bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Placebo-Controlled Clinical Trial of Dutasteride for Reducing Heavy Drinking in Men
Authors: Covault Jonathan , Tennen Howard , Feinn Richard 
Published: April 2024

Abstract

Background
Prior studies indicate that neuroactive steroids mediate some of alcohol's effects. Dutasteride, widely used to treat benign prostatic hypertrophy, is an inhibitor of 5-alpha reductase enzymes, which play a central role in the production of 5α-reduced neuroactive steroids. The purpose of this study was to test dutasteride's tolerability and efficacy for reducing drinking.

Methods
Men (n = 142) with heavy drinking (>24 drinks per week) and a goal to either stop or reduce drinking to nonhazardous levels were randomized to placebo or 1 mg dutasteride daily for 12 weeks. We hypothesized that dutasteride-treated patients would be more successful in reducing drinking.

Results
Generalized linear mixed models that included baseline drinking, treatment, time and their 2-way interaction identified significant interactions of treatment-time, such that dutasteride treatment reduced drinking more than placebo. During the last month of treatment, 25% of dutasteride-treated participants had no hazardous drinking (no heavy drinking days and not more than 14 drinks per week) compared with 6% of placebo-treated participants (P = 0.006; NNT = 6). Sensitivity analysis identified baseline drinking to cope as a factor associated with larger reductions in drinking for dutasteride compared with placebo-treated participants. Dutasteride was well tolerated. Adverse events more common in the dutasteride group were stomach discomfort and reduced libido.

Conclusion
Dutasteride 1 mg daily was efficacious in reducing the number of heavy drinking days and drinks per week in treatment-seeking men. The benefit of dutasteride compared with placebo was greatest for participants with elevated baseline drinking to cope motives.
Diagnostic challenge: a case report of primary breast tuberculosis mimicking recurrent pyogenic breast abscess
Authors: Thapaliya Ishwor , Kumari Khusbu , Oli Pradeep , Karki Susmin , Deo Aakash 
Published: April 2024

Introduction:
Breast tuberculosis (BTB) is a rare form of extrapulmonary tuberculosis with its primary form considered even rarer.

Case presentation:
A 28-year-old female initially diagnosed with a breast abscess presented with chronic right breast pain and nipple discharge. Despite initial treatment, symptoms recurred, and further investigations revealed a space-occupying lesion. Fine needle aspiration confirmed recurrent breast abscess, but subsequent DNA detection of tubercular bacilli in the pus sample led to a diagnosis of primary BTB, necessitating antitubercular therapy.

Clinical discussion:
BTB, being rare and often misdiagnosed as an abscess, poses diagnostic challenges. However, persistent symptoms despite treatment should prompt consideration of BTB in TB endemic regions.

Conclusion:
Primary BTB might not have any systemic symptoms to drag the clinician towards a possible diagnosis so culturing the aspirate for acid-fast bacilli or looking for MTB DNA in the available clinical sample should always be kept in mind for better outcomes.
Consequences of Inpatient Falls in Acute Care: A Retrospective Register Study
Authors: Heikkilä Anniina , Lehtonen Lasse , Junttila Kristiina 
Published: April 2024

Aims
The objectives of this study were (1) to explore the consequences of falls; (2) to find out time and place of the fall events; and (3) to explore the impact of falls on the length of hospital stays in adults’ inpatient acute care.

Background
In hospitals, falls are the most common accidents that can occur to a patient during hospitalization. Injuries resulting from serious falls can cause lifelong harm to the patient due to loss of well-being and independence.

Design
A retrospective, cross-sectional, register study based on the data from electronic patient records was conducted.

Methods
The data included 114,951 inpatients, of which 743 had fallen. Data was collected between January 2014 and December 2016.

Results
One-third of falls caused injury. Most injuries were to the head area, and the most common injuries were pain or confusion. The falls usually occurred at the beginning of the treatment in the patient’s room or on the way to the toilet. Falls in the hospital increased the length of stay.

