita , Stege Henner , Klespe Kai Christian , Schatton Kerstin , Tomsitz Dirk , Rübben Albert , Thiem Alexander , Berking Carola , Biedermann Tilo 
Published: August 2024

Summary:
Most patients with advanced melanomas have a known primary site [melanoma of known primary (MKP)]. However, 2%–9% of patients are diagnosed with melanoma metastasis of unknown primary (MUP). As MUP and MKP have similar UV-induced mutations and molecular signatures, it is proposed that the primary tumor has regressed completely in patients with MUP. As regression of the primary tumor could be indicative of enhanced recognition of melanoma antigens, we hypothesize that patients with advanced MUP have a better outcome compared with MKP.Patients with advanced MUP from 10 German university hospitals were retrospectively analyzed and matched with MKP based on the type of systemic treatment (BRAF and MEK inhibitors, PD-1 inhibitor monotherapy, combined CTLA-4 and PD-1 inhibitor therapy) therapy line (first or second line) and AJCC stage (IIIC, IV M1a–M1d). Three hundred thirty-seven patients with MUP were identified, and 152 treatments with PD-1 and CTLA-4 inhibitors, 142 treatments with PD-1 inhibitors, and 101 treatments with BRAF and MEK inhibitors were evaluated. Median time to treatment failure was significantly prolonged in patients with MUP treated with PD-1 monotherapy (17 mo, 95% CI: 9–25, P = 0.002) compared with MKP (5 mo, 95% CI: 3.4–6.6), as well as in MUP treated with combined PD-1 and CTLA-4 therapy (11 mo, 95% CI: 4.5–17.5, P < 0.0001) compared with MKP (4 mo, 95% CI: 2.9–5.1) Occurrence of immune-related adverse events and time to treatment failure for patients with BRAF and MEK inhibitors was similar in MKP and MUP. In our multicentre collective, patients with MUP have better outcomes under immunotherapy compared with MKP.
Mechanisms of thiazide-induced hypertension treatment: insights from gene expression and histological analysis in malignant stroke-prone spontaneously hypertensive rats
Authors: Ashenagar Mohammad Said , Higashino Toshihide , Matsumoto Akiko , Higashino Hideaki 
Published: August 2024

Objective:
Diuretics, including thiazides and thiazide-like drugs, are commonly recommended for treating hypertension, though their precise mechanism of action is not fully understood. This study aimed to investigate the pharmacological effects of trichloromethiazide (TCM) in malignant stroke-prone spontaneously hypertensive rats (M-SHRSP).

Methods:
M-SHRSPs were treated with varying doses of TCM. Prognosis, histological changes, and mRNA expression related to hypertension and stroke were assessed.

Results:
The high-dose TCM group (3%) exhibited significantly lower SBP compared with the untreated group, whereas the low-dose group (0.3%) did not show a significant reduction in SBP. The survival rate was 54% in the low-dose group, whereas all rats in the high-dose group survived without experiencing a stroke by 16 weeks of age. Organ weights in both TCM-treated groups were lower than those in the control group, without severe histological abnormalities, including stroke and sclerosis. Plasma levels of thiobarbituric acid-reactive substances (TBARS) were significantly reduced in both TCM-treated groups. Additionally, 20 genes related to tissue protection, repair, proliferation, maintenance, and function were significantly expressed.

Conclusion:
TCM administration in M-SHRSPs significantly modulated the expression of 20 genes associated with tissue protection and maintenance, and reduced plasma TBARS levels. These findings suggest that TCM, a thiazide diuretic, may protect against tissue impairment in hypertension by modulating gene expression and exhibiting antioxidant activity.
Femtosecond Laser–Assisted Autologous Glueless Simple Limbal Epithelial Transplantation in Unilateral Limbal Stem Cell Deficiency: 12-Month Outcome of the First Clinical Cases
Authors: Malyugin Boris , Svetlana Kalinnikova , Fabian Muller , Werner Bernau , Boris Knyazer , Maksim Gerasimov 
Published: August 2024

Purpose:
Surgical treatment of unilateral limbal stem cell deficiency (LSCD) is based on limbal stem cell transplantation. Glueless simple limbal epithelial transplantation (G-SLET) technique implements several limbal micrografts harvested from the healthy eye of the same patient into the peripheral corneal tunnels without the use of fibrin glue and human amniotic membrane.

Methods:
A novel customized algorithm and software for a low-energy femtosecond laser (FSL) were developed and tested using 5 pairs of isolated porcine eyes. FSL-assisted G-SLET modification was assessed in 3 clinical cases of unilateral LSCD caused by chemical burns. Corneal epithelization efficacy, best-corrected visual acuity, corneal epithelial mapping, central corneal thickness, and impression cytology with immunohistochemical examination were evaluated. All patients were followed up for 12 months postoperatively.

