bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Noncontrast Computed Tomography, Multiphase Computed Tomography Angiography, and Computed Tomography Perfusion to Assess Infarct Growth Rate in Acute Stroke
Authors: Pensato Umberto , Bosshart Salome L. , Stebner Alexander , Dowlatshahi Dar , Bang Oh Young , Sahlas Demetrios J. , Field Thalia S. , Puetz Volker , Buck Brian H. , Hill Michael D. , Goyal Mayank , Demchuk Andrew M. , Ospel Johanna M. 
Published: February 2025

BACKGROUND:
Infarct growth rate is remarkably heterogeneous in acute ischemic stroke, reflecting diverse clinical-physiological phenotypes. We compared different methods of estimating infarct growth rate in patients with acute ischemic stroke undergoing thrombectomy using multimodal computed tomography (CT) stroke imaging.

METHODS:
Secondary analysis of the international ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) which evaluated the effect of nerinetide in patients with large vessel occlusion undergoing thrombectomy. Infarct growth rate was estimated leveraging each component of multimodal stroke CT imaging: (1) 10 minus baseline Alberta Stroke Program Early CT Score (ASPECTS) divided by hours elapsed from symptom onset on noncontrast CT (ASPECTS decay per hour); (2) collateral status on multiphase CT angiography (mCTA), and (3) hypoperfusion intensity ratio on CT perfusion. Patients were dichotomized into intermediate and slow progressors (since fast progressors were likely to be excluded from ESCAPE-NA1 based on trial enrollment criteria) according to median ASPECTS decay, presence of good versus moderate/poor mCTA collaterals, and median hypoperfusion intensity ratio, respectively. Associations between progressor phenotypes and 90-day modified Rankin Scale score were assessed across neuroimaging modalities using adjusted logistic regression analyses.

RESULTS:
Among 1105 patients enrolled in ESCAPE-NA1 between 2017 and 2019, 619 (56.0%) were assessed for progressor phenotypes using noncontrast CT, 1084 (98.1%) with mCTA, and 415 (37.6%) with CT perfusion. Median ASPECTS decay per hour was 1.05 (interquartile range, 0.05–1.85), 188/1084 (17%) patients had good collateral status on mCTA, and the median hypoperfusion intensity ratio was 0.44 (interquartile range, 0.28–0.59). Intermediate progressors showed worse functional outcomes compared with slow progressors only in CT perfusion strata: adjusted common odds ratio for modified Rankin Scale ordinal shift analysis of 1.69 (95% CI, 1.14–2.49). No significant association between progressor phenotypes and 90-day modified Rankin Scale was seen when the noncontrast CT and the mCTA approaches were used.

CONCLUSIONS:
Stroke progressor phenotypes based on CT perfusion criteria (using the hypoperfusion intensity ratio approach) were associated with clinical outcomes, while stroke progressor phenotypes based on noncontrast CT (ASPECTS decay) and mCTA (collateral status) criteria were not.
Three-Dimensional Curvature of the Cervical Carotid Artery Predicts Long-Term Neurovascular Risk in Loeys-Dietz Syndrome
Authors: Lee Jin Vivian , Huguenard Anna L. , Braverman Alan C. , Dacey Ralph G. , Osbun Joshua W. 
Published: February 2025

BACKGROUND:
Although the relationship between cervical carotid tortuosity and cardiovascular risk in patients with Loeys-Dietz syndrome has been studied, it is unclear whether cervical carotid tortuosity influences the risk of neurovascular events.

METHODS:
This is a single-institution retrospective cohort study. Cervical carotid tortuosity and morphology were assessed in patients with Loeys-Dietz syndrome who underwent baseline computed tomography/magnetic resonance imaging of the cervical and cerebral arteries from 2010 to 2022. The primary end point was a composite of adverse neurovascular events (multiple vessel cervical artery dissection, ischemic stroke, intracerebral hemorrhage, and any neurovascular intervention) at 5- and 10-year follow-ups. Independent risk factors were identified using univariate and multivariate logistic regression analyses. Single-variable predictors of 5- and 10-year outcomes were analyzed via receiver operating curve analyses. Cutoff values were determined per the Youden J index. Stratification analyses were performed for ages <60 and ≥60 years.

