bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction
Authors: Huang Yan-Ping , Jing Tao , Liu Kai-Feng , Liu Wei , Zhang Ming , Zhong Da-Chuan , Liu Yi-Dong , Xu Shi-Ran , Lu Mu-Jun 
Published: March 2024

Abstract

Background
The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria.

Aim
We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED).

Methods
Participants 18 to 60 years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated.

Outcomes
The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test.

Results
A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P &lt; .001), 4.75 minutes (sensitivity: 75.9%, specificity: 75.4%; P &lt; .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P &lt; .001), and 7.75 minutes (sensitivity: 79.3%, specificity: 75.7%; P &lt; .001).

Clinical Implications
The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes.

Strengths and Limitations
Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained.

Conclusions
The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.
Gender Disparity in Full Professor Rank Among Academic Physicians: A Systematic Review and Meta-Analysis
Authors: Marhoffer Elizabeth A. , Ein-Alshaeba Samer , Grimshaw Alyssa A. , Holleck Jürgen L. , Rudikoff Benjamin , Bastian Lori A. , Gunderson Craig G. 
Published: March 2024

Abstract

Purpose
The gender gap in promotion in academic medicine is well established. However, few studies have reported gender differences in promotion adjusted for scholarly production and national or international reputation, namely, career duration, publications, grant funding, and leadership positions. The authors performed a systematic review and meta-analysis of the differences between men and women in achieving benchmarks for promotion and analyze where such differences lie geographically and within specialties.

Method
A systematic search of Academic Search Premier, Business Source Complete, Cochrane Library, ERIC, GenderWatch, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science was conducted from inception to August 17, 2022. All studies that reported the number of male and female full professors on medical school faculty were included. The primary outcome was the adjusted odds ratio (AOR) for promotion to full professor for women compared with men.

Results
Two hundred forty-four studies met the inclusion criteria. The unadjusted OR for promotion to full professor for women was 0.38 (95% confidence interval [CI], 0.36–0.41). Sixteen studies reported an AOR. The pooled AOR of promotion for women to full professor was 0.60 (95% CI, 0.46–0.77). The AOR for promotion to full professor was 0.55 (95% CI, 0.34–0.88) in surgery and 0.80 (95% CI, 0.57–1.11) in internal medicine. Statistical heterogeneity was high (Q = 66.6, I
2 = 79.4%, P < .001). On meta-regression, 77% of the heterogeneity was from studies outside the United States, where more disparity was reported (AOR, 0.29; 95% CI, 0.22–0.38).

Conclusions
Most studies continued to find decreased promotion of women. Gender disparity was particularly notable in surgery and in studies from outside the United States. The results suggest that differences in promotion were due to differences in productivity and leadership and to gender bias.
Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder
Authors: Wyse Jessica J. , Eckhardt Alison , Waller Dylan , Gordon Adam J. , Shull Sarah , Lovejoy Travis I. , Mackey Katherine , Morasco Benjamin J. 
Published: March 2024

ObjectivesBuprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, with half of patients discontinuing in the first year of treatment. Addressing OUD is a major clinical priority, yet little is known about the causes of medication discontinuation from the patient perspective.MethodsFrom March 2021 to April 2022, we conducted qualitative interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past 12 months. Eligible participants were selected from 2 Veterans Health Administration Health Care Systems in Oregon. Coding and analysis were guided by conventional qualitative content analysis.ResultsTwenty participants completed an interview; 90% were White and 90% were male, and the mean age was 54.2 years. Before discontinuation, participants had received buprenorphine for 8.3 months on average (range, 1–40 months); 80% had received buprenorphine for less than 12 months. Qualitative analysis identified the following themes relating to discontinuation: health system barriers (eg, logistical hurdles, rules and policy violations), medication effects (adverse effects; attributed adverse effects, lack of efficacy in treating chronic pain) and desire for opioid use. Patient description of decisions to discontinue buprenorphine could be multicausal, reflecting provider or system-level barriers in interaction with patient complexity or medication ambivalence.ConclusionsStudy results identify several actionable ways OUD treatment could be modified to enhance patient retention.
A Clinical Guide to Support the Implementation of Addiction Consult Services and the Value of Teaching and Technical Assistance
Authors: Fielman Sarah , McNeely Jennifer , Fitzpatrick Amy , Kerensky Todd , Tomanovich Mary , Walley Alexander Y. , Kosakowski Sarah , King Carla , Appleton Noa , Weinstein Zoe M. 
Published: March 2024

