bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population
Authors: Lee Keng Siang , Siow Isabel , Riandini Tessa , Narasimhalu Kaavya , Tan Kelvin Bryan , De Silva Deidre Anne 
Published: May 2024

Objective: There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality. Methods: This cohort study adhered to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We obtained data from the Singapore Stroke Registry (SSR) from 2005 to 2016 and cross referenced to the Death Registry and the Myocardial Infarction Registry. Outcome measures included recurrent stroke, acute myocardial infarction (AMI), and all-cause and stroke-related deaths. Multivariable Cox proportional hazards regression models were performed to determine risk factors for recurrent stroke, AMI, and all-cause and stroke-related deaths. Results: A total of 64,915 patients (6705 young, and 58,210 older) were included in our analysis. Older stroke patients were found to have an increased risk of recurrent stroke (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.12–1.30), AMI (HR = 1.73, 95% CI = 1.54–1.95), all-cause death (HR = 2.49, 95% CI = 2.34–2.64), and stroke-related death (HR = 176, 95% CI = 1.61–1.92). Among young stroke patients, males were at increased risk for recurrent stroke (HR = 1.18, 95% CI = 1.01–1.39) and AMI (HR = 1.41, 95% CI = 1.08–1.83), but at reduced risk for all-cause (HR = 0.78, 95% CI = 0.69–0.89) and stroke-related deaths (HR = 0.79, 95% CI = 0.67–0.94). Ethnicity appeared to influence outcomes, with Malay patients at increased risk of recurrent stroke (HR = 1.37, 95% CI = 1.14–1.65), AMI (HR = 2.45, 95% CI = 1.87–3.22), and all-cause (HR = 1.43, 95% CI = 1.24–1.66) and stroke-related deaths (HR = 1.34, 95% CI = 1.09–1.64). Indian patients were also at increased risk of AMI (HR = 1.96, 95% CI = 1.41–2.72). Similar findings were seen among the older stroke patients. Conclusion: This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.
Subcapital realignment osteotomy for the treatment of moderate and severe slipped upper femoral epiphysis: A retrospective study of 123 hips in a tertiary center
Authors: Winson Daniel MG , Cundy William J , Roser Megan JN , Carty Christopher P , Maine Sheanna , Donald Geoffrey 
Published: May 2024

Background: The surgical treatment of moderate and severe slipped capital femoral epiphysis is controversial. Treatment ranges from pinning in situ to open dislocation and reduction of the slipped epiphysis. The modified Dunn procedure has been associated with variable avascular necrosis with rates, ranging between 0% and 67%. The aim of this study was to evaluate the outcomes and complications of patients who have undergone a subcapital realignment osteotomy (SCRO) in our center. Methods: A retrospective longitudinal study of the osteotomies performed between 2009 and 2019 in a tertiary referral center for Pediatric Orthopedics in Queensland, Australia. Patient demographics, stability, and severity of slip and surgical outcomes were collected. Results: A total of 123 procedures were performed on 116 patients. The mean age was 12.4 years, 65 (56%) patients were male and the mean posterior sloping angle was 60.10 with 93 (75%) being severe slips. There were 51 (41.5%) Loder’s stable and 72 (58%) unstable slipped capital femoral epiphysis. Our overall avascular necrosis rate following SCRO was 17.8%. Time between surgery and diagnosis did not have an effect on avascular necrosis. Conclusion: The subcapital realignment osteotomy remains a controversial and complex procedure for the management of moderate and severe slipped capital femoral epiphysis. We found that our cohort demonstrated an avascular necrosis rate in keeping with the existing literature. This indicates that when performed in a high-volume center with experienced surgical staff, it can be an effective treatment option for these patients. Level of evidence: Level IV
The Impact of Changing Antithrombotic Management in Patients With Atrial Fibrillation and Ischemic Cerebrovascular Events Despite Anticoagulation
Authors: Harahsheh Ehab , Elshaigi Omer , Alhayek Nour , Buckner Skye A. , Quillen Jaxon K. , O’Carroll Cumara B. , Dumitrascu Oana M. 
Published: May 2024

