bluuebunny/crossref_metadata_2025_split huggingface dataset:
Memory B cell–guided extended interval dosing of ocrelizumab in multiple sclerosis
Authors: Meng Delania , Sacco Rosaria , Disanto Giulio , Widmer Fausto , Jacober Sarah Lena Susanna , Gobbi Claudio , Zecca Chiara 
Published: May 2024

Background: Ocrelizumab (OCR) is an anti-CD20 monoclonal antibody approved for the treatment of relapsing-remitting and primary-progressive multiple sclerosis (MS). We aimed to evaluate the effectiveness of an individualized OCR extended interval dosing (EID), after switching from standard interval dosing (SID). Methods: This was a retrospective, observational, single-centre study including MS patients regularly followed at the Neurocenter of Southern Switzerland. After a cumulative OCR dose ⩾1200 mg, stable patients were switched to EID (OCR infusions following CD19+ 27+ memory B cell repopulation). Results: A total of 128 patients were included in the study, and 113 (88.3%) were switched to EID with a median interval of 9.9 (8.8–11.8) months between infusions. No clinical relapses occurred; 2 (1.8%) patients experienced disability worsening. Three (2.7%) and 2 (1.8%) patients experienced new T2 brain and spinal lesions, respectively. There was a mild decrease in IgG and IgM concentrations during both SID and EID OCR regimens (β = −0.23, p = 0.001 and β = −0.07, p < 0.001, respectively). Conclusion: Switch to personalized dosing of OCR based on CD19+ 27+ memory B cell repopulation led to a great extension of the interval between infusions, with maintained clinical and radiological efficacy. Given the potential advantages in terms of safety and health costs, EID OCR regimens should be further investigated.
Stimulus-related modulation in the 1/f spectral slope suggests an impaired inhibition during a working memory task in people with multiple sclerosis
Authors: Akbarian Fahimeh , Rossi Chiara , Costers Lars , D’hooghe Marie B , D’haeseleer Miguel , Nagels Guy , Van Schependom Jeroen 
Published: May 2024

Background: An imbalance of excitatory and inhibitory synaptic transmission in multiple sclerosis (MS) may lead to cognitive impairment, such as impaired working memory. The 1/f slope of electroencephalography/magnetoencephalography (EEG/MEG) power spectra is shown to be a non-invasive proxy of excitation/inhibition balance. A flatter slope is associated with higher excitation/lower inhibition. Objectives: To assess the 1/f slope modulation induced by stimulus and its association with behavioral and cognitive measures. Methods: We analyzed MEG recordings of 38 healthy controls (HCs) and 79 people with multiple sclerosis (pwMS) while performing an n-back task including target and distractor stimuli. Target trials require an answer, while distractor trials do not. We computed the 1/f spectral slope through the fitting oscillations and one over f (FOOOF) algorithm within the time windows 1 second before and after each stimulus presentation. Results: We observed a flatter 1/f slope after distractor stimuli in pwMS compared to HCs. The 1/f slope was significantly steeper after stimulus for both HCs and pwMS and was significantly correlated with reaction times. This modulation in 1/f slope was significantly correlated with visuospatial memory assessed by the BVMT-R test. Conclusion: Our results suggest possible inhibitory mechanism deficits in pwMS during a working memory task.
Single-Center Retrospective Study on the Efficacy of Contrast-Enhanced Ultrasound for Detection of Endoleak After Endovascular Aortic Repair
Authors: Nijhawan Akash D. , Pourmoussa Austin J. , Fox Bradley R. , Salazar Samuel A. , Lugo Charles J. , Hasan Muhammad , Benenati James F. , Schiro Brian J. 
Published: May 2024