Abstract
People with substance use disorders (SUDs) are increasingly admitted to general hospitals; however, many hospital systems lack both formal structures and skilled staff to provide high-quality care for inpatients with SUDs. Inpatient addiction consult services (ACSs), which are increasingly being implemented around the country, are an evidence-based strategy to add focused care for people with SUDs into the general medical setting. In 2018, New York City Health + Hospitals (H + H) launched an ACS program called Consult for Addiction Care and Treatment in Hospitals in six hospitals, supported by a team of addiction consult experts to deliver teaching and technical assistance (TTA) for the Consult for Addiction Care and Treatment in Hospitals ACSs. This commentary describes the TTA, which included site visits, introductory educational lectures, case conferences, ad hoc support, implementation assistance, and the creation of an addiction care guide. Similar TTA services could be used in the future when hospitals or systems want to launch novel clinical programs.
How Reliable Is Endoscopic Scoring of Postoperative Recurrence in Crohn Disease?: A Systematic Review and Meta-Analysis
Authors: van der Does de Willebois Eline M. L. , Bellato Vittoria , Duijvestein Marjolijn , van Dieren Susan , Danese Silvio , Sileri Pierpaolo , Buskens Christianne J. , Vignali Andrea , Bemelman Willem A. 
Published: March 2024

Objective:
Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications.

Methods:
A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle–Ottawa Quality Assessment Scale and Cochrane Collaboration’s tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208.

Results:
Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56–44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2–59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0–59.5) and 19.8% to 62.9% (IQR, 37.3–46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively.

Conclusions:
This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.
Assessment of haemostasis in pregnant women
Authors: Zec Tamara , Schmartz Denis , Temmerman Pomeline , Fils Jean-François , Ickx Brigitte , Bonhomme Fanny , Van Der Linden Philippe 
Published: March 2024

BACKGROUND
Contemporary guidelines pertaining to the evaluation of bleeding risk recommend conducting a comprehensive examination of both personal and family histories concerning haemorrhagic diatheses.

OBJECTIVES
We employed the standardised HEMSTOP (Hematoma, hEmorrhage, Menorrhagia, Surgery, Tooth extraction, Obstetrics, Parents) questionnaire in pregnant women to evaluate its efficacy in detecting a haemostatic disorder and predicting the risk of haemorrhage associated with delivery.

DESIGN
A single-centre retrospective observational cohort study.

SETTING
Brugmann Hospital, a tertiary university institution.

PATIENTS
All full-term parturients who underwent vaginal or caesarean delivery in our hospital between January 2020 and December 2021 were included in the study. A total of 3588 patients were enrolled.

MAIN OUTCOME MEASURES
The primary aim of this study was to assess the sensitivity and specificity of the HEMSTOP questionnaire in identifying individuals with an abnormal primary haemostatic profile. The secondary objective was to evaluate the sensitivity and specificity of the HEMSTOP questionnaire in predicting postpartum haemorrhage (PPH; defined as blood loss >1000 ml). Additionally, positive-predictive values and negative-predictive values (NPVs) were calculated.

RESULTS
The specificity and sensitivity of the HEMSTOP questionnaire to predict an abnormal standard coagulation test in pregnant women are respectively 96% [95% confidence interval (CI), 0.95 to 0.97] and 39% (95% CI, 0.20 to 0.61). Its NPV is 100%. The specificity and sensitivity of the HEMSTOP questionnaire to predict postpartum bleeding risk are respectively 96% (95% CI, 0.95 to 0.97) and 8% (95% CI, 0.06 to 0.11).

CONCLUSION
In the conditions of our study, the HEMSTOP questionnaire enables the prediction of a primary haemostatic anomaly with a specificity and sensitivity comparable to routine haemostatic assessments. These findings concur with the recommendation against the routine prescription of laboratory tests for patients lacking a history of bleeding diathesis.

