bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative pain and pain management following selective dorsal rhizotomy
Authors: Adams Isabel G , Jayaweera Ramanie , Lewis Jennifer , Badawi Nadia , Abdel-Latif Mohamed E , Paget Simon 
Published: March 2024

BackgroundSelective dorsal rhizotomy (SDR) is a neurosurgical procedure that reduces lower limb spasticity, performed in some children with spastic diplegic cerebral palsy. Effective pain management after SDR is essential for early rehabilitation. This study aimed to describe the anaesthetic and early pain management, pain and adverse events in children following SDR.MethodsThis was a retrospective cohort study. Participants were all children who underwent SDR at a single Australian tertiary hospital between 2010 and 2020. Electronic medical records of all children identified were reviewed. Data collected included demographic and clinical data (pain scores, key clinical outcomes, adverse events and side effects) and medications used during anaesthesia and postoperative recovery.Results22 children (n=8, 36% female) had SDR. The mean (SD) age at surgery was 6 years and 6 months (1 year and 4 months). Common intraoperative medications used were remifentanil (100%), ketamine (95%), paracetamol (91%) and sevoflurane (86%). Postoperatively, all children were prescribed opioid nurse-controlled analgesia (morphine, 36%; fentanyl, 36%; and oxycodone, 18%) and concomitant ketamine infusion. Opioid doses were maximal on the day after surgery. The mean (SD) daily average pain score (Wong-Baker FACES scale) on the day after surgery was 1.4 (0.9), decreasing to 1.0 (0.5) on postoperative day 6 (POD6). Children first attended the physiotherapy gym on median day 7 (POD8, range 7–8). Most children experienced mild side effects or adverse events that were managed conservatively. Common side effects included constipation (n=19), nausea and vomiting (n=18), and pruritus (n=14). No patient required return to theatre, ICU admission or prolonged inpatient stay.ConclusionsMost children achieve good pain management following SDR with opioid and ketamine infusions. Adverse events, while common, are typically mild and managed with medication or therapy. This information can be used as a baseline to improve postoperative care and to support families’ understanding of SDR before surgery.
Ultrasound-guided electrocoagulation of neovascularisation for persistent patellar tendinopathy in athletes: a cohort study of 25 patients with a mean follow-up of 5 years from the SANTI Study Group
Authors: Carrozzo Alessandro , Shatrov Jobe , El Helou Abdo , Pettinari Francesco , Alayane Ali , Abed Ali Ahmad , Clechet Julien , Vieira Thais Dutra , Sonnery-Cottet Bertrand 
Published: March 2024

BackgroundPatellar tendinopathy (PT) is a common condition characterised by persistent patellar tendon pain and dysfunction, particularly in athletes. Neovascularisation is frequently observed in the PT and is associated with increased pain. Ultrasound-guided electrocoagulation of neovascularisation has emerged as a minimally invasive alternative treatment for recalcitrant PT.Hypothesis/purposeThe purpose of this study was to evaluate the clinical outcomes of ultrasound-guided electrocoagulation of neovascularisation in athletes with persistent PT.Study designCase series; level of evidence, IV.MethodsA retrospective analysis of prospectively collected data was performed on 25 athletes who underwent ultrasound-guided electrocoagulation of neovascularisation for recalcitrant PT. Clinical outcomes including complications, reinterventions and patient-reported outcome measures were recorded. Comparisons between variables were assessed using χ2test or Fisher’s exact test for categorical variables and Student’s t-test or Wilcoxon test for quantitative variables.Results25 patients were included in the final analysis. 96% returned to their preoperative activity level at a mean of 3.8 months. At a mean follow-up of 5 years 4% did not receive significant benefit from electrocoagulation therapy. Significant improvements were observed in outcome measures, including the Victorian Institute of Sport Assessment Questionnaire for Patients with Patellar Tendinopathy, Kujala score, modified Blazina score and Visual Analogue Scale for pain.ConclusionUltrasound-guided electrocoagulation of neovascularisation for persistent PT in elite athletes resulted in a low complication rate, a high rate and rapid return to sport and a significant improvement in outcome measures.
Primary care providers practice patterns regarding female pelvic floor disorders
Authors: Weimer Anna , Hallock Jennifer L , Chen Chi Chiung Grace 
Published: March 2024

IntroductionPelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary care providers (PCPs) have a unique opportunity to increase treatment and provide appropriate referrals for these patients.MethodsAn online survey was administered to PCPs to assess provider practices, knowledge, comfort managing and ease of referral for PFDs. Logistic regression was used to assess the association between demographic/practice characteristics of PCPs and two primary outcomes of interest: discomfort with management and difficulty with referral of PFDs.ResultsOf the 153 respondents to the survey, more felt comfortable managing stress urinary incontinence (SUI) and overactive bladder (OAB), compared with pelvic organ prolapse (POP) and faecal incontinence (FI) and were less likely to refer patients with urinary symptoms. Few providers elicited symptoms for POP and FI as compared with SUI and OAB. Provider variables that were significantly associated with discomfort with management varied by PFD, but tended to correlate with less exposure to PFDs (eg, those with fewer years of practice, and internal medicine and family physicians as compared with geriatricians); whereas the factors that were significantly associated with difficulty in referral, again varied by PFD, but were related to practice characteristics (eg, specialist network, type of practice, practice setting and quantity of patients).ConclusionThese findings highlight the need to increase PCPs awareness of PFDs and develop effective standardised screening protocols, as well as collaboration with pelvic floor specialists to improve screening, treatment and referral for patients with PFDs.
BTN1A1 is a novel immune checkpoint mutually exclusive to PD-L1
Authors: Kim Young-Seung , Lee Seung-Hoon , Park Andrew H , Wu Chunai , Hong Bong-Ki , Jung Hyunjin , Lin Steven H , Yoo Stephen S 
Published: March 2024

BackgroundWhile Programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) blockade is a potent antitumor treatment strategy, it is effective in only limited subsets of patients with cancer, emphasizing the need for the identification of additional immune checkpoints. Butyrophilin 1A1 (BTN1A1) has been reported to exhibit potential immunoregulatory activity, but its ability to function as an immune checkpoint remains to be systematically assessed, and the mechanisms underlying such activity have yet to be characterized.MethodsBTN1A1 expression was evaluated in primary tumor tissue samples, and its ability to suppress T-cell activation and T cell-dependent tumor clearance was examined. The relationship between BTN1A1 and PD-L1 expression was further characterized, followed by the development of a BTN1A1-specific antibody that was administered to tumor-bearing mice to test the amenability of this target to immune checkpoint inhibition.ResultsBTN1A1 was confirmed to suppress T-cell activation in vitro and in vivo. Robust BTN1A1 expression was detected in a range of solid tumor tissue samples, and BTN1A1 expression was mutually exclusive with that of PD-L1 as a consequence of its inhibition of Janus-activated kinase/signal transducer and activator of transcription signaling-induced PD-L1 upregulation. Antibody-mediated BTN1A1 blockade suppressed tumor growth and enhanced immune cell infiltration in syngeneic tumor-bearing mice.ConclusionTogether, these results confirm that the potential of BTN1A1 is a bona fide immune checkpoint and a viable immunotherapeutic target for the treatment of individuals with anti-PD-1/PD-L1 refractory or resistant disease, opening new avenues to improving survival outcomes for patients with a range of cancers.
Efficacy of colchicine in addition to anakinra in patients with recurrent pericarditis
Authors: Collini Valentino , Andreis Alessandro , De Biasio Marzia , De Martino Maria , Isola Miriam , Croatto Nicole , Lepre Veronica , Cantarini Luca , Merlo Marco , Sinagra Gianfranco , Abbate Antonio , Lazaros George , Brucato Antonio , Klein Allan L , Imazio Massimo 
Published: March 2024

AimAnakinra, an anti IL-1 agent targeting IL-1 alfa and beta, is available for the treatment of recurrent pericarditis in cases with corticosteroid dependence and colchicine resistance after failure of conventional therapies. However, it is unclear if the combination with colchicine, a non-specific inhibitor of the inflammasome targeting the same inflammatory pathway of IL-1, could provide additional benefit to prevent further recurrences. The aim of the present observational study is to assess whether the addition of colchicine on top of anakinra could prolong the time to first recurrence and prevent recurrences better than anakinra alone.MethodsInternational, all-comers, multicentre, retrospective observational cohort study analysing all consecutive patients treated with anakinra for corticosteroid-dependent and colchicine-resistant recurrent pericarditis. The efficacy endpoint was recurrence rate and the time to the first recurrence.ResultsA total of 256 patients (mean age 45.0±15.4 years, 65.6% females, 80.9% with idiopathic/viral aetiology) were included. 64 (25.0%) were treated with anakinra as monotherapy while 192 (75.0%) with both anakinra and colchicine. After a follow-up of 12 months, 56 (21.9%) patients had recurrences. Patients treated with colchicine added to anakinra had a lower incidence of recurrences (respectively, 18.8% vs 31.3%; p=0.036) and a longer event-free survival (p=0.025). In multivariable analysis, colchicine use prevented recurrences (HR 0.52, 95% CI 0.29 to 0.91; p=0.021).ConclusionsThe addition of colchicine on top of anakinra treatment could be helpful to reduce recurrences and prolong the recurrence-free survival.
Concordance and agreement between different activity scores in polymyalgia rheumatica
Authors: D'Agostino Justine , Souki Aghiles , Lohse Anne , Carvajal Alegria Guillermo , Dernis Emanuelle , Richez Christophe , Truchetet Marie-Elise , Wendling Daniel , Toussirot Eric , Perdriger Aleth , Gottenberg Jacques-Eric , Felten Renaud , Fautrel Bruno , Chiche Laurent , Hilliquin Pascal , Le Henaff Catherine , Dervieux Benjamin , Direz Guillaume , Chary-Valckenaere Isabelle , Cornec Divi , Guellec Dewi , Marhadour Thierry , Nowak Emmanuel , Saraux Alain , Devauchelle-Pensec Valérie 
Published: March 2024