RESULTS:

Of 105 eligible participants, 63 were included (mean age, 40±17 years; 52% female). During a mean follow-up of 8.7±4.1 years, 23 (37%) developed an adverse neurovascular event. Five-year follow-up was achieved in 86% and 10-year follow-up in 48%. Carotid total absolute curvature (TAC;
P
=0.008), coiling morphology (
P
=0.012), and
TGFBR1/2
genetic variant (
P
=0.037) were independently associated with 5-year events. Stratification analyses revealed that the age group <60 years was more vulnerable to high TAC (unadjusted odds ratio, 7.2 [95% CI, 2.0–25.4];
P
=0.002). Baseline TAC was the only independent predictor of adverse events at 5 years (area under the curve, 0.84;
P
<0.001) and 10 years (area under the curve, 0.75;
P
=0.007) in this age group. An optimal threshold for predicting neurovascular events was TAC ≥16.5. None were predictive in the age group ≥60 years.

CONCLUSIONS:
Cervical carotid tortuosity is associated with a long-term increased risk of neurovascular events in Loeys-Dietz syndrome. Angiographic findings of high-risk features such as increased TAC and coiling morphology may help to identify neurovascular vulnerability noninvasively at an early stage.
The impact of white matter brain lesions on processing speed deficits in systemic lupus erythematosus patients
Authors: Wójcicka-Frankiewicz Anna , Pawlak Mikołaj A , Piernik Maciej , Forycka Maria , Wiłkość-Dębczyńska Monika , Więsik-Szewczyk Ewa , Pawlak-Buś Katarzyna , Leszczyński Piotr , Michalak Sławomir , Wypych Aleksandra , Serafin Zbigniew , Kozubski Wojciech , Kalinowska-Łyszczarz Alicja 
Published: February 2025

Background The mechanism of cognitive dysfunction in systemic lupus erythematosus (SLE) is still not fully understood. Even though many SLE patients present some neurological dysfunction, including various cognitive deficits, neither a specific pattern of cognitive dysfunction nor specific structural changes associated with cognitive impairment in SLE patients have been established. Moreover, although prevalent and bothersome, cognitive deficits have not been included in the most recent SLE diagnostic criteria. Purpose The aim of this study was to determine the relationship between the presence of white matter lesions (WMLs) and cognitive dysfunction in patients diagnosed with SLE. Research Design 33 SLE patients underwent 3 T brain magnetic resonance imagining (MRI) and an extensive battery of psychological tests, including Automated Neuropsychological Assessment Metrics (ANAM) and the standard pen and paper neuropsychological tests. Patients were stratified into two groups based on the presence ( N = 15) or absence ( N = 18) of WMLs. Psychometric scores were compared between the two groups. Results and conclusions Significant deficits in cognitive functions were observed. Patients with WMLs showed deficits in attention and executive functions, as well as memory deficits in comparison to the group without WMLs. As measured with: STROOP Test (executive function), Color Trail Test (CTT) (attention), Californian Verbal Learning Test (CVLT) (memory), and from ANAM tests with: Procedural Reaction Time (PRT) (attention), Code Substitution Delayed (CS_D) (memory), Spatial Processing (SP) (visuospatial functions), Tower Puzzle (TP) (executive functions), 2 Choice Reaction Time (2CHRT) (attention), Running Memory CPT (RM CPT) (memory), Matching Grids (Mat GR) (visuospatial functions), Go/No _Go inhibition (Go/No_Go Go) (executive functions). Additionally, we analyzed structural volumetric measures derived from a comprehensive segmentation pipeline recon-all using Freesurfer 5.3. Significant differences were identified for the following structures’ volumes: right choroid plexus, left choroid plexus, right lateral ventricle. All these structures had a greater volume in patients with WMLs.
Low-Cost Telerehabilitation in Low- and Middle-Income Countries (LMICs): Overcoming Barriers to Access and Improving Healthcare Delivery
Authors: Surya Nirmal , Someshwar Hitav Pankaj 
Published: February 2025

