bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of comprehensiveness of antiretroviral care and detectable HIV viral load suppression among pregnant and postpartum women in the Democratic Republic of the Congo: a cross-sectional study
Authors: Boisson-Walsh Alix , Ravelomanana Noro L. R. , Tabala Martine , Malongo Fathy , Kawende Bienvenu , Babakazo Pélagie , Yotebieng Marcel 
Published: June 2024

IntroductionWorldwide, over two-thirds of people living with HIV are on antiretroviral therapy (ART). Despite increased ART access, high virological suppression prevalence remains out of reach. Few studies consider the quality of ART services and their impact on recipients' viral suppression. We assessed the association between ART service readiness and HIV viral load suppression among pregnant and breastfeeding women living with HIV (WLH) receiving ART in maternal and child health (MCH) clinics in Kinshasa, Democratic Republic of Congo.MethodsWe performed a cross-sectional analysis leveraging data from a continuous quality improvement intervention on WLH's long-term ART outcomes. From November 2016 to May 2020, we enrolled WLH from the three largest clinics in each of Kinshasa'Łs 35 health zones. We measured clinic's readiness using three WHO-identified ART care quality indicators: relevant guidelines in ART service area, stocks of essential ART medicines, and relevant staff training in ≥24 months, scoring clinics 0-3 based on observed indicators. We defined viral load suppression as ≤1,000 cp/ml. Multilevel mixed-effect logistic models were used to estimate prevalence odds ratios (ORs) measuring the strength of the association between ART service readiness and viral suppression.ResultsOf 2,295 WLH, only 1.9% received care from a clinic with a score of 3, 24.1% received care from a 0-scoring clinic, and overall, 66.5% achieved virologically suppression. Suppression increased from 65% among WLH receiving care in 0-scoring clinics to 66.9% in 1-scoring clinics, 65.8% in 2-scoring clinics, and 76.1% in 3-scoring clinics. We did not observe a statistically significant association between ART service readiness score and increased viral suppression prevalence, however we did find associations between other factors, such as the location of the health center and pharmacist availability with suppressed viral load.DiscussionA lack of comprehensive ART care underscores the need for enhanced structural and organizational support to improve virological suppression and overall health outcomes for women living with HIV..
Proficiency-based progression training in robot-assisted laparoscopy for endometrial cancer: peri-operative and survival outcomes from an observational cohort study
Authors: Sickinghe Ariane , Nobbenhuis Marielle , Nelissen Ellen , Heath Owen , Ind Thomas 
Published: June 2024

IntroductionOver the last decade there has been a transition from traditional laparoscopy to robotic surgery for the treatment of endometrial cancer. A number of gynecological oncology surgical fellowship programmes have adopted robot-assisted laparoscopy, but the effect of training on complications and survival has not been evaluated. Our aim was to assess the impact of a proficiency-based progression training curriculum in robot-assisted laparoscopy on peri-operative and survival outcomes for endometrial cancer.MethodsThis is an observational cohort study performed in a tertiary referral and subspecialty training center. Women with primary endometrial cancer treated with robot-assisted laparoscopic surgery between 2015 and 2022 were included. Surgery would normally include a hysterectomy and salpingo-oophorectomy with some form of pelvic lymph node dissection (sentinel lymph nodes or lymphadenectomy). Training was provided according to a training curriculum which involves step-wise progression of the trainee based on proficiency to perform a certain surgical technique. Training cases were identified pre-operatively by consultant surgeons based on clinical factors. Case complexity matched the experience of the trainee. Main outcome measures were intra- and post-operative complications, blood transfusions, readmissions &lt; 30 days, return to theater rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Mann–Witney U, Pearson’s chi-squared, multivariable regression, Kaplan-Meier and Cox proportional hazard analyses were performed to assess the effect of proficiency-based progression training on peri-operative and survival outcomes.ResultsTraining cases had a lower BMI than non-training cases (30 versus 32 kg/m2, p = 0.013), but were comparable in age, performance status and comorbidities. Training had no influence on intra- and post-operative complications, blood transfusions, readmissions &lt; 30 days, return to theater rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min, p = &lt; 0.001). The range of estimated blood loss was smaller in training cases. Conversion rates, critical care unit-admissions and lymphoedema rates were comparable.DiscussionProficiency-based progression training can be used safely to teach robot-assisted laparoscopic surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of robot-assisted laparoscopic surgery performed by a trainee on endometrial cancer outcomes.
Understanding the burden of antibiotic resistance: a decade of carbapenem-resistant Gram-negative bacterial infections in Italian intensive care units
Authors: Scaglione Giovanni , Perego Matilde , Colaneri Marta , Genovese Camilla , Brivio Fabio , Covizzi Alice , Viaggi Bruno , Bandera Alessandra , Gori Andrea , Finazzi Stefano , Palomba Emanuele 
Published: June 2024

IntroductionIn patients admitted to intensive care units (ICUs), Gram-negative bacteria (GNB) infections pose significant challenges due to their contribution to morbidity, mortality, and healthcare costs. During the SARS-CoV-2 pandemic, Italy witnessed a rise in healthcare-associated infections (HAIs), with GNBs involved in a substantial proportion of cases. Concerningly, carbapenem-resistant GNBs (CR-GNBs) have increased worldwide, posing therapeutic challenges.MethodsRetrospective multicentre study analysing data from over 299,000 patients admitted to Italian ICUs from 2013 to 2022.ResultsThe study revealed an average of 1.5 infections per patient, with HAIs peaking during the pandemic years. Ventilator associated pneumonia (VAP) emerged as the most common HAI, with Klebsiella spp. and Pseudomonas aeruginosa predominating. Alarmingly, CR-GNBs accounted for a significant proportion of infections, particularly in VAP, bloodstream infections, and intra-abdominal infections.DiscussionOur findings underscore the pressing need for enhanced infection control measures, particularly in the ICU setting, to mitigate the rising prevalence of CR-GNBs and their impact on patient outcomes. The study provides valuable insights into the epidemiology of HAIs in Italian ICUs and highlights the challenges posed by CR-GNBs, especially in the context of the SARS-CoV-2 pandemic, which exacerbated the issue and may serve as a crucial example for the management of future viral pandemics.
Mid-life sleep is associated with cognitive performance later in life in aging American Indians: data from the Strong Heart Study
Authors: Fonseca Luciana Mascarenhas , Finlay Myles G. , Chaytor Naomi S. , Morimoto Natalie G. , Buchwald Dedra , Van Dongen Hans P. A. , Quan Stuart F. , Suchy-Dicey Astrid 
Published: June 2024

BackgroundSleep-related disorders have been associated with cognitive decline and neurodegeneration. American Indians are at increased risk for dementia. Here, we aim to characterize, for the first time, the associations between sleep characteristics and subsequent cognitive performance in a sample of aging American Indians.MethodsWe performed analyses on data collected in two ancillary studies from the Strong Heart Study, which occurred approximately 10 years apart with an overlapping sample of 160 American Indians (mean age at follow-up 73.1, standard deviation 5.6; 69.3% female and 80% with high school completion). Sleep measures were derived by polysomnography and self-reported questionnaires, including sleep timing and duration, sleep latency, sleep stages, indices of sleep-disordered breathing, and self-report assessments of poor sleep and daytime sleepiness. Cognitive assessment included measures of general cognition, processing speed, episodic verbal learning, short and long-delay recall, recognition, and phonemic fluency. We performed correlation analyses between sleep and cognitive measures. For correlated variables, we conducted separate linear regressions. We analyzed the degree to which cognitive impairment, defined as more than 1.5 standard deviations below the average Modified Mini Mental State Test score, is predicted by sleep characteristics. All regression analyses were adjusted for age, sex, years of education, body mass index, study site, depressive symptoms score, difference in age from baseline to follow-up, alcohol use, and presence of APOE e4 allele.ResultsWe found that objective sleep characteristics measured by polysomnography, but not subjective sleep characteristics, were associated with cognitive performance approximately 10 years later. Longer sleep latency was associated with worse phonemic fluency (β = −0.069, p = 0.019) and increased likelihood of being classified in the cognitive impairment group later in life (odds ratio 1.037, p = 0.004). Longer duration with oxygen saturation &lt; 90% was associated with better immediate verbal memory, and higher oxygen saturation with worse total learning, short and long-delay recall, and processing speed.ConclusionIn a sample of American Indians, sleep characteristics in midlife were correlated with cognitive performance a decade later. Sleep disorders may be modifiable risk factors for cognitive impairment and dementia later in life, and suitable candidates for interventions aimed at preventing neurodegenerative disease development and progression.
Early identification of Parkinson’s disease with anxiety based on combined clinical and MRI features
Authors: Jia Min , Yang Shijun , Li Shanshan , Chen Siying , Wu Lishuang , Li Jinlan , Wang Hanlin , Wang Congping , Liu Qunhui , Wu Kemei 
Published: June 2024