ObjectiveThe C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs.MethodData from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots.ResultsA total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time.ConclusionThe correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used.Trial registration numberNTC02908217.
Homecare workers needs and experiences in end of life care: rapid review
Authors: Forward Catherine , Bayley Zana , Walker Liz , Krygier Justine , White Caroline , Mwaba Kasonde , Elliott-button Helene , Taylor Paul , Johnson Miriam J 
Published: March 2024

BackgroundSocial homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group.AimTo gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care.MethodsWe conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool.Data sourcesCINAHL and Medline databases (2011–2023; English language).Results19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients’ and clients’ family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant.ConclusionsSocial homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.
Back-reaction of long-wavelength cosmological fluctuations as measured by a clock field
Authors: Comeau Vincent , Brandenberger Robert 
Published: March 2024

AbstractWe consider the back-reaction of cosmological fluctuations on the local expansion rate averaged over a space-like hypersurface of constant value of a clock field. We show that in the infrared limit, the fluctuations lead to a decrease in the average expansion rate, measured at a fixed value of the clock field, compared to what would be obtained in a homogeneous universe. We work in the context of Einstein gravity coupled to perfect fluid matter.
Fuzzy dark matter and the dark dimension
Authors: Anchordoqui Luis A. , Antoniadis Ignatios , Lüst Dieter 
Published: March 2024

AbstractWe propose a new dark matter contender within the context of the so-called “dark dimension”, an innovative 5-dimensional construct that has a compact space with characteristic length-scale in the micron range. The new dark matter candidate is the radion, a bulk scalar field whose quintessence-like potential drives an inflationary phase described by a 5-dimensional de Sitter (or approximate) solution of Einstein equations. We show that the radion could be ultralight and thereby serve as a fuzzy dark matter candidate. We advocate a simple cosmological production mechanism bringing into play unstable Kaluza–Klein graviton towers which are fueled by the decay of the inflaton.
Medical Image Segmentation with Dual-Encoding and Multi-Level Feature Adaptive Fusion
Authors: Wu Shulei , Yang You , Zhang Fanghong 
Published: March 2024

Purpose: Accurate segmentation of medical images is critical for disease diagnosis, surgical planning and prognostic assessment. TransUNet, a hybrid CNN-Transformer-based method, extracts local features using CNN and compensates for the lack of long-range dependencies through a self-attention mechanism. However, the initial focus on extracting local features from specific regions impacts the generation of subsequent global features, thus constraining the model’s capacity to effectively capture a broader range of semantic information. Effective integration of local and global features plays a pivotal role in achieving precise and dense prediction. Therefore, we propose a novel hybrid CNN-Transformer-based method aimed at enhancing medical image segmentation. Approach: In this study, a dual-encoder parallel structure is used to enhance the feature representation of the input image. By introducing a multi-scale adaptive feature fusion module, a fine fusion of local features across perceptual domains is realized in the decoding process. The generalized convolutional block attention module helps to increase cross-channel interactions in layers with more channels, thus enabling the fusion of local features and global representations at different resolutions during the decoding process. Results: The proposed method achieves average DSC scores of 79.98%, 84.83% and 85.78% on the Synapse, ISIC2017 and Pediatric Pyelonephritis datasets, respectively. These scores are 2.5%, 0.56% and 0.42% higher than those of TransUNet. The best performance of 91.66% is observed on the ACDC dataset, representing improvements of 2.46% and 7.24% compared to HiFormer and DAE-Former, respectively. Conclusions: The experimental results show that the proposed model has a significant competitive advantage in terms of ACDC image segmentation performance.
Health Inequity and Time From Pediatric Stroke Onset to Arrival
Authors: Pai Akshat M. , To Teresa , deVeber Gabrielle A. , Nichol Daniel , Kassner Andrea , Ertl-Wagner Birgit , Rafay Mubeen F. , Dlamini Nomazulu 
Published: March 2024

BACKGROUND:
Time from stroke onset to hospital arrival determines treatment and impacts outcome. Structural, socioeconomic, and environmental factors are associated with health inequity and onset-to-arrival in adult stroke. We aimed to assess the association between health inequity and onset-to-arrival in a pediatric comprehensive stroke center.

