bluuebunny/crossref_metadata_2025_split huggingface dataset:
Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review
Authors: Araki Hiroshi , Sekino Motohiro , Hasegawa Yuri , Kurobe Masaya , Motokawa Tetsufumi , Tanigawa Akihiko , Egashira Takashi , Iwasaki Naoya , Suzumura Miki , Yano Rintaro , Matsumoto Sojiro , Ichinomiya Taiga , Higashijima Ushio , Kanayama Naohiro , Miura Kiyonori , Hara Tetsuya 
Published: May 2024

Rationale:
Amniotic fluid embolism (AFE) is a fatal obstetric condition that often rapidly leads to severe respiratory and circulatory failure. It is complicated by obstetric disseminated intravascular coagulation (DIC) with bleeding tendency; therefore, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is challenging. We report the case of a patient with AFE requiring massive blood transfusion, rescued using VA-ECMO without initial anticoagulation.

Patient’s concerns:
A 39-year-old pregnant patient was admitted with a complaint of abdominal pain. An emergency cesarean section was performed because a sudden decrease in fetal heart rate was detected in addition to DIC with hyperfibrinolysis. Intra- and post-operatively, the patient had a bleeding tendency and required massive blood transfusions. After surgery, the patient developed lethal respiratory and circulatory failure, and VA-ECMO was introduced.

Diagnosis:
Based on the course of the illness and imaging findings, the patient was diagnosed with AFE.

Interventions:
By controlling the bleeding tendency with a massive transfusion and tranexamic acid administration, using an antithrombotic ECMO circuit, and delaying the initiation of anticoagulation and anti-DIC medication until the bleeding tendency settled, the patient was managed safely on ECMO without complications.

Outcomes:
By day 5, both respiration and circulation were stable, and the patient was weaned off VA-ECMO. Mechanical ventilation was discontinued on day 6. Finally, she was discharged home without sequelae.

Lessons:
VA-ECMO may be effective to save the lives of patients who have AFE with lethal circulatory and respiratory failure. For safe management without bleeding complications, it is important to start VA-ECMO without initial anticoagulants and to administer anticoagulants and anti-DIC drugs after the bleeding tendency has resolved.
Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study
Authors: Liu Ziqing , Li Zhangjie , Duan Chaoyang 
Published: May 2024

Background:
The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke.

Methods:
From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study.

Results:
There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05).

Conclusion:
Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.
Global perspectives on the burden of sexually transmitted diseases: A narrative review
Authors: Elendu Chukwuka , Amaechi Dependable C. , Elendu Ijeoma D. , Elendu Tochi C. , Amaechi Emmanuel C. , Usoro Emmanuel U. , Chima-Ogbuiyi Nkechi L. , Arrey Agbor Divine B. , Onwuegbule Chukwunnonso J. , Afolayan Eniola F. , Balogun Benjamin B. 
Published: May 2024

Sexually transmitted diseases (STDs) pose a significant global health challenge with far-reaching social, economic, and public health implications. These infections have haunted humanity from ancient times to today, transcending geographical boundaries and cultural contexts. This article explores the multifaceted landscape of STDs, delving into their epidemiology, pathophysiology, clinical manifestations, and global response strategies. The global prevalence of STDs is staggering, with millions of new cases reported annually. Prominent among these infections is HIV/AIDS, which remains a major global health crisis, affecting over 38 million people worldwide.
Additionally, bacterial STDs like chlamydia, gonorrhea, and syphilis continue to pose significant health risks, with millions of new cases reported yearly. Beyond the physical manifestations, STDs have profound social and economic implications. They can result in severe reproductive health issues, stigma, discrimination, and psychological distress, burdening healthcare systems and affecting individuals’ quality of life. The global response to STDs has been multifaceted, with international organizations and governments implementing various prevention and control strategies, including sexual education programs and scaling up access to testing and treatment. However, challenges persist, including disparities in healthcare access, sociocultural factors influencing transmission, and evolving pathogens with increasing resistance to treatment. Through case studies and real-world examples, we illuminate the human stories behind the statistics, highlighting the lived experiences of individuals grappling with STDs and the complex interplay of factors shaping their journeys. Ultimately, this review calls for continued research, innovative strategies, and sustained global commitment to mitigating the burden of STDs and promoting sexual health and well-being for all.
Palliative treatment of generalized metastatic follicular carcinoma of thyroid after operation: A case report and literature review
Authors: Zhao Han , Kang Wenyan , Guan Jian , Wang Ying 
Published: May 2024

Rationale:
Follicular carcinoma of thyroid is a rare pathological type of thyroid carcinoma, accounting for 4.5% of the total. At present, the main treatment methods include surgery, iodine therapy, thyroid hormone inhibitors, etc. Targeted drug therapy is very important for distant metastasis and iodine-refractory differentiated thyroid cancer.

