bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICOPATHOLOGIC CHANGES OF VITREOMACULAR INTERFACE IN IDIOPATHIC EPIRETINAL MEMBRANE WITH DISORGANIZATION OF RETINAL INNER LAYERS
Authors: Li Huanhuan , Liu Yan , Yao Jinghong , Zheng Jiusheng , Yang Yanting , Li Hui , Wang Fang , Liu Yao 
Published: June 2024

Purpose:
To compare the pathological characteristics of the vitreomacular interface of the idiopathic epiretinal membrane with and without disorganization of retinal inner layers (DRIL) and to correlate with clinical data.

Methods:
In this clinicopathologic study, the samples of epiretinal membrane and internal limiting membrane were extracted from DRIL(+) (19 eyes) and DRIL(−) (22 eyes) idiopathic epiretinal membrane eyes. Ultrathin series sectioning for transmission electron microscopy was observed and correlated with surgery status and prognosis.

Results:
All idiopathic epiretinal membrane eyes presented fibrocellular membranes accompanied by vitreous collagen, glial cells, and myofibroblasts, regardless of association with DRIL. A robust signal indicative of Collagen Type VI was observed in eyes DRIL(−), whereas Collagen Type I was discovered in DRIL eyes. Cell debris and microvascular basement membrane were seen on the retinal side of DRIL eyes and a larger cell count on the vitreous side. These have more intraoperative complications and less surgery benefit.

Conclusion:
Although internal limiting membrane peeling seems important, the histopathologic findings underscore the potential for retinal injury in DRIL(+) idiopathic epiretinal membrane eyes. This suggests that further research is needed to investigate individual preoperative assessment and to modify surgical procedures.
Exogenous testosterone use and acute central serous chorioretinopathy in a transgender patient
Authors: Fowler Benjamin J , Schildroth Kathleen R 
Published: June 2024

Purpose:
To describe the presentation and clinical course of a transgender patient with central serous chorioretinopathy (CSCR) and discuss the role of exogenous testosterone use in CSCR in this patient population.

Method:
Case report.

Results:
A 63-year-old transgender male with a history of exogenous testosterone use for over twenty years was referred to retina clinic for evaluation of macular pathology. The patient’s most recent total testosterone levels prior to presentation were 962 and 1,179 ng/dL (normal cisgender male levels for age 60+: 300-720 ng/dL). Fundus imaging revealed subretinal fluid involving the fovea without choroidal neovascularization in the right eye. There was no recent corticosteroid use. The patient’s dose of testosterone was reduced. After four months of observation, the subretinal fluid persisted and was successfully treated with half-fluence photodynamic therapy (PDT). At last follow-up, 15 months after PDT, the patient remained stable without recurrence and the best-corrected visual acuity was at baseline.

Conclusion:
Exogenous testosterone use with elevated serum testosterone levels may be associated with the development of central serous chorioretinopathy in the transgender patient population. CSCR in these patients might be effectively treated with PDT and testosterone dose reduction. Ophthalmologists should be aware of potential side effects of testosterone supplementation in this patient population, as well as the role of testosterone in CSCR pathophysiology.
Characterization of Emergency Department Quality Assurance Cases Seen Within a Midwestern United States Health System
Authors: Smith Karli , Smith Hayden L. , Wittry Alex , Conley Gabriel , Leech Jodi , Kluesner Nicholas 
Published: June 2024

ABSTRACT

BACKGROUND:
Hospital quality-assurance (QA) processes, including peer-review committees, seek to identify high-risk areas.

PURPOSE:
To characterize emergency department (ED) cases sent for QA review.

METHODS:
A retrospective observational study was conducted of ED cases sent to a QA committee from November 2018 through July 2022 at three midwestern US hospitals. The QA records analyzed for these cases included the original incident report, case summary, and the committee determinations.

RESULTS:
One hundred and forty-seven cases were reviewed by the ED QA Committee. The most frequent referrals came from physicians. Common diagnostic categories included infectious (21%), cardiac (16%), gastrointestinal (11%), and neurologic (10%) concerns. Of the cases, 51% were considered nonpreventable, 33% were potentially preventable, and 9% were preventable. Inpatient boarding in the ED was explicitly implicated as a contributing factor in 6% of case reports.

CONCLUSIONS:
Peer physician reporting represent the largest referral source sent for review with the most frequent diagnostic categories, including infectious, cardiac, gastrointestinal, and neurological conditions. Preventable concerns were rare.

