bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recurrence of Diabetic Foot Complications: A Domino Effect Leading to Lethal Consequences—Insights From a National Longitudinal Study
Authors: Hsu Chun-Chien , Lai Hsi-Yu , Lin Hung-Yu , Pan Sung-Ching , Cheng Nai-Chen , Chen Liang-Kung , Hsiao Fei-Yuan , Lin Shu-Wen 
Published: May 2024

Abstract

Background
Foot complications are common in people with diabetes mellitus (DM), leading to increased health care utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events.

Methods
People with DM admitted with foot complications (ulcer, skin and soft tissue infection, or osteomyelitis) from 2012 to 2014 were identified from Taiwan's National Health Insurance Research Database, with a 3-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admissions with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality.

Results
In this study, 28 754 eligible individuals were enrolled and classified into 3 groups: no repeated diabetic foot events (76.1%), 1 repeated event (16.0%), and 2 or more repeated events (7.9%). Logistic regression revealed that advanced age, male sex, congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared with those with no repeated events, the adjusted hazard ratios for all-cause mortality were 1.26 (95% CI, 1.19–1.34) for 1 repeated event and 1.36 (95% CI, 1.26–1.47) for 2 or more repeated events.

Conclusions
The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies.
Artificial intelligence as a second reader for screening mammography
Authors: Nakai Etsuji , Miyagi Yumi , Suzuki Kazuhiro , Scoccia Pappagallo Alessandro , Kayama Hiroki , Matsuba Takehito , Yang Lin , Xu Shawn , Kelly Christopher , Najafi Ryan , Kohlberger Timo , Golden Daniel , Uddin Akib , Nakamura Yusuke , Kokubu Yumi , Takahashi Yoko , Ueno Takayuki , Oguchi Masahiko , Ohno Shinji , Ledsam Joseph R 
Published: May 2024

Abstract

Background
Artificial intelligence (AI) has shown promise in mammography interpretation, and its use as a second reader in breast cancer screening may reduce the burden on health care systems.

Purpose
To evaluate the performance differences between routine double read and an AI as a second reader workflow (AISR), where the second reader is replaced with AI.

Materials and Methods
A cohort of patients undergoing routine breast cancer screening at a single center with mammography was retrospectively collected between 2005 and 2021. A model developed on US and UK data was fine-tuned on Japanese data. We subsequently performed a reader study with 10 qualified readers with varied experience (5 reader pairs), comparing routine double read to an AISR workflow.

Results
A “test set” of 4,059 women (mean age, 56 ± 14 years; 157 positive, 3,902 negative) was collected, with 278 (mean age 55 ± 13 years; 90 positive, 188 negative) evaluated for the reader study. We demonstrate an area under the curve =.84 (95% confidence interval [CI], 0.805-0.881) on the test set, with no significant difference to decisions made in clinical practice (P = .32). Compared with routine double reading, in the AISR arm, sensitivity improved by 7.6% (95% CI, 3.80-11.4; P = .00004) and specificity decreased 3.4% (1.42-5.43; P = .0016), with 71% (212/298) of scans no longer requiring input from a second reader. Variation in recall decision between reader pairs improved from a Cohen kappa of κ = .65 (96% CI, 0.61-0.68) to κ = .74 (96% CI, 0.71-0.77) in the AISR arm.

Conclusion
AISR improves sensitivity, reduces variability and decreases workload compared to routine dual screening.
Towards the DSM-6: Results of a Survey of Experts on the Reintroduction of First-Rank Symptoms as Core Criteria of Schizophrenia and on Redefining Hallucinations
Authors: Moritz Steffen , Borgmann Lisa , Heinz Andreas , Fuchs Thomas , Gallinat Jürgen 
Published: May 2024

Abstract

Background
Diagnostic criteria for mental disorders are subject to change. This is particularly true for schizophrenia, whose diagnostic criteria in the current DSM-5 bear little resemblance to what Kraepelin once named “dementia praecox” and Bleuler termed “the schizophrenias.” The present study reports results from a survey of experts on two core topics of schizophrenia: (a) whether subsequent editions of the DSM should once again give the Schneiderian first-rank symptoms (FRS; eg, thought broadcasting) the prominent role they had in the DSM-IV and (b) whether the currently quite narrow definition of hallucinations in the DSM-5 requiring them to be vivid and clear and have the full force and impact of normal perceptions should be broadened to incorporate perceptual-like phenomena that the individual can differentiate from proper perceptions but still perceives as real and externally generated.

Hypothesis
The aim of the survey was to learn about experts’ opinions with no clear hypotheses.

