bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of ultrasound-guided distal catheter placement in pediatric ventriculoatrial shunts for patients with hydrocephalus: Effectiveness and consequences
Authors: Rollo Giovanni , Silvestri Francesca Maria , Persano Giorgio , Mastronuzzi Angela , Carai Andrea , Marras Carlo Efisio , Cacchione Antonella , Madafferi Silvia , Martucci Cristina , Reali Simone , Grimaldi Chiara , Natali Gian Luigi , Kelly Daniella Araiza , Crocoli Alessandro 
Published: February 2025

Background and aims: Ventriculoatrial (VA) shunts are frequently used for hydrocephalus (HS) management when peritoneal catheter placement is inappropriate. Historically, open surgical cut-down (OSC) on the internal jugular vein has been the standard method for distal catheter insertion. In contrast, percutaneous Seldinger-type ultrasound-guided (USG) venipuncture offers advantages such as reduced operating times and lower postoperative pain. However, its use in pediatric patients is limited. Methods: This study reviewed patients diagnosed with HS who underwent VA shunt procedures (OSC vs USG) at Bambino Gesù Children’s Hospital from January 1, 2014, to February 29, 2024. The analysis focused on surgical times for VA shunt placements and associated neurosurgical operations, as well as catheter replacement rates. Results: Thirteen patients (6 males, 7 females; median age 12 years, range 0.5–14.2) were enrolled, with a total of 23 procedures performed. The mean surgical time for distal VA placement using the USG technique was significantly shorter than for the OSC method (13.36 min vs 30.22 min, p = 0.00001). Conversely, neurosurgical operations performed using OSC had a 15-min reduction in average operative time compared to USG, though this difference was not statistically significant. Catheter replacement was required in 35.7% of the USG group compared to 55.5% in the OSC group ( p = ns). Conclusions: USG VA shunt placement demonstrates reduced operating times and lower perioperative complication rates compared to OSC. Our findings indicate that percutaneous VA shunts are technically simpler and do not necessitate specialized pediatric vascular surgery skills, enhancing their applicability in pediatric hydrocephalus management.
Characteristics and longitudinal clinical outcomes of people with type 2 diabetes in regional areas accessing a tertiary telehealth service: A retrospective cohort study
Authors: Tornvall Ida , Bennetts Denise , Balasooriya Namal N , Comans Tracy , Russell Anthony W , Menon Anish 
Published: February 2025

Background The prevalence of type 2 diabetes is rising in Australia, particularly in regional areas where access to specialist care is limited. To address this, Queensland Health (Queensland, Australia) established a telehealth network, including the Diabetes Telehealth Service (DTS) at the Princess Alexandra Hospital (PAH). The service facilitates video consultations between city-based endocrinologists and regional health centres, with local clinicians providing in-person support. While telehealth interventions have been evaluated in short-term studies, there is a need for longitudinal data to assess their long-term effectiveness in routine diabetes care. This study aims to describe the clinical characteristics and outcomes of patients with type 2 diabetes accessing care from the PAH DTS. Methods This retrospective cohort study used data from the PAH DTS to follow adults with type 2 diabetes over 24 months. Data was collected as part of routine care and analysed to assess changes in glycated haemoglobin (HbA1c) levels and cardiovascular risk factors. Statistical analyses included descriptive analysis, t-tests, Chi-squared tests, and fixed effects regression models. Results The study included 374 patients with type 2 diabetes, with a mean age of 57.9 years and a mean duration of diabetes at enrolment of 11.6 years. Baseline HbA1c levels were available for 86% of the patients, with a median HbA1c of 8.4%. The median number of appointments in the 24-month period was 2, and the average time between a person's first and last visit was 72 weeks. The average change in HbA1c between these visits was −0.8%. Statistically significant changes were also seen in cholesterol levels, weight, body mass index, and diastolic blood pressure. A linear regression analysis revealed that the greatest decrease in HbA1c levels occurred within the first 3 months since the initial clinic visit. HbA1c levels continued to decrease over the 24-month follow-up period, but the rate of decrease slowed after the first 3 months. Conclusion This study provides valuable insights into the telehealth model of care for tertiary diabetes in regional, rural, and remote settings. It demonstrates the effectiveness of this model in improving glycaemic control, particularly in the initial months, while also highlighting areas for improvement.
Preservation of Blood Flow to the Internal Iliac Artery Using a Custom-Made Single Fenestrated Endograft: A Case Report
Authors: Shakery Sara , Nio Denise , Truijers Maarten 
Published: February 2025