Conclusions
A large proportion of falls occur at the beginning of treatment, so it is important to start fall prevention measures as soon as the patient arrives at the hospital.
Practicality and Hemodynamic Advantage of Microvascularly Augmented Pectoralis Major Musculocutaneous Flap
Authors: Miyazaki Hidetaka , Kumegawa Shinji , Kudo Toshifumi , Wada Yoshitaka , Ueno Kazuki , Takahashi Yasuhiro , Tanaka Kae , Asamura Shinichi 
Published: April 2024

Abstract
We have recently shown that including the blood flow from the lateral thoracic artery (LTA) in addition to the thoracoacromial artery in the pectoralis major muscle musculocutaneous (PMMC) flap (bipedicle PMMC flap) can increase the perfusion of the flap. We also developed the concept of the supercharged PMMC flap, in which the LTA included in the flap was once cut and anastomosed to a cervical artery under a microscope. It is an effective solution to maintain the additional blood flow from the LTA, when the length of the LTA is compromised for reconstruction. The mandibular reconstruction of an oral cancer patient was performed with a supercharged PMMC flap. Intraoperative indocyanine green angiography was performed in a single pedicle, bipedicle, and supercharged conditions, and the videos were analyzed with a quantitative assessment system of perfusion using some parameters. As a result, blood supply from the LTA was essential for flap survival in this patient, and supercharging from the cervical artery improved flap perfusion compared with the perfusion in the bipedicle condition. The supercharged PMMC flap can resolve the compromise of pedicle length and be also hemodynamically advantageous, thus making the reconstruction more reliable than the conventional technique.
Prevalence of Regret in Gender-Affirming Surgery
Authors: Ren Thomas , Galenchik-Chan Andre , Erlichman Zachary , Krajewski Aleksandra 
Published: April 2024

Introduction
Gender-affirmation surgeries are a rapidly growing set of procedures in the field of plastic surgery. This study is novel in that a thorough analysis has not been performed quantifying, identifying, and recognizing the reasons and factors associated with regret in a largely US population.

Methods
A systematic review of several databases was conducted. After compiling the articles, we extracted study characteristics. From the data set, weighted proportions were generated and analyzed.

Results
A total of 24 articles were included in this study, with a population size of 3662 patients. A total of 3673 procedures were conducted in the United States, 514 in European nations, 97 in Asian nations, which included only Thailand, and 19 in South American nations, which included only Brazil. The pooled prevalence of regret was 1.94%. The prevalence of transfeminine regret was 4.0% while the prevalence of transmasculine regret was 0.8%.

Conclusions
Both transfeminine and transmasculine patients had significantly lower rates of regret in the United States when compared with the rest of the world. Our study largely excluded facial gender-affirming surgeries as most of its articles did not fall into our inclusion search criteria. To our knowledge, this is the most recent review performed on the topic of regret among gender-affirming surgery patients with an emphasis on a US cohort. This analysis can help shed light on better ways to enhance patient selection and surgical experience.
Synovial Lipomatosis With Extra-articular Extension in the Arthritic Wrist
Authors: Miller Rebecca L.R. , Donaldson Elsa K. , Giuffre Jennifer L. 
Published: April 2024

Abstract
Synovial lipomatosis is a rare condition characterized by adipocyte proliferation within joint synovial tissue. It most commonly affects the knee and is typically intra-articular. Only 5 published case reports describe extra-articular synovial lipomatosis of the wrist. We present a case of a sexagenarian patient seen for his wrist arthropathy. His x-ray revealed pan-wrist arthritis and inflammatory soft tissue swelling. The patient was slated for a wrist fusion and Darrach procedure. Following the dorsal skin incision in the operating room, an unusual adipose mass was identified infiltrating all extensor compartments: midcarpal, radiocarpal, and distal radioulnar joints. The mass was excised and sent to pathology prior to proceeding with the slated surgery. Synovial lipomatosis was diagnosed postoperatively based on histopathology. Six weeks postoperatively, the wrist fusion had healed clinically and radiographically, and his pain had improved. There was no evidence of recurrence. Synovial lipomatosis is a rare entity that may imitate multiple other pathologies. It is possible that synovial lipomatosis may represent a secondary occurrence following degenerative articular disease or trauma in older patients. This is the first case report to date describing synovial lipomatosis of the wrist with extra-articular extension in the setting of pan-carpal wrist arthritis.
Construction of a Lentiviral Vector for Fgfr2 Overexpression and its Impact on the Biological Behavior of Cranial Suture Mesenchymal Stem Cells
Authors: Yue Yingying , Chen Zong , Dong Xinhang , Song Guodong , Jin Xiaolei 
Published: April 2024

Objective:
Suture mesenchymal stem cells (SuSCs), possessing self-renewal and multilineage differentiation abilities, play a crucial role in cranial bone growth. However, the impact of the disease-causing fibroblast growth factor receptor 2 (FGFR2) mutation on SuSCs in Crouzon syndrome has not been explored. This study aims to employ a lentivirus to overexpress Fgfr2 and investigate its role in the pathogenesis of Crouzon syndrome.

