bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury
Authors: Tsalatsanis Athanasios , Dismuke-Greer Clara , Kumar Ambuj , Hoffman Jeanne , Monden Kimberley R. , Magalang Ulysses , Schwartz Daniel , Martin Aaron M. , Nakase-Richardson Risa 
Published: April 2024

Objective:
To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation.

Setting:
Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) clinical trial (NCT03033901) on an inpatient rehabilitation TBI cohort were used in this study.

Study Design:
Decision tree analysis was used to determine the cost-effectiveness of approaches to diagnosing and treating sleep apnea. Costs were determined using 2021 Centers for Medicare and Medicaid Services reimbursement codes. Effectiveness was defined in terms of the appropriateness of treatment. Costs averted were extracted from the literature. A sensitivity analysis was performed to account for uncertainty. Analyses were performed for all severity levels of OSA and a subgroup of those with moderate to severe OSA. Six inpatient approaches using various phases of screening, testing, and treatment that conform to usual care or guideline-endorsed interventions were evaluated: (1) usual care; (2) portable diagnostic testing followed by laboratory-quality testing; (3) screening with the snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire; (4) Multivariable Apnea Prediction Index (MAPI) followed by portable diagnostic testing and laboratory-quality testing; (5) laboratory-quality testing for all; and (6) treatment for all patients.

Main Measures:
Cost, Effectiveness, and Incremental Cost-Effectiveness Ratio (ICER).

Results:
Phased approaches utilizing screening and diagnostic tools were more effective in diagnosing and allocating treatment for OSA than all alternatives in patients with mild to severe and moderate to severe OSA. Usual care was more costly and less effective than all other approaches for mild to severe and moderate to severe OSA.

Conclusions:
Diagnosing and treating OSA in patients with TBI is a cost-effective strategy when compared with usual care.
Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration
Authors: Stodulka Pavel , Packard Richard , Mordaunt David 
Published: April 2024

Purpose:
To compare 3 capsulotomy centration methods.

Setting:
Private clinic, Zlin, Czech Republic.

Design:
Prospective, consecutive case series.

Methods:
180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made.

Results:
The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis.

Conclusions:
The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.
Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan
Authors: Su Guan-Yu , Yeh Chang-Ching , Yang Shun-Jie , Yang Chen-Chang , Hwu Chii-Min , Wang Fan-Fen , Huang Chun-Jui 
Published: April 2024

Background:
Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan.

Methods:
Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for checkup of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed.

Results:
A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 μg/L (interquartile range [IQR]: 105.0-246.2 μg/L), indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: thyroid stimulating hormone (TSH) (median: 0.93 [0.007-2.9] µIU/mL), free T4 (1.3 [0.93-2.2] ng/dL), free T3 (3.0 [2.3-5.0] ng/dL), total T4 (9.9 [6.4-16.9] ng/dL), and total T3 (135 [88-231] ng/dL). If the nonpregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous (adjusted odds ratio [OR] from model 1-3: 2.02, 2.05, 2.02; 95% CI, 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively) and multivitamin nonusers (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI, 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 μg/L.

Conclusion:
The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin nonusers are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.
Unraveling variations and enhancing prediction of successful sphincter-preserving resection for low rectal cancer: a post hoc analysis of the multicentre LASRE randomized clinical trial
Authors: Wang Xiaojie , Jiang Weizhong , Deng Yu , Chen Zhifen , Zheng Zhifang , Sun Yanwu , Xie Zhongdong , Lu Xingrong , Huang Shenghui , Lin Yu , Huang Ying , Chi Pan 
Published: April 2024

Background:
Accurate prediction of successful sphincter-preserving resection (SSPR) for low rectal cancer enables peer institutions to scrutinize their own performance and potentially avoid unnecessary permanent colostomy. The aim of this study is to evaluate the variation in SSPR and present the first artificial intelligence (AI) models to predict SSPR in low rectal cancer patients.

Study design:
This was a retrospective post hoc analysis of a multicenter, non-inferiority randomized clinical trial (LASRE, NCT01899547) conducted in 22 tertiary hospitals across China. A total of 604 patients who underwent neoadjuvant chemoradiotherapy (CRT) followed by radical resection of low rectal cancer were included as the study cohort, which was then split into a training set (67%) and a testing set (33%). The primary end point of this post hoc analysis was SSPR, which was defined as meeting all the following criteria: (1) sphincter-preserving resection; (2) complete or nearly complete TME, (3) a clear CRM (distance between margin and tumour of 1 mm or more), and (4) a clear DRM (distance between margin and tumour of 1 mm or more). Seven AI algorithms, namely, support vector machine (SVM), logistic regression (LR), extreme gradient boosting (XGB), light gradient boosting (LGB), decision tree classifier (DTC), random forest (RF) classifier, and multilayer perceptron (MLP), were employed to construct predictive models for SSPR. Evaluation of accuracy in the independent testing set included measures of discrimination, calibration, and clinical applicability.