Background Patients with atrial fibrillation (AF) are at increased risk of ischemic cerebrovascular events despite anticoagulants (AC). We aim to evaluate whether changing AC or adding antiplatelet therapy to anticoagulants (AP + AC) in patients with AF presenting with acute ischemic stroke (AIS) or transient ischemic attack (TIA) despite AC, decreases the risk of recurrent AIS/TIA compared to patients continued on same AC regimen. Methods Patients with AF on AC presenting with AIS or TIA at our center between 2011- 2021 were included. Data on Demographics, index event, antithrombotic therapy before and after index event, recurrent AIS/TIA, or major bleeding events (MBE) were extracted. Cox proportional hazards models were used to compare outcomes between AC unchange vs AC change, and AP + AC vs AC only groups. Results One hundred eighty-five patients were included (mean age 78.3 years; 62% males, median follow-up 9 months (IQR 1-34)). Seventeen patients (9%) had AC change, 100 (54%) received AP + AC, 39 (21%) had recurrent AIS/TIA, and 27 (15%) had MBE following index event. No difference was observed between AC unchange vs AC change and AP + AC vs AC only groups regarding recurrent AIS/TIA (HR 1.72 [.65-4.57], P = .27 and HR 1.02 [.53- 1.98], P = .95, respectively) or MBE (HR .85 [.19-3.67], P = .83 and HR 1.49 [.67-3.33)], P = .33, respectively). Fourteen vascular neurologists treated this cohort and 9(64%) implemented AC changes. Conclusion In this single center retrospective study of 185 patients with AF and AIS/TIA despite AC, changing AC or adding AP agents did not decrease the risk of ischemic cerebrovascular events.
Choledochoduodenostomy combined with Billroth II procedure for extrahepatic biliary obstruction and duodenal perforation in a cat
Authors: Tomura Shintaro , Iwata Taisuke , Sugimoto Taichi , Nakashima Ko , Kojima Kazuhiro , Uchida Kazuyuki , Fujita Atsushi 
Published: May 2024

Case summary A 5-year-old neutered Somali cat presented with a 2-week history of icterus. Diagnostic imaging revealed extrahepatic biliary obstruction (EHBO) due to a common bile duct (CBD) mass. During exploratory laparotomy, a duodenal perforation was discovered incidentally. Choledochoduodenostomy combined with the Billroth II procedure was performed after resection of the CBD mass and the proximal duodenum to treat the EHBO and duodenal perforation. Based on histological and immunohistochemical findings, the CBD mass was diagnosed as a neuroendocrine carcinoma with gastrin-producing cell differentiation. The cat recovered almost uneventfully and was discharged 11 days after surgery. The cat survived for nearly 100 days without recurrence of EHBO or duodenal perforation; however, intermittent vomiting and weight loss persisted despite supportive medications. Relevance and novel information To the best of our knowledge, there is no detailed report on the application of choledochoduodenostomy combined with the Billroth II procedure in cats, as we used to treat the EHBO and duodenal perforation in the present case. As serum gastrin concentrations were elevated on the first day of hospitalisation, the CBD mass was diagnosed as a neuroendocrine carcinoma with gastrin-producing cell differentiation, which seemed to have caused not only EHBO but also duodenal perforation (Zollinger–Ellison syndrome). The cat survived for almost 100 days without any perioperative complications. However, this combined procedure might be considered as only a salvage option and not as a definitive treatment option in cats requiring simultaneous biliary and gastrointestinal reconstruction because postoperative supportive care could not improve the cat’s condition or maintain its quality of life.
An innovative technological infrastructure for managing SARS-CoV-2 data across different cohorts in compliance with General Data Protection Regulation
Authors: Dellacasa Chiara , Ortali Maurizio , Rossi Elisa , Abu Attieh Hammam , Osmo Thomas , Puskaric Miroslav , Rinaldi Eugenia , Prasser Fabian , Stellmach Caroline , Cataudella Salvatore , Agarwal Bhaskar , Mata Naranjo Juan , Scipione Gabriella 
Published: May 2024

Background The ORCHESTRA project, funded by the European Commission, aims to create a pan-European cohort built on existing and new large-scale population cohorts to help rapidly advance the knowledge related to the prevention of the SARS-CoV-2 infection and the management of COVID-19 and its long-term sequelae. The integration and analysis of the very heterogeneous health data pose the challenge of building an innovative technological infrastructure as the foundation of a dedicated framework for data management that should address the regulatory requirements such as the General Data Protection Regulation (GDPR). Methods The three participating Supercomputing European Centres (CINECA - Italy, CINES - France and HLRS - Germany) designed and deployed a dedicated infrastructure to fulfil the functional requirements for data management to ensure sensitive biomedical data confidentiality/privacy, integrity, and security. Besides the technological issues, many methodological aspects have been considered: Berlin Institute of Health (BIH), Charité provided its expertise both for data protection, information security, and data harmonisation/standardisation. Results The resulting infrastructure is based on a multi-layer approach that integrates several security measures to ensure data protection. A centralised Data Collection Platform has been established in the Italian National Hub while, for the use cases in which data sharing is not possible due to privacy restrictions, a distributed approach for Federated Analysis has been considered. A Data Portal is available as a centralised point of access for non-sensitive data and results, according to findability, accessibility, interoperability, and reusability (FAIR) data principles. This technological infrastructure has been used to support significative data exchange between population cohorts and to publish important scientific results related to SARS-CoV-2. Conclusions Considering the increasing demand for data usage in accordance with the requirements of the GDPR regulations, the experience gained in the project and the infrastructure released for the ORCHESTRA project can act as a model to manage future public health threats. Other projects could benefit from the results achieved by ORCHESTRA by building upon the available standardisation of variables, design of the architecture, and process used for GDPR compliance.
Telestroke network to robotic telestroke network: How to upgrade regional stroke care to include remote robotics?
Authors: Charbonnier Guillaume , Consoli Arturo , Bonnet Louise , Biondi Alessandra , Vuillier Fabrice , Rabenorosoa Kanty , Mendes Pereira Vitor , Moulin Thierry 
Published: May 2024