Study Design
International experts on schizophrenia were recruited via various sources and invited to participate in a short online survey. The final sample comprised 136 experts with a subgroup of 53 experts with verified identity and at least 6 years of clinical and/or research experience.

Study Results
Slightly more experts voted in favor (49.3%) of returning FRS to the prominent role they had in earlier versions of the DSM than against (34.6%). Approximately four out of five experts agreed that the definition of hallucinations in the DSM should be expanded. According to the results, alongside internal symptoms that are phenomenologically indistinguishable from true perceptions, sensory intrusions that the holder is convinced were inserted from another source (ie, not self-generated) should be included in the definition.

Conclusions
While a large majority of experts recommend a change in the definition of hallucinations, the experts’ opinions on FRS are more mixed. We hope that this article will stimulate future studies targeting the diagnostic relevance of these symptoms and encourage discussion about the definition of core psychotic symptoms and the diagnostic criteria for the upcoming edition of the DSM.
Race and Religion in Everyday Life: Antisemitism, Islamophobia, and Christian Privilege Among Female Converts in the Netherlands
Authors: Schrijvers Lieke L 
Published: May 2024

Abstract
This article analyzes how the intersections of race and religion impact the experiences of women converting to Judaism, Christianity, or Islam in the Netherlands. It builds on the innovative historical and philosophical work by scholars who call attention to the intersections of race and religion. In ethnographic studies of female converts such entanglements of race and religion have primarily been noted in the case of white converts in Islam. However, research into race and racialization among Christian and Jewish female converts is rare, and a comparative approach even rarer. A bottom-up comparative approach, I argue, has the potential to critically examine not only the positions of religio-racialized minorities, but also the mechanisms of religious/racial hegemony at work in Western Europe. The article thus explores how becoming a religious minority impacts one’s sense of belonging to the nation and how processes of racialization, specifically antisemitism and Islamophobia, impact the conversion process.
Effect of traditional roughage-based or limit-fed, high-energy diets on growth performance and digestion in newly received growing cattle and subsequent implications on feedlot growth performance and carcass characteristics
Authors: Scilacci Morgan A , Titgemeyer Evan C , Duncan Zachary M , Spore Tyler J , Montgomery Sean P , O’Quinn Travis G , Tarpoff Anthony J , Hollenbeck William R , Blasi Dale A 
Published: May 2024

Abstract
The objective was to determine the effects of ad libitum-fed roughage-based diets or limit-fed high-energy diets on growth performance, behavior, health, and digestion in newly received growing cattle and subsequent implications on feedlot growth performance and carcass characteristics. In experiment 1, 409 crossbred heifers (initial body weight [BW] = 279 ± 24 kg) in 32 pens were used in a randomized block design. Heifers were fed one of two dietary treatments: a total mixed ration with 0.99 Mcal net energy for gain (NEg)/kg dry matter (DM) fed ad libitum (0.99AL) or 1.32 Mcal NEg/kg DM limit-fed at 85% of intake of heifers fed 0.99AL (1.32LF85%). Both diets contained 40% DM as a branded wet corn gluten feed. In experiment 2, 370 crossbred heifers (initial BW = 225 ± 20 kg) were used in a randomized block design and were fed a diet formulated to contain 0.99 Mcal of NEg/kg DM for ad libitum intake or a diet formulated to contain 1.32 Mcal of NEg/kg DM and fed at 2.2% of BW daily (DM basis; 1.32LF2.2). For experiments 1 and 2, treatment integrity was maintained through the finishing phase where cattle were fed a common diet. Cattle were sorted by BW into heavy and light groups prior to finishing, with light cattle fed longer than heavy cattle to reach similar harvest BW. In experiment 3, eight ruminally cannulated heifers (average BW = 305 ± 23 kg) were used in a 2-period cross-over design and fed treatments from experiment 1 to assess digestibility and ruminal fermentation characteristics. Gain:feed was 47% and 35% greater (P &lt; 0.01) in experiments 1 and 2, respectively, for limit-fed heifers compared with 0.99AL heifers. Rumination time was greater (P &lt; 0.01) for 0.99AL compared with limit-fed treatments in experiments 1 and 2. Activity was greater (P &lt; 0.01) for 1.32LF2.2 than for 0.99AL in experiment 2. In experiment 1, more (P = 0.03) carcasses from light-sort heifers than carcasses from heavy-sort heifers had livers with large, active abscesses. In experiment 2, finishing phase morbidity was greater (P &lt; 0.01) for 1.32LF2.2 than for 0.99AL. Light-sort groups had fewer (P &lt; 0.01) edible livers than heavy-sort groups, suggesting that greater number of days on feed may increase the risk of liver abscess prevalence and condemnation. In experiment 3, apparent total-tract DM and organic matter digestibilities were greater (P &lt; 0.01) for 1.32LF85% than for 0.99AL. Overall, dietary treatments during the growing phase had little carryover effect on feedlot growth performance, carcass characteristics, or liver abscesses prevalence at harvest.
Mid to Long-Term Outcomes of Grade III-B Open Tibial Fractures Definitively Managed With a Circular Frame: A 13-Year Prospective Database Study at a Major Trauma Center
Authors: Madhvani Kiran R. , Fong Angus , Clark Thomas , Eng Khemerin , Condurache Codrin , McGregor-Riley Jonathan , Shields David W. 
Published: May 2024

