bluuebunny/crossref_metadata_2025_split huggingface dataset:
From couplepause to doublepause: the impact of midlife physical, psychological, and social changes on the sexual life of aging couples
Authors: Giraldi Annamaria , Nappi Rossella E , Palacios Santiago , Reisman Yacov , Jannini Emmanuele A 
Published: March 2024

Abstract

Introduction
Midlife men and women are facing frequent sexual problems that affect not only individuals’ sexual health but also the sexual health of aging couples.

Objectives
To review the main sexual life challenges faced by midlife couples, to present the concepts of couplepause and doublepause as 2 new paradigms to address the sexual health needs of aging couples, and to discuss key aspects in couple-focused care.

Methods
An online meeting attended by 5 European experts in sexual health was carried out in June 2023 to discuss the topic. The conversation centered on their clinical experience and expert opinion. Additionally, the indexed literature was reviewed to endorse and complement the expert opinions obtained in the aforementioned meeting.

Results
Midlife men and women face physical, psychological, and sociocultural changes that affect their sexual activity. These changes may be experienced differently between genders. Both members of a couple may experience age-related changes concurrently or in an unsynchronized manner affecting their sexual health. Communication, sharing expectations, defining sexual dynamics, and couple goals are determinant for the sexual health of a midlife couple. Couplepause and doublepause are 2 new complementary paradigms that effectively address the sexual health needs of aging couples as a unit, considering physical, psychological, cultural, social, and dyadic-related factors. Couple-centered strategies should promote open communication about couple intimacy issues, understanding the diverse expectations according to gender and orientation, communication styles, and goals. The following are identified as crucial aspects to promote couple-focused care: education and training of health care professionals, the provision of information to aging couples, physician involvement in addressing sexual problems, the need for collaboration across medical specialties, and the development of effective tools and strategies.

Conclusions
The sexual problems of aging couples should be managed following couple-centered strategies that effectively address their sexual health needs as a couple.
Intrawound Vancomycin Powder Reduces Delayed Deep Surgical Site Infections Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Authors: Shinohara Kensuke , Newton Peter O. , Kelly Michael P. , Upasani Vidyadhar V. , Bartley Carrie E. , Bryan Tracey P. ,   Harms Study Group
Published: March 2024

Study Design.
Retrospective.

Objective.
Evaluate whether the use of vancomycin powder (VP) placed in the surgical site before wound closure prevents delayed deep surgical site infections (DDI).

Summary of Background Data.
DDI after posterior spinal fusion (PSF) in adolescent idiopathic scoliosis (AIS) patients remains a significant and major complication. The use of VP to prevent acute surgical site infection has been reported, but the impact on DDI is unknown.

Materials and Methods.
AIS patients treated over the past 20 years with PSF or instrumentation from a large multicenter registry were reviewed. Patients were divided into two groups: intraoperative vancomycin powder placed in the wound (VP) or no antibiotics placed in the wound (NVP). DDI was defined as an infection that occurred >90 days after surgery and required surgical intervention in the operating room. Patients who developed a DDI had secondary verification of VP use or not. χ2 and Kaplan-Meier (K-M) survivorship analyses were used to compare demographics and the incident rate of DDI between groups.

Results.
Totally, 4145 cases met the inclusion criteria for this study. A total of 43 DDI cases were identified (1.0%). The incidence of DDI for the VP group was 0.2% (4/2111), and 1.9% (39/2034) in the NVP group (P<0.001). Given the difference in follow-up for the two groups, a cumulative survival and Kaplan-Meier analysis revealed the VP group had significantly better “survival” (no DDI) than the NVP group (P<0.001).

Conclusion.
DDIs are significant adverse events that can greatly complicate patient recovery after PSF for AIS, including rehospitalization. This study found that patients who received VP intraoperatively were 10 times less likely to develop a DDI than those who did not receive VP. Although other advances and changes in surgical techniques may contribute to the significant decrease in infections found in the more recent VP cohort, VP should be considered as a prophylactic measure.