Methods:
Starting with the prevalent FGFR2 mutation site in patients with Crouzon syndrome, a lentiviral vector carrying the Fgfr2.C361Y mutation was developed and transfected into SuSCs, with a determined multiplicity of infection values. The experimental group, SuSCs+Fgfr2.C361Y, was compared with the empty vector and normal SuSC groups. Cell proliferation, cycle, apoptosis, and osteogenic functionality were assessed using CCK-8 assays, flow cytometry, ALP activity assays, and real-time quantitative polymerase chain reaction.

Results:
The lentiviral vector effectively infected SuSCs, leading to heightened Fgfr2 expression, with optimal multiplicity of infection values of 80. The experimental group demonstrated decreased proliferation activity and a higher apoptosis rate compared with controls (P < 0.05). After osteogenic induction, the experimental group showed significantly higher ALP activity than controls (P < 0.05). Real-time quantitative polymerase chain reaction indicated lower mRNA expression levels of Gli1, Axin2, Pcna, Cdk2, and Bcl-2 in the experimental group than controls, whereas Bax, Runx2, and Bmp-2 showed higher expression (P < 0.05).

Conclusion:
This study constructed a lentivirus vector to upregulate Fgfr2 expression in SuSCs, suppressing stem cell stemness by inhibiting proliferation, promoting apoptosis, and accelerating premature osteogenic differentiation, resulting in premature suture closure. These findings establish the groundwork for further understanding the pathogenesis of Crouzon syndrome.
Bispectral Index Monitoring in the Nursing of Patients With Paroxysmal Sympathetic Hyperactivity
Authors: Chen YuJing , Huang WenJing , Li ShuFang , Dong Lun , Zhang HengZhu , Shao Qiang , Hu Fei , Chen Lang 
Published: April 2024

Aim:
To investigate the clinical nursing effect of bispectral index (BIS) monitoring for paroxysmal sympathetic hyperactivity (PSH) patients in the neurosurgical intensive care unit (NICU).

Methods:
From January 2022 to June 2023, a total of 30 patients with PSH secondary to moderate to severe craniocerebral injury in the NICU were monitored for BIS. The patients’ paroxysmal sympathetic hyperactivity-assessment measure (PSH-AM) scores were recorded. PSH patients generally appear in 3 states: calm state, seizure state, and postmedication state. Thirty PSH patients’ BIS values were recorded during the calm period, during the seizure state, and postmedication state, and these 3 different stages’ BIS values were divided into groups A, B, and C, using the Kruskal-Wallis H test to compare groups.

Results:
The Kruskal-Wallis H test yielded a value of H=22.599, P<0.001. H0 was rejected against the test standard of α=0.05, and the BIS values of groups A, B, and C differed. The BIS values of group A and group B differed after a pairwise comparison, and the difference was statistically significant (adjusted P=0.001). Group B and group C had different BIS values, and the difference was statistically significant (adjusted P=0.001); group A and Group C had no difference in BIS values, and the difference was not statistically significant (adjusted P=1.00).

Conclusions:
Taking BIS value as the nursing observation index for PSH patients can make nursing work more objective, reasonable, and accurate, reduce the inducing factors of PSH attack, further reduce the attack of PSH, save nursing resources, and help guide the safety assessment of sedative use.
Ictal Direct Current Shifts Preceded Much Earlier Than High Frequency Oscillations After Status: Is It the Effect of Status or Antiseizure Medication?
Authors: Kanazawa Kyoko , Kajikawa Shunsuke , Matsumoto Riki , Takatani Miwa , Nakatani Mitsuyoshi , Daifu-Kobayashi Masako , Imamura Hisaji , Kikuchi Takayuki , Kunieda Takeharu , Miyamoto Susumu , Takahashi Ryosuke , Matsuhashi Masao , Ikeda Akio 
Published: April 2024

Purpose:
While spikes and sharp waves are considered as markers of epilepsy in conventional electroencephalography, ictal direct current (DC) shifts and high-frequency oscillations (HFOs) appear to be useful biomarkers for epileptogenicity. We analyzed how ictal DC shifts and HFOs were affected by focal status epilepticus and antiseizure medications (ASMs).