METHODS:
A retrospective observational study was conducted on a consecutive cohort of children (>28 days–18 years) diagnosed with acute arterial ischemic stroke (AIS) between 2004 and 2019. Neighborhood-level material deprivation was derived from residential postal codes and used as a proxy measure for health inequity. Patients were stratified by level of neighborhood-level material deprivation, and onset-to-arrival was categorized into 3 groups: <6, 6 to 24, and >24 hours. Association between neighborhood-level material deprivation and onset-to-arrival was assessed in multivariable ordinal logistic regression analyses adjusting for sociodemographic and clinical factors.

RESULTS:

Two hundred and twenty-nine children were included (61% male; median age [interquartile range] at stroke diagnosis 5.8-years [1.1–11.3]). Over the 16-year study period, there was an increase in proportion of children diagnosed with AIS living in the most deprived neighborhoods and arriving at the emergency room within 6 hours (
P
=0.01). Among Black patients, a higher proportion lived in the most deprived neighborhoods (
P
=0.02) and level of material deprivation was associated with AIS risk factors (
P
=0.001).

CONCLUSIONS:
Our study suggests an increase in pediatric stroke in deprived neighborhoods and certain communities, and earlier arrival times to the emergency room over time. However, whether these changes are due to an increase in incidence of childhood AIS or increased awareness and diagnosis is yet to be determined. The association between AIS risk factors and material deprivation highlights the intersectionality of clinical factors and social determinants of health. Finally, whether material deprivation impacts onset-to-arrival is likely complex and requires further examination.
Updated adult ferritin reference intervals based on a large, healthy UK sample, measured on Roche Cobas series analysers
Authors: Rodgers Sam , Woolley Timothy , Smith Joshua , Prinsloo Peter , Fernando Natasha 
Published: March 2024

Background There is a lack of standardization of reference intervals (RIs) for ferritin across laboratories, particularly for postmenopausal women. Depending on the RI used, there can be more than a 4-fold difference in the upper limit of normal between laboratories, resulting in potential misinterpretation. Methods This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over a 7-year period. Exclusion criteria were used to screen out individuals with conditions known to affect iron metabolism or raise ferritin as part of the acute phase response. Distributions were assessed using density and Q-Q plots, and age-banded cut-offs were determined. The non-parametric method was used to establish RIs for sex and age bands. Results For females, 4 age bands were established (18–39, 40–49, 50–59 and 60+). For males, 2 bands were identified (18–39 and 40+). Performance against a validation dataset, followed by an expansive validation against an inclusive dataset, demonstrated the robustness of the derived RIs. Conclusion This study addresses the inconsistency in serum ferritin RIs by presenting intervals based on demographic parameters. This approach can potentially enhance the accuracy of interpreting serum ferritin levels, assisting clinicians in identifying patients requiring further evaluation.
Rare Cases of Pseudomonas aeruginosa Meningitis in Children: 10-Year Experience in a Single Center
Authors: Liu Lijun , Zhu Lvchang , Hu Chanchan , Zhu Shuzhen , Ye Sheng 
Published: March 2024

Objective The primary objective was to elucidate the epidemiologic characteristics, risk determinants, and clinical outcomes associated with Pseudomonas aeruginosa–induced meningitis. Methods All cases of meningitis caused by Pseudomonas aeruginosa that were treated at the hospital between 2012 and 2022 were retrospectively analyzed and detailed. Results During a 10-year period, only 10 patients satisfied the inclusion criteria. Three patients had previously undergone neurosurgical procedures and 4 patients had leukemia. Conclusions Although Pseudomonas aeruginosa meningitis possesses a low incidence rate, the rate of mortality is high. Patients with leukemia or those who have undergone neurosurgery are the most susceptible to diagnosis. Cases of severe neutropenia present only mild or no cerebrospinal fluid pleocytosis. In patients with sensitive Pseudomonas aeruginosa meningitis, the timely use of anti- Pseudomonas carbapenems for intravenous treatment is highly effective. For drug-resistant Pseudomonas aeruginosa meningitis, intrathecal polymyxins administration can be an effective treatment option.