TRIAL REGISTRATION
Clinical Trial NCT 05191251.
Impact of sugammadex and neostigmine on outcome after major orthopaedic surgery
Authors: Cozowicz Crispiana , Zhong Haoyan , Poeran Jashvant , Illescas Alex , Liu Jiabin , Poultsides Lazaros A. , Athanassoglou Vassilis , Memtsoudis Stavros G. 
Published: March 2024

BACKGROUND
Residual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.

OBJECTIVE
We investigated the use of sugammadex and neostigmine in the USA, and their impact on postoperative complications by examining national data,

DESIGN
This population-based retrospective study used national Premier Healthcare claims data.

SETTING AND PARTICIPANTS
Patients undergoing total hip/knee arthroplasty (THA, TKA), or lumbar spine fusion surgery between 2016 and 2019 in the United States who received neuromuscular blocking agents.

INTERVENTION
The effects of sugammadex and neostigmine for pharmacologically enhanced reversal were compared with each other and with controls who received no reversal agent.

MAIN OUTCOMES
included pulmonary complications, cardiac complications, and a need for postoperative ventilation. Mixed-effects regression models compared the outcomes between neostigmine, sugammadex, and controls. We report odds ratios (OR) and 95% confidence intervals (CI). Bonferroni-adjusted P values of 0.008 were used to indicate significance.

RESULTS
Among 361 553 patients, 74.5% received either sugammadex (20.7%) or neostigmine (53.8%). Sugammadex use increased from 4.4% in 2016 to 35.4% in 2019, whereas neostigmine use decreased from 64.5% in 2016 to 43.4% in 2019. Sugammadex versus neostigmine or controls was associated with significantly reduced odds for cardiac complications (OR 0.86, 95% CI, 0.80 to 0.92 and OR 0.83, 95% CI, 0.78 to 0.89, respectively). Both sugammadex and neostigmine versus controls were associated with reduced odds for pulmonary complications (OR 0.85, 95% CI, 0.77 to 0.94 and OR 0.91, CI 0.85 to 0.98, respectively). A similar pattern of sugammadex and neostigmine was observed for a reduction in severe pulmonary complications, including the requirement of invasive ventilation (OR 0.54, 95% CI, 0.45 to 0.64 and OR 0.53, 95% CI, 0.46 to 0.6, respectively).

CONCLUSIONS
Population-based data indicate that sugammadex and neostigmine both appear highly effective in reducing the odds of severe life-threatening pulmonary complications. Sugammadex, especially, was associated with reduced odds of cardiac complications.
Probe Electrospray Ionization Tandem Mass Spectrometry for the Detection and Quantification of Benzodiazepines
Authors: Griffeuille Pauline , El Balkhi Souleiman , Dulaurent Sylvain , Saint-Marcoux Franck 
Published: March 2024

Background:
Legally prescribed benzodiazepines (BZDs) and designer BZDs are widely misused and must be determined in multiple contexts (eg, overdose, drug-facilitated sexual assaults, or driving under the influence of drugs). This study aimed to develop a method for measuring serum BZD levels using probe electrospray ionization (PESI) mass spectrometry and an isotope dilution approach.

Methods:
A tandem mass spectrometer equipped with a probe electrospray ionization source in multiple reaction monitoring mode was used. Isotope dilution was applied for quantification using a deuterated internal standard at a fixed concentration for alprazolam, bromazepam, diazepam, nordiazepam, oxazepam, temazepam, zolpidem, and zopiclone. This method included designer BZDs: clonazolam, deschloroetizolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam, meclonazepam, nifoxipam, and pyrazolam. Sample preparation was done by mixing 10 µL of serum with 500 µL of an ethanol/ammonium formate 0.01 mol/L buffer. Complete validation was performed, and the method was compared with liquid chromatography coupled with mass spectrometry (LC-MS/MS) and immunoassays (IC) by analyzing 40 real samples.

Results:
The analysis time for identification and quantification of the 18 molecules was 2.5 minutes. This method was fully validated, and the limits of quantification varied from 5 to 50 mcg/L depending on the molecule. In the 40 real samples, 100% of molecules (n = 89) were detected by both LC-MS/MS and PESI-MS/MS, and regression analysis showed excellent agreement between the 2 methods (r2 = 0.98). On IC, bromazepam and zolpidem were not detected in 2 and 1 cases, respectively.