Introduction: Surveillance for endoleak after endovascular aortic aneurysm repair with computed tomography angiography has the associated risks of radiation exposure and nephrotoxic contrast agents. The purpose of this study was to evaluate the performance of contrast-enhanced ultrasound in the detection of endoleak post–endovascular aortic aneurysm repair. Methods: A single-center retrospective cohort study was performed evaluating patients with abdominal aortic aneurysm treated with endovascular aortic aneurysm repair between October 29, 2017 and April 21, 2021 and follow-up imaging with both computed tomography angiography and contrast-enhanced ultrasound. The sample included 35 imaging combinations in 28 patients. Positive and negative results for detection of endoleak by contrast-enhanced ultrasound were tabulated as true positive, false positive, true negative, and false negative compared to computed tomography angiography and conventional angiography. Sensitivity, specificity, positive predictive value, and negative predictive value of contrast-enhanced ultrasound were calculated. Results: Out of 35 imaging combinations, endoleak was detected in 24 cases by computed tomography angiography and in 23 cases by contrast-enhanced ultrasound. Using computed tomography angiography as the reference standard, contrast-enhanced ultrasound yielded 96% sensitivity, 100% specificity, 100% positive predictive value, and 92% negative predictive value for endoleak detection. In the 23 cases of endoleak detection by both contrast-enhanced ultrasound and computed tomography angiography, contrast-enhanced ultrasound discerned the correct endoleak type in all 23 cases, while computed tomography angiography identified the correct endoleak type in 20 cases ( P = .2333). Discussion: Endoleak detection by contrast-enhanced ultrasound appears at least equivalent to computed tomography angiography. Some of the advantages of contrast-enhanced ultrasound in the surveillance of endoleak after endovascular aortic aneurysm repair include an avoidance of radiation, elimination of nephrotoxic contrast agents, reduction in costs, real-time imaging, discerning flow directionality, and visualizing endoleaks in regions previously embolized with coils/plugs/liquid embolic agents. Limitations include operator dependence and variables that obscure the visual field including obese body habitus. With these advantages and excellent comparison data, contrast-enhanced ultrasound should be considered as a first-line imaging modality for long-term surveillance of endoleaks after endovascular aortic aneurysm repair. Conclusion: Contrast-enhanced ultrasound is a safe and viable option for long-term surveillance post–endovascular aortic aneurysm repair.
A study of the feasibility, ability and acceptability of self-testing of HbA1c before consultation (FLASH) in primary care setting
Authors: Fan Sharon Siew May , Koot David , Chua Boon Ming , Shu Jun Hao , Seah Ai Choo , Tan Ngiap Chuan , Ng Ding Xuan , Koh Yi Ling Eileen , Goh Paul Soo Chye 
Published: May 2024

Background: HbA1c test is the most-ordered laboratory test in public primary care clinics, accounting for 17% of laboratory services. In recent years, there has been growing adoption of self-service technology in taking clinical measurements. However, there are currently no on-site self-testing HbA1c facilities. This study assessed patients’ acceptability and ability to perform self-testing of HbA1c levels and the feasibility of implementation in primary care setting. Methods: A total of 30 eligible diabetic patients were recruited in Tampines Polyclinic. Participants were shown a demonstration video before self-testing with a Point-of-Care HbA1c analyzer and completed a questionnaire after self-testing. The usability of the system was assessed using System Usability Scale (SUS). Acceptance and ability were assessed using either a five or six point-Likert Scale for the 7-step procedure. Fisher’s exact test was used to test for association with SUS score. Results: The study population comprises mainly males (60.0%), Chinese (50.0%), had highest qualification of secondary education and beyond (80.0%), with a mean age of 61.4 ± 8.3 years. The mean SUS score was 66.5 ± 13.3 and the average time taken to complete the HbA1c self-testing was 11.8 ± 4.5 min. No significant association was observed between demographics and SUS score. Although 40.0% of participants experienced some difficulty in inserting the cartridge into the analyzer, all were able to understand and follow the video and were willing to perform self-testing in the future. Conclusion: There is high level of acceptance and ability among diabetic patients to adopt HbA1c self-testing. It is feasible for use in primary care.
Risk factors associated with severe perineal tear at Public Hospitals in Bahir Dar town, Northwest Ethiopia
Authors: Addisu Dagne , Fentahun Betelihem 
Published: May 2024