Results:
The SSPR rate for the entire cohort was 71.9% (434/604 patients). Significant variation in the rate of SSPR, ranging from 37.7 to 94.4%, was observed among the hospitals. The optimal set of selected features included tumour distance from the anal verge before and after CRT, the occurrence of clinical T downstaging, post-CRT weight and clinical N stage measured by magnetic resonance imaging. The seven different AI algorithms were developed and applied to the independent testing set. The LR, LGB, MLP and XGB models showed excellent discrimination with area under the receiver operating characteristic (AUROC) values of 0.825, 0.819, 0.819 and 0.805, respectively. The DTC, RF and SVM models had acceptable discrimination with AUROC values of 0.797, 0.766 and 0.744, respectively. LR and LGB showed the best discrimination, and all seven AI models had superior overall net benefits within the range of 0.3–0.8 threshold probabilities. Finally, we developed an online calculator based on the LGB model to facilitate clinical use.

Conclusions:
The rate of SSPR exhibits substantial variation, and the application of AI models has demonstrated the ability to predict SSPR for low rectal cancers with commendable accuracy.
Diagnostic accuracy of artificial intelligence assisted clinical imaging in the detection of oral potentially malignant disorders and oral cancer: a systematic review and meta-analysis
Authors: Li JingWen , Kot Wai Ying , McGrath Colman Patrick , Chan Bik Wan Amy , Ho Joshua Wing Kei , Zheng Li Wu 
Published: April 2024

Background:
The objective of this study is to examine the application of artificial intelligence (AI) algorithms in detecting oral potentially malignant disorders (OPMD) and oral cancerous lesions, and to evaluate the accuracy variations among different imaging tools employed in these diagnostic processes.

Materials and methods:
A systematic search was conducted in four databases: Embase, Web of Science, PubMed, and Scopus. The inclusion criteria included studies using machine learning algorithms to provide diagnostic information on specific oral lesions, prospective or retrospective design, and inclusion of OPMD. Sensitivity and specificity analyses were also required. Forest plots were generated to display overall diagnostic odds ratio (DOR), sensitivity, specificity, negative predictive values, and summary receiver operating characteristic (SROC) curves. Meta-regression analysis was conducted to examine potential differences among different imaging tools.

Results:
The overall DOR for AI-based screening of OPMD and oral mucosal cancerous lesions from normal mucosa was 68.438 (95% CI= [39.484–118.623], I
2=86%). The area under the SROC curve was 0.938, indicating excellent diagnostic performance. AI-assisted screening showed a sensitivity of 89.9% (95% CI= [0.866–0.925]; I
2=81%), specificity of 89.2% (95% CI= [0.851–0.922], I
2=79%), and a high negative predictive value of 89.5% (95% CI= [0.851–0.927], I
2=96%). Meta-regression analysis revealed no significant difference among the three image tools. After generating a GOSH plot, the DOR was calculated to be 49.30, and the area under the SROC curve was 0.877. Additionally, sensitivity, specificity, and negative predictive value were 90.5% (95% CI [0.873–0.929], I
2=4%), 87.0% (95% CI [0.813–0.912], I
2=49%) and 90.1% (95% CI [0.860–0.931], I
2=57%), respectively. Subgroup analysis showed that clinical photography had the highest diagnostic accuracy.

Conclusions:
AI-based detection using clinical photography shows a high DOR and is easily accessible in the current era with billions of phone subscribers globally. This indicates that there is significant potential for AI to enhance the diagnostic capabilities of general practitioners to the level of specialists by utilizing clinical photographs, without the need for expensive specialized imaging equipment.
A Ropivacaine-Eluting Poly(Lactide-Co-Caprolactone) Wound Dressing Provided Enhanced Analgesia in Partial-Thickness Porcine Injuries
Authors: Niederauer Stefan , Beeman Mike , Cleveland Andrew , Wojtalewicz Susan , Erickson Sierra , Reilly Christopher A. , Rower Joseph E. , Garrett Caroline , Floyd Candace , Shea Jill , Agarwal Jay , Lade Caleb , Davis Brett 
Published: April 2024