Purpose This report describes the use of a custom-made single-fenestrated endograft to preserve blood flow to the internal iliac artery (IIA) in a patient with an aorto-iliac aneurysm with unsuitable anatomy for a standard iliac branch device (IBD). Case Report A 56-year-old man presented with an abdominal aortic aneurysm (AAA) of 56 mm involving the right common iliac artery (CIA). Use of a standard IBD for preservation of the IIA was deemed impossible due to narrow arrow anatomy of the right CIA. To preserve IIA flow, a custom-made Terumo endograft with an additional single-fenestration for the IIA was designed. The repair was successful and flow to the right IIA was preserved. Conclusion Using a custom-made single-fenestrated endograft for the IIA in case of unsuitable anatomy for off-the-shelf IBDs prevents exclusion of the IIA and might prevent complications like buttock claudication and erectile dysfunction in patients with an aorto-iliac aneurysm. This report describes the use of a custom-made single fenestrated endograft to preserve blood flow to the IIA as a valuable alternative to standard iliac branched repair in patients with anatomical challenges.
Recovery in the symmetry of hand use after distal radius fracture
Authors: Iitsuka Terufumi , Kurumadani Hiroshi , Inagaki Yoshiyuki , Ota Hideyuki 
Published: February 2025

Introduction Hand use recovery after a distal radius fracture (DRF) depends on whether the injured hand is dominant or not, which can affect laterality and influence functional outcomes. This study aimed to investigate how the injured side impacts changes in laterality and its relationship to functional outcome, aiming to contribute to the development of future hand therapy strategies. Methods Patients with DRF were prospectively recruited. Triaxial accelerometers were wrist-mounted to collect data at 1, 4, 8, and 12 weeks postoperatively and examine the laterality index (LI), total hand use time, and total vector magnitude. Correlations between LI and functional outcomes were assessed at each time point. Results 42 patients participated in this study. Among them, 19 and 23 had injured dominant (DI) and injured non-dominant (non-DI) hands, respectively. The LI showed a faster restoration of symmetry in the DI group than in the non-DI group at 8 and 12 weeks postoperatively. Moderate correlations between LI and functional outcomes were observed in wrist joints and grip strength in the DI and non-DI groups, respectively, at all time points. Discussion The change in LI in the DI group was considered recovery, as it was identical to the symmetry observed in healthy adults. Additionally, the non-DI group was considered to have adapted to a pattern of predominant use of the dominant hand. The correlation between LI and some functional outcomes appeared to depend on hand use patterns, specifically whether the injured hand was dominant or not. These findings underscore the importance of tailoring interventions.
Flecainide use in arrhythmic patients who have structural heart disease
Authors: Sangpornsuk Naruepat , Rungpradubvong Voravut , Tiensantisuk Tachawut , Leelapattana Pattranee , Chokesuwattanakul Ronpichai , Prechawat Somchai 
Published: February 2025