Level of Evidence.
4
The predictive role of N-terminal pro-B-type natriuretic peptide in assessing outcomes for atrial fibrillation patients, with or without heart failure: a comprehensive systematic review and meta-analysis
Authors: Lidvihurin Afina Syarah , Fikri Yusuf Ananda 
Published: March 2024

Background and purpose:
Brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are commonly used to predict clinical outcomes in patients with heart failure (HF). The prognostic role of BNP/NT-proBNP in patients with atrial fibrillation (AF) and comorbid HF is controversial. The current study aimed to understand the clinical importance of BNP/NT-proBNP measurement in predicting the outcomes of AF patients regardless of HF status.

Methods:
This is a systematic review and meta-analysis. A comprehensive literature search was conducted using PubMed, EBSCOHost, Cochrane, ScienceDirect, and ClinicalKey. Studies that reported all-cause mortality, stroke/systemic embolic events (SEE)/thromboembolic events (TE), major adverse cardiovascular events (MACE), and major bleeding were included in this study. All-cause mortality was the primary outcome. Studies that reported BNP data but not NT-proBNP were also included. BNP/NT-proBNP is categorized as high and low level based on the highest and lowest groups compared in the included studies.

Results:
Sixteen studies (n = 45,400) were included in data synthesis: six were post hoc analysis of randomized controlled trials and the remaining were prospective cohort studies. The included studies were published between 2011 and 2022. The follow-up duration ranged from 1.0 to 5.2 years. High level of BNP/NT-proBNP was associated with a significantly increased risk of all-cause mortality (pooled hazard ratio [HR]: 2.26, 95% confidence interval [95% CI]: 1.98–2.56), stroke/SEE/TE (pooled HR: 2.45, 95% CI: 2.07–2.90), and MACE (pooled HR: 2.38, 95% CI: 1.90–2.99) in patients with AF; the pooled HR of major bleeding was 1.17 (95% CI: 1.01–1.36). Sensitivity analysis in patients with AF and HF produced similar results.

Conclusions:
BNP and NT-proBNP are strong predictors of clinical outcomes in patients with AF regardless of HF.
Neurodevelopmental Disorders Including Autism Spectrum Disorder and Intellectual Disability as a Risk Factor for Delayed Diagnosis of Catatonia
Authors: Zappia Katherine J. , Shillington Amelle , Fosdick Cara , Erickson Craig A. , Lamy Martine , Dominick Kelli C. 
Published: March 2024

Objective:
Catatonia is a distinct and severe medical syndrome comprising motor, somatic, and psychiatric symptoms that is reported in upwards of 17% of young patients with autism spectrum disorders. Clinical experience indicates catatonia is often under-recognized in this clinical population. Here we characterize the clinical presentation of catatonia in patients with and without neurodevelopmental disorders (NDDs) including autism, including the time from symptom onset to diagnosis of catatonia.

Method:
Retrospective chart review of electronic medical records at a large, academic pediatric medical center identified 113 pediatric and young adult patients with a charted history of catatonia, as identified by an encounter diagnosis or problem list entry between September 2017 and September 2021. Workup, treatments, and diagnoses (psychiatric, neurodevelopmental, and genetic) were identified.

Results:
We observed a clear and substantial delay in identification of catatonia in those with NDDs (diagnosis after 330 days for those without psychosis) compared with neurotypical patients (∼16 days). Psychiatry involvement was associated with shorter delays.

Conclusion:
Intellectual disability and autism are risk factors for significantly delayed diagnosis of catatonia. It is unknown whether delayed diagnosis contributes to the difficulty in treating catatonia in this patient population or whether the treatment difficulties relate instead to differential and ongoing biological mechanisms and underlying encephalopathy. Overall, these findings highlight the importance of increased recognition of catatonia symptoms in patients with NDDs and suggest early referral to psychiatric specialists may shorten the delay to diagnosis.
Development of a liver disease–specific large language model chat interface using retrieval-augmented generation
Authors: Ge Jin , Sun Steve , Owens Joseph , Galvez Victor , Gologorskaya Oksana , Lai Jennifer C. , Pletcher Mark J. , Lai Ki 
Published: March 2024

Background and Aims:
Large language models (LLMs) have significant capabilities in clinical information processing tasks. Commercially available LLMs, however, are not optimized for clinical uses and are prone to generating hallucinatory information. Retrieval-augmented generation (RAG) is an enterprise architecture that allows the embedding of customized data into LLMs. This approach “specializes” the LLMs and is thought to reduce hallucinations.

