bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence rates of bladder and kidney cancers among US military servicemen: comparison with the rates in the general US population
Authors: Bytnar Julie A. , McGlynn Katherine A. , Kern Sean Q. , Shriver Craig D. , Zhu Kangmin 
Published: April 2024

Objective
The military population may differ from the general population in factors related to bladder and kidney cancers. However, incidence rates of these cancers have not been systematically compared between the two populations. This study compared incidence rates of bladder and kidney cancers between active-duty servicemen and men in the general US population.

Methods
Data were obtained from the Department of Defense’s Automated Central Tumor Registry (ACTUR) and the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database. Included were 18–59-year-old active-duty servicemen in ACTUR and men in SEER who were diagnosed with malignant bladder and kidney cancers from 1990 to 2013. Age-adjusted rates, incidence rate ratios (IRR) and their 95% confidence intervals (95% CI) were compared between the two populations by age, race, and cancer stage.

Results
Incidence rates were lower in ACTUR than SEER for bladder cancer overall (IRR = 0.55, 95% CI, 0.48–0.62) and by age (except ages 50–59), race, and tumor stage. For ages 50–59, rates did not differ between the populations. Kidney cancer incidence rates were lower in the military for younger groups and Black men, but higher for ages 50–59.

Conclusion
Lower bladder and kidney cancer incidence in ACTUR, notably in younger men, may be primarily associated with better health and healthcare access. The lack of differences in bladder or kidney cancer incidence among 50–59-year-old men between the populations might result from multifactorial effects, such as the possible effects of cumulative military-related exposures offset by healthier status and better medical care.
Validation of ICD-10 Codes for Severe Maternal Morbidity at Delivery in a Public Hospital
Authors: Boulet Sheree L. , Stanhope Kaitlyn K. , Valdez-Sinon Arielle N. , Vuncannon Danielle , Preslar Jessica , Bergbower Hannah , Gray Brendan , Gathoo Asmita , Hansen Nora , Andre Kerri , Bensouda Sabrine , Braun Cally , Platner Marissa 
Published: April 2024

Background:
Severe maternal morbidity is a composite measure of serious obstetric complications that is often identified in administrative data using the International Classification of Diseases (ICD) diagnosis and procedure codes for a set of 21 indicators. Prior studies of screen-positive cases have demonstrated low predictive value for ICD codes relative to the medical record. To our knowledge, the validity of ICD-10 codes for identifying severe maternal morbidity has not been fully described.

Methods:
We estimated the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-10 codes for severe maternal morbidity occurring at delivery, compared with medical record abstraction (gold standard), for 1,000 deliveries that took place during 2016–2018 at a large, public hospital.

Results:
We identified a total of 67 cases of severe maternal morbidity using the ICD-10 definition and 74 cases in the medical record. The sensitivity was 26% (95% confidence interval [CI] = 16%, 37%), the positive predictive value was 28% (95% CI = 18%, 41%), the specificity was 95% (95% CI = 93%, 96%), and the negative predictive value was 94% (95% CI = 92%, 96%).

Conclusions:
The validity of ICD-10 codes for severe maternal morbidity in our high-burden population was poor, suggesting considerable potential for bias.
Science-informed Policy Making for Protecting People and the Environment from Radiation
Authors: Borrego David , Nagata Jonathan S. , Boyd Michael A. , DeCair Sara D. , Matakas Lauren R. , Wang Ellen W. , Pawel David J. , Ansari Armin J. 
Published: April 2024

Abstract
The process to arrive at the radiation protection practices of today to protect workers, patients, and the public, including sensitive populations, has been a long and deliberative one. This paper presents an overview of the US Environmental Protection Agency’s (US EPA) responsibility in protecting human health and the environment from unnecessary exposure to radiation. The origins of this responsibility can be traced back to early efforts, a century ago, to protect workers from x rays and radