bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adaptive Optics Imaging in Diabetic Retinopathy: A Prospective Cohort Study
Authors: Balas Michael , Issa Mariam , Popovic Marko M. , Moayad Lana , Zajner Chris , Aponte Paola Oquendo , Hamli Hesham , Yan Peng , Wright Tom , Melo Isabela M , Muni Rajeev H. 
Published: March 2024

Purpose:
To investigate the correlation between diabetic retinopathy (DR) severity and microscopic retinal and vascular alterations using adaptive optics imaging (AOI).

Methods:
In this single-center, prospective cohort study, adult participants with healthy eyes or DR underwent AOI. Participants were classified into control/mild non-proliferative DR (NPDR), moderate/severe NPDR, and proliferative DR. AOI using the RTX1 camera was obtained from 48 participants (87 eyes) for photoreceptor data, and from 36 participants (62 eyes) for vascular data.

Results:
Photoreceptor parameters significantly differed between DR groups at 2° and 4° of retinal eccentricity. Wall-to-lumen ratio varied significantly at 2° eccentricity, while other vascular parameters remained non-significant. Cone density and dispersion were the strongest predictors for DR severity (p<0.001) in multivariable generalized estimating equation (GEE) modeling, while other vascular parameters remained non-significant between DR severity groups. All photoreceptor parameters showed significant correlations with visual acuity overall and across most DR severity groups.

Conclusion:
To date, this is one of the largest studies evaluating the use of AOI in DR. AOI was demonstrated to differentiate between various levels of disease severity in DR. These results support the potential role in diagnostic and therapeutic microstructural evaluation in research and clinical practice.
Ectasia Detection by Anterior Segment Optical Coherence Tomography in Scheimpflug Tomographically Normal Keratoconus Fellow Eyes
Authors: Naujokaitis Tadas , Augustin Victor A. , Son Hyeck-Soo , Köppe Maximilian , Kovalchuk Bogdana , Auffarth Gerd U. , Khoramnia Ramin 
Published: March 2024

Purpose:
The purpose of this study was to determine whether the Scheimpflug tomographically normal fellow eyes of keratoconus patients are also classified as normal using an ectasia screening algorithm based on anterior segment optical coherence tomography (AS-OCT).

Methods:
This monocentric cross-sectional study included 22 very asymmetric ectasia patients with tomographically significant keratoconus in 1 eye and normal Scheimpflug tomography in the fellow eye. Twenty-two eyes of 22 healthy subjects served as a control group. We performed corneal tomography using Pentacam AXL (Oculus, Wetzlar, Germany) and used Belin/Ambrósio Enhanced Ectasia total deviation index as well as Belin ABCD keratoconus classification to identify Scheimpflug tomographically normal eyes. We also performed AS-OCT using Anterion (Heidelberg Engineering, Heidelberg, Germany) and analyzed for the presence of ectasia using the Screening Corneal Objective Risk of Ectasia (SCORE) algorithm, with positive values indicating ectasia suspect tomography.

Results:
The SCORE value was positive in 9.1% (n = 2) of the healthy eyes, in 45.5% (n = 10) of the Scheimpflug tomographically normal eyes of keratoconus patients and in all eyes (n = 22) with tomographically significant keratoconus. The Scheimpflug tomographically normal eyes of keratoconus patients had higher SCORE values compared with healthy controls (P < 0.001). The median (interquartile range) SCORE value was −1.7 (1.3) in healthy controls, −0.5 (2.2) in Scheimpflug tomographically normal eyes of keratoconus patients, and 11.1 (11.0) in tomographically significant keratoconus eyes.

Conclusions:
The Scheimpflug tomographically normal fellow eyes of keratoconus patients had higher AS-OCT–based SCORE values than healthy controls, with positive SCORE values found in 46% of the eyes, indicating early tomographic ectatic changes.
Scoping Review of Workplace Mental Health and Well-being Programs in Higher Education Institutions
Authors: Coats Shari Fallek , Roemer Enid Chung , Kent Karen B. , Zhang Ying , Davis Meghan F. , Goetzel Ron Z. 
Published: March 2024

ObjectiveThe study aimed to conduct a scoping review of stressors in higher education institutions (HEIs), exacerbated by the COVID-19 pandemic, and to identify successful interventions.MethodsWe reviewed 79 studies published between January 2020 and January 2023.ResultsStressors were organized into psychosocial, organizational, and environmental categories. They included high job demand/low control, work/personal life imbalance, pressure to publish, lack of resources, low perceived organizational support, and fear of infection. Interventions included providing back-up childcare, employee assistance programs, financial well-being resources, paid medical leave, flexible work arrangements, greater transparency in decision making, leadership development, and adaptive physical space design.ConclusionsMental health and well-being interventions directed at faculty and staff in HEIs are needed given the many stressors faced by this workforce. Several interventions are highlighted in the literature, but most are speculative regarding their impact, given the limited number of outcome studies.
Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials
Authors: Wang Ruihan , Huang Lei , Jiang Songtao , You Guixuan , Zhou Xin , Wang Guoyou , Zhang Lei 
Published: March 2024

Background:
Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture.