ObjectiveTo identify cortical and subcortical volume, thickness and cortical area features and the networks they constituted related to anxiety in Parkinson’s disease (PD) using structural magnetic resonance imaging (sMRI), and to integrate multimodal features based on machine learning to identify PD-related anxiety.MethodsA total of 219 patients with PD were retrospectively enrolled in the study. 291 sMRI features including cortical volume, subcortical volume, cortical thickness, and cortical area, as well as 17 clinical features, were extracted. Graph theory analysis was used to explore structural networks. A support vector machine (SVM) combination model, which used both sMRI and clinical features to identify participants with PD-related anxiety, was developed and evaluated. The performance of SVM models were evaluated. The mean impact value (MIV) of the feature importance evaluation algorithm was used to rank the relative importance of sMRI features and clinical features within the model.Results17 significant sMRI variables associated with PD-related anxiety was used to build a brain structural network. And seven sMRI and 5 clinical features with statistically significant differences were incorporated into the SVM model. The comprehensive model achieved higher performance than clinical features or sMRI features did alone, with an accuracy of 0.88, a precision of 0.86, a sensitivity of 0.81, an F1-Score of 0.83, a macro-average of 0.85, a weighted-average of 0.92, an AUC of 0.88, and a result of 10-fold cross-validation of 0.91 in test set. The sMRI feature right medialorbitofrontal thickness had the highest impact on the prediction model.ConclusionWe identified the brain structural features and networks related to anxiety in PD, and developed and internally validated a comprehensive model with multimodal features in identifying.
Predictive factors influencing outcome of early cranioplasty after decompressive craniectomy: a outcome prediction model study
Authors: Yan Zhongnan , Li Xiaolei , Xia Bin , Xue Chaolin , Wang Yuangang , Che Hongmin , Shen Dongqing , Guo Shiwen 
Published: June 2024

ObjectiveThe timing of cranioplasty (CP) has become a widely debated topic in research, there is currently no unified standard. To this end, we established a outcome prediction model to explore the factors influencing the outcome of early CP. Our aim is to provide theoretical and practical basis for whether patients with skull defects after decompressive craniectomy (DC) are suitable for early CP.MethodsA total of 90 patients with early CP after DC from January 2020 to December 2021 were retrospectively collected as the training group, and another 52 patients with early CP after DC from January 2022 to March 2023 were collected as the validation group. The Nomogram was established to explore the predictive factors that affect the outcome of early CP by Least absolute shrinkage analysis and selection operator (LASSO) regression and Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the prediction model. Calibration curve was used to evaluate the accuracy of data fitting, and decision curve analysis (DCA) diagram was used to evaluate the benefit of using the model.ResultsAge, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC to CP were the predictors of the risk prediction model of early CP in patients with skull defects. The area under ROC curve (AUC) of the training group was 0.924 (95%CI: 0.867–0.980), and the AUC of the validation group was 0.918 (95%CI, 0.842–0.993). Hosmer-Lemeshow fit test showed that the mean absolute error was small, and the fit degree was good. The probability threshold of decision risk curve was wide and had practical value.ConclusionThe prediction model that considers the age, preoperative GCS, preoperative NIHSS, defect area, and interval time from DC has good predictive ability.
Efficacy and safety of acupuncture for painful diabetic neuropathy: a systematic review and meta-analysis
Authors: Liu Jiaming , Lin Yueqi , Huang Yuheng , Yang Qingyi , Li Xiaojie , Ye Yinglan , Zheng Bohui , Song Wei 
Published: June 2024

