bluuebunny/crossref_metadata_2025_split huggingface dataset:
Older age and risk for delayed abdominal pain care in the emergency department
Authors: Bloom Ben , Fritz Christie L. , Gupta Shivani , Pott Jason , Skene Imogen , Astin-Chamberlain Raine , Ali Mohammad , Thomas Sarah A. , Thomas Stephen H. 
Published: May 2024

Background and importanceSuboptimal acute pain care has been previously reported to be associated with demographic characteristics.ObjectivesThe aim of this study was to assess a healthcare system’s multi-facility database of emergency attendances for abdominal pain, to assess for an association between demographics (age, sex, and ethnicity) and two endpoints: time delay to initial analgesia (primary endpoint) and selection of an opioid as the initial analgesic (secondary endpoint).Design, setting, and participantsThis retrospective observational study assessed four consecutive months’ visits by adults (≥18 years) with a chief complaint of abdominal pain, in a UK National Health Service Trust’s emergency department (ED). Data collected included demographics, pain scores, and analgesia variables.Outcome measures and analysisCategorical data were described with proportions and binomial exact 95% confidence intervals (CIs). Continuous data were described using median (with 95% CIs) and interquartile range (IQR). Multivariable associations between demographics and endpoints were executed with quantile median regression (National Health Service primary endpoint) and logistic regression (secondary endpoint).Main resultsIn 4231 patients, 1457 (34.4%) receiving analgesia had a median time to initial analgesia of 110 min (95% CI, 104–120, IQR, 55–229). The univariate assessment identified only one demographic variable, age decade (P= 0.0001), associated with the time to initial analgesia. Association between age and time to initial analgesia persisted in multivariable analysis adjusting for initial pain score, facility type, and time of presentation; for each decade increase the time to initial analgesia was linearly prolonged by 6.9 min (95% CI, 1.9–11.9;P= 0.007). In univariable assessment, time to initial analgesia was not associated with either detailed ethnicity (14 categories,P= 0.109) or four-category ethnicity (P= 0.138); in multivariable analysis ethnicity remained non-significant as either 14-category (all ethnicities’P≥ 0.085) or four-category (allP≥ 0.138). No demographic or operational variables were associated with the secondary endpoint; opioid initial choice was associated only with pain score (P= 0.003).ConclusionIn a consecutive series of patients with abdominal pain, advancing age was the only demographic variable associated with prolonged time to initial analgesia. Older patients were found to have a linearly increasing, age-dependent risk for prolonged wait for pain care.
Comprehensive treatment of gallbladder cancer: a case report
Authors: Cui Zhaoyang , Le Yi , Liu Hu , Feng Linjing , Zhang Shaogeng 
Published: May 2024

Introduction and importance:
Gallbladder cancer is an extremely aggressive digestive system tumor. It is difficult to treat as early symptoms are insidious, and patients are usually diagnosed in advanced stages. The authors’ case highlights the need for effective treatment strategies and underscores the critical role of an individualized approach in the management of complicated gallbladder cancer.

Case presentation:
The authors report a patient admitted to the hospital with back pain and discomfort who was diagnosed with advanced gallbladder cancer. The patient received two cycles of chemotherapy with gemcitabine and cisplatin (GC), but the response was unsatisfactory. The authors changed the treatment regimen to gemcitabine and oxaliplatin (GEMOX) combined with targeted therapy (lenvatinib) and immunotherapy (toripalimab), and achieved significant therapeutic effect. Subsequently, the patient underwent "extended right hemihepatectomy, cholecystectomy, lymph node dissection of the hepatoduodenal ligament " and continued to receive combined therapy after surgery, and no tumor recurrence has been observed so far.

Clinical discussion:
The authors delve into the challenges faced during treatment, exploring the subtle impact of modified regimens and the strategic integration of surgery and combination therapy. The focus of this study is on the intricate synergy between GEMOX, lenvatinib and teraplizumab, providing a holistic view of treatment effects and new insights into the clinical decision-making process.