Background:
Partial-thickness skin wounds are some of the most painful injuries because of large areas of exposed nerve endings. These injuries often require systemic opioid treatment to manage pain adequately. However, the Centers for Disease Control and Prevention reported nearly 17,000 prescription opioid-related deaths in the United States in 2021 alone, highlighting the ongoing need for nonopioid treatment strategies. The authors developed a novel single-application ropivacaine-eluting primary wound dressing that could provide sustained ropivacaine delivery to partial-thickness wounds and assessed its in vivo feasibility for prolonged nonopioid analgesia.

Methods:
Sustained release of ropivacaine from a poly(lactide-co-caprolactone) matrix was first optimized in vitro using dissolution testing and a Box Behnken design of experiments. The optimized dressing was then tested against a clinical control silicone dressing in a porcine partial-thickness wound study to assess analgesic effect, pharmacokinetics, and wound healing.

Results:
The ropivacaine-eluting dressing showed a moderate analgesic effect in vivo, where normalized single pinprick scores significantly improved pain over the testing period (4 to 168 hours) (control versus treatment: 232 ± 25% versus 145 ± 16%; P < 0.0003). Ropivacaine blood plasma levels peaked at 8 hours after treatment, with a maximum concentration of 246 ± 74 ng/mL. No significant differences in wound healing were found when compared with control.

Conclusion:
The ropivacaine-loaded poly(lactide-co-caprolactone)–based wound dressing provided sustained delivery of ropivacaine to partial-thickness skin wounds and enhanced analgesic effect compared with a clinical standard control dressing.

Clinical Relevance Statement:
This article describes the development and porcine testing of an analgesic wound dressing for management of acute pain in partial-thickness dermal wounds.
Surgical Techniques in Nontraumatic Midcarpal Instability: Evaluating the Dorsal Capsulodesis and 3-Ligament Tenodesis Technique
Authors: Hakkesteegt Stefanie N. , Jongen Isabel C. , Hundepool Caroline A. , van der Oest Mark J. W. , Duraku Liron S. , Feitz Reinier ,   The Hand-Wrist Study Group, Zuidam J. Michiel 
Published: April 2024

Background:
Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial because of limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, satisfaction, range of motion, and return to work in patients with nontraumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or 3-ligament tenodesis (3LT).

Methods:
Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation and Satisfaction with Treatment Result Questionnaire at 12 months postoperatively. All data were analyzed retrospectively.

Results:
A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December of 2011 and December of 2019 were included. At 12 months postoperatively, both treatment groups reported significant improvements in pain and function scores. However, at 3 months postoperatively, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return-to-work rate (72%) compared with the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at 3 months that was restored at 12 months postoperatively. No significant difference in satisfaction with treatment was observed.

Conclusions:
Both 3LT and dorsal capsulodesis demonstrate promising results for addressing nontraumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, the authors recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient.
Risk and predictors of penile cancer in US Veterans with HIV
Authors: Zhao Jing , Dong Yongquan , Clark Eva , Garcia Jose M. , White Donna L. , Kramer Jennifer R. , Mazul Angela L. , Hartman Christine , Chiao Elizabeth Y. 
Published: April 2024

Objectives:
People with HIV (PWH) may have an increased burden of penile cancer. We aimed to evaluate the risk of penile cancer in PWH compared with that of the general population.

Design:
We conducted a nationwide retrospective matched cohort study of penile cancer incidence among veterans with HIV (VWH) compared with veterans without HIV.

Methods:
We compared penile cancer incidence rates in 44 173 VWH to those of veterans without HIV (N = 159 443; 4 : 1 matched in age). We used Cox regression models to estimate hazard ratios and 95% confidence intervals (CIs) for associations with HIV infection and for penile cancer risk factors.

Results:
HIV positivity was associated with an increased risk of penile cancer, with adjusted hazard ratios of 2.63 (95% CI 1.64–4.23) when adjusting for age, race/ethnicity, baseline BMI, smoking and alcohol use, economic means test, and history of condyloma. The risk increased to hazard ratio = 4.25 (95% CI 2.75–6.57) when adjusting for all factors except history of condyloma. Risk factors for penile cancer in VWH included lower nadir CD4+ count, less than 50% of follow-up time with undetectable HIV viral load, and history of condyloma.