Background: Birth-related perineal trauma is a public health issue that can lead to significant maternal morbidity in low-income countries like Ethiopia. Research on the proportion and underlying factors of birth-related severe perineal tears is rare, both in the study area and throughout Ethiopia. As a result, this study was intended to determine the proportion of birth-related severe perineal tears and associated factors at hospitals in Bahir Dar town, Ethiopia. Methods: A cross-sectional study was undertaken at government hospitals in Bahir Dar, Ethiopia. Five hundred fifteen study subjects were selected using a systematic sampling technique. The data was collected through chart reviews and interviews. Data was entered and analyzed using SPSS Version 23. A binary logistic regression was employed to identify factors, and an adjusted odds ratio and a 95% CI were used to estimate the strength of relationships. Statistical significance was declared at p-value < 0.05. Result: The prevalence of severe perineal tears was 7.4%. Previous history of a perineal tear (AOR = 3.06, 95% CI = 1.24–7.59), being nullipara (AOR = 4.03, 95% CI = 1.42–11.44), occipito-posterior position (AOR = 5.49, 95% CI = 2.27–13.28), duration of second stage of labor > 2 h (AOR = 5.42, 95% CI = 2.26–12.99), birth attendant’s work experience <1 year (AOR = 5.98, 95% CI = 2.16–16.57) were found to be associated with birth-related severe perineal tear. Conclusion: The proportion of birth-related severe perineal tears was high at governmental hospitals in Bahir Dar town. Previous history of perineal tear, work experience of birth attendants, duration of the second stage of labor, being nullipara, and occipito-posterior position were the major determinants of severe perineal tear. This study suggests that strategies and regulations should be developed to shorten the second stage of labor.
Understanding citizens’ attitudes within user-centered digital health ecosystems: A sequential mixed method methodology including a web-survey
Authors: Huettemann Robin , Sevov Benedict , Meister Sven , Fehring Leonard 
Published: May 2024

ObjectiveTransitioning from digital health applications to digital health ecosystems, leveraging the advances in technologies and informatics, could be the next revolution in digital health. This includes offering centralized access to various health services and improving citizens’ well-being, delivery, clinical processes, and data management. However, a limited understanding of citizens may impede adaptation. Therefore, this study investigates citizens’ attitudes within digital health ecosystems, differentiated by their characteristics, to support health service-providers and governmental policymakers in establishing user-centered solutions.MethodsThis study follows a three-step sequential mixed method methodology: (1) a literature review. (2) Qualitative thematic analyses based on semi-structured qualitative interviews. (3) Quantitative analyses based on a web-survey (descriptive statistics, one-way analysis of variances, Tukey-honestly, and Cohen's d tests).ResultsN = 15 citizens were interviewed and n = 1289 responded to the web-survey, to our knowledge the largest survey on this topic. Citizens desire a more convenient management of health services and data (M = 5.2, SD = 1.59). Services with peer-to-peer interactions (M = 3.7, SD = 1.81) and lower involvement of health professionals (M = 3.8, SD = 1.75) are less demanded. Data protection is critical (M = 6.2, SD = 1.23). Public payers are mandated as orchestrators (M = 4.3, SD = 1.99), while private companies receive lower acceptance (M = 3.0, SD = 1.42).ConclusionsHealth service-providers could follow a three-staged approach to establish digital health ecosystems: (1) Increasing the convenience for citizens by enabling online management of health services and data. (2) Extending the citizen–healthcare provider partnership through online interactions. (3) Fostering preventative behaviors and quicker recovery by personalizing health services and interactions. Governmental policymakers should integrate an electronic health record.
“They Ask Questions, But They Don’t Want the Answers”—Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder
Authors: Eckhardt Alison , Waller Dylan E. , Shull Sarah , Lovejoy Travis I. , Morasco Benjamin J. , Gordon Adam J. , Wyse Jessica J. 
Published: May 2024