Materials and methods:
Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85, Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87.

Results:
A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26–4.17; I
2=44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76–7.27; I
2=51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91–9.99; I
2=0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96–5.43; I
2=20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00–7.73; I
2=64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11–3.59; I
2=21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12–3.90; I
2=0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76–6.89; I
2=33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25–4.03; I
2=22.09%).

Conclusions:
This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.
Characterization of research trends and prospects on hepatic echinococcosis over the past forty years: a bibliometric analysis
Authors: Li Tianen , Su Wei , Wang Zhiqiang , Wang Xiao , Ma Xiaoguang , Cao Yigeng , Zhao Rui 
Published: March 2024

Background:
The distribution of hepatic echinococcosis (HE) is extensive, significantly impacting public health and economic development. Therefore, analyzing global collaboration networks and tracking developmental trends over the past four decades are crucial. This study aimed to demonstrate collaboration in the field of HE and explore key topics and future directions.

Materials and Methods:
Bibliometric analyses were conducted using CiteSpace, Bibliometrix package of R, and VOSviewer software on HE-related studies from the Web of Science Core Collection published before 1 August 2023.

Results:
This study identified 2605 records published in 196 journals by 9860 authors from 2607 institutes in 90 countries. Publications significantly notably increased in 2021. Developing countries like Turkey and China made notable contributions, while developed countries like the USA had higher average citation rates. The largest nodes in every cluster of the collaboration network were Hacettepe University, Tehran University, Xinjiang Medical University, Salford University, and the University of Pavia, and the top-producing authors were Wen H, Vuitton DA, Gottstein B, and Craig PS. Keyword co-occurrence analysis suggested that surgical techniques and novel drugs targeting combined immune checkpoints are the main therapeutic approaches in the future.

Conclusion:
Although developing countries had significantly contributed to publications on HE, the citation rate for individual articles from developed countries was significantly higher. Additionally, advancements in surgical techniques and novel drugs targeting combined immune checkpoints may emerge as the next research focus and developmental direction.
Asthma in pregnancy: a review of recent literature
Authors: Colas Kelly , Namazy Jennifer 
Published: March 2024

Purpose of review
Asthma remains the most common respiratory disease in pregnancy. Identifying risk factors for asthma exacerbations during pregnancy is critical, as uncontrolled asthma can have detrimental effects for both mother and baby. In this review, we discuss recent literature exploring risk factors, fetal and maternal effects, and treatment options for asthma during pregnancy.

Recent findings
Recent literature suggests that optimizing asthma during pregnancy improves outcomes for both mother and baby, as well as later in childhood. Current research affirms that the benefit of asthma medication use outweighs any potential risks related to the medications themselves. Limited information is available regarding the use of newer therapies such as biologics during pregnancy.

Summary
Identifying risk factors for asthma exacerbations during pregnancy is critical to prevent adverse outcomes for both mother and baby. Recent evidence continues to affirm the safety of asthma medication use; more studies are needed regarding the use of new therapies during pregnancy.
Myosteatosis is an independent risk factor for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunting
Authors: Shi Wenfeng , Yin Hua , Yu Zhijian , Li Yong , Bai Xiao , Fu Sirui , Duan Chongyang , Xu Weiguo , Yang Yang 
Published: March 2024

Objective
The relationship between skeletal muscle and adipose tissue compositions and risk of overt hepatic encephalopathy (OHE) following transjugular intrahepatic portosystemic shunt (TIPS) treatment needs to be investigated.

Methods
A total of 282 patients were collected from two medical centres. The median time of follow-up was 48.23 + 1.36 months and the first-year results of all patients after TIPS therapy were collected. The muscle and adipose tissue indices were quantified at the third lumbar vertebra level. Sarcopenia and myosteatosis were defined according to previous researches. Receiver operating characteristic curves, chi-square test, univariate and multivariate logistic regression analyses were employed to investigate the potential association between muscle and adipose indices, sarcopenia, myosteatosis and the risk of developing post-TIPS OHE.