Results:
The FSL set for 100% energy and the pattern of 8 nonpenetrating vertical cuts with oblique tunnel portions having variable incision depths and diameter of 8.5 mm and higher were selected for further clinical evaluation. Clinically, stable corneal epithelialization was achieved 2 to 3 weeks after intervention. At the 6-month follow-up, all patients had a healthy corneal epithelium with limbal micrografts visible inside the corneal tunnels. Best-corrected visual acuity markedly improved in 2 cases, but not in the third case with severe corneal stromal scarring. In addition, all patients noted a full-scale reduction in subjective complaints and substantial improvement in their quality of life.

Conclusions:
The FSL-assisted G-SLET is a new technique for autologous limbal stem cell transplantation in patients with unilateral LSCD. It allows the standardization of corneal tunnel localization and dimensions, thereby increasing the safety of the surgical procedure.
Comparison of postoperative inflammatory response between natural orifice specimen extraction surgery and conventional laparoscopy in the treatment of colorectal cancer: a meta-analysis and systematic review
Authors: Liu Xinyue , Yuan Xingzhu , Ye Peiling , Yang Jie , Li Ka 
Published: August 2024

Purpose:
Natural orifice specimen extraction surgery (NOSES) has attracted attention because of its minimal invasiveness. This meta-analysis compared inflammatory response profiles and infectious complications between colorectal cancer patients treated with NOSES and those treated with conventional laparoscopy.

Methods:
Seven medical databases were searched up to February 2024. The authors included studies that examined changes in the inflammatory response and outcomes in the patients after NOSES surgery. The Cochrane tool and the Newcastle–Ottawa Scale were used to evaluate the quality of the studies. Pooled standardized mean differences and odds ratios with 95% CIs were calculated using either fixed- or random-effects models. Review Manager 5.4 (RevMan 5.4) and the R project were used for the meta-analysis.

Results:
This meta-analysis included 22 studies. Pooled analyses revealed lower tumor necrosis factor-α levels (SMD=−1.34,95% CI [−2.43, −0.25]; Z=2.40, P=0.02 and SMD =−1.49,95% CI [−2.15, −0.82]; Z=4.36, P<0.0001) and C reactive protein levels (SMD=−0.56, 95% CI [−4.17, −2.50]; Z=2.19, P=0.03 and SMD =−1.24,95% CI [−1.77, −0.71]; Z=4.56, P<0.00001) on postoperative day 1 and postoperative day 3 for NOSES than for conventional laparoscopy. Pooled analysis revealed significantly lower interleukin-6 levels in the NOSES group (SMD=−1.88,95% CI [−2.84, −0.93]; Z=3.88, P=0.0001) on postoperative day 3. There were no significant differences in white blood cell count, procalcitonin levels, or the incidence of infectious complications between the two groups.

Conclusions:
NOSES has a superior inflammatory profile and does not increase the incidence of postoperative infectious diseases. The reported results should be validated in a larger population of colorectal cancer patients.
Long-Term Outcomes of Modified Endoscopic Transcanal Approach to Small Acoustic Tumors
Authors: Abdul Halim Riana Kipiani , Lapina Gerard , Shin Seung Ho , Jung Youngrak , Lee Jeong Gum , Moon In Seok 
Published: August 2024

Objective
The management options for small acoustic tumors are still controversial, and surgery is indicated in a select number of patients only. This is to avoid unnecessary extensive operations and risk of complications. Endoscopic transcanal approach, which was recently introduced, can be an alternative option to overcome these challenges. We have developed a modified technique for endoscopic transcanal removal of small acoustic tumors with tympanoplasty using tragal cartilage and without the need to harvest abdominal fat for obliteration. There was also no need to do an ear cul-de-sac procedure compared with the previous method. We report the long-term outcomes of this approach.

Study Design
Retrospective review.

Setting
Tertiary hospital.

Patients
Those who were diagnosed with small acoustic tumors between June 2016 and June 2022 were enrolled.

Interventions
Tumor removal via a Modified Endoscopic Transcanal Transpromontorial Approach (mETTA).

Main Outcome Measure
Tumor control rate, closure rate of tympanic membrane, and complications such as cerebrospinal fluid (CSF) leakage and facial palsy were analyzed. Operation time and hospital stay were also analyzed.

Results
Twenty-two patients with a mean age of 55.5 ± 9.4 years were enrolled. Eighteen were vestibular schwannomas (VS), two were intracochlear schwannomas (ICS), and two were with intravestibulocochlear schwannomas (IVCS). Gross total removal was achieved in 21 cases. One had developed significant CSF leakage, and the other patient complicated with permanent facial palsy. The tympanic membrane healed well in all patients, but three patients showed delayed healing until several months and treated conservatively. Mean operation time was 149.6 ± 48.4 minutes, mean hospital stay was 8.9 ± 4.5 days, and mean postoperative follow-up period was 42.0 ± 15.7 months.