Background: Many patients with opioid use disorder (OUD) discontinue treatment prematurely, increasing their risk of opioid-related overdose and death. While patient-centered care is considered the gold standard in treating chronic illness, it may be practiced less frequently in the context of OUD care. Patient-provider communication can influence patients’ care experiences, potentially having an impact on treatment retention and care decision-making. Methods: This study was conducted at the VA Portland Health Care System from March 2021 to April 2022. We conducted qualitive interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past year. Coding and analysis were guided by inductive qualitative content analysis. Retrospective medical record review identified clinical and demographic characteristics of participants. Results: Twenty patients completed an interview. Participant age ranged from 28 to 74 years (median 63 years). Ninety percent of participants were white and 90% male. Many participants expressed frustration and feelings of disempowerment in OUD care processes. Patients with a history of long-term prescribed opioid use frequently expressed stigmatizing views of OUD, and perceptions of disagreement with providers over diagnosis and care choices. Elderly patients and those with multiple comorbidities expressed confusion over significant aspects of their care, as well as difficulty navigating treatment logistics like appointment requirements and medication dose changes. Some patients reported later restarting buprenorphine in new settings, and described feeling respected and involved in care decisions as a facilitator for continuing treatment. Conclusions: Prioritizing patient-centered communication in OUD treatment could improve the patient experience and potentially support treatment retention. Subgroups of OUD patients, such as those with a history of long-term prescribed opioid use, elderly patients with multiple comorbidities, or those who express stigmatizing medication views, could particularly benefit from tailored communication strategies that address their individual concerns.
Modified Oblique Lobenhoffer (MOL) approach for posterolateral and posteromedial column access in tibial plateau fractures: a detailed cadaveric anatomical study
Authors: Boluda-Mengod Juan , Olías-López Beatriz , Forcada-Calvet Pau , Martín-Herrero Azucena , Herrera-Pérez Mario , Álvarez-De-La-Cruz Javier , Herrera-Rodríguez Alejandro , Pais-Brito José Luis 
Published: May 2024

Abstract
Background
Tibial plateau fractures involving posteromedial (PM) and posterolateral (PL) columns are complex injuries that require an appropriate approach. The management of the PL column in these cases can be controversial, and limitations using deep posteromedial interval approaches have been referenced. In this paper, a modification of the Lobenhoffer approach, designed to optimize the access to the PL column, is described in detail. The aim of this study was to assess the feasibility of this approach in a cadaveric anatomical study.

Materials and methods
In total, five fresh-frozen cadaveric specimens were used for detailed anatomical study surrounding the approach. Relationships with cutaneous and deep neurovascular structures were evaluated. The exposure area of the PL and PM columns using this approach was assessed.

Results
The cadaveric study showed safe and adequate exposure. Oblique skin and fascia incision just medial to the posterior midline was safe to protect the medial sural cutaneous nerve and the small saphenous vein. Elevation of the popliteus and tibialis posterior muscles offered safe protection of the anterior tibial artery and popliteal neurovascular bundle during retractor placement. Adequate full proximal exposure of the PM and PL columns, including the posterolateral lateral (PLL) and posterolateral central (PLC) segments, was obtained in all specimens.

Conclusions
The Modified Oblique Lobenhoffer (MOL) approach can be a feasible option to access PL and PM columns in tibial plateau fractures.

Level of evidence
IV.
Comparative analysis of codon usage bias in chloroplast genomes of ten medicinal species of Rutaceae
Authors: Shen Lianwen , Chen Shengqun , Liang Mei , Qu Shang , Feng Shijing , Wang Dawei , Wang Gang 
Published: May 2024