Background: Current guidelines recommend the use of only on a limited basis in patients with normal or minimal structural heart disease. The CAST study, the only randomized controlled trials, showed increased mortality from long-term flecainide use in post-myocardial infarction (MI) patients with reduced left ventricular ejection fraction (LVEF). However, many later studies have revealed its safety when used in other structural heart diseases. Objectives: This study investigates the incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) VT/VF in patients with structural heart disease compared to those with a normal heart when using flecainide. Methods: We retrospectively recruited patients who had received at least one dose of flecainide in the past 5 years. Baseline characteristics, indications for flecainide use, and echocardiography results were reviewed. After 1 year, we evaluated the incidence of ventricular arrhythmias and all-cause mortality. Results: After screening, 447 patients had received at least one dose of flecainide, and 336 patients were included in the study. Forty-seven patients (14%) had structural heart disease as defined by our protocols. Left ventricular hypertrophy (LVH) and impaired LVEF accounted for 28% and 25% of cases, respectively. There were five patients with coronary artery disease (CAD). After 1 year, ventricular arrhythmias occurred in two patients (4.7%) in the structural heart group; these patients had also experienced arrhythmias before receiving flecainide. In the non-structural heart group, ventricular arrhythmias were detected in three patients (1.1%). In multivariate analysis, structural heart disease was not associated with an increased incidence of ventricular arrhythmias (OR = 4.8 (0.6–38.44), p = 0.139). Conclusion: Our study showed that no patients died due to ventricular arrhythmia, and the incidence of VT/VF was not increased in patients with structural heart disease. A prospective study is needed to further evaluate the safety of flecainide in patients with structural heart disease other than ischemic heart disease.
Development of a predictive model for severe peripartum hemorrhage in placenta accreta spectrum cases under neuraxial anesthesia: a multicenter retrospective analysis
Authors: Li Yanan , Li Liang , Song Xiao , Meng Fanqing , Zhang Meiling , Li Yarong , Chu Ran 
Published: February 2025

Background: The placenta accreta spectrum (PAS) represents a significant risk factor for severe postpartum hemorrhage. Recent studies have demonstrated the safety of neuraxial anesthesia (NA) in cesarean delivery (CD) for patients with PAS. Objectives: To evaluate the risk of severe peripartum hemorrhage in patients with PAS who underwent CD under NA. Design: A multicenter retrospective cohort study. Methods: This study analyzed 214 patients diagnosed with PAS. Logistic regression was used to identify factors increasing the risk of severe peripartum hemorrhage. A total of six machine learning (ML) algorithms were employed for model validation. Results: The predictive model includes the following risk factors: age at delivery >33 years ( p = 0.004), history of CD >1 ( p = 0.020), preoperative HGB ⩽ 100 g/L ( p = 0.013), placenta previa classification ( p = 0.001), vascular lacunae within the placenta ( p = 0.015), and labor duration ( p = 0.026). The validation of ML algorithms revealed that the model achieved an accuracy ranging from 0.68 to 0.71, with an area under the receiver operating characteristic curve between 0.75 and 0.79. A nomogram list and web-based calculator were constructed for clinical implementation, and a risk stratification system was established based on model scores. Conclusion: A prenatal risk assessment model was developed to estimate the likelihood of severe peripartum hemorrhage in PAS patients undergoing CD under NA. This model may provide preliminary support for clinicians in tailoring anesthetic management strategies for potentially high-risk cases, but further studies are needed to confirm its clinical utility.
A comparison of short- and long-term prognoses between cases with and without antenatal corticosteroid administration in late preterm delivery: a nationwide population-based study
Authors: Cho Geum Joon , Park Chan-Wook , Cho Kyu-Dong , Ha Sungyeon , Choi Suk-Joo , Oh Min-Jeong 
Published: February 2025

Abstract

Background
There is a paucity of information concerning the short- and long-term benefits and harm of antenatal corticosteroid administration and of expanded corticosteroid administration with dexamethasone in the late preterm period. Thus, we aimed to compare the effect on short-term respiratory complications, hypoglycemia, and long-term neurodevelopmental disorders in neonates born in the late preterm period between cases with and without corticosteroid administration and evaluate the difference in effects according to the type of corticosteroid administered.

Methods
This retrospective observational cohort study included all women who had a singleton delivery in the late preterm period between January 2007 and December 2015. We extracted data from Korea National Health Insurance claims and National Health Screening Program for Infants and Children databases. Primary short-term outcomes were in the late preterm period. Concerning short-term effectiveness for respiratory morbidity, dexamethasone administration in the late preterm period was associated with respiratory complications and hypoglycemia in neonates. Long-term outcomes were neurodevelopmental disorders in infants/children observed at follow-up among all neonates until the end of 2018.