Patient concerns:
This clinical case is a 51-year-old male patient with follicular carcinoma of thyroid.

Diagnoses:
After 7 years of total thyroidectomy, multiple distant metastasis occurred to bilateral lungs, bones, multiple lymph nodes, etc.

Intervention:
After multidisciplinary consultation in the department of oncology, thoracic surgery, nuclear medicine and other departments, he received targeted drug therapy of Lenvatinib.

Outcomes:
After 3 months, his condition was partially relieved, and his quality of life was significantly improved. After 11 months of treatment, the evaluated efficacy was still in remission.

Lesson:
Late metastatic thyroid cancer is faced with dilemma of radioiodine refractory after traditional treatment. This will provide further evidence for therapeutic intervention in similar patients in the future.
Incidence of perioperative complications in COVID-19 survivors: Prospective observational clinical trial
Authors: Özen Özge , Ankay Yilbaş Aysun , Kanbak Meral 
Published: May 2024

Background:
As long as the COVID-19 pandemic continued, the continuation of elective surgery had been unavoidable. There is still no consensus on the timing of elective surgery in patients who have recovered from COVID-19. The primary aim of this study was to determine the effect of time after COVID-19 infection on perioperative complications.

Methods:
This prospective observational single center included adult patients who had recovered from COVID-19 and underwent surgery between February and July 2021. Data were prospectively collected from the patient and hospital database, the preoperative evaluation form and the perioperative anesthesia forms.

Results:
A total of 167 patients were included in our study. Preoperative COVID-19 RT-PCR test results were negative in all patients. The mean time of positive COVID-19 diagnosis was 151.0 ± 74.0 days before the day of surgery. Intraoperative general and airway complications occurred in 33 (19.8%) and 17 (10.2%) patients, respectively. Although the time from COVID-19 positivity to surgery was shorter in patients with intraoperative general and airway complications, the difference between the groups did not reach statistical significance (P = .241 and P = .133, respectively). The median time from COVID-19 positivity to surgery in patients with and without postoperative complications was 156.0 (min: 27.0–max: 305.0) and 148.5 (min: 14.0–max: 164.0) days, respectively (P = .757). In patients with and without oxygen support in the postoperative period, the median time from COVID-19 positivity to surgery was 98.0 (min: 27.0–max: 305.0) and 154.0 (min: 14.0–max: 364.0) days, respectively. In patients who received oxygen support in the postoperative period, the time from COVID-19 positivity to surgery was shorter and the difference between the groups was statistically significant (P = .014).

Conclusions:
The incidence of perioperative complications decreased with increasing time after a positive SARS-CoV-2 infection, but there was no difference in perioperative complications between the groups. As the time between COVID-19 positivity and surgery increased, the need for oxygen support in the postoperative period decreased. It is not possible to share clear data on the timing of operation after SARS-CoV-2 infection.
Numerical study of pedicle screw construction and locking compression plate fixation in posterior pelvic ring injuries: Analyzed by finite element method
Authors: Zhang Jun , Wei Yan , Wang Jian , Yu Baoqing 
Published: May 2024

Background:
The aim of this study was to compare the biomechanical performance of pedicle screw construction and locking compression plate fixation in posterior pelvic ring injuries analyzed by finite element method.

Methods:
A 3-dimensional finite element model of the spine-pelvis-femur complex with ligaments was reconstructed from computed tomography images. An unstable posterior pelvic ring injury was created, which was fixed with a pedicle screw construction or locking compression plate. A follower load of 400 N was applied to the upper surface of the vertebrae to simulate the upper body weight, while the ends of the proximal femurs were fixed. The construct stiffness, the maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum, and stress distributions of the implants and pelvises were assessed.

