bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-effectiveness analysis of durvalumab, tremelimumab, and etoposide-platinum in first-line treatment of extensive-stage small cell lung cancer
Authors: Meng Mingyu , Liu Xiaoxia , Liang Xueyan , Chen Xiaoyu , Li Yan 
Published: April 2024

Background:
Durvalumab plus etoposide-platinum (DEP) showed sustained overall survival improvements in patients with extensive-stage small-cell lung cancer (ES-SCLC) compared to etoposide-platinum (EP), but adding tremelimumab to DEP (DTEP) did not significantly improve outcomes. A third-party payer perspective is taken here to evaluate the cost-effectiveness of DTEP, DEP, and EP for ES-SCLC.

Methods:
The cost-effectiveness was evaluated by partitioning survival models into 3 mutually exclusive health states. In this model, clinical characteristics and outcomes were obtained from the CASPIAN. Model robustness was evaluated through 1-way deterministic and probabilistic sensitivity analyses. Outcome measurements included costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio, life-years, incremental net health benefit, and incremental net monetary benefit. The analysis was conducted with a 10-year lifetime horizon in a United States setting.

Results:
Compared with EP, DEP, and DTEP were associated with an increment of 0.480 and 0.313 life-years, and an increment of 0.247 and 0.165 QALYs, as well as a $139,788 and $170,331 increase in cost per patient. The corresponding ICERs were $565,807/QALY and $1033,456/QALY, respectively. The incremental net health benefit and incremental net monetary benefit of DEP or DTEP were −0.685 QALYs and −$102,729, or −0.971 QALYs and −$145,608 at a willingness to pay threshold of $150,000/QALY, respectively. Compared with DTEP, DEP was dominated. DTEP and DEP were 100% unlikely to be cost-effective if the willingness to pay threshold was $150,000/QALY. DEP was cost-effective compared to EP when durvalumab was priced below $0.994/mg. Compared with EP, DEP, and DTEP were unlikely to be considered cost-effective across all subgroups.

Conclusion:
DEP and DTEP were not cost-effective options in the first-line treatment for ES-SCLC compared with EP, from the third-party payer perspective in the United States. Compared with DTEP, DEP was dominated.
Early intrauterine pregnancy with an intrauterine device in place and terminated with spontaneous abortion: A case report
Authors: Chu Yu-Qun , Tien Chin-Tzu , Ding Dah-Ching 
Published: April 2024

Rationale:
The overall pregnancy rate in individuals with an intrauterine device (IUD) for contraception is <1%. If pregnancy occurs while an IUD is in place, there is a higher risk of an ectopic pregnancy. We report the case of a woman with an IUD who was 7 weeks pregnant and experienced a spontaneous abortion 1 week later.

Patient concern:
A 32-year-old woman presented to our outpatient department with intermittent vaginal staining for several days.

Diagnoses:
She was 7 weeks pregnant and had an IUD in place for over 4 years. A vaginal examination revealed no vaginal bleeding and no blood clots; however, a parous cervix was observed. The IUD string was not visible. Transvaginal ultrasonography revealed a gestational sac in the uterine cavity, with a fetal pole and a crown-rump length of 11.4 mm. The fetal heart rate was 159 beats/min. The IUD was located in the retroplacental region. The bilateral adnexa appeared normal (right ovary, 2.9 cm; left ovary, 2.5 cm). The patient was diagnosed with an intrauterine pregnancy with an IUD in place and threatened abortion.

Interventions:
Attempts to remove the IUD were abandoned due to its location, and conservative treatment was initiated with Utrogestan (100 mg) administered 3 times a day for 1 week. Bed rest was advised.

Outcomes:
Unfortunately, she experienced a complete abortion 1 week later.