IMPLICATIONS:
This study provides a better understanding of the referral sources, diagnostic categories, and committee determinations in ED quality concerns. These results can target future investigations into case reporting and patient safety.
A System Intervention to Increase Pneumococcal Vaccination Rates in Adults Living With Human Immunodeficiency Virus Who Present for Scheduled Medical Care
Authors: Jensen Jodene , Waldrop Julee , Derouin Anne , Siegel Amber 
Published: June 2024

Abstract
Pneumococcal vaccinations are recommended for adults living with HIV; however, eligibility criteria are complex. At a clinic specializing in the care of lesbian, gay, bisexual, transgender, or queer/questioning persons, only 36% of patients who were vaccine-eligible received the vaccination. A set of decision trees was developed to guide clinic personnel in determining whether a vaccine is recommended. The provider then determined whether the vaccine was appropriate based on each patient's complete clinical presentation. When appropriate, patients were offered the vaccine at the same appointment. This practice change led to a 22% increased vaccination rate.
Understanding the Social Dimensions and Context in HIV Research: Instrument Adaptation Is More Than Just Translation
Authors: Mtei Rachel Jared , Kilonzo Mrema N. , Pan Wei , Kisamo Diana H. , Kisigo Godfrey , Nyblade Laura , Kajula Lusajo , Relf Michael V. 
Published: June 2024

Abstract
There is a shortage of health-related questionnaires developed specifically for African countries' cultural contexts and local languages. Researchers have translated some tools to the target local languages. However, poor-quality or even high-quality translation can lead to an instrument that is not comparable with the original language if linguistic nuances, and cultural differences are not considered. This can affect the validity and reliability of the research data. The objective of this commentary was to highlight limitations of the commonly accepted forward–backward translation approach and the importance of more rigorous cultural and linguistic adaptation processes in social and behavioral research related to HIV.
Unlocking HIV Prevention in Primary Care: Implementation of the Denver HIV Risk Score Tool in an Urban Michigan Primary Care Setting
Authors: Knight Jay Julienne 
Published: June 2024

Abstract
The Unlocking HIV Prevention Project was designed and implemented to address missed opportunities to address HIV risks. The project's site noted a gap in the use of an HIV risk assessment tool during primary care visits. The purpose of this quality-improvement project was to determine whether the translation of the Denver HIV Risk Score tool into primary care visits would affect the number of individuals identified as at risk for HIV and increase preexposure prophylaxis (PrEP) prescription rates among adults seeking care at an urban Michigan primary care clinic. Data on PrEP prescriptions were collected from the electronic health record before and after implementation of the HIV risk assessment tool. Before implementing this screening tool, no patients were identified as at risk and no prescriptions for PrEP were written. After implementation, 16 patients were identified as at risk with seven prescriptions written. These data suggest that this tool has the potential to improve the identification of patients at risk for HIV who are candidates for PrEP prescribing in primary care.
Association Between Pupil Light Reflex and Delirium in Adults With Traumatic Brain Injury: Preliminary Findings
Authors: Lapierre Alexandra , Proulx Annie , Gélinas Céline , Dollé Stéphanie , Alexander Sheila , Williamson David , Bernard Francis , Arbour Caroline 
Published: June 2024

ABSTRACTBACKGROUND:Delirium is a common neurological complication in patients admitted to the intensive care unit (ICU) after moderate to severe traumatic brain injury (TBI). Although current clinical guidelines prioritize delirium prevention, no specific tool is tailored to detect early signs of delirium in TBI patients. This preliminary 2-phase observational study investigated the correlation between the pupillary light reflex (PLR), measured with a pupillometer during mechanical ventilation, and the development of postextubation delirium in TBI patients.METHODS:A convenience sample of 26 adults with moderate to severe TBI under mechanical ventilation was recruited during their ICU stay. In phase I, PLR measurements were performed in the first 3 days of ICU admission using automated infrared pupillometry. In phase II, 2 raters independently extracted delirium data in the 72 hours post extubation period from medical records. Delirium was confirmed with a documented medical diagnosis. Point-biserial correlations (rpb) were used to examine the association between PLR scores and the presence of postextubation delirium. Studentttests were also performed to compare mean PLR scores between patients with and without delirium.RESULTS:Ten TBI patients (38%) were diagnosed with postextubation delirium, whereas 16 (62%) were not. Significant correlations between delirium and 2 PLR variables were found: pupil constriction percentage (rpb(24) = −0.526,P= .006) and constriction velocity (rpb(24) = −0.485,P= .012). Thettest also revealed a significant difference in constriction percentage and velocity scores between TBI patients with and without delirium (P≤ .01).CONCLUSION:Our findings suggest that the use of pupillometry in the first 3 days of mechanical ventilation during an ICU stay may help identify TBI patients at risk for delirium after extubation. Although further research is necessary to support its validity, this technological tool may enable ICU nurses to better screen TBI patients for delirium and prevent its development.
Creative Solutions for a Condensed Anatomy Course
Authors: DeVaul Nicole , Carroll Melissa A. , Brown Kirsten M. 
Published: June 2024