Objective Selected patients with large vessel occlusion (LVO) strokes can benefit from endovascular therapy (EVT). However, the effectiveness of EVT is largely dependent on how quickly the patient receives treatment. Recent technological developments have led to the first neurointerventional treatments using robotic assistance, opening up the possibility of performing remote stroke interventions. Existing telestroke networks provide acute stroke care, including remote administration of intravenous thrombolysis (IVT). Therefore, the introduction of remote EVT in distant stroke centers requires an adaptation of the existing telestroke networks. The aim of this work was to propose a framework for centers that are potential candidates for telerobotics according to the resources currently available in these centers. Methods In this paper, we highlight the future challenges for including remote robotics in telestroke networks. A literature review provides potential solutions. Results Existing telestroke networks need to determine which centers to prioritize for remote robotic technologies based on objective criteria and cost-effectiveness analysis. Organizational challenges include regional coordination and specific protocols. Technological challenges mainly concern telecommunication networks. Conclusions Specific adaptations will be necessary if regional telestroke networks are to include remote robotics. Some of these can already be put in place, which could greatly help the future implementation of the technology.
A Longer Life or a Quality Death? A Discrete Choice Experiment to Estimate the Relative Importance of Different Aspects of End-of-Life Care in the United Kingdom
Authors: Skedgel Chris , Mott David John , Elayan Saif , Cramb Angela 
Published: May 2024

Background. Advocates argue that end-of-life (EOL) care is systematically disadvantaged by the quality-adjusted life-year (QALY) framework. By definition, EOL care is short duration and not primarily intended to extend survival; therefore, it may be inappropriate to value a time element. The QALY also neglects nonhealth dimensions such as dignity, control, and family relations, which may be more important at EOL. Together, these suggest the QALY may be a flawed measure of the value of EOL care. To test these arguments, we administered a stated preference survey in a UK-representative public sample. Methods. We designed a discrete choice experiment (DCE) to understand public preferences over different EOL scenarios, focusing on the relative importance of survival, conventional health dimensions (especially physical symptoms and anxiety), and nonhealth dimensions such as family relations, dignity, and sense of control. We used latent class analysis to understand preference heterogeneity. Results. A 4-class latent class multinomial logit model had the best fit and illustrated important heterogeneity. A small class of respondents strongly prioritized survival, whereas most respondents gave relatively little weight to survival and, generally speaking, prioritized nonhealth aspects. Conclusions. This DCE illustrates important heterogeneity in preferences within UK respondents. Despite some preferences for core elements of the QALY, we suggest that most respondents favored what has been called “a good death” over maximizing survival and find that respondents tended to prioritize nonhealth over conventional health aspects of quality. Together, this appears to support arguments that the QALY is a poor measure of the value of EOL care. We recommend moving away from health-related quality of life and toward a more holistic perspective on well-being in assessing EOL and other interventions. Highlights Advocates argue that some interventions, including but not limited to end-of-life (EOL) care, are valued by patients and the public but are systematically disadvantaged by the quality-adjusted life-year (QALY) framework, leading to an unfair and inefficient allocation of health care resources. Using a discrete choice experiment, we find some support for this argument. Only a small proportion of public respondents prioritized survival in EOL scenarios, and most prioritized nonhealth aspects such as dignity and family relations. Together, these results suggest that the QALY may be a poor measure of the value of EOL care, as it neglects nonhealth aspects of quality and well-being that appear to be important to people in hypothetical EOL scenarios.
Enhanced sensitivity to pitch perception and its possible relation to language acquisition in autism
Authors: Hisaizumi Megumi , Tantam Digby 
Published: May 2024