AbstractRutaceae family comprises economically important plants due to their extensive applications in spices, food, oil, medicine, etc. The Rutaceae plants is able to better utilization through biotechnology. Modern biotechnological approaches primarily rely on the heterologous expression of functional proteins in different vectors. However, several proteins are difficult to express outside their native environment. The expression potential of functional genes in heterologous systems can be maximized by replacing the rare synonymous codons in the vector with preferred optimal codons of functional genes. Codon usage bias plays a critical role in biogenetic engineering-based research and development. In the current study, 727 coding sequences (CDSs) obtained from the chloroplast genomes of ten Rutaceae plant family members were analyzed for codon usage bias. The nucleotide composition analysis of codons showed that these codons were rich in A/T(U) bases and preferred A/T(U) endings. Analyses of neutrality plots, effective number of codons (ENC) plots, and correlations between ENC and codon adaptation index (CAI) were conducted, which revealed that natural selection is a major driving force for the Rutaceae plant family’s codon usage bias, followed by base mutation. In the ENC vs. CAI plot, codon usage bias in the Rutaceae family had a negligible relationship with gene expression level. For each sample, we screened 12 codons as preferred and high-frequency codons simultaneously, of which GCU encoding Ala, UUA encoding Leu, and AGA encoding Arg were the most preferred codons. Taken together, our study unraveled the synonymous codon usage pattern in the Rutaceae family, providing valuable information for the genetic engineering of Rutaceae plant species in the future.
Mortality and cardiac arrest rates of emergency surgery in developed and developing countries: a systematic review and meta-analysis
Authors: Guo Kaikai , Xu Fengying , Li Ye , Ma Mingxing , Li Jing , Wang Long 
Published: May 2024

Abstract
Background
The magnitude of the risk of death and cardiac arrest associated with emergency surgery and anesthesia is not well understood. Our aim was to assess whether the risk of perioperative and anesthesia-related death and cardiac arrest has decreased over the years, and whether the rates of decrease are consistent between developed and developing countries.

Methods
A systematic review was performed using electronic databases to identify studies in which patients underwent emergency surgery with rates of perioperative mortality, 30-day postoperative mortality, or perioperative cardiac arrest. Meta-regression and proportional meta-analysis with 95% confidence intervals (CIs) were performed to evaluate global data on the above three indicators over time and according to country Human Development Index (HDI), and to compare these results according to country HDI status (low vs. high HDI) and time period (pre-2000s vs. post-2000s).

Results
35 studies met the inclusion criteria, representing more than 3.09 million anesthetic administrations to patients undergoing anesthesia for emergency surgery. Meta-regression showed a significant association between the risk of perioperative mortality and time (slope: -0.0421, 95%CI: from − 0.0685 to -0.0157; P = 0.0018). Perioperative mortality decreased over time from 227 per 10,000 (95% CI 134–380) before the 2000s to 46 (16–132) in the 2000–2020 s (p < 0–0001), but not with increasing HDI. 30-day postoperative mortality did not change significantly (346 [95% CI: 303–395] before the 2000s to 292 [95% CI: 201–423] in the 2000s-2020 period, P = 0.36) and did not decrease with increasing HDI status. Perioperative cardiac arrest rates decreased over time, from 113 per 10,000 (95% CI: 31–409) before the 2000s to 31 (14–70) in the 2000–2020 s, and also with increasing HDI (68 [95% CI: 29–160] in the low-HDI group to 21 [95% CI: 6–76] in the high-HDI group, P = 0.012).

Conclusions
Despite increasing baseline patient risk, perioperative mortality has decreased significantly over the past decades, but 30-day postoperative mortality has not. A global priority should be to increase long-term survival in both developed and developing countries and to reduce overall perioperative cardiac arrest through evidence-based best practice in developing countries.
A rare case of pheochromocytoma in a pregnant woman presenting with chest pain: extraordinary management
Authors: Ge Tao , Xie Xiangrong , Liu Jichun 
Published: May 2024

Abstract
Background
Pheochromocytoma is rare in pregnant women. It presents as diverse symptoms, including hypertension and sweating. The symptoms of pregnant women with pheochromocytoma and comorbid hypertension often mimic the clinical manifestations of preeclampsia, and these women are often misdiagnosed with preeclampsia.

Case presentation
In this case, a pregnant woman presented with chest pain as the primary symptom, and a diagnosis of pheochromocytoma was considered after ruling out myocardial ischemia and aortic dissection with the relevant diagnostic tools. This patient then underwent successful surgical resection using a nontraditional management approach, which resulted in a positive clinical outcome.

Conclusions
It is essential to consider pheochromocytoma as a potential cause of chest pain and myocardial infarction-like electrocardiographic changes in pregnant women, even if they do not have a history of hypertension.