Conclusion
Long-term results of modified endoscopic transcanal approach to small acoustic tumors are acceptable and comparable to classical treatments such as translabyrinthine approach or gamma knife radiation. This is an alternative option for smaller tumors warranting surgical removal and maintained cosmetic advantages.
Evaluation of accuracies of large language models in answering clinical questions related to Mediterranean diet on cardiodiabesity
Authors: Chen Chao , Li Xinxin , Luo Hongmiin 
Published: August 2024

Abstract

Objectives:
To explore a method to answer clinical questions (CQs) pertaining to the Mediterranean diet (MedDiet) on cardiodiabesity.

Methods:
We assessed the accuracies of responses provided by large language models (LLMs) to CQs pertaining to the MedDiet on cardiodiabesity. In addition, a comparative analysis of CQs was conducted among various LLMs, including Claude, Gemini, generative pretrained transformer (GPT)-4, Doctor generative language model (GLM), Bencao, and HuatuoGPT, with 1-way analysis of variance, accuracies, and Shannon entropies.

Results:
The results of the analysis of variance show that there are significant discrepancies between the CQ and LLM groups, thereby warranting further analysis. The results of accuracies and Shannon entropies show that GPT-4 and Bencao have the highest accuracy (0.978) in responses to CQs among all 6 LLMs, according to cardiovascular experts.

Conclusions:
We endorse GPT-4 as the preferred model for responding to CQs related to MedDiet on cardiodiabesity. Concurrently, other LLMs also exhibit the potential to respond to these CQs.
Internalized HIV stigma and viral suppression: examining the mediating and moderating roles of substance use and social support
Authors: Crawford Timothy N. , Neilands Torsten B. , Drumright Lydia N. , Fredericksen Rob J. , Johnson Mallory O. , Mayer Kenneth H. , Bamford Laura , Batchelder Abigail W. , Crane Heidi M. , Elopre Latesha , Moore Richard D. , Rosengren A. Lina , Christopoulos Katerina A. 
Published: August 2024

Objective:
The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects.

Design:
Longitudinal observational clinical cohort of patients in HIV care in the US.
Methods: Data from the CFAR Network for Integrated Clinical Systems (2016–2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence. Moderated mediation with an interaction between social support and internalized HIV stigma was examined.

Results:
Among 9574 individuals included in the study sample, 81.1% were men and 41.4% were black, non-Hispanic. The model demonstrated good fit (root mean square error of approximation = 0.028; standardized root means square residual = 0.067). The overall indirect effect was significant [b = 0.058; se  = 0.020; β = 0.048; 95% confidence interval (95% CI) = 0.019–0.098], indicating that internalized HIV stigma's impact on viral nonsuppression was mediated by depressive symptoms, illicit drug use, and medication adherence. An interaction was observed between internalized HIV stigma and social support on alcohol use; however, there was no moderated mediation for any of the mediators.

Conclusion:
Internalized HIV stigma indirectly impacts viral nonsuppression through its effects on depressive symptoms, illicit drug use, and medication adherence. Social support may buffer the impact, but more research is needed. Understanding the pathways through which internalized stigma impacts viral suppression is key to improving health of people with HIV.
Volumetric Bone Changes in Double Barrel Vascularized Fibula Flap Used for Mandibular Reconstruction: A Randomized Clinical Trial
Authors: Okba Hussam Ashraf , Helmy Emad Saeed , Ayad Wael Mohamed , Abdelaziz Omnyia Mohamed 
Published: August 2024

Aim:
To assess the volumetric bone changes in double barrel vascularized fibular flap used for mandibular reconstruction using 3D miniplate versus 3D titanium mesh tray.

Materials and Methods:
Twenty patients seeking mandibular reconstruction were selected for this 2-arm parallel randomized clinical trial with a 1:1 allocation ratio. Both groups underwent double-barrel fibula free flap for mandibular reconstruction with fixation of the superior barrel to the inferior barrel using a Titanium mesh (Group A) or a 3D plate (Group B). The primary outcome was volumetric bone changes (immediate to 6 months postoperatively).

Results:
Eleven participants (55%) were females, and 9 participants (45%) were males. The mean age of patients in group A was (28.8±8.9) years, while group B was (30.7±11.4) years. There was a statistically significant difference within each group in the volumetric bone changes with means of −7942.1±1804.8 mm3 and −6288.8±2607.3 for groups A and B, respectively. The difference between both groups was statistically insignificant with the mean of −1653.3±1002.8 mm3. The percentage of mean volumetric change relative to immediate postoperatively for group A was −14.15%, while in group B was −11.01%.

Conclusions:
Both the titanium mesh tray and the 3D plate were effective in the fixation of the superior barrel of the vascularized fibular flap for mandibular reconstruction. There was no difference between both modalities regarding volumetric bone changes.