Conclusions:
This case emphasizes the success of precision medicine in the treatment of advanced gallbladder cancer. The adjustment of strategy can not only improve the therapeutic effect but also promote the success of surgical intervention. This case provides a valuable lesson in the holistic management of gallbladder cancer patients and prompts further reflection on the nuances of individualized therapeutic approaches in cancer treatment.
Awareness of consanguineous marriage burden and willingness towards premarital genetic testing in Sudan: a national cross-sectional study
Authors: Elmugadam Fatima M. , Ahmed Haythem , KARAMELGHANI MOHAMMED , Ali Almigdad , Ali Israa , Ahmed Almegdad , Salman Mohammed , Mohamed Wadah , Ahmed Elhami A. , Abbasher Hussien Mohamed Ahmed Khabab , Mustafa Ahmed Ghassan E. , Elsayed Liena , Musa Ahmed 
Published: May 2024

Background:
Despite the widespread practice of consanguinity in Sudan, there is a lack of exploration into the community’s awareness of its health implications on offspring and their overall attitude towards consanguineous unions.

Aim:
This study aimed to evaluate the community’s awareness of the possible health adversities of consanguinity on children and assess the effect of knowledge level on the prevailing attitude towards this practice in Sudan.

Methods:
From August to December 2018, data were collected from adults aged 18 years and above in five provinces of Sudan regardless of their marital status. The analysis involved both descriptive and multivariate statistical techniques.

Results:
This study revealed a consanguinity rate of 30.2%. Despite a high awareness level (73.7%) regarding the effects of consanguineous marriage on the health of the offspring, a moderately negative attitude towards this practice (63.9%) was observed.

Conclusion:
The discordance between the high consanguinity rate in the Sudanese population and the moderately negative attitude suggests a potential persistence of this practice in the future. Without the implementation of educational programs and the provision of genetic counselling services to consanguineous couples, the prevalence of consanguinity is likely to endure.
Primary Sjögren’s syndrome without ocular manifestation: a case report
Authors: Mohammad Aya , Btrush Sana , Makhlouf Zeina , Alkasem Abeer , Abdoh Hoda , Kudsi Maysoun 
Published: May 2024

Introduction and importance:
Sjögren’s Syndrome is a systemic immune disorder, manifested in dry eyes and mouth. Primary Sjögren’s syndrome without ocular manifestation is seldom mentioned in the literature.

Case presentation:
The authors report a case of a 48-year-old female who complained of dryness of mouth and dysphagia for 6 months. Physical examinations showed dry lips with angular cheilitis, an erythematous tongue, and dry buccal mucosa, with multiple carious teeth. The salivary flow was scanty from the Stenson’s and Wharton’s ducts on both sides. Her ophthalmological examination was normal. Laboratory tests revealed leukopenia, anemia, thrombocytopenia, elevated levels of C-reactive protein and erythrocyte sedimentation rate, a strongly positive antinuclear antibody, anti-SS-A, anti-SS-, and rheumatic factor. Hyperechoic nodules in both parotids were shown by Ultrasonography. Salivary gland biopsy showed lymphocytic infiltration. Diagnosis of primary Sjögren’s syndrome was made. She was treated with Pilocarpine 5 mg for 3 months, Vitamin C, and artificial saliva for oral dryness. She is under continuous follow-up with 50–60% relief, without any systemic complications

Discussion:
Sjögrenʼs Syndrome affects the exocrine glands causing dry mouth and eyes, and can cause systemic symptoms, including fatigue and joint pain. The incidence of ocular involvement among the reported cases is 86.1%, whereas our patient did not have any ocular involvement, and this represents a rare condition. The differential diagnosis included diabetes mellitus, hypothyroidism, chronic virology infection, and some medications that cause dryness, which were very much ruled out. Treatment of sicca symptoms involves artificial tears and medications that stimulate saliva flow while treatment of systemic disease includes corticosteroids, and various DMARDs, Rituximab. this disease has an increased relative risk for the development of B-cell non-Hodgkinʼs lymphoma. Therefore, patients need to be monitored, especially in the presence of risk factors.