Abstract
There are many variations of anatomy courses taught in accredited physician assistant (PA) programs in the United States. Course directors and program leadership must choose how to effectively deliver content within their program constraints. Our anatomy course has faced challenges related to instructional time for didactic and laboratory sessions, course length, curricular placement and alignment, assessments, and faculty availability. These challenges are not specific to anatomy courses in PA curricula but exist in anatomy courses in various health care programs. In this article, we present major solutions to challenges in didactic delivery, laboratory sessions, course content, and assessments over a 5-year period. Through modifications and problem-solving, we identified the following 4 lessons learned during this process: course alignment to clinical relevance, intentional content delivery for different pedagogical approaches, structured laboratory sessions with appropriate staffing, and an appropriate weighting for assessments. These lessons and solutions will be useful to other anatomy and disciplines-based course directors facing similar challenges.
An Analgesic Technique for Orogastric Tube Insertion in Newborns
Authors: Darretain Hélène , Laborne François-Xavier , Lagadec Steven , Garrigue Bruno , Maillard Frédéric , Harbi Faiza , Waszak Paul , Granier Michele , Galand Nathalie , Walter-Nicolet Elizabeth , Razafimahefa Hasinirina 
Published: June 2024

Background:
Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure. Objective: To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure.

Design:
Prospective, controlled, randomized, multicentered and open label study.

Setting(s):
Three neonatal intensive care units in France (2 level 3 units and 1 level 2B).

Participants:
Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique (n = 36) and experimental technique (n = 35).

Methods:
Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN—Douleur Aiguë du Nouveau-né; APN—Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models.

Results:
All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group (P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015).

Conclusions:
This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.
Multimodal imaging-based prediction of recurrence for unresectable HCC after downstage and resection-cohort study
Authors: Jiang Hanyu , Zuo Mengxuan , Li Wang , Zhuo Shuiqing , Wu Peihong , An Chao 
Published: June 2024

Background:
Surgical resection (SR) following transarterial chemoembolization (TACE)-based downstaging is a promising treatment for unresectable hepatocellular carcinoma (uHCC), and identification of patients at high-risk of postoperative recurrence may assist individualized treatment.

Purpose:
To develop and externally validate preoperative and postoperative prognostic models integrating multimodal CT and digital subtraction angiography features as well as clinico-therapeutic-pathological features for predicting disease-free survival (DFS) after TACE-based downstaging therapy.

Materials and methods:
From March 2008 to August 2022, 488 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) A/B uHCC receiving TACE-based downstaging therapy and subsequent SR were included from four tertiary-care hospitals. All CT and digital subtraction angiography images were independently evaluated by two blinded radiologists. In the derivation cohort (n=390), the XGBoost algorithm was used for feature selection, and Cox regression analysis for developing nomograms for DFS (time from downstaging to postoperative recurrence or death). In the external testing cohort (n=98), model performances were compared with five major staging systems.

Results:
The preoperative nomogram included over three tumors [hazard ratio (HR), 1.42; P=0.003], intratumoral artery (HR, 1.38; P=0.006), TACE combined with tyrosine kinase inhibitor (HR, 0.46; P<0.001) and objective response to downstaging therapy (HR, 1.60; P<0.001); while the postoperative nomogram included over three tumors (HR, 1.43; P=0.013), intratumoral artery (HR, 1.38; P=0.020), TACE combined with tyrosine kinase inhibitor (HR, 0.48; P<0.001), objective response to downstaging therapy (HR, 1.69; P<0.001) and microvascular invasion (HR, 2.20; P<0.001). The testing dataset C-indexes of the preoperative (0.651) and postoperative (0.687) nomograms were higher than all five staging systems (0.472–0.542; all P<0.001). Two prognostically distinct risk strata were identified according to these nomograms (all P<0.001).

Conclusion:
Based on 488 patients receiving TACE-based downstaging therapy and subsequent SR for BCLC A/B uHCCs, the authors developed and externally validated two nomograms for predicting DFS, with superior performances than five major staging systems and effective survival stratification.
Role of 18F-FDG PET/CT for providing a targeted approach for etiology of PUO
Authors: Khan Dikhra , Phulia Ankita , Kumar Suraj , Sarswat Sulochana , KV Sivasankar , Sagar Sambit 
Published: June 2024

Aim
This study aimed to evaluate the potential role of 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in providing a targeted approach for diagnosing the etiology of Pyrexia of Unknown Origin (PUO).