Results
Of 57,963 women who delivered late preterm births during the study period, 1,255 (2.2%) had received antenatal corticosteroid administration in late preterm period. Dexamethasone administration was associated with a decreased risk of transient tachypnea (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.50–0.88) compared with no antenatal corticosteroid administration, but this effect was not observed in relation to betamethasone administration (aOR 0.69, 95% CI 0.42–1.14).

Conclusions
Dexamethasone administration in late preterm infants was associated with a decreased risk of transient tachypnea compared with no corticosteroid administration but this effect was not observed with betamethasone administration. However, antenatal corticosteroid administration in the late preterm period did not lower the risk of other respiratory complications nor increase the risk of hypoglycemia, with no effect on neurodevelopment regardless of the type used.
Diversity competence in medical education: short-term effectiveness of an interprofessional diversity-specific undergraduate learning
Authors: Linde Philipp , Hallal Houda , Charkina Polina , Adams Anne , Frank Julia , Wegen Simone , Fan Jiaqi , Nadjiri Lukas , Zims Heike , Stosch Christoph , Baues Christian 
Published: February 2025

Abstract

Background
Diversity competence, diversity itself, and a corresponding awareness of possible (intersectional) discrimination mechanisms have not been anchored in the German National Competence based Learning Objectives Catalogue for Medicine 2.0 (Nationaler Kompetenzbasierter Lernzielkatalog 2.0., NKLM) yet, highlighting a systemic gap in national competency frameworks. We present our first experience with a prospective diversity-specific intervention in medical students to assess its short-term impact on students' diversity acceptance (DA) and to develop actionable recommendations for integrating diversity into medical education.

Methods
We designed a prospective cohort study using a control group (CG) and intervention group (IG) design. The IG absolved a five-day diversity-specific intervention (50 h; field trip; seminar). Quantitative data were collected using the validated DWD-O5 scale at baseline (T0), three months (T3), and six months (T6), complemented by qualitative responses (diversity issues in the medical curriculum; perceptions and criticisms) categorized using Mayring’s content analysis. Descriptive and non-parametric statistics were performed.

Results
Thirty-one medical students (n = 10, IG vs n = 21, CG) were enrolled. The IG demonstrated a short-term improvement in diversity competence (+ 9.72%) across all DWD-O5 factors during the intervention. While scores slightly declined at T6, they remained above baseline levels. 35% (CG) vs. 56% (IG) have experienced discrimination in context of medical studies on their own. Participants in both groups stressed the importance of integrating diversity criteria into curricula at an early stage (100% agreement). Findings revealed three key themes: perceived inadequacies in current curricula, self-reported discrimination experiences, and a strong desire for practical diversity training, such as simulation-based learning.

Conclusion
The intervention shows promise as an initial step toward addressing diversity gaps in medical education. By combining historical, cultural, and experiential learning approaches, the program fosters essential competencies such as empathy, self-reflection, and bias recognition. More broadly, sustained improvements in diversity competence require longitudinal integration of diversity training across curricula and systemic reforms to national frameworks like the NKLM. Future research should explore the long-term impact of such interventions and strategies for institutionalizing equity-focused medical education.
Microbial lipases: advances in production, purification, biochemical characterization, and multifaceted applications in industry and medicine
Authors: Abdelaziz Ahmed A. , Abo-Kamar Amal M. , Elkotb Esraa Sobhy , Al-Madboly Lamiaa A. 
Published: February 2025