Background and aims Fascinations for or aversions to particular sounds are a familiar feature of autism, as is an ability to reproduce another person's utterances, precisely copying the other person's prosody as well as their words. Such observations seem to indicate not only that autistic people can pay close attention to what they hear, but also that they have the ability to perceive the finer details of auditory stimuli. This is consistent with the previously reported consensus that absolute pitch is more common in autistic individuals than in neurotypicals. We take this to suggest that autistic people have perception that allows them to pay attention to fine details. It is important to establish whether or not this is so as autism is often presented as a deficit rather than a difference. We therefore undertook a narrative literature review of studies of auditory perception, in autistic and nonautistic individuals, focussing on any differences in processing linguistic and nonlinguistic sounds. Main contributions We find persuasive evidence that nonlinguistic auditory perception in autistic children differs from that of nonautistic children. This is supported by the additional finding of a higher prevalence of absolute pitch and enhanced pitch discriminating abilities in autistic children compared to neurotypical children. Such abilities appear to stem from atypical perception, which is biased toward local-level information necessary for processing pitch and other prosodic features. Enhanced pitch discriminating abilities tend to be found in autistic individuals with a history of language delay, suggesting possible reciprocity. Research on various aspects of language development in autism also supports the hypothesis that atypical pitch perception may be accountable for observed differences in language development in autism. Conclusions The results of our review of previously published studies are consistent with the hypothesis that auditory perception, and particularly pitch perception, in autism are different from the norm but not always impaired. Detail-oriented pitch perception may be an advantage given the right environment. We speculate that unusually heightened sensitivity to pitch differences may be at the cost of the normal development of the perception of the sounds that contribute most to early language development. Implications The acquisition of speech and language may be a process that normally involves an enhanced perception of speech sounds at the expense of the processing of nonlinguistic sounds, but autistic children may not give speech sounds this same priority.
Prehospital stroke diagnostics using three different simulation methods: A pragmatic pilot study
Authors: Christensen Emma , Fagerheim Bugge Helge , Hagemo Jostein , Larsen Karianne , Harring Astrid KV , Gleditsch Jostein , Ibsen Jørgen , Guterud Mona , Sandset Else Charlotte , Hov Maren Ranhoff 
Published: May 2024

Introduction: The optimal pathway for ultra-early diagnostics and treatment in patients with acute stroke remains uncertain. The aim of this study was to investigate how three different methods of simulated, rural prehospital computed tomography (CT) affected the time to prehospital treatment decision in acute stroke. Materials and Methods: In this pragmatic, simulation, pilot study of prehospital CT we investigated a conventional ambulance with transport to a standard care rural stationary CT machine managed by paramedics, a Mobile Stroke Unit (MSU), and a helicopter with a simulated CT machine. Each modality completed 20 real-life dispatches combined with simulation of predetermined animated patient cases with acute stroke symptoms and CT images. The primary endpoint of the study was the time from alarm to treatment decision. Results: Median time from alarm to the treatment decision differed significantly between the three groups ( p = 0.0005), with 38 min for rural CT, 33 min for the MSU, and 30 min for the helicopter. There was no difference in time when comparing rural CT with MSU, nor when comparing the MSU with the helicopter. There was a difference in time to treatment decision between the rural CT and the helicopter ( p < 0.0001). The helicopter had significantly lower estimated time from treatment decision to hospital ( p = 0.001). Disscussion/Conclusion: Prehospital CT can be organized in several ways depending on geography, resources and need. Further research on paramedic run rural CT, MSU in rural areas, and helicopter CT is needed to find the optimal strategy.
New models for prediction of postoperative pulmonary complications in lung resection candidates
Authors: Svoboda Michal , Cundrle Ivan , Plutinsky Marek , Homolka Pavel , Mitas Ladislav , Chovanec Zdenek , Olson Lyle J. , Brat Kristian 
Published: May 2024

IntroductionIn recent years, ventilatory efficiency (minute ventilation (V′E)/carbon dioxide production (V′CO2) slope) and partial pressure of end-tidal carbon dioxide (PETCO2) have emerged as independent predictors of postoperative pulmonary complications (PPC). Single parameters may give only partial information regarding periprocedural hazards. Accordingly, our aim was to create prediction models with improved ability to stratify PPC risk in patients scheduled for elective lung resection surgery.MethodsThispost hocanalysis was comprised of consecutive lung resection candidates from two prior prospective trials. All individuals completed pulmonary function tests and cardiopulmonary exercise testing (CPET). Logistic regression analyses were used for identification of risk factors for PPC that were entered into the final risk prediction models. Two risk models were developed; the first used restPETCO2(for patients with no available CPET data), the second usedV′E/V′CO2slope (for patients with available CPET data). Receiver operating characteristic analysis with the De-Long test and area under the curve (AUC) were used for comparison of models.ResultsThe dataset from 423 patients was randomly split into the derivation (n=310) and validation (n=113) cohorts. Two final models were developed, both including sex, thoracotomy, “atypical” resection and forced expiratory volume in 1 s/forced vital capacity ratio as risk factors. In addition, the first model also included restPETCO2, while the second model usedV′E/V′CO2slope from CPET. AUCs of risk scores were 0.795 (95% CI: 0.739–0.851) and 0.793 (95% CI: 0.737–0.849); both p<0.001. No differences in AUCs were found between the derivation and validation cohorts.ConclusionsWe created two multicomponental models for PPC risk prediction, both having excellent predictive properties.