Methods
A total of 573 PUO patients were included in this ambispective study, with a mean age of 39.40 ± 4.6 years. Patients underwent FDG PET/CT scans using dedicated hybrid scanners. PET/CT data were interpreted by experienced nuclear medicine physicians. The study analyzed the guidance provided by FDG PET/CT for appropriate biopsy sites and assessed concordance between PET/CT findings and histopathological examination.

Results
Out of the 573 patients, a final diagnosis was reached for 219 patients, including malignancy, infectious causes, noninfectious inflammatory causes (NIID), and precancerous conditions. FDG PET/CT played a crucial role in guiding clinicians to appropriate biopsy sites, contributing to a higher diagnostic yield. Concordance between PET/CT findings and histopathological examination emphasized the noninvasive diagnostic potential of PET/CT in identifying underlying causes of PUO. Overall, FDG PET/CT contributed to guiding the appropriate site of biopsy or concordance of the first differential diagnosis with the final diagnosis in 50.05% of cases.

Conclusion
This study highlights the valuable role of FDG PET/CT in providing a targeted approach for diagnosing PUO, showcasing its potential in guiding clinicians towards appropriate biopsy sites and improving the diagnostic yield. The findings underscore the importance of integrating FDG PET/CT into the diagnostic pathway for PUO, ultimately enhancing patient management and outcomes. Further prospective studies are necessary to validate these results and refine the integration of FDG PET/CT in the diagnosis of PUO.
Bone mineral density in adult thalassaemias: a retrospective longitudinal study
Authors: Algodayan Sarah , Balachandar Ramya , Papathanasiou Nikolaos , Bomanji Jamshed , Porter John B. , Waung Julian 
Published: June 2024

Objectives
In this study, we aim to evaluate the long-term impact of thalassaemia on bone mineral density (BMD) through sequential analysis, compare changes in BMD values between male and female patients and find any correlation between BMD and biochemical markers in the adult thalassaemia group. BMD is a bone mineral density test using dual-energy X-ray to measure calcium hydroxyapatite per unit of bone, reflecting bone strength.

Methods
We conducted a longitudinal retrospective observational cohort study to determine the changes in BMD values and biochemical parameters in adult thalassaemia patients. BMD was assessed at the lumbar spine (L1–L4) and proximal femora using Hologic’s bone dual-energy X-ray absorptiometry. Five serial BMD values were retrieved from electronic records. Biochemical parameters, including serum calcium, phosphorus and 25-hydroxyvitamin D levels, were also assessed.

Results
A total of 108 patients (47 males and 61 females; median age: 44 years) with thalassaemia major 71 patients, intermedia 20 patients, haemoglobin E disease 14 patients and thalassaemia-alpha three patients were included. The incidence of low BMD in patients with thalassaemia increased from 64 to 74% over three decades of analysis. Females and thalassaemia major patients had lower hip BMD values and corresponding Z-scores.

Conclusion
There is a progressive decline in BMD values in adult thalassaemia, which was apparent in female thalassaemia major patients. No changes in biochemical parameters, however, were observed over long-term assessments.
Analysis of delayed initial radioactive iodine therapy and clinical outcomes in papillary thyroid cancer: a two-center retrospective study
Authors: He Tao , Li Ming , Gao Zheng-lian , Li Xiang-yu , Zhong Hai-rong , Ding Cui-shuang , Cai Hua-wei 
Published: June 2024

Background
It remains unclear whether the time interval between total thyroidectomy and radioactive iodine (RAI) therapy influences clinical outcomes in papillary thyroid carcinoma (PTC). This study aims to evaluate the impact of the timing to initiate RAI therapy on the response in PTC patients.

Methods
We retrospectively included 405 patients who underwent total thyroidectomy and subsequent RAI therapy at two tertiary hospitals in southwest China. Patients were categorized into two groups based on the interval between thyroidectomy and initial RAI therapy, that is, an early group (interval ≤90 days, n = 317) and a delayed group (interval >90 days, n = 88). Responses to RAI therapy were classified as excellent, indeterminate, biochemical incomplete, or structural incomplete. Univariate and multivariate analyses were conducted to identify factors associated with a nonexcellent response.

Results
Excellent responses were observed in 77.3% of the early group and 83.0% of the delayed group (P = 0.252). No significant impact of RAI therapy timing was also observed across all American Thyroid Association risk classification categories. These findings persisted when patients were analyzed separately according to RAI dose (intermediate-dose group: 3.7 GBq [n = 332]; high-activity group: ≥5.5 GBq [n = 73]), further subdivided by the timing of RAI therapy. Multivariate analysis identified lymph node dissection, RAI dose, and stimulated thyroglobulin as independent risk factors for excellent response (P < 0.05).

Conclusion
The timing of initial RAI therapy following surgery did not significantly affect outcomes in patients with PTC.