Approach and Results
We developed “LiVersa,” a liver disease–specific LLM, by using our institution’s protected health information-complaint text embedding and LLM platform, “Versa.” We conducted RAG on 30 publicly available American Association for the Study of Liver Diseases guidance documents to be incorporated into LiVersa. We evaluated LiVersa’s performance by conducting 2 rounds of testing. First, we compared LiVersa’s outputs versus those of trainees from a previously published knowledge assessment. LiVersa answered all 10 questions correctly. Second, we asked 15 hepatologists to evaluate the outputs of 10 hepatology topic questions generated by LiVersa, OpenAI’s ChatGPT 4, and Meta’s Large Language Model Meta AI 2. LiVersa’s outputs were more accurate but were rated less comprehensive and safe compared to those of ChatGPT 4.

Results:
We evaluated LiVersa’s performance by conducting 2 rounds of testing. First, we compared LiVersa’s outputs versus those of trainees from a previously published knowledge assessment. LiVersa answered all 10 questions correctly. Second, we asked 15 hepatologists to evaluate the outputs of 10 hepatology topic questions generated by LiVersa, OpenAI’s ChatGPT 4, and Meta’s Large Language Model Meta AI 2. LiVersa’s outputs were more accurate but were rated less comprehensive and safe compared to those of ChatGPT 4.

Conclusions:
In this demonstration, we built disease-specific and protected health information-compliant LLMs using RAG. While LiVersa demonstrated higher accuracy in answering questions related to hepatology, there were some deficiencies due to limitations set by the number of documents used for RAG. LiVersa will likely require further refinement before potential live deployment. The LiVersa prototype, however, is a proof of concept for utilizing RAG to customize LLMs for clinical use cases.
Vitrectomy with Subretinal Injection of Recombinant Tissue Plasminogen Activator for Submacular Hemorrhage with or without Vitreous Hemorrhage
Authors: Shi Tingkun , Wen Jing , Xia Honghe , Chen Haoyu 
Published: March 2024

Purpose:
To evaluate the outcomes and prognostic factors of pars plana vitrectomy (PPV) combined with subretinal injection of recombinant tissue plasminogen activator (rt-PA) for submacular hemorrhage (SMH) patients with or without vitreous hemorrhage.

Methods:
Sixty-four eyes of 64 patients with SMH patients underwent PPV with subretinal injection of rt-PA. Best-corrected visual acuity (BCVA), SMH displacement, and postoperative complications were analyzed. Predictive factors of the final BCVA were determined using multivariant linear regression.

Results:
There were 26 eyes with VH and 38 without VH BCVA significantly improved in both VH group (from 2.27±0.40 to 1.25±0.70 LogMAR) and non-VH group (from 1.76±0.55 to 0.85±0.65 LogMAR). Completely displacement of SMHs was observed in 47 (73.43%) eyes. Postoperative complications included recurrent SMH (4.69%), recurrent vitreous hemorrhage (10.94%), rhegmatogenous retinal detachment (3.13%), and epiretinal membrane (4.68%). Treatment-naive condition, early surgery, and younger age were significantly associated with better final BCVA (B =0.502, 0.303, and 0.021, respectively, with all p <0.05).

Conclusion:
PPV combined with subretinal rt-PA injection is an effective treatment for SMH patients with and without VH.
Mound-like Epiretinal Material: Its Short-term Changes and Association with Posterior Vitreous Detachment
Authors: Tetsumura Issei , Aoki Shuichiro , Inoue Tatsuya , Kitamoto Kohdai , Arai Takahiro , Azuma Keiko , Obata Ryo 
Published: March 2024

Purpose:
To describe clinical characteristics of a retinal finding termed mound-like epiretinal material (MOLEM), and distinguish it from epiretinal proliferation, a similar epiretinal finding previously described in various pathologies.