Conclusion:
It is very important to diagnose this disorder early, using the various diagnostic criteria.
A Case of Long-Term Survival After Glioblastoma, IDH-Wild Type
Authors: Webb Lauren M. , Neth Bryan J. , Raghunathan Aditya , Greipp Patricia T. , Ida Cristiane M. , Carabenciov Ivan D. , Ruff Michael W. 
Published: May 2024

Introduction:
Glioblastoma is a uniformly lethal primary central nervous system neoplasm. Despite the increased understanding of its pathophysiology and treatment advancements, median overall survival for patients with glioblastoma, IDH-wild type remains 14 to 21 months from diagnosis.

Case Report:
We present the case of a 48-year-old female who presented with a focal seizure and was found to have a right frontal lobe mass on the brain magnetic resonance imaging. She underwent gross total resection and received a histological diagnosis of glioblastoma. She received radiotherapy and 6 cycles of carmustine (BCNU). Seventeen months later, she developed left hemiparesis. Imaging was concerning for tumor progression, and she was treated with 1 cycle of mechlorethamine, vincristine (oncovin), procarbazine, and prednisone (MOPP). Subsequent surveillance imaging demonstrated a therapeutic response. Twenty-seven years after her glioblastoma diagnosis, she developed status epilepticus and died from respiratory failure. Neuropathology on autopsy demonstrated extensive treatment-related changes but no evidence of recurrent glioblastoma. Genomic testing performed over 30 years after her original diagnosis revealed a profile diagnostic of glioblastoma, IDH-wild type per 2021 World Health Organization criteria.

Conclusions:
This patient is one of the longest-known survivors of glioblastoma, IDH-wild type, with pathologic confirmation of glioblastoma at the time of her resection and no evidence of residual disease 26 years after her last treatment. She presented with multiple factors associated with long-term glioblastoma survivorship, including female sex, young age, high Karnofsky score, and multimodal therapy. This case shows that long-term survival after glioblastoma diagnosis is possible and likely mediated through a combination of individual, tumor, and treatment factors.
The Relationship Between Cardiac CT-based Left Atrial Structure and Epicardial Adipose Tissue and Postablation Atrial Fibrillation Recurrence Within 2 Years
Authors: Yuan Yuan , Zhu Yinsu , Wu Dandan , Wang Jun , Lin Shushen , Zhu Yaxin , Xu Yi , Wu Feiyun 
Published: May 2024

Purpose:
The aim of this study was to explore the association of cardiac CT-based left atrium (LA) structural and functional parameters and left atrial epicardial adipose tissue (LA-EAT) parameters with postablation atrial fibrillation (AF) recurrence within 2 years.

Materials and Methods:
Contrast-enhanced cardiac CT images of 286 consecutive AF patients (median age: 65 y; 97 females) who underwent initial ablation between June 2018 and June 2020 were retrospectively analyzed. Structural and functional parameters of LA, including maximum and minimum volume and ejection fraction of LA and left atrial appendage (LAA), and LA-EAT volume, were measured. The body surface area indexed maximum and minimum volume of LA (LAVImax, LAVImin) and LAA (LAAVImax, LAAVImin), and LA-EAT volume index (LA-EATVI) were calculated. Independent predictors of AF recurrence were determined using Cox regression analysis. The clinical predictors were added to the imaging predictors to build a combined model (clinical+imaging). The predictive performance of the clinical, imaging, and combined models was assessed using the area under the receiver operating characteristics curve (AUC).

Results:
A total of 108 (37.8%) patients recurred AF within 2 years after ablation at a median follow-up of 24 months (IQR=11, 32). LA and LAA size and LA-EAT volume were significantly increased in patients with AF recurrence (P<0.05). After the multivariable regression analysis, LA-EATVI, LAAVImax, female sex, AF duration, and stroke history were independent predictors for AF recurrence. The combined model exhibited superior predictive performance compare to the clinical model (AUC=0.712 vs. 0.641, P=0.023) and the imaging model (AUC=0.712 vs. 0.663, P=0.018).