Background Telerehabilitation (TR) holds promise for addressing healthcare disparities in low- and middle-income countries (LMICs), where access to rehabilitation services is often limited due to economic, geographical, and infrastructure barriers. Despite its potential, TR faces unique challenges in LMICs, including inadequate digital infrastructure, limited access to affordable devices, and variable internet connectivity. Objective This study investigates the feasibility, barriers, and outcomes of implementing low-cost TR interventions in LMICs. Method A narrative review was conducted where studies were analyzed for outcomes including cost-effectiveness, patient adherence, and clinical efficacy. Results Findings indicate that low-cost TR can significantly improve accessibility to rehabilitation in LMICs, with positive clinical outcomes for patients with stroke, musculoskeletal disorders, and chronic pain. TR led to a 40–60% reduction in travel-related costs for patients, with adherence rates comparable to in-person sessions. However, limited access to reliable internet and devices were major barriers, particularly in rural areas, highlighting a digital divide within LMIC populations. Innovative solutions, such as asynchronous video-based therapy, were found effective in overcoming connectivity challenges. Conclusion Low-cost TR is a viable approach to enhancing rehabilitation accessibility in LMICs, offering substantial reductions in cost and travel barriers. Addressing infrastructure challenges through scalable, offline-enabled platforms could enhance TR’s reach and efficacy. Further research is necessary to develop sustainable TR models tailored to the specific needs of LMICs.
Can the Use of Artificial Intelligence-Generated Content Bridge the Cancer Knowledge Gap? A Longitudinal Study With Health Self-Efficacy as a Mediator and Educational Level as a Moderator
Authors: Xie Zehang , Chen Ru , Ding Wenjuan 
Published: February 2025

Objectives The cancer knowledge gap represents a significant disparity in awareness and understanding of cancer-related information across different demographic groups. Leveraging Artificial Intelligence-Generated Content (AIGC) offers a promising approach to personalize health education and potentially bridge this gap. This study aimed to evaluate the potential of AIGC to bridge the cancer knowledge gap, assessing the roles of health self-efficacy as a mediator and educational level as a moderator in this relationship. Methods A 6-month longitudinal study was conducted using online surveys distributed to undergraduate students in non-medical disciplines at one university and graduate students in medical specialties at another university in China. The study assessed the frequency of AIGC use, health self-efficacy, and cancer knowledge at two time points. Results The results indicated that AIGC use significantly enhanced cancer knowledge levels and health self-efficacy over time. Educational level notably moderated the effects of AIGC use, with non-medical undergraduate students showing greater gains in knowledge and self-efficacy. Additionally, health self-efficacy mediated the relationship between AIGC use and cancer knowledge, underscoring the importance of health self-efficacy. The study confirms the efficacy of AIGC in narrowing the cancer knowledge gap and enhancing health self-efficacy, particularly among students with lower initial medical knowledge. Conclusion These findings highlight the potential of integrating AIGC tools in cancer education and public health interventions, particularly for individuals at different educational levels. By tailoring digital health resources to varying educational needs, these interventions could enhance cancer knowledge acquisition, improve health self-efficacy, and contribute to better cancer prevention and control outcomes.
Risk Factors for Adverse Cardiac Events in Individuals Prescribed Stimulants Across the Lifespan
Authors: Groff Destin , Tuan Wen-Jan , Holt Kraig , Latronica James R. , Bone Curtis 
Published: February 2025