OBJECTIVES:
The aim of this study was to report experience of a major trauma center utilizing circular frames as definitive fixation in patients sustaining Gustilo–Anderson 3B open tibial fractures.

METHODS:

Design:
A prospectively maintained database was retrospectively interrogated.

Setting:
Single major trauma center in the United Kingdom.

Patient Selection Criteria:
All patients over the age of 16 sustaining an open tibial fracture with initial debridement performed at the study center. All patients also received orthoplastic care for a soft tissue defect (via skeletal deformation or a soft tissue cover procedure) and subsequent definitive management using an Ilizarov ring fixator. Patients who received primary debridement at another center, had preexisting infection, sustained a periarticular fracture, or those who did not afford a minimum of 12-month follow-up were excluded. Case notes and radiographs were reviewed to collate patient demographics and injury factors.

Outcome Measures and Comparisons:
The primary outcome of interest was deep infection rate with secondary outcomes including time to union and secondary interventions.

RESULTS:
Two hundred twenty-five patients met inclusion criteria. Mean age was 43.2 year old, with 72% males, 34% smokers, and 3% diabetics. Total duration of frame management averaged 6.4 months (SD 7.7). Eight (3.5%) patients developed a deep infection and 41 (20%) exhibited signs of a pin site infection. Seventy-nine (35.1%) patients had a secondary intervention, of which 8 comprised debridement of deep infection, 29 bony procedures, 8 soft tissue operations, 30 frame adjustments, and 4 patients requiring a combination of soft tissue and bony procedures. Bony union was achieved in 221 cases (98.2%), 195 (86.7%) achieved union in a single frame without the need for secondary intervention, 26 required frame adjustments to achieve union. Autologous bone grafts were used in 10 cases.

CONCLUSIONS:
Orthoplastic care including circular frame fixation for Gustilo–Anderson-3B fractures of the tibia resulted in a low rate of deep infection (3.5%) and achieved excellent union rates (98.2%).

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intraoperative Hypotension Is an Important Modifiable Risk Factor for Major Complications in Spinal Fusion Surgery
Authors: Glassman Steven D. , Carreon Leah Y. , Djurasovic Mladen , Chappell Desiree , Saasouh Wael , Daniels Christy L. , Mahoney Colleen H. , Brown Morgan E. , Gum Jeffrey L. 
Published: May 2024

Study Design.
Retrospective observational cohort.

Objectives:
This study explores the impact of Intraoperative hypotension (IOH) on postoperative complications for major thoracolumbar spine fusion procedures.

Summary of Background Data.
IOH with mean arterial pressure (MAP) <65 mm Hg is associated with postoperative acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction.

Methods.
A total of 539 thoracolumbar fusion cases, more than six surgical levels and >3 hours duration, were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1-minute intervals. Cummulative duration of MAP <65 mm Hg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI, and encephalopathy were noted. Cumulative complications were grouped as none, one to two complications, or more than three complications.

Results.
There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs. 5.6 min, P<0.001) and across the entire procedure (28.1 vs. 19.3 min, P=0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT, and postoperative cognitive dysfunction. Comparison of patients with zero versus one to two versus three or more complications demonstrated that patients with three or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had one to two or three or more complications.

Conclusion.
This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multilevel lumbar fusion surgery.

Level of Evidence.
III.
Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion
Authors: Gouzoulis Michael J. , Seddio Anthony E. , Winter Adam D. , Jabbouri Sahir S. , Zhu Justin R. , Rubio Daniel R. , Varthi Arya G. , Grauer Jonathan N. 
Published: May 2024

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion.

Summary of Background data.
Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic-assisted systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature.

Methods.
Patients undergoing one-level to three-level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015 to 2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic-assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using the Kaplan-Meier survival analysis.

Results.
From 2015 to 2022, there has been a significant increase in both navigation-assisted and robotic-assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there were no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P<0.001). There were no differences in 3-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% vs. 94.0%, P=0.30).

Conclusions.
As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated.