BackgroundPainful diabetic neuropathy (PDN) is a common chronic neurological complication of diabetes mellitus. Medications are often used to relieve pain, but with significant side effects. Acupuncture is now a component of pragmatic and integrative treatment for PDN. An increasing number of relevant randomized controlled trials have been published in recent years, but a comprehensive meta-analysis has not yet been performed. The aim of this paper is to verify the effectiveness and safety of acupuncture for PDN by meta-analysis and trial sequential analysis (TSA).MethodsAll participants in this study should have had a PDN diagnosis and the trial group was treated with acupuncture. Eight databases, including EMbase, PubMed, Web of science, Cochrane Library, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang and Chongqing VIP (CQVIP) were retrieved from inception to 5 April 2023. Meta-analysis was conducted utilizing RevMan 5.3 and Stata 15.0. TSA was performed to assess the adequacy of sample size for the outcomes.ResultsA total of 36 studies, comprising 2,739 PDN patients, were included. Among them, 1,393 patients were assigned to the trial group and 1,346 patients were treated in the control group. Outcomes covers the primary indicator Total effective rate (RR = 1.42, 95%CI [1.34, 1.52], p &lt; 0.00001), with 21 studies reported, Pain intensity (SMD = −1.27, 95%CI [−1.58, −0.95], p &lt; 0.00001), with 23 studies reported, and other outcomes, including motor nerve conduction velocity (MCV; MD = 3.58, 95%CI [2.77, 4.38], p &lt; 0.00001), sensory nerve conduction velocity (SCV; MD = 3.62, 95%CI [2.75, 4.49], p &lt; 0.00001), Depression score (SMD = −1.02, 95%CI [1.58, 0.46]), Toronto clinical scoring system (TCSS; MD = −2.41, 95%CI [−3.37, −1.45], p &lt; 0.00001), Quality of life (SMD = 1.06, 95%CI [0.66, 1.46]), traditional Chinese medicine (TCM) syndrome score (MD = −4.99, 95%CI [−6.79, −3.18], p &lt; 0.00001), suggesting that acupuncture have an ameliorating effect on PDN in various respect. Egger’s test revealed publication bias for four outcomes. TSA showed that as for Total effective rate, Pain Intensity, MCV and SCV, the number of included studies was sufficient to support the conclusions.ConclusionAcupuncture demonstrates significant effectiveness in improving PDN outcomes, including Total effective rate, Pain intensity, MCV, SCV, Depression score, TCSS, Quality of life, TCM syndrome score. But the Adverse events rate is no different in trail group and control group. The publication bias presented in Total effective rate, Pain intensity, MCV and SCV can be remedied by Trim and filling method.Systematic review registrationProspero, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477295.
Nomogram to predict prognosis in patients with posterior circulation acute ischemic stroke after mechanical thrombectomy
Authors: Li Jiayang , Zhang Jin , Li Changxin , Li Jun , Wu Xupeng , Wang Shaoshuai 
Published: June 2024

PurposeThis study aimed to investigate the risk factors of prognosis and hemorrhagic transformation after mechanical thrombectomy (MT) in patients with posterior circulation acute ischemic stroke (PC-AIS) caused by large vessel occlusion. We sought to develop a nomogram for predicting the risk of poor prognosis and symptomatic intracerebral hemorrhage (sICH) in patients with PC-AIS.MethodsA retrospective analysis was conducted on 81 patients with PC-AIS who underwent MT treatment. We collected clinical information from the patients to assessed sICH and prognosis based on CT results and National Institutes of Health Stroke Scale (NIHSS) scores. Subsequently, they were followed up for 3 months, and their prognosis was assessed using the Modified Rankin Scale. We used the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression to determine the factors affecting prognosis to construct a nomogram. The nomogram’s performance was assessed through receiver operating characteristic curves, calibration curves, decision curve analysis, and clinical impact curves.ResultsAmong the 81 patients with PC-AIS, 33 had a good prognosis, 48 had a poor prognosis, 19 presented with sICH, and 62 did not present with sICH. The results of the LASSO regression indicated that variables, including HPT, baseline NIHSS score, peak SBP, SBP CV, SBP SD, peak SBP, DBP CV, HbA1c, and BG SD, were predictors of patient prognosis. Variables such as AF, peak SBP, and peak DBP predicted the risk of sICH. Multivariate logistic regression revealed that baseline NIHSS score (OR = 1.115, 95% CI 1.002–1.184), peak SBP (OR = 1.060, 95% CI 1.012–1.111), SBP CV (OR = 1.296, 95% CI 1.036–1.621) and HbA1c (OR = 3.139, 95% CI 1.491–6.609) were independent risk factors for prognosis. AF (OR = 6.823, 95% CI 1.606–28.993), peak SBP (OR = 1.058, 95% CI 1.013–1.105), and peak DBP (OR = 1.160, 95% CI 1.036–1.298) were associated with the risk of sICH. In the following step, nomograms were developed, demonstrating good discrimination, calibration, and clinical applicability.ConclusionWe constructed nomograms to predict poor prognosis and risk of sICH in patients with PC-AIS undergoing MT. The model exhibited good discrimination, calibration, and clinical applicability.
Association of bilaterally suppressed EEG amplitudes and outcomes in critically ill children
Authors: Paul Luisa , Greve Sandra , Hegemann Johanna , Gienger Sonja , Löffelhardt Verena Tamara , Della Marina Adela , Felderhoff-Müser Ursula , Dohna-Schwake Christian , Bruns Nora 
Published: June 2024