Conclusions:
PESI-MS/MS allows serum BZD detection and measurement. Given the isotope dilution approach, a calibration curve was not required, and its performance was similar to that of LC-MS/MS, and its specificity was higher than that of IC.
Clinical criteria accurately diagnose severe but not moderate alcohol-associated hepatitis: A systematic review and meta-analysis
Authors: Verma Nipun , Mehtani Rohit , Haiar Jacob Martin , Pradhan Pranita , Duseja Ajay , Im Gene Young , Singal Ashwani K. 
Published: March 2024

Background:
The precision of clinical criteria and the utility of liver biopsy for diagnosis or prognosis remain unclear in patients with alcohol-associated hepatitis (AH). We systematically reviewed the literature to answer these questions.

Methods:
Four databases were searched for studies describing the precision of clinical criteria (National Institute on Alcohol Abuse and Alcoholism, European Association for Study of Liver, or classical) and the role of histology in AH. The precision(positive predictive value) of criteria was pooled through random-effects meta-analysis, and its variation was investigated through subgroups and meta-regression of study-level factors with their percent contribution to variation (R
2). The risk of bias among studies was evaluated through the QUADAS2 tool (PROSPERO-ID-CRD4203457250).

Results:
Of 4320 studies, 18 in the systematic review and 15 (10/5: low/high risk of bias, N=1639) were included in the meta-analysis. The pooled precision of clinical criteria was 80.2% (95% CI: 69.7–89.7, I
2:93%, p < 0.01), higher in studies with severe AH (mean-Model for End-Stage Liver Disease > 20) versus moderate AH (mean-Model for End-Stage Liver Disease < 20): 92% versus 67.1%, p < 0.01, and in studies with serum bilirubin cutoff 5 versus 3 mg/dL (88.5% vs.78.8%, p = 0.01). The factors contributing to variation in precision were Model for End-Stage Liver Disease (R
2:72.7%), upper gastrointestinal bleed (R
2:56.3%), aspartate aminotransferase:aspartate aminotransferase ratio (R
2:100%), clinical criteria (R
2:40.9%), bilirubin (R
2:22.5%), and Mallory body on histology (R
2:19.1%).
The net inter-pathologist agreement for histologic findings of AH was variable (0.33–0.97), best among 2 studies describing AH through simple and uniform criteria, including steatosis, ballooning, and neutrophilic inflammation. Few studies reported the utility of histology in estimating steroid responsiveness (N = 1) and patient prognosis (N = 4); however, very broad septa, pericellular fibrosis, and cholestasis were associated with mortality. Bilirubinostasis was associated with infection in 1 study.

Conclusions:
Clinical criteria are reasonably precise for diagnosing severe AH, while there is an unmet need for better criteria for diagnosing moderate AH. Histologic diagnosis of AH should be simple and uniform.
Meeting Report for the 2023 International Scientific Conference on Complex Lymphatic Anomalies
Authors: Dellinger Michael T. , Ferry Tiffany , Williams David , Milne Tracy , Murgia Louise , Kelly Michael 
Published: March 2024

Objectives:
Complex lymphatic anomalies (CLAs) are rare diseases with variable clinical manifestations caused by the abnormal development of lymphatic vessels. The Lymphatic Malformation Institute (LMI), Lymphangiomatosis & Gorham’s Disease Alliance (LGDA), and LGD Alliance Europe sponsored an international conference on CLAs so leaders in the field could discuss recent advances in research on CLAs.

Methods:
The conference occurred in Dallas, Texas, between September 29th and September 30th, 2023. The event had 22 distinguished speakers and 38 attendees. Additional researchers, clinicians, and patients attended the conference virtually.

Results:
In this article, we summarize the key takeaways from the meeting. The conference emphasized the crucial role of the patient voice in guiding research, and attendees heard stories from patients and parents of children with CLAs. The conference covered topics such as the genetic causes of CLAs, preclinical models, clinical advances, new technologies for CLA research, lymphatic imaging, and patient-centered research. Videos of all the presentations can be found on the LGDA website.

Conclusions:
The meeting revealed that while progress has been made, many challenges still exist surrounding the diagnosis and treatment of CLAs. Sustained research efforts are necessary to fill the gaps in knowledge and improve the care and quality of life of CLA patients.