Methods:
A 20-year-old female patient who underwent long-term intracranial electrode implantation for epilepsy surgery presented with 72 habitual seizures and a focal status epilepticus episode lasting for 4 h. Ten, 3, and 10 consecutive habitual seizures were analyzed before the status, after the status, and after ASM (valproate) loading, respectively.

Results:
Before and immediately after the status, ictal DC shifts remained the same in terms of the amplitude, duration, and slope of DC shifts. High-frequency oscillations also remained the same in terms of the duration, frequency, and power except for the power of the lower frequency band. After ASM loading, the duration, amplitude, and slope of the ictal DC shift were significantly attenuated. The duration, frequency, and power of the HFOs were significantly attenuated. Furthermore, the interval between the DC onset and HFO onset was significantly longer and the interval between the HFO onset and ictal DC shift peak was significantly shorter.

Conclusions:
The attenuation of ictal DC shifts and HFOs after ASM loading implies that astrocyte and neuronal activity may be both attenuated by ASMs. This finding may help with our understanding of the pathophysiology of epilepsy and can aid with the discovery of new approaches for epilepsy management.
MyoVision-US: an Artificial Intelligence-Powered Software for Automated Analysis of Skeletal Muscle Ultrasonography
Authors: Calulo Rivera Zoe , González-Seguel Felipe , Horikawa-Strakovsky Arimitsu , Granger Catherine , Sarwal Aarti , Dhar Sanjay , Ntoumenopoulos George , Chen Jin , Bumgardner V. K. Cody , Parry Selina M. , Mayer Kirby P. , Wen Yuan 
Published: April 2024

AbstractIntroduction/AimsMuscle ultrasound has high utility in clinical practice and research; however, the main challenges are the training and time required for manual analysis to achieve objective quantification of morphometry. This study aimed to develop and validate a software tool powered by artificial intelligence (AI) by measuring its consistency and predictability of expert manual analysis quantifying lower limb muscle ultrasound images across healthy, acute, and chronic illness subjects.MethodsQuadriceps complex (QC [rectus femoris and vastus intermedius]) and tibialis anterior (TA) muscle ultrasound images of healthy, intensive care unit, and/or lung cancer subjects were captured with portable devices. Automated analyses of muscle morphometry were performed using a custom-built deep-learning model (MyoVision-US), while manual analyses were performed by experts. Consistency between manual and automated analyses was determined using intraclass correlation coefficients (ICC), while predictability of MyoVision -US was calculated using adjusted linear regression (adj.R2).ResultsManual analysis took approximately 24 hours to analyze all 180 images, while MyoVision - US took 247 seconds, saving roughly 99.8%. Consistency between the manual and automated analyses by ICC was good to excellent for all QC (ICC:0.85–0.99) and TA (ICC:0.93–0.99) measurements, even for critically ill (ICC:0.91–0.98) and lung cancer (ICC:0.85–0.99) images. The predictability of MyoVision-US was moderate to strong for QC (adj.R2:0.56–0.94) and TA parameters (adj.R2:0.81–0.97).DiscussionThe application of AI automating lower limb muscle ultrasound analyses showed excellent consistency and strong predictability compared with human analysis. Future work needs to explore AI-powered models for the evaluation of other skeletal muscle groups.
Refining SARS-CoV-2 Intra-host Variation by Leveraging Large-scale Sequencing Data
Authors: Mostefai Fatima , Grenier Jean-Christophe , Poujol Raphäel , Hussin Julie G. 
Published: April 2024