Conclusion:
Cardiac CT-based LA-EATVI and LAAVImax are independent predictors for postablation AF recurrence within 2 years and may provide a complementary value for AF recurrence risk assessment.
Pre-PCI CT-FFR Predicts Target Vessel Failure After Stent Implantation
Authors: Wang Zewen , Tang Chunxiang , Zuo Rui , Zhou Aiming , Xu Wei , Zhong Jian , Xu Zhihan , Zhang Longjiang 
Published: May 2024

Objectives:
To investigate the predictive value of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) before percutaneous coronary intervention (PCI) to predict target vessel failure (TVF) after stent implantation.

Methods:
This retrospective study included 429 patients (429 vessels) who underwent PCI and stent implantation after CCTA within 3 months. All patients underwent coronary stent implantation between January 2012 and December 2019. A dedicated workstation (Syngo Via, Siemens) was used to analyze and measure the CT-FFR value. The cut-off values of pre-PCI CT-FFR for predicting TVF were defined as 0.80 and the value using the log-rank maximization method, respectively. The primary outcome was TVF, defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization (TVR), which was a secondary outcome.

Results:
During a median 64.0 months follow-up, the cumulative incidence of TVF was 7.9% (34/429). The cutoff value of pre-PCI CT-FFR based on the log-rank maximization method was 0.74, which was the independent predictor for TVF [hazard ratio (HR): 2.61 (95% CI: 1.13, 6.02); P=0.024] and TVR [HR: 3.63 (95%CI: 1.25, 10.51); P=0.018]. Compared with the clinical risk factor model, pre-PCI CT-FFR significantly improved the reclassification ability for TVF [net reclassification improvement (NRI), 0.424, P<0.001; integrative discrimination index (IDI), 0.011, P=0.022]. Adding stent information to the prediction model resulted in an improvement in reclassification for the TVF (C statistics: 0.711, P=0.001; NRI: 0.494, P<0.001; IDI: 0.020, P=0.028).

Conclusions:
Pre-PCI CT-FFR ≤0.74 was an independent predictor for TVF or TVR, and integration of clinical, pre-PCI CT-FFR, and stent information models can provide a better risk stratification model in patients with stent implantation.
Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study
Authors: Ho Vanessa P. , Kishawi Sami K. , Hill Hannah , O'Brien Joseph , Ratnasekera Asanthi , Seng Sirivan Suon , Ton Trieu Hai , Butts Christopher A. , Muller Alison , Diaz Bernardo Fabian , Baltazar Gerard A. , Petrone Patrizio , Pacheco Tulio Brasileiro Silva , Morrissey Shawna , Chung Timothy , Biller Jessica , Jacobson Lewis E. , Williams Jamie M. , Nebughr Cole S. , Udekwu Pascal O. , Tann Kimberly , Piehl Charles , Veatch Jessica M. , Capasso Thomas J. , Kuncir Eric J. , Kodadek Lisa M. , Miller Samuel M. , Altan Defne , Mentzer Caleb , Damiano Nicholas , Burke Rachel , Earley Angela , Doris Stephanie , Villa Erica , Wilkinson Michael C. , Dixon Jacob K. , Wu Esther , Moncrief Melissa L. , Palmer Brandi , Herzing Karen , Egodage Tanya , Williams Jennifer , Haan James , Lightwine Kelly , Colling Kristin P. , Harry Melissa L. , Nahmias Jeffry , Tay-Lasso Erika , Cuschieri Joseph , Hinojosa Christopher J. , Claridge Jeffrey A. 
Published: May 2024

BACKGROUND
Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.

METHODS
We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.

RESULTS
We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.

CONCLUSION
Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.

LEVEL OF EVIDENCE
Diagnostic Tests or Criteria; Level II.
Cytoprotective 3K3A-activated protein C and plasma: A comparison of therapeutics for the endotheliopathy of trauma
Authors: Thielen Otto , Stafford Preston , Debot Margot , Kelher Marguerite , Mitra Sanchayita , Hallas William , Gallagher Lauren T. , Schaid Terry , Stocker Benjamin , Ramser Benjamin , D’Alessandro Angelo , Hansen Kirk , Silliman Christopher C. , Moore Ernest , Mosnier Laurent , Griffin John , Cohen Mitchell 
Published: May 2024

BACKGROUND
Both healthy plasma and cytoprotective aPC (3K3A-aPC) have been shown to mitigate the endotheliopathy of trauma (EoT), but optimal therapeutics remain unknown. Our aim was therefore to determine optimal therapies to mitigate EoT by investigating the effectiveness of 3K3A-aPC with and without plasma-based resuscitation strategies.