Results
All skeletal muscle indices, adipose tissue indices and sarcopenia had limited associations with post-TIPS OHE. Myosteatosis (148 cases, 52.5%, 55 with OHE, 37.2%) was identified as an independent risk factor for post-TIPS OHE. with P < 0.001 in Chi-square test, P < 0.001, odds ratio (OR): 2.854, 95% confidence interval (CI): 1.632–4.993 in univariate logistic regression analyses, and P = 0.007, OR: 2.372, 95% CI: 1.268–4.438 in multivariate logistic regression analyses, respectively.

Conclusion
Our results showed that myosteatosis was proven as an independent risk factor for the development of post-TIPS OHE.
Iron therapy supplementation in inflammatory bowel disease patients with iron deficiency anemia: findings from a real-world analysis in Italy
Authors: Fiorino Gionata , Colombel Jean-Frederic , Katsanos Kostas , Mearin Fermín , Stein Jürgen , Andretta Margherita , Antonacci Stefania , Arenare Loredana , Citraro Rita , Dell’Orco Stefania , Degli Esposti Luca , Ramirez de Arellano Serna Antonio , Morin Neige Teldja , Koutroubakis Ioannis E. 
Published: March 2024

Background
This real-world analysis evaluated iron therapy supplementation in inflammatory bowel disease patients with iron-deficiency anemia, considering disease progression and healthcare resource consumption.

Methods
A retrospective observational study was conducted using administrative databases of a pool of Italian healthcare entities, covering about 9.3 million beneficiaries. Between January 2010 and September 2017, adult patients were enrolled in the presence of either hospitalization or active exemption code for ulcerative colitis/Crohn’s disease, or one vedolizumab prescription. Iron-deficiency anemia was identified by at least one prescription for iron and/or hospitalization for iron-deficiency anemia and/or blood transfusion (proxy of diagnosis). Patients were divided in untreated and iron-treated during 12-month follow-up and analyzed before and after propensity score matching. Disease progression, was evaluated through inflammatory bowel disease-related hospitalizations and surgeries, and healthcare resource utilization was assessed.

Results
Overall, 1753 patients were included, 1077 (61.4%) treated with iron therapy and 676 (38.6%) untreated. After propensity score matching, 655 patients were included in each group. In unbalanced cohorts, disease progression was significantly reduced in patients receiving iron therapy compared to the untreated (11.0% vs. 15.7%, P < 0.01), and this trend was maintained also after applying propensity score matching. The overall mean cost/patient was significantly lower in iron-treated than untreated (4643€ vs. 6391€, P < 0.01).

Conclusion
The findings of this real-world analysis suggest that iron therapy was associated with significant benefits in inflammatory bowel disease patients with iron-deficiency anemia, in terms of both disease progression and healthcare resource utilization.
Prevalence, trends, and characteristics of metabolic dysfunction-associated steatotic liver disease among the US population aged 12–79 years
Authors: Shen Tsung-Hua , Wu Chung-Hsuen , Lee Yuan-Wen , Chang Chun-Chao 
Published: March 2024

Background and aims
Clinical observation revealed an increase in metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence among adults and adolescents and young adults (AYA). However, its prevalence trend in specific subgroups and its characteristics are unclear.

Approach and results
This cross-sectional study included adults and AYA aged 20–79 and 12–19 years, respectively, from the National Health and Nutrition Examination Survey from 1999 to 2018. MASLD was defined as US Fatty Liver Index ≥30 in adults and alanine amino transaminase elevation and obesity in AYA. Joinpoint and logistic regression were used to evaluate the MASLD prevalence trend and its associated characteristics. MASLD was diagnosed in 17 156 892 of 51 109 914 (33.6%) adults and 1 705 586 of 29 278 666 AYA (5.8%). During the study period, MASLD prevalence significantly increased from 30.8% to 37.7% (P < 0.01) in adults and in subgroups of female participants, individuals aged 20–45 and 61–79 years, and non-Hispanic white individuals. Conversely, MASLD prevalence did not significantly change in AYA (from 5.1% to 5.2%, P = 0.139), except in the subgroup of Mexican Americans (from 8.2% to 10.8%, P = 0.01). Among adults, high MASLD prevalence was associated with male sex, Mexican American ethnicity, age >50 years, being unmarried, poverty income ratio <130, poor or fair health condition, obesity or overweight, and chronic conditions. Among AYA, high MASLD prevalence was associated with male sex, poverty income ratio <130, and education.

Conclusion
Accordingly, we concluded that health care providers should prevent and treat conditions associated with MASLD by raising awareness of the increasing trend of MASLD.
Referral for liver transplant following acute variceal bleeding: a multicenter cohort study
Authors: Bragança Sofia , Ramos Marta , Lopes Sara , Alexandrino Gonçalo , Mendes Milena , Perdigoto Rui , Coimbra João , Marques Hugo P. , Cardoso Filipe S. 
Published: March 2024

Objectives
Referral for liver transplant (LT) following acute variceal bleeding (AVB) varies widely. We aimed to characterize and assess its impact on clinical outcomes.