Lessons:
The novelty of this case report lies in the rare occurrence of an intrauterine pregnancy with a long-term IUD in place, the challenges posed by the IUD’s specific location, and the complex management of threatened abortion in this context. Our case highlights the diagnostic management approach for intrauterine pregnancy with an IUD in place. Furthermore, it explores the impact of IUD location on pregnancy prognosis.
Giant retinal pigment epithelial tear following photodynamic therapy for the bullous variant of central serous chorioretinopathy: A case report
Authors: Kimura Eri , Miura Masahiro 
Published: April 2024

Rationale:
The bullous variant of central serous chorioretinopathy (CSC) is a severe form of chronic CSC. Patients with the bullous variant of CSC have an increased risk of experiencing multiple pigment epithelial detachments (PEDs) and retinal pigment epithelium (RPE) tears. Photodynamic therapy (PDT) is a treatment for the bullous variant of CSC. RPE tear is a possible postoperative complication of PDT for eyes with PEDs. To our knowledge, no cases of giant RPE tears following PDT for the bullous variant of CSC have been reported previously. This case report presents the first instance of a giant RPE tear after half-time PDT for the bullous variant of CSC, accompanied by a series of images depicting the tear development.

Patient concerns:
A 63-year-old male patient presented with rapidly deteriorating vision in his left eye over a 3-month period. He also reported a previous episode of vision loss in his right eye 2 years prior. Best-corrected visual acuity (BCVA) in the left eye was 0.2.

Diagnosis:
The right eye was diagnosed with chronic non-bullous CSC, while the left eye was diagnosed with the bullous variant of CSC with a large PED.

Interventions:
Half-time PDT was administered to the left eye.

Outcomes:
One month after half-time PDT, a giant RPE tear exceeding 3 clock-hours in size was confirmed in the lower temporal quadrant of the left eye. Three months after the initial half-time PDT, a second half-time PDT was performed owing to recurrent retinal detachment. Two months after the second half-time PDT, the retinal detachment resolved, and BCVA improved to 0.4, 6 months after the second half-time PDT.

Lessons:
In cases where the bullous variant of CSC is complicated by extensive PED, clinicians should consider the potential development of a giant RPE tear as a treatment complication.
Primary intraorbital inflammatory lumpy lesion: A rare case report
Authors: Yang Jinxin , Liang Qianlei , Han Liang , Wang Yan , Guo Yongchuan 
Published: April 2024

Rationale:
Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery.

Patient concerns:
This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case.

Diagnoses:
Orbital EAF.

Interventions:
Surgical radical resection and postoperative glucocorticoid therapy.

Outcomes:
After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief.

Lessons:
EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.
Aggressive vertebral hemangiomas contain no adipose tissue resulting in thoracic spine kyphosis: A case report
Authors: Wang Liang-Jie , Zou Hong-Mei , Hou Feng , Wang Guan-Xi , Gao Chuan-Ping 
Published: April 2024

Rationale:
Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very aggressive behavior was attributable to its significant vascular component and contained no adipose tissue.

Patient concerns:
We report a case of thoracic spine kyphosis of AVHs with multiple vertebral bodies and intervertebral disc destruction in a 45-year-old woman.

Diagnoses:
Based on the imaging studies, the patient underwent surgical removal of this lesion and spinal reconstruction. Histopathology consistent with vertebral hemangioma and contained no adipose.

Interventions:
The patient underwent surgical removal of the lesion and spinal reconstruction. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, the laminae of the T5–7 vertebrae were removed and exposing the lesion. The lesion was soft and showed cystic changes, completely curetted and autogenous bone was implanted. Vertebroplasty was performed through T3-T9 pedicles bilaterally. Pedicle screw fixation was performed for segmental fixation and fusion.

Outcomes:
After 9 days of operation, the incision healed cleanly and free of pain. She was discharged in good general condition. The patient remained asymptomatic after follow-up 6 months of postoperative.