Conclusion:
VWH – particularly those with low CD4+ counts, detectable HIV viral loads, or history of condyloma – are at increased risk of penile cancer, suggesting the penile cancer prevention activities are needed in this population.
Role of mucositis in predicting gut microbiota composition in people with cancer
Authors: Scott Jacqui S. , Li Anna , Wardill Hannah R. 
Published: April 2024

Purpose of review
Disruption of the precious ecosystem of micro-organisms that reside in the gut – the gut microbiota – is rapidly emerging as a key driver of the adverse side effects/toxicities caused by numerous anti-cancer agents. Although the contribution of the gut microbiota to these toxicities is understood with ever increasing precision, the cause of microbial disruption (dysbiosis) remains poorly understood. Here, we discuss current evidence on the cause(s) of dysbiosis after cancer therapy, positioning breakdown of the intestinal mucosa (mucositis) as a central cause.

Recent findings
Dysbiosis in people with cancer has historically been attributed to extensive antibiotic use. However, evidence now suggests that certain antibiotics have minimal impacts on the microbiota. Indeed, recent evidence shows that the type of cancer therapy predicts microbiota composition independently of antibiotics. Given most anti-cancer drugs have modest effects on microbes directly, this suggests that their impact on the gut microenvironment, in particular the mucosa, which is highly vulnerable to cytotoxicity, is a likely cause of dysbiosis. Here, we outline evidence that support this hypothesis, and discuss the associated clinical implications/opportunities.

Summary
The concept that mucositis dictates microbiota compositions provides two important implications for clinical practice. Firstly, it reiterates the importance of prioritising the development of novel mucoprotectants that preserve mucosal integrity, and indirectly support microbial stability. Secondly, it provides an opportunity to identify dysbiotic events and associated consequences using readily accessible, minimally invasive biomarkers of mucositis such as plasma citrulline.
“I′m not a risk taker”
Authors: Behrens Liza L. , Anderson Hannah L. , Kowalchik Kaléi H. , Mogle Jacqueline , Roman Jones Joanne , Van Haitsma Kimberly , Hodgson Nancy , Boltz Marie 
Published: April 2024

Background:Persons living with Alzheimer disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences.Methods:As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living.Results:Residents generally self-identified as risk avoiders (M=3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care.Discussion:Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.
Escalating Surgical Treatment for Left Ventricular Assist Device Infection and Expected Mortality: Clinical Risk Prediction Score
Authors: Finnan Michael J , Chi David , Chiang Sarah N , Vader Justin M , Cabrera Nicolo L , Kells Amy F , Masood Muhammad F , Kotkar Kunal D , Fox Ida K 
Published: April 2024

BACKGROUND:
Left ventricular assist devices (LVAD) improve survival for patients with cardiac failure, but LVAD-specific infection (VSI) remains a challenge with poorly understood predictive risk factors. The indications and use of escalating medical treatment to surgical debridement and potential flap reconstruction are not well characterized.

STUDY DESIGN:
A retrospective review of consecutive patients undergoing primary LVAD implantation at a tertiary academic center was performed. The primary outcome measures were 90-day and overall mortality after VSI. Cox proportional hazards regression was used to generate a risk prediction score for mortality.

RESULTS:
Of the 760 patients undergoing primary LVAD implantation, 255 (34%) developed VSI; of these patients, 91 (36%) were managed medically, 134 (52%) with surgical debridement, and 30 (12%) with surgical debridement and flap reconstruction. One-year survival after infection was 85% with median survival of 2.40 years. Factors independently associated with increased mortality were diabetes (hazard ratio [HR] 1.44, p = 0.04), MRSA infection (HR 1.64, p = 0.03), deep space (pump pocket or outflow cannula) involvement (HR 2.26, p < 0.001), and extracorporeal membrane oxygenation after LVAD (HR 2.52, p < 0.01). Factors independently associated with decreased mortality were flap reconstruction (HR 0.49, p = 0.02) and methicillin-sensitive Staphylococcus aureus infection (HR 0.63, p = 0.03). A clinical risk prediction score was developed using these factors and showed significant differences in median survival, which was 5.67 years for low-risk (score 0 to 1), 3.62 years for intermediate-risk (score 2), and 1.48 years for high-risk (score ≥3; p < 0.001) patients.

CONCLUSIONS:
We developed a clinical risk prediction score to stratify patients with VSI. In selected cases, escalating surgical treatment was associated with increased survival. Future work is needed to determine whether early surgical debridement and flap reconstruction can alter outcomes in select cases of VSI.