Methods:
Five eyes from five patients were retrospectively identified from medical records. Clinical findings and images, including fundus photographs and optical coherence tomography (OCT), were reviewed.

Results:
All eyes displayed mound-like material with uniform and low-to-moderate reflectivity on an otherwise intact retinal surface detected on OCT. No eyes presented with concurrent pathology typically observed in cases of epiretinal proliferation, such as lamellar/full-thickness macular hole, epiretinal membrane, vitreomacular traction, or uveitis. Two eyes exhibited central serous chorioretinopathy, but there was no association of MOLEM with serous retinal detachment. In three out of five eyes, MOLEM appeared simultaneously with posterior vitreous detachment (PVD). Some lesions underwent irregular transformations over months and occasionally disappeared. While all cases were monitored without intervention, no visual decline or complications attributed to MOLEM were detected.

Conclusion:
MOLEM represents a novel clinical finding, characterized by transient morphological changes without symptoms and potential association with PVD. It may occur in eyes lacking macular diseases linked with epiretinal proliferation, a similar yet distinct lesion. The incidence, etiology, and clinical significance of MOLEM warrant further investigation by accumulating comparable cases, although the lesion appears benign and self-limiting.
“I wish I knew then what I know now” — pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis
Authors: Mardon Amelia K. , Chalmers K. Jane , Heathcote Lauren C. , Curtis Lee-Anne , Freedman Lesley , Malani Rinkle , Parker Romy , Neumann Patricia B. , Moseley G. Lorimer , Leake Hayley B. 
Published: March 2024

Abstract
Pain science education (PSE) provides people with an understanding of “how pain works” grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having “improved” pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with “improved” pelvic pain: (1) “A sensitised nervous system leads to overprotective pain” validated their pelvic pain as being real; (2) “Pain does not have to mean the body is damaged (although sometimes it does)” provided reassurance that pelvic pain does not mean their condition is worsening; (3) “How I think, feel, and ‘see’ my pain can make it worse” enabled participants to find optimal ways to manage their pain; and (4) “I can change my pain… slowly” provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
The ketogenic diet mitigates opioid–induced hyperalgesia by restoring short–chain fatty acids–producing bacteria in the gut
Authors: Crawford Joshua , Liu Sufang , Tao Ran , Kramer Phillip , Bender Steven , Tao Feng 
Published: March 2024

Abstract
Opioids are commonly prescribed to patients with chronic pain. Chronic opioid usage comes with a slew of serious side effects, including opioid-induced hyperalgesia (OIH). The patients with long-term opioid treatment experience paradoxical increases in nociceptive hypersensitivity, namely, OIH. Currently, treatment options for OIH are extremely lacking. In this study, we show that the ketogenic diet recovers the abnormal pain behavior caused by chronic morphine treatment in male mice, and we further show that the therapeutic effect of the ketogenic diet is mediated through gut microbiome. Our 16S rRNA sequencing demonstrates that chronic morphine treatment causes changes in mouse gut microbiota, specifically a decrease in short-chain fatty acids–producing bacteria, and the sequencing data also show that the ketogenic diet rescues those bacteria in the mouse gut. More importantly, we show that supplementation with short-chain fatty acids (butyrate, propionate, and acetate) can delay the onset of OIH, indicating that short-chain fatty acids play a direct role in the development of OIH. Our findings suggest that gut microbiome could be targeted to treat OIH, and the ketogenic diet can be used as a complementary approach for pain relief in patients with chronic opioid treatment. We only used male mice in this study, and thus, our findings cannot be generalized to both sexes.
Validation of a Novel Neurologic Assessment Test for Healthcare Staff
Authors: Doyle Brittany R. , von Gaudecker Jane R. , Techan Asmiet K. , Nairon Emerson B. , Olson DaiWai M. 
Published: March 2024