Introduction: Prescription stimulants are an effective FDA approved treatment for attention deficit hyperactivity disorder (ADHD) however their safety has come under scrutiny. Multiple studies demonstrate safe use in pediatric populations, but prescriptions are increasing to adults and it is not evident which comorbidities might place people at risk of adverse outcomes. The aim of this study is to identify risk factors of adverse cardiovascular events for individuals exposed to stimulants across the lifespan. Methods: We conducted a case control study utilizing the TriNetX research network database. Individuals were included for study if they were younger than 90 years old and prescribed stimulants between January 1, 2010 and December 31, 2020. We utilized summary statistics, chi2, and multivariate logistic regression to identify risk factors for cardiovascular events. Results: Of the 987,762 individuals prescribed stimulants, 49,902 experienced an adverse cardiovascular event. Individuals with atherosclerotic heart disease had the highest odds of adverse events (aOR = 36.7, p < .001). Hypertension (aOR = 2.78 p < .001), cocaine use (aOR = 1.64 p < .001), and anxiety (aOR = 1.46 p < .001) were also strongly predictive of adverse outcomes, but risk varied by age. Conclusions: Atherosclerotic heart disease and its antecedents pose the greatest risk for cardiovascular events for people prescribed stimulants. Mental health diagnoses are also independent predictors and age may be an effect modifier of these relationships. ADHD was not an independent risk factor for major adverse cardiovascular events when controlling for other biopsychosocial variables in adult populations. Additional research focused on predictive models and prospective studies may be warranted to better inform clinical decisions regarding stimulant prescriptions for the broad demographic of patients that may benefit from these medications.
Enlarged perivascular spaces correlate with blood-brain barrier leakage and cognitive impairment in Alzheimer's disease
Authors: Wen Chen , Gan Jing-Huan , Liu Shuai , Lu Hao , Wang Li-Chen , Wu Hao , Shi Zhi-Hong , Ji Yong 
Published: February 2025

Background The clinical significance of enlarged perivascular spaces (EPVS) in Alzheimer’ s disease (AD) was ambiguous. Objective To investigate whether EPVS contribute to blood-brain barrier (BBB) leakage and cognition in AD. Methods The study included a total of 64 participants (26 healthy controls and 38 patients with AD). The evaluation of EPVS and BBB permeability was performed in specific anatomical locations: the centrum semiovale (CSO), basal ganglia, and hippocampus. The EPVS ratings were performed according to Potter's instructions. BBB permeability was evaluated using dynamic contrast-enhanced-MRI. The relationship between EPVS and global cognition (Mini-Mental State Examination and Montreal Cognitive Assessment), cognitive subdomains, and BBB permeability were examined in both groups. Finally, the relationship between CSO BBB permeability and cognition in AD patients was investigated. Results High-grade CSO EPVS was found associated with AD (OR: 3.40, 95% CI: 1.11–11.90, p = 0.04). In the AD group, a significant correlation was observed between high-grade CSO EPVS and lower MMSE score (r = −0.36, p = 0.03) and verbal fluency (r = −0.44, p = 0.01). High-grade CSO EPVS positively correlated with BBB leakage (r = 0.58, p < 0.001). The BBB permeability of CSO negatively correlated with verbal fluency (r = −0.52, p < 0.001) and attention (r = −0.40, p = 0.01). Conclusions High-grade CSO EPVS is related to BBB leakage, which contributes to cognitive impairment in AD patients, especially verbal frequency. CSO EPVS can function as a convenient AD marker for intervention and therapy.
Real-world disease burden, mortality, and healthcare resource utilization associated with bronchiectasis
Authors: Shoaib Sofia , Feliciano Joseph , Dasenbrook Elliott C , Maynard Jason , Batchu Lakshmi , Mohanty Maitreyee , Lauterio Melanie , Feld Alexandra J 
Published: February 2025

Objectives To assess real-world survival and healthcare resource utilization (HCRU) in US patients with non-cystic fibrosis bronchiectasis (NCFBE). Methods This retrospective analysis, using data from the STATinMED RWD Insights database from Jan 2015–Oct 2022, included adults with NCFBE (from Jan 2015–Oct 2021) and non-NCFBE comparators (from Jan 2015–Aug 2020); baseline characteristics were balanced by inverse probability treatment weighting. Outcomes included survival through end of study. HCRU was assessed over 12 months. Results 117,718 patients with NCFBE and 306,678 comparators were included. Patients with NCFBE had a 77% higher risk of death than comparators (hazard ratio [HR] 1.77 [95% CI 1.74-1.80]). Risk of death was higher among patients aged ≥65 years (vs 18–34 years; HR 11.03 [95% CI 10.36-11.74]), among Black patients (vs White; HR 1.53 [95% CI 1.50-1.55]), and among patients with comorbid COPD (HR 1.42 [95% CI 1.40-1.44]). Patients with NCFBE incurred higher all-cause and respiratory-related HCRU than comparators for outpatient office, outpatient hospital, emergency department (ED), inpatient and respiratory-related pulmonologist visits (all p < .0001); HCRU increased with exacerbations. Conclusions Patients with NCFBE have high mortality burden and incur high HCRU, both of which are further increased with exacerbations. Prevention and delay of exacerbations are key areas for improvement of disease management.
A Novel Surgical Technique for Transsphincteric Anal Fistulas: A Comparison Between the Modified Submucosal Ligation of Fistula Tract (MSLOFT) and the Hybrid Seton Techiniques - A Propensity Score Matching Analysis
Authors: Gündoğdu Ramazan , Gojayev Afig , Erkent Murathan , Avcı Tevfik , Kuş Murat , Erkan Serkan , Aydın Hüseyin Onur , Ezer Ali 
Published: February 2025