Results:
The construct stiffness of the pedicle screw model (435.14 N/mm) was 2 times that of the plate model (217.01 N/mm). The maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum in the pedicle screw model were smaller than those in the plate model (0.919, 1.299, 0.259, and 1.413 mm in the pedicle screw model, and 1.843, 2.300, 1.053, and 2.895 mm in the plate model, respectively). The peak stresses of the implant and pelvis in the pedicle screw model decreased by 80.4% and 25% when compared with the plate model (44.57 and 34.48 MPa in the pedicle screw model, and 227.47 and 45.97 MPa in the plate model, respectively).

Conclusion:
The study suggested that the pedicle screw construction could provide better fixation stability than the locking compression plate and serves as the recommended fixation method for the treatment of posterior pelvic ring injuries.
Variation in Time-to-Gender-Affirming Hormone Therapy in US Active Duty Service Members
Authors: Klein David A. , Gonzalez Xenia B. , Highland Krista B. , Thornton Jennifer A. , Sunderland Kevin W. , Funk Wendy , Pav Veronika , Brydum Rick , Schvey Natasha A. , Roberts Christina M. 
Published: May 2024

Background:
Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired.

Objective:
This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System.

Research Design:
This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository.

Participants:
A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code.

Measures:
Time-to-gender-affirming hormone initiation after diagnosis receipt.

Results:
A total of 2439 Service members were included (Mage 24 y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female (P<0.001), and Asian and Pacific Islander (P=0.02) and Black (P=0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis.

Conclusion:
The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.
Evaluating the Correlation Between Anteroposterior Diameter, Body Surface Area, and Height for Liver Transplant Donors and Recipients
Authors: Little Christopher J. , Biggins Scott W. , Perkins James D. , Kling Catherine E. 
Published: May 2024

Background.
Small stature and female sex correlate to decreased deceased donor liver transplant (DDLT) access and higher waitlist mortality. However, efforts are being made to improve access and equity of allocation under the new continuous distribution (CD) system. Liver anteroposterior diameter (APD) is a method used by many centers to determine size compatibility for DDLT but is not recorded systematically, so it cannot be used for allocation algorithms. We therefore seek to correlate body surface area (BSA) and height to APD in donors and recipients and compare waitlist outcomes by these factors to support their use in the CD system.

Methods.
APD was measured from single-center DDLT recipients and donors with cross-sectional imaging. Linear, Pearson, and PhiK correlation coefficient were used to correlate BSA and height to APD. Competing risk analysis of waitlist outcomes was performed using United Network for Organ Sharing data.

Results.
For 143 pairs, donor BSA correlated better with APD than height (PhiK = 0.63 versus 0.20). For recipient all comers, neither BSA nor height were good correlates of APD, except in recipients without ascites, where BSA correlated well (PhiK = 0.63) but height did not. However, among female recipients, BSA, but not height, strongly correlated to APD regardless of ascites status (PhiK = 0.80 without, PhiK = 0.70 with). Among male recipients, BSA correlated to APD only in those without ascites (PhiK = 0.74). In multivariable models, both BSA and height were predictive of waitlist outcomes, with higher values being associated with increased access, decreased delisting for death/clinical deterioration, and decreased living donor transplant (model concordance 0.748 and 0.747, respectively).

Conclusions.
Taken together, BSA is a good surrogate for APD and can therefore be used in allocation decision making in the upcoming CD era to offset size and gender-based disparities among certain candidate populations.
Efficacy and Safety of Mirabegron Add-on Therapy After Failure With Solifenacin in Multiple Sclerosis Patients With Overactive Bladder: A Pilot Study
Authors: Mut Senem Ertugrul , Selcuk Ferda , İncirli Sila Usar , Delibas Sedef 
Published: May 2024

ObjectivesMultiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative progressive disease of central nervous system that mostly affects young adults. (1) Because of involvement of spinal cord and brain, lower urinary dysfunction symptoms are commonly encountered. MS patients mostly show overactive bladder symptoms like urgency, frequent daytime urination, and urgency incontinence. Among MS patients, antimuscarinic therapy is the first-line treatment with overactive bladder symptoms as well as in general population yet 30% of the patients show insufficient improvement or intolerance to the treatment (2). In our study, our aim is to evaluate the efficacy and safety of mirabegron add-on treatment in MS patients after inadequate response to antimuscarinic monotherapy.MethodsUniversity of Kyrenia and Dr Burhan Nalbantoglu State hospital's databases were screened for the study. Seventy patients who were residents diagnosed with MS according to McDonald criteria were questioned. Among these patients, a total of 22 of them were included in the study. Inclusion criteria was at least 3 years of MS diagnosis, score of <6 at Expanded Disability Status Scale, and a score of ≥3 at Overactive Bladder Symptom Score Scale.ResultsAmong selected patients, 10 mg solifenacin treatment was daily started and followed for 4 weeks. Mirabegron add-on treatment was initiated to the 11 patient who had inadequate improvement in overactive bladder symptom score. After mirabegron add-on treatment among 11 patient, there was a sufficient improvement in overactive bladder symptom score (P< 0.008).ConclusionsIn our study, we have found that antimuscarinic and mirabegron combination causes improved efficacy for overactive bladder in MS population.
Feminization of the precarious at the UNAM: examining obstacles to gender equality
Authors: ciccia lu , Espinosa-Lugo Geraldine , García-Guzmán Graciela , Gasca-Pineda Jaime , Velez Patricia , Espinosa-Asuar Laura 
Published: May 2024

AbstractIn this article we seek a better understanding of the specificities of the gender gap, regarding the reality of women in the different disciplines contained in STEM within Latin America. Specifically, we analyze and compare the situation of women in the Institutes of Mathematics, Ecology and Biology, belonging to the National Autonomous University of Mexico (UNAM). In this novel study, we contribute to deepen in how the phenomena of horizontal and vertical segregation are combined with symbolic and structural obstacles, as well as economic-labor precariousness, within the framework of gender norms. We also analyze the points in common regarding the situation in the Global North. We consider that these facts are fundamental to understand how gender stereotypes are perpetuated in the production of knowledge, and what are the values implied in gender norms that explain the exclusion, and self-exclusion, of women in certain disciplines and statuses. Related to this, we inquired into the relationship between these values and the cultural capital represented in each of the disciplines mentioned and found that the knowledge areas that currently represent the highest cultural capital pose symbolic obstacles for women. Conversely, those areas that less strongly embody values associated with masculinity, and therefore have less cultural capital, present mainly structural obstacles for women.
Model-based deconvolution of a force signal to estimate motor unit twitch parameters under low, moderate and high force isometric contractions
Authors: Rohlén Robin , Celichowski Jan 
Published: May 2024

AbstractMuscle force generation and human movement are organised by the central nervous system and executed by the peripheral nervous system and the muscle fibres through molecular and electrical mechanisms. Over the last half-century, attempts have been made to elucidate these mechanisms in vivo, primarily focusing on the motor unit (MU) activity because of its role as the smallest voluntarily contractible unit. Although it is firmly established that the nervous system controls muscle force by modulating MU activity, it is yet possible to distinguish between the activities of slow- and fast-twitch MUs non-invasively, which is important for rehabilitation and diagnostic purposes. Although different methods exist to extract MU twitch parameters from a force signal, no method can accurately identify a single MU twitch given a single MU spike train. We addressed this problem by developing a model-based deconvolution method. We evaluated the method using a MU-based recruitment model under isometric contractions and tested it on experimental data. We found that the deconvolution method can provide non-biased average twitch parameter estimates with low variance for the latest recruited MUs, irrespective of contraction level. It can estimate average twitch parameters when the underlying MUs comprise unequal successive twitch profiles, the force signal has lower signal-to-noise ratios, or when the spike train includes missed firings at the cost of slightly increased bias or variance. Finally, the method provides twitch parameter estimates that align with the expected MU recruitment characteristics in experimental conditions. To conclude, the deconvolution method may be used to study slow and fast MUs for rehabilitation and neuromuscular diagnostics.Author SummaryTo generate force voluntarily with a specific muscle, the brain plans and sends signals through the spinal cord via motor neurons, each of which communicates with a set of muscle fibres. Together, these muscle fibres and the motor neuron are called a motor unit. In the literature, the neural signals have received much attention, whereas the mechanical force-generating muscle fibres have received much less due to the limitations of current methods. By extracting the mechanical characteristics of these muscle fibres connected to a specific motor neuron type in vivo, one can use this information for rehabilitation and neuromuscular diagnostics of humans. Here, we proposed a method that can accurately estimate the force profile from each motor unit during low to high contraction levels. This method can be used for rehabilitation and neuromuscular diagnostics purposes.