Methods
Observational retrospective cohort including cirrhosis patients with AVB from 3 hospitals in Lisbon, Portugal, from 2018 to 2019. Primary exposure was referral for LT and primary endpoint was all-cause mortality within 2 years of index hospital admission.

Results
Among 143 patients, median (IQR) age was 59 (52–72) years and 90 (62.9%) were males. Median (IQR) MELDNa scores on hospital admission and discharge were 15 (11–21) and 13 (10–16), respectively. Overall, 30 (21.0%) patients were assessed for LT, 13 (9.1%) prior to and 17 (11.9%) within 2 years of hospital admission. Overall, 58 (40.6%) patients had at least one potential contra-indication for transplant. LT was performed in 3 (2.1%) patients (among 5 listed). Overall, 34 (23.8%) and 62 (43.4%) patients died at 6 weeks and 2 years post hospital admission, respectively. Following adjustment for confounders, referral for LT was associated with lower 2-year mortality (aHR (95% CI) = 0.20 (0.05–0.85)).

Conclusion
In a multicenter cohort of cirrhosis patients with AVB, less than a quarter underwent formal LT evaluation. Improved referral for LT following AVB may benefit cirrhosis patients’ longer-term mortality.
Fatigue, depression, and sleep disorders are more prevalent in patients with metabolic-associated fatty liver diseases
Authors: Mostafa Alaa M. , Hafez Shaimaa Moustafa , Abdullah Noha M. , Fouad Yasser 
Published: March 2024

Patients with metabolic-associated fatty liver disorders (MAFLD) report feeling fatigued. It adversely affects their mortality, morbidity, and health-related quality of life (HRQL).

Aim
To determine the prevalence and risk factors for depression, sleep disturbances, and exhaustion in MAFLD patients.

Methods
Two hundred twenty-four consecutive patients with MAFLD attending the outpatient clinic from April to October 2023; were subjected to clinical evaluation, laboratory testing including non-invasive laboratory markers, fibroscan (measuring steatosis and fibrosis), and different quantitative and qualitative fatigue scores. A control group including 342 patients without MAFLD was taken.

Results
The prevalence of fatigue, depression, and sleeping disorders in the MAFLD group was 67.8%, 75%, 62.5% vs 21%, 16.4%, and 19.5% in the control group respectively (P = <0.001, P = <0.001 and P = <0.001). MAFLD with fatigue was significantly associated with the presence and severity of steatosis and fibrosis by fibroscan (P = <0.0001). By univariate and multivariate analysis: age, BMI, waist circumference, T2DM, hypertension, steatosis, fibrosis, and Fib-4 were considered risk factors for fatigue in the MAFLD group. The age, high social level, diabetes, hypertension, steatosis, fibrosis, and fib-4 were considered, by univariate and multivariate analysis, independent risk factors for depression in the MAFLD group. age, BMI, waist circumference, diabetes, hypertension, steatosis, fibrosis, and fib-4 were independent risk factors for sleep disorders in MAFLD.

Conclusion
Fatigue, sleeping disorders, and depression are more prevalent in MAFLD patients than in the general population. The lower health utility scores in patients with MAFLD are associated with more advanced stages of the disease.
Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an Emergency Room Setting
Authors: Dubinin Alexandra , Bialostozky Mario , Richardson Andrew , Laub Natalie 
Published: March 2024

Objectives
Rates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time.

Methods
Retrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) “ingestion” versus those without.

Results
Of the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an “ingestion” CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with “ingestion” CC were less likely to be reported to Child Protective Services.

Conclusions
Pediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
Early Diagnosis of Rare Diaphragmatic Synovial Sarcoma in a Pediatric Patient With Epigastric Pain Using Point-of-Care Ultrasound
Authors: Rong Katie , Good Amanda , Chicaiza Henry , Jones Ruchika Mohla 
Published: March 2024

Abstract
Synovial cell sarcoma is a rare mesenchymal tumor that typically originates from the soft tissues of the extremities of young adults. Only 3 cases of primary diaphragmatic synovial cell sarcoma have been described in the literature: 2 in adult males and 1 in a 12-year-old pediatric patient.1–3 When this tumor is found in the mediastinum or pericardial region, prognosis is historically poor because of the advanced disease stage at time of diagnosis. The surgical course and pathology have been described in this 12-year-old boy.3 This is the first case, to our knowledge, of the use of cardiac point-of-care ultrasound in the early identification and diagnosis of a primary diaphragmatic synovial sarcoma in a pediatric patient.