Background This study aimed to compare the outcomes of a modified submucosal ligation of the fistula tract (MSLOFT) technique with the hybrid seton technique for treating transsphincteric anal fistulas. Material and Methods A retrospective analysis was conducted with ethical approval from Baskent University. Patients over 18 years of age with a diagnosis of transsphincteric fistula and complete data were included in the study. Patients with fistulas of non-cryptoglandular origin, incontinence, multiple fistula tracts, inflammatory bowel disease, or malignancy were excluded. The study involved 255 patients, divided into: MSLOFT (n = 31) and hybrid seton (n = 224) groups. Propensity score matching (PSM) was performed to balance age, gender, and body mass index between the groups, resulting in 30 patients per group. Results There was no significant difference between the MSLOFT and hybrid seton groups regarding Wexner scores, incontinence rates, recurrence, or reoperation rates, in the overall cohort and after PSM. However, in the overall cohort and after PSM analysis, the operation time ( P = 0.047) and follow-up time ( P < 0.001) of the MSLOFT group were significantly longer. Recurrence was noted in 3 MSLOFT patients and 2 hybrid seton patients after PSM. Conclusion MSLOFT is a feasible and effective sphincter-preserving technique for transsphincteric anal fistulas, providing low recurrence and incontinence rates similar to the hybrid seton technique.
Ankle Arthrodesis: Epidemiology, Etiology, and Complications in Diabetic vs Nondiabetic Patients Using US Nationwide Inpatient Sample Data
Authors: Mahamid Assil , Maman David , Sofer Summer , Pavlenko Mykhail , Mansour Amr , Hodruj Marah , Berkovich Yaron , Behrbalk Eyal 
Published: February 2025

Background: Ankle arthrodesis (AA), or ankle fusion, is a surgical procedure used to treat severe ankle pathologies, particularly in patients with chronic pain and reduced mobility due to conditions like osteoarthritis, posttraumatic arthritis, and Charcot arthropathy. Diabetic patients undergoing AA often face higher risks of complications due to comorbidities such as dyslipidemia and hypertension. This study aims to compare the outcomes of AA in diabetic vs nondiabetic patients, using data from the Nationwide Inpatient Sample (NIS) from 2016 to 2019. Methods: Using the Nationwide Inpatient Sample database, 12 325 patients who underwent ankle arthrodesis were identified from 2016 to 2019 based on ICD-10 procedure codes. χ2 tests and t tests were used for univariate analysis, followed by multivariate logistic regression to assess complications between diabetic and nondiabetic patients. Temporal trends in surgical volume were analyzed using linear regression models, and risk ratios were calculated for perioperative complications during the index hospital stay. Results: Primary osteoarthritis was the most common cause, accounting for 55.4% of AA procedures. Multivariate logistic regression revealed that diabetes mellitus (DM) was significantly associated with increased risks of blood loss (odds ratio [OR] 1.59, 95% CI 1.23-2.05, P = .004), infection (OR 3.12, 95% CI 2.55-3.82, P < .001), heart failure (OR 1.35, 95% CI 1.06-1.73, P = .01), and acute kidney injury (OR 2.42, 95% CI 1.57-3.75, P = .001). No significant association was observed between DM and pneumonia (OR 2.27, 95% CI 1.645-4.605, P = .20). Conclusion: Diabetic patients undergoing AA have higher rates of comorbidities and postoperative complications, leading to longer hospital stays. These findings highlight the need for comprehensive preoperative and postoperative care to improve outcomes in this population. Level of Evidence: Level III, retrospective study.