AbstractUnderstanding the evolution of viral genomes is essential for elucidating how viruses adapt and change over time. Analyzing intra-host single nucleotide variants (iSNVs) provides key insights into the mechanisms driving the emergence of new viral lineages, which are crucial for predicting and mitigating future viral threats. Despite the potential of next-generation sequencing (NGS) to capture these iSNVs, the process is fraught with challenges, particularly the risk of capturing sequencing artifacts that may result in false iSNVs. To tackle this issue, we developed a workflow designed to enhance the reliability of iSNV detection in large heterogeneous collections of NGS libraries. We use over 130,000 publicly available SARS-CoV-2 NGS libraries to show how our comprehensive workflow effectively distinguishes emerging viral mutations from sequencing errors. This approach incorporates rigorous bioinformatics protocols, stringent quality control metrics, and innovative usage of dimensionality reduction methods to generate representations of this high-dimensional dataset. We identified and mitigated batch effects linked to specific sequencing centers around the world and introduced quality control metrics that consider strand coverage imbalance, enhancing iSNV reliability. Additionally, we pioneer the application of the PHATE visualization approach to genomic data and introduce a methodology that quantifies how related groups of data points are within a two-dimensional space, enhancing our ability to explain clustering patterns based on their shared genetic characteristics. Our workflow sheds light on the complexities of viral genomic analysis with state-of-the-art sequencing technologies and advances the detection of accurate intra-host mutations, opening the door for an enhanced understanding of viral adaptation mechanisms.
Effect of diabetic kidney disease complications on fatigability in patients with type 2 diabetes mellitus
Authors: Hirano Yuma , Tsuriya Daisuke , Kono Kenichi , Fujikura Tomoyuki , Yamaguchi Tomoya , Matsushita Kento , Yokoyama Yurina , Yamauchi Katsuya , Nishida Yusuke 
Published: April 2024

AbstractPurposeType 2 diabetes mellitus (T2DM) emphasizes the maintenance of high levels of physical activity and requires interventions tailored to the characteristics of each patient. We hypothesized that T2DM combined with diabetic kidney disease (DKD) could increase skeletal muscle fatigability, becoming a specific contributor to physical inactivity. This study aimed to determine the effects of DKD complications on fatigability and the relationship between fatigability and physical activity in patients with T2DM.MethodsThe participants were 50 patients with T2DM aged 40–65 years with an estimated glomerular filtration rate of 30 ml/min/1.73 m2 or higher. An experimental protocol was performed using a isokinetic dynamometer to assess muscle function. Fatigability (maximal voluntary concentric contraction [ΔMVCC] velocity, maximal voluntary isometric contraction [ΔMVIC] torque) was calculated, indicating the decrease in angular velocity and muscle strength associated with the exercise task. The patient characteristics, physical activity (IPAQ-SV), knee extension strength, and skeletal muscle index were evaluated. Participants were divided into two groups (DKD and non-DKD) according to the presence or absence of DKD, and ΔMVCC velocity and ΔMVIC torque were compared.ResultsΔMVCC velocity was significantly higher in the DKD group than that in the non-DKD group (p<0.05). Similarly, ΔMVIC torque was significantly higher in the DKD group compared with the non-DKD group (p<0.05). Subgroup analysis showed that ΔMVCC velocity was independently associated with physical activity in the DKD group (odds ratio: 0.045, 95% confidence interval: 0.913–0.999).ConclusionFatigability increased with DKD in patients with T2DM and may be related to physical activity.
Novel Insights for Radiation Risk Assessment Unveiled by Deep Learning
Authors: Liu Zhenqiu , Shuryak Igor , Brenner David J , Ullrich Robert L 
Published: April 2024

AbstractContemporary radiation risk assessment predominantly depends on nonlinear parametric models, which typically include a baseline term, a dose-response term, and an effect modifier term. Despite their widespread application in estimating tumor risks, parametric models face a notable drawback: their rigid model structure can be overly restrictive, potentially introducing bias and inaccuracies into risk estimations.In this study, we analyze data on solid tumors and leukemia from the Life Span Study (LSS) to compare the performance of deep neural network (DNN) and nonlinear parametric (NLP) models in assessing ERRs. DNN presents novel perspectives for radiation risk assessment. Our findings indicate that DNN can perform better than the traditional parametric models. Even if DNN and NLP models exhibit similar performance in predicting tumor incidence, they diverge significantly in their estimated ERRs. Standard NLP models tend to underestimate ERRs directly linked to radiation dose, overestimate ERRs for individuals at younger attained ages and ages at exposure, and underestimate ERRs for those at older attained ages. Furthermore, DNN consistently identifies radiation dose as the primary and predominant risk factor for ERRs in leukemia and solid tumors, underscoring the critical role of radiation dose in risk assessment. The insights from DNN could enhance low-dose radiation risk assessment and improve parametric model development.