Level of Evidence.
Level III.
LONG-TERM VISUAL OUTCOMES AND OPTICAL COHERENCE TOMOGRAPHY BIOMARKERS IN EYES WITH MACULAR EDEMA SECONDARY TO RETINAL VEIN OCCLUSION FOLLOWING ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: Viggiano Pasquale , Bisceglia Giulia , Bacherini Daniela , Chhablani Jay , Grassi Maria Oliva , Boscia Giacomo , Borrelli Enrico , Reibaldi Michele , Evangelista Federica , Alessio Giovanni , Boscia Francesco 
Published: May 2024

Purpose:
To evaluate the structural characteristics and long-term visual outcomes in eyes impacted by macular edema as a consequence of retinal vein occlusion that has undergone effective treatment with anti–vascular endothelial growth factor therapy.

Methods:
Inclusion criteria comprised 42 eyes of 41 patients, subjected to long-term follow-up, displaying resolved macular edema after a minimum of 5 years since the commencement of anti–vascular endothelial growth factor therapy. During the final visit, two experienced observers evaluated several qualitative parameters using spectral-domain optical coherence tomography, such as the integrity of the external limiting membrane, the state of the ellipsoid zone and retinal pigment epithelium, and the presence of disorganization of the retinal inner layers. In addition, a quantitative evaluation of the inner and outer retinal thicknesses was conducted for the purpose of topographical analysis.

Results:
The most prominent qualitative correlation identified with best-corrected visual acuity during the final visit was connected to the presence of disorganization of the retinal inner layers (P = 0.004) and the integrity of the external limiting membrane (P = 0.015). In relation to quantitative aspects, a noteworthy correlation was noted between the visual acuity during the last visit and the parafoveal thickness in both the inner (P = 0.003) and outer retina (P = 0.018).

Conclusion:
In eyes where macular edema resulting from retinal vein occlusion has been successfully resolved with anti–vascular endothelial growth factor therapy, changes in the status of the external limiting membrane and the presence of disorganization of the retinal inner layers serve as valuable optical coherence tomography biomarkers, indicating prolonged visual outcomes.
Endovascular treatment versus standard medical treatment in patients with established large infarct: a cohort study
Authors: Guo Changwei , Li Linyu , Huang Jiandi , Yang Jie , Song Jiaxing , Huang Jiacheng , Peng Zhouzhou , Yu Nizhen , Liu Chang , Kong Weilin , Hu Jinrong , Chen Li , Guo Meng , Yue Chengsong , Yang Dahong , Liu Xiang , Miao Jian , Wang Mengmeng , Luo Xiangyun , Tang Zhaoyin , Bai Xiubing , Wang Duolao , Li Fengli , Yang Qingwu , Zi Wenjie 
Published: May 2024

Background:
Previous trials confirmed the benefit of endovascular treatment (EVT) in acute large core stroke, but the effect of EVT on outcomes in these patients based on noncontrast computed tomography (NCCT) in real-world clinical practice was unclear. The aim of this study was to explore the effect of EVT versus standard medical treatment (SMT) in patients with large ischemic core stroke defined as Alberta Stroke Program Early CT Score (ASPECTS) ≤5 based on NCCT alone.

Materials and methods:
Patients with acute large core stroke at 38 Chinese centers between November 2021 and February 2023 were reviewed from a prospectively maintained database. The primary outcome was favorable functional outcome [modified Rankin Scale score (mRS), 0–3] at 90 days. Safety outcomes included 48 h symptomatic intracerebral hemorrhage (sICH) and 90-day mortality.

Results:
Of 745 eligible patients recruited at 38 stroke centers between November 2021 and February 2023, 490 were treated with EVT+SMT and 255 with SMT alone. One hundred and eighty-one (36.9%) in the EVT group achieved favorable functional independence versus 48 (18.8%) treated with SMT only [adjusted risk ratio (RR), 1.86; 95% CI: 1.43–2.42, P<0.001; adjusted risk difference (RD), 13.77; 95% CI: 7.40–20.15, P<0.001]. The proportion of sICH was significantly higher in patients undergoing EVT (13.3 vs. 2.4%; adjusted RR, 5.17; 95% CI: 2.17–12.32, P<0.001; adjusted RD, 10.10; 95% CI: 6.12–14.09, P<0.001). No significant difference of mortality between the groups was observed (41.8 vs. 49.0%; adjusted RR, 0.91; 95% CI: 0.77–1.07, P=0.24; adjusted RD, −5.91; 95% CI: −12.91–1.09, P=0.1).

Conclusion:
Among patients with acute large core stroke based on NCCT in real-world, EVT is associated with better functional outcomes at 90 days despite of higher risk of sICH. Rates of procedure-related complications were relatively higher in the EVT+SMT group.