ABSTRACTBACKGROUND:To measure the effectiveness of an educational intervention, it is essential to develop high-quality, validated tools to assess a change in knowledge or skills after an intervention. An identified gap within the field of neurology is the lack of a universal test to examine knowledge of neurological assessment.METHODS:This instrument development study was designed to determine whether neuroscience knowledge as demonstrated in a Neurologic Assessment Test (NAT) was normally distributed across healthcare professionals who treat patients with neurologic illness. The variables of time, knowledge, accuracy, and confidence were individually explored and analyzed in SAS.RESULTS:The mean (standard deviation) time spent by 135 participants to complete the NAT was 12.9 (3.2) minutes. The mean knowledge score was 39.5 (18.2), mean accuracy was 46.0 (15.7), and mean confidence was 84.4 (24.4). Despite comparatively small standard deviations, Shapiro-Wilk scores indicate that the time spent, knowledge, accuracy, and confidence are nonnormally distributed (P< .0001). The Cronbachαwas 0.7816 considering all 3 measures (knowledge, accuracy, and confidence); this improved to anαof 0.8943 when only knowledge and accuracy were included in the model. The amount of time spent was positively associated with higher accuracy (r2= 0.04,P< .05), higher knowledge was positively associated with higher accuracy (r2= 0.6543,P< .0001), and higher knowledge was positively associated with higher confidence (r2= 0.4348,P< .0001).CONCLUSION:The scores for knowledge, confidence, and accuracy each had a slightly skewed distribution around a point estimate with a standard deviation smaller than the mean. This suggests initial content validity in the NAT. There is adequate initial construct validity to support using the NAT as an outcome measure for projects that measure change in knowledge. Although improvements can be made, the NAT does have adequate construct and content validity for initial use.
18F-FDG PET/CT in Pediatric Immunoglobulin G4–Related Disease
Authors: Singh Karan , Bennett Olivia , Wegner Eva Alina , Marsden Amanda , Grewal Davinder Singh 
Published: March 2024

Abstract
A 14-year-old boy presented with severe, nonintentional weight loss, fatigue, and cough. Investigations were notable for raised inflammatory markers and significantly elevated serum immunoglobulin G4 (IgG4). 18F-FDG PET/CT was obtained for assessment of disease involvement and extent, to exclude differential diagnoses and to guide biopsy. The study demonstrated extensive FDG-avid nodal disease and multisystem organ involvement. Excisional biopsy of a right inguinal lymph node demonstrated reactive changes with numerous IgG4-positive plasma cells consistent with IgG4-related disease. He was commenced on immunosuppressive therapy with consequent weight restoration and symptom resolution.
The Efficiency of Segmental Le Fort I Surgery in Clear Aligner Therapy of Skeletal Class III Deformity: A Pilot Study
Authors: Xiao Xiufeng , Wu Zhongxing , Yeweng Sanjie 
Published: March 2024

Introduction:
The purpose of this study was to investigate the efficiency of segmental Le Fort I osteotomy in clear aligner therapy of skeletal Class III deformities and to explore whether Le Fort I segmental osteotomy was effective for maxillary incisor axis correction and reduced the duration of perioperative orthodontics.

Materials and Methods:
Patients who had skeletal Class III deformities (ANB<0) treated with extraction of the maxillary first premolars, segmental Le Fort I osteotomy, and clear aligners therapy were included in this retrospective study. We measured the amount of tooth extraction space that was closed by surgery and recorded the preoperative orthodontic and total treatment duration. Lateral cephalograms were analyzed to measure changes of maxillary incisor inclination before treatment (T0), 1 week before surgery (T1), 1 week after surgery (T2), and after total orthodontic treatment (T3). Statistical analyses were performed, and the P value was set at 0.05.

Results:
The sample was composed of 15 patients aged 19 to 30 (M=22.9) years. The average preoperative orthodontic treatment duration was 16.2±5.22 mo, with 33.5 pairs of clear aligners. The gap at the extraction site decreased from 5.42±1.57 mm to 0.80±0.62 mm on average after surgery. U1-SN and U1-NA(deg) increased sparingly with preoperative decompensation, decreased in quantity after surgery, and then slightly increased with postoperative compensation (T2<T3<T0<T1; △U1-SN, △U1-NA: T1-T2, P<0.05; T0-T1 and T2-T3, P >0.05).

Conclusions:
Le Fort I segmental osteotomy assisted decompensation of the upper anterior teeth and reduced the duration of preoperative orthodontics with clear aligners.