Background and objectivesAmplitude-integrated EEG (aEEG) is used to assess electrocortical activity in pediatric intensive care if (continuous) full channel EEG is unavailable but evidence regarding the meaning of suppressed aEEG amplitudes in children remains limited. This retrospective cohort study investigated the association of suppressed aEEG amplitudes in critically ill children with death or decline of neurological functioning at hospital discharge.MethodsTwo hundred and thirty-five EEGs derived from individual patients &lt;18 years in the pediatric intensive care unit at the University Hospital Essen (Germany) between 04/2014 and 07/2021, were converted into aEEGs and amplitudes analyzed with respect to age-specific percentiles. Crude and adjusted odds ratios (OR) for death, and functional decline at hospital discharge in patients with bilateral suppression of the upper or lower amplitude below the 10th percentile were calculated. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were assessed.ResultsThe median time from neurological insult to EEG recording was 2 days. PICU admission occurred due to neurological reasons in 43% and patients had high overall disease severity. Thirty-three (14%) patients died and 68 (29%) had a functional decline. Amplitude suppression was observed in 48% (upper amplitude) and 57% (lower amplitude), with unilateral suppression less frequent than bilateral suppression. Multivariable regression analyses yielded crude ORs between 4.61 and 14.29 and adjusted ORs between 2.55 and 8.87 for death and functional decline if upper or lower amplitudes were bilaterally suppressed. NPVs for bilaterally non-suppressed amplitudes were above 95% for death and above 83% for pediatric cerebral performance category Scale (PCPC) decline, whereas PPVs ranged between 22 and 32% for death and 49–52% for PCPC decline.DiscussionThis study found a high prevalence of suppressed aEEG amplitudes in critically ill children. Bilaterally normal amplitudes predicted good outcomes, whereas bilateral suppression was associated with increased odds for death and functional decline. aEEG assessment may serve as an element for risk stratification of PICU patients if conventional EEG is unavailable with excellent negative predictive abilities but requires additional information to identify patients at risk for poor outcomes.
Visual light flicker stimulation: enhancing alertness in sleep-deprived rats
Authors: Wang Kun , Chen Kang , Wei Zilin , Wang Tianhui , Wei Aili , Gao Xiujie , Qin Yingkai , Zhu Yingwen , Ge Yi , Cui Bo , Zhu Mengfu 
Published: June 2024

IntroductionIn the evolving field of neurophysiological research, visual light flicker stimulation is recognized as a promising non-invasive intervention for cognitive enhancement, particularly in sleep-deprived conditions.MethodsThis study explored the effects of specific flicker frequencies (40 Hz and 20–30 Hz random flicker) on alertness recovery in sleep-deprived rats. We employed a multidisciplinary approach that included behavioral assessments with the Y-maze, in vivo electrophysiological recordings, and molecular analyses such as c-FOS immunohistochemistry and hormone level measurements.ResultsBoth 40 Hz and 20–30 Hz flicker significantly enhanced behavioral performance in the Y-maze test, suggesting an improvement in alertness. Neurophysiological data indicated activation of neural circuits in key brain areas like the thalamus and hippocampus. Additionally, flicker exposure normalized cortisol and serotonin levels, essential for stress response and mood regulation. Notably, increased c-FOS expression in brain regions related to alertness and cognitive functions suggested heightened neural activity.DiscussionThese findings underscore the potential of light flicker stimulation not only to mitigate the effects of sleep deprivation but also to enhance cognitive functions. The results pave the way for future translational research into light-based therapies in human subjects, with possible implications for occupational health and cognitive ergonomics.