Lessons:
AVHs destroy multiple vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare.
Severe fibromyalgia alleviated by the unique muscle relaxation method of applying low force: A case report
Authors: Amitani Haruka , Nishi Ryusei , Fukumoto Takamasa , Hamada Kazumasa , Kato Ryuichi , Yamamoto Takako , Fuku Yuuki , Sagiyama Kenichiro , Asakawa Akihiro 
Published: April 2024

Rationale:
Fibromyalgia (FM) is characterized by idiopathic persistent chronic pain in the ligaments or musculoskeletal system, and more than half of the patients with FM might have migraine headaches. Direct musculoskeletal intervention could be a non-pharmacological management to relieve symptoms. However, patients with severe FM often have intense pain from only a soft touch, thereby rendering musculoskeletal intervention challenging.

Patient concerns:
A 47-year-old man had progressing intense pain, and this affected his everyday life. There were no abnormal physical findings on laboratory examination such as levels of complement, antinuclear antibodies, and C-reactive protein, which were within normal limits. Magnetic resonance imaging did not indicate abnormalities.

Diagnoses, interventions, and outcomes:
The patient satisfied the American College of Rheumatology criteria. Finally, we made a final diagnosis of fibromyalgia. The therapeutic intervention of Kanshoho, the unique muscle relaxation technique with low force, relieved his pain.

Lessons:
If Kanshoho is carefully applied in a state of hospitalization under surveillance by an experienced physician, it could be a promising muscle relaxation method. Relaxing the trapezius muscle and reducing its intramuscular pressure might be key in treating patients with severe FM. However, it needs elucidation of its mechanism.
The impact of obesity-induced inflammation on clonal hematopoiesis
Authors: Pasupuleti Santhosh Kumar , Kapur Reuben 
Published: April 2024

Purpose of review
This review meticulously delves into existing literature and recent findings to elucidate the intricate link between obesity and clonal hematopoiesis of indeterminate potential (CHIP) associated clonal hematopoiesis. It aims to enhance our comprehension of this multifaceted association, offering insights into potential avenues for future research and therapeutic interventions.

Recent findings
Recent insights reveal that mutations in CHIP-associated genes are not limited to symptomatic patients but are also present in asymptomatic individuals. This section focuses on the impact of obesity-induced inflammation and fatty bone marrow (FBM) on the development of CHIP-associated diseases. Common comorbidities such as obesity, diabetes, and infection, fostering pro-inflammatory environments, play a pivotal role in the acceleration of these pathologies. Our research underscores a notable association between CHIP and an increased waist-to-hip ratio (WHR), emphasizing the link between obesity and myeloid leukemia. Recent studies highlight a strong correlation between obesity and myeloid leukemias in both children and adults, with increased risks and poorer survival outcomes in overweight individuals.

Summary
We discuss recent insights into how CHIP-associated pathologies respond to obesity-induced inflammation, offering implications for future studies in the intricate field of clonal hematopoiesis.
Postdischarge Mental Health Care and Emergency General Surgery Readmission for Patients With Serious Mental Illness
Authors: Brown Danielle E. , Rosen Claire B. , Roberts Sanford E. , Moneme Adora , Wirtalla Chris , Kelz Rachel R. 
Published: April 2024

Objective:
To determine the association between postdischarge mental health care and odds of readmission after emergency general surgery (EGS) hospitalization for patients with serious mental illness (SMI).

Background:
A mental health visit (MHV) after medical hospitalization is associated with decreased readmissions for patients with SMI. The impact of a MHV after surgical hospitalization is unknown.

Methods:
Using Medicare claims, we performed a retrospective cohort study of hospitalized EGS patients with SMI aged above 65.5 (2016–2018). EGS included colorectal, general abdominal, hepatopancreatobiliary, hernia, intestinal obstruction, resuscitation, and upper gastrointestinal conditions. SMI was defined as schizophrenia spectrum, mood, or anxiety disorders. The exposure was MHV within 30 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included emergency department presentation and psychiatric admission. Inverse probability weighting was used to evaluated outcomes.

Results:
Of 88,092 analyzed patients, 11,755 (13.3%) had a MHV within 30 days of discharge. 23,696 (26.9%) of patients were managed operatively, 64,395 (73.1%) nonoperatively. After adjustment for potential confounders, patients with a postdischarge MHV had lower odds of acute care readmission than patients without a MHV in both operative (OR=0.60; 95% CI: 0.40–0.90) and nonoperative (OR=0.67; 95% CI: 0.53–0.84) cohorts. There was no association between postdischarge MHV and ED presentation or psychiatric admission in the operative or nonoperative groups.