METHODS
Electric cell-substrate impedance sensing (ECIS) was used to measure real-time permeability changes in endothelial cells. Cells were treated with a 2-μg/mL solution of aPC 30 minutes prior to stimulation with plasma taken from severely injured trauma patients (ISS > 15 and BD < −6) (TP). Healthy plasma, or plasma frozen within 24 hours (FP24), was added concomitantly with TP. Cells treated with thrombin and untreated cells were included in this study as control groups.

RESULTS
A dose-dependent difference was found between the 5% and 10% plasma-treated groups when human umbilical vein endothelial cells were simultaneously stimulated with TP (μd, 7.346; 95% confidence interval [CI], 4.574–10.12). There was no difference when compared with TP alone in the 5% (μd, 5.713; 95% CI, −1.751 to 13.18) or 10% group (μd, −1.633; 95% CI, −9.097 to 5.832). When 3K3A-aPC was added to plasma and TP, the 5% group showed improvement in permeability compared with TP alone (μd, 10.11; 95% CI, 2.642 to 17.57), but there was no difference in the 10% group (μd −1.394; 95% CI, −8.859 to 6.070). The combination of 3K3A-aPC, plasma, and TP at both the 5% plasma (μd, −28.52; 95% CI, −34.72 to −22.32) and 10% plasma concentrations (μd, −40.02; 95% CI, −46.22 to −33.82) had higher intercellular permeability than the 3K3A-aPC preincubation group.

CONCLUSION
Our data show that FP24, in a posttrauma environment, pretreatment with 3K3A-aPC can potentially mitigate the EoT to a greater degree than FP24 with or without 3K3A-aPC. Although further exploration is needed, this represents a potentially ideal and perhaps superior therapeutic treatment for the dysregulated thromboinflammation of injured patients.
Development and Initial Characterization of Pigs withDNAI1Mutations and Primary Ciliary Dyskinesia
Authors: Abou Alaiwa Mahmoud A. , Hilkin Brie M. , Price Margaret P. , Gansemer Nicholas D. , Rector Michael R. , Stroik Mal R. , Powers Linda S. , Whitworth Kristin M. , Samuel Melissa S. , Jain Akansha , Ostedgaard Lynda S. , Ernst Sarah E. , Philibert Winter , Boyken Linda D. , Moninger Thomas O. , Karp Phillip H. , Hornick Douglas B. , Sinn Patrick L. , Fischer Anthony J. , Pezzulo Alejandro A. , McCray Paul B. , Meyerholz David K. , Zabner Joseph , Prather Randy S. , Welsh Michael J. , Stoltz David A. 
Published: May 2024

ABSTRACTMutations in more than 50 different genes cause primary ciliary dyskinesia (PCD) by disrupting the activity of motile cilia that facilitate mucociliary transport (MCT). Knowledge of PCD has come from studies identifying disease-causing mutations, characterizing structural cilia abnormalities, finding genotype-phenotype relationships, and studying the cell biology of cilia. Despite these important findings, we still lack effective treatments and people with PCD have significant pulmonary impairment. As with many other diseases, a better understanding of pathogenic mechanisms may lead to effective treatments. To pursue disease mechanisms, we used CRISPR-Cas9 to develop a PCD pig with a disruptedDNAI1gene. PCD pig airway cilia lacked the outer dynein arm and had impaired beating. MCT was impaired under both baseline conditions and after cholinergic stimulation in PCD pigs. Neonatal PCD pigs developed neonatal respiratory distress with evidence of atelectasis, air trapping, and airway mucus obstruction. Despite airway mucus accumulation, lung bacterial counts were similar between neonatal wild-type and PCD pigs. Sinonasal disease was present in all neonatal PCD pigs. Older PCD pigs developed worsening airway mucus obstruction, inflammation, and bacterial infection. This pig model closely mimics the disease phenotype seen in people with PCD and can be used to better understand the pathophysiology of PCD airway disease.