Abstract
Lipases are biocatalysts of significant industrial and medical relevance, owing to their ability to hydrolyze lipid substrates and catalyze esterification reactions under mild conditions. This review provides a comprehensive overview of microbial lipases’ production, purification, and biochemical properties. It explores optimized fermentation strategies to enhance enzyme yield, including using agro-industrial residues as substrates. The challenges associated with purification techniques such as ultrafiltration, chromatography, and precipitation are discussed, alongside methods to improve enzyme stability and specificity. Additionally, the review addresses the growing importance of genetic engineering approaches for improving lipase characteristics, such as activity, stability, and specificity.
Additionally, this review highlights the diverse applications of microbial lipases in industries, including food, pharmaceuticals, biofuels, and cosmetics. The enzyme’s role in bioremediation, biodegradation, and the synthesis of bioactive compounds is analyzed, emphasizing its potential in sustainable and eco-friendly technologies. The biocatalytic properties of lipases make them ideal candidates for the green chemistry initiatives in these industries. In the biomedical domain, lipase has shown promise in drug delivery systems, anti-obesity treatments, and diagnostics.
This review provides insights into the strategic development of microbes as microbial cell factories for the sustainable production of lipases, paving the way for future research and industrial innovations in enzyme technology.
Patient–ventilator synchrony under non-invasive ventilation is improved by an automated real time waveform analysis algorithm: a bench study
Authors: Renaud Yann , Auroi Jocelyne , Cabrio Davy , Lupieri Ermes , Chiche Jean-Daniel , Piquilloud Lise 
Published: February 2025

Abstract

Background
Because of inherent leaks, obtaining good patient–ventilator synchrony during non-invasive ventilation (NIV) is challenging. The IntelliSync + ® software (Hamilton medical, Bonaduz, CH), that can be used together with the NIV mode, performs real-time automated analysis of airway pressure- and flow-time curves to detect the transition between inspiration and expiration. It then controls the ventilator inspiratory and expiratory valves to improve patient–ventilator synchrony. The main goal of this NIV bench study was to evaluate the impact of IntelliSync + ® on synchrony in the presence of leaks of 9 and 20 L/min in the tested ventilator circuit (no face mask used), with normal, obstructive and restrictive respiratory mechanics and two levels of NIV pressure support (PS 8 and 14 cmH2O). For this, the time needed to trigger the ventilator (Td) and the difference between the end of the simulated breath and the termination of pressurization (Tiex) were measured. The number of classical asynchronies and the ventilator pressurization capacity were also assessed.

Results
Compared to NIV delivered with the classical NIV mode (compensating leaks and limiting inspiratory time to 2 s), activating IntelliSync + ® improved Tiex and, to a lesser extent, Td in clinically relevant setups. IntelliSync + ® also showed a trend towards reducing classical asynchronies, particularly directly after leak flow increase. The impact of the system was most significant with high PS levels and pathological respiratory mechanics. Especially, in the obstructive model, in the presence of large leak (20 L/min) and PS 14 cmH2O, Tiex decreased from 0.61 [0.56–0.64] to 0.16 [0.07–0.18] s and Td from 0.07 [0.06–0.08] to 0.06 [0.06–0.08] s. In less challenging situations, IntelliSync + ® was less beneficial. Overall, ventilator pressurization was improved when IntelliSync + ® was activated.

Conclusions
In this NIV bench model, IntelliSync + ®, used in addition to NIV-PS, improved both expiratory and inspiratory synchrony. It was particularly efficient in the presence of obstructive and restrictive respiratory mechanics and high-pressure support levels. These pre-clinical results tend to support the ability of IntelliSync + ® to improve patient–ventilator synchrony in the presence of leaks and provide pre-clinical data supporting a clinical evaluation of the automated algorithm during NIV.
Contestability Theory and the Deregulation of US Airlines
Authors: Button Kenneth 
Published: February 2025

Abstract
This essay discusses the development of the notion of contestable markets—the idea that optimal Pareto conditions can be induced by facilitating ultrafree entry into and exit from markets—set within the development of applied economics. The role of potential competition in influencing the behavior of incumbent suppliers had been discussed previously, but the work of William Baumol, Elizabeth Bailey, and others, they claimed, offered a more rigorous and internally consistent framework of analysis and a sounder basis for economic policymaking. This article outlines the history of the development of the theory and provides insights into the roles of key figures and institutions. It does this in the context of the role contestability played in influencing the deregulation of US airlines in the 1970s and in terms of the empirical findings of subsequent studies of the implications of this liberalization. Overall, it is also set against an intellectual background when applied and empirical research was becoming a more central part of political economy.