Conclusions:
Postdischarge MHV after EGS hospitalization was associated with decreased odds of readmission for patients with SMI managed operatively and nonoperatively. In older EGS patients with SMI, coordination of MHVs may be a mechanism to reduce readmission disparities.
Evidence-based practice — implementation level and attitude among physical, occupational, and speech and language therapists in Germany: status quo
Authors: Reinecke Sarah , Mijic Marko , Gerhard Janina , Jung Andrés , Ernst Kathrin , Dreher Christian , Lohmann Marieke , Koch Maren , Jahjah Akram , Fichtemüller Andrea , Balzer Julia 
Published: April 2024

ABSTRACT

Introduction:
Evidence-based practice (EBP) is an important component of clinical practice in public health. Its implementation involves interpreting scientific studies and then applying this knowledge to clinical decision-making. In Germany, the therapy professions are often trained in non-academic medical schools, and only a small number of therapists are university graduates.

Aims:
This study assessed the current status of EBP among physiotherapists, occupational therapists, and speech and language therapists and to determine whether academization influences the implementation of EBP in Germany.

Methods:
To assess the EBP implementation level and therapists’ attitudes toward EBP, a cross-sectional study was conducted using the German version of the Evidence-Based Practice Inventory (EBPI), which consists of five dimensions: attitude; subjective norm; perceived behavioral control; decision-making; and intention and behavior. The structural validity and internal consistency of the EBPI survey were also tested.

Results:
Of the 2,412 responses, only 557 were eligible. There were statistically significant differences between academically educated vs. non-academically educated therapists in four of the five EBPI dimensions. Furthermore, four of the five dimensions had sufficient unidimensionality and internal consistency.

Conclusion:
There are differences between academically educated and non-academically educated therapists regarding EBP knowledge, attitudes, and implementation. Academically educated therapists are more likely to use EBP than non-academically educated therapists. There are still barriers to clinical application that need to be addressed.

Spanish abstract:

http://links.lww.com/IJEBH/A195
Remodeling of the brain angioarchitecture in experimental chronic neurodegeneration
Authors: Thomsen Maj Schneider , Kostrikov Serhii , Routhe Lisa Juul , Johnsen Kasper Bendix , Helgudóttir Steinunn Sara , Gudbergsson Johann Mar , Andresen Thomas Lars , Moos Torben 
Published: April 2024

AbstractBackgroundChronic neurodegenerative diseases are characterized by substantial neuroinflammation with accumulation of macrophages, reactive microglia, and reactive astrocytes. Impairment of the brain vasculature is also commonly seen in chronic neurodegeneration with causal links warranting further investigation.MethodsTo address the effects of chronic neurodegeneration on regional vasculature, we performed a unilateral injection of a glutamate receptor agonist ibotenic acid into striatum of adult rats, which caused excitotoxicity in the substantia nigra pars reticulata (SNpr) due to imbalance between inhibitory inputs from the striatum and excitatory signals from the subthalamic nucleus. Brains were examined at 28 days (short-term neurodegeneration) and 91 days (long-term neurodegeneration). Dissected brain samples were analyzed for protein and gene expression using immunohistochemistry and qPCR. Brains were further analyzed for remodeling of vasculature labeled with wheat germ agglutinin (WGA) Alexa Fluor™ 647 conjugate using 3D deep confocal microscopy of optically cleared samples combined with machine learning-based image analysis.ResultsThe resulting neurodegeneration was accompanied by neuroinflammation, verified by the expression of inflammatory markers with gradual, regional loss of brain tissue. An in-depth analysis of the angioarchitecture of the degenerating SNpr revealed substantial changes of the vasculature with higher density, increased diameter, and number of tortuous vessels already after 28 days continuing at 91 days. Interestingly, the vascular remodeling changes occurred without changes in the expression of endothelial tight junction proteins, vascular basement membrane proteins, or markers of angiogenesis.ConclusionsThese results demonstrate how neurodegeneration causing prominent tissue loss in SNpr also leads to substantial remodeling of the angioarchitecture, while not altering the structural integrity of the vessel wall judged from the continuous expression of hallmarks of brain endothelial cells and the vascular basement membrane. We propose that this remodeling occurs as a consequence of the loss of brain tissue and with the resulting changes leaving the vasculature prone to additional vascular pathologies like vessel occlusion or formation of aneurysms.
Enteric glia regulate Paneth cell secretion and intestinal microbial ecology
Authors: Prochera Aleksandra , Muppirala Anoohya N. , Kuziel Gavin A. , Soualhi Salima , Shepherd Amy , Sun Liang , Issac Biju , Rosenberg Harry J. , Karim Farah , Perez Kristina , Smith Kyle H. , Archibald Tonora H. , Rakoff-Nahoum Seth , Hagen Susan J. , Rao Meenakshi 
Published: April 2024

AbstractGlial cells of the enteric nervous system (ENS) interact closely with the intestinal epithelium and secrete signals that influence epithelial cell proliferation and barrier formationin vitro. Whether these interactions are importantin vivo,however, is unclear because previous studies reached conflicting conclusions [1]. To better define the roles of enteric glia in steady state regulation of the intestinal epithelium, we characterized the glia in closest proximity to epithelial cells and found that the majority expressPLP1in both mice and humans. To test their functions using an unbiased approach, we genetically depleted PLP1+cells in mice and transcriptionally profiled the small and large intestines. Surprisingly, glial loss had minimal effects on transcriptional programs and the few identified changes varied along the gastrointestinal tract. In the ileum, where enteric glia had been considered most essential for epithelial integrity, glial depletion did not drastically alter epithelial gene expression but caused a modest enrichment in signatures of Paneth cells, a secretory cell type important for innate immunity. In the absence of PLP1+glia, Paneth cell number was intact, but a subset appeared abnormal with irregular and heterogenous cytoplasmic granules, suggesting a secretory deficit. Consistent with this possibility, ileal explants from glial-depleted mice secreted less functional lysozyme than controls with corresponding effects on fecal microbial composition. Collectively, these data suggest that enteric glia do not exert broad effects on the intestinal epithelium but have an essential role in regulating Paneth cell function and gut microbial ecology.
The path toward generalizable clinical prediction models
Authors: Hieronymus Fredrik , Hieronymus Magnus , Sjöstedt Axel , Nilsson Staffan , Näslund Jakob , Lisinski Alexander , Østergaard Søren Dinesen 
Published: April 2024

AbstractThe peaking phenomenon refers to the observation that, after a point, the performance of prediction models starts to decrease as the number of predictors (p) increases. This issue is commonly encountered in small datasets (colloquially known as “small n, large p” datasets or high-dimensional data). It was recently reported based on analysis of data from five placebo-controlled trials that clinical prediction models in schizophrenia showed poor performance (average balanced accuracy, BAC, 0.54). This was interpreted to suggest that prediction models in schizophrenia have poor generalizability. In this paper we demonstrate that this outcome more likely reflects the peaking phenomenon in a small n, large p dataset (n=1513 participants, p=217) and generalize this to a set of illustrative cases using simulated data. We then demonstrate that an ensemble of supervised learning models trained using more data (18 placebo-controlled trials, n=4634 participants), but fewer predictors (p=33), achieves better prediction (average BAC = 0.64) which generalizes to out-of-sample studies as well as to data from active-controlled trials (n=1463, average BAC = 0.67). Based on these findings, we argue that the achievable prediction accuracy for treatment response in schizophrenia— and likely for many other medical conditions—is highly dependent on sample size and the number of included predictors, and, hence, remains unknown until more data has been analyzed. Finally, we provide recommendations for how researchers and data holders might work to improve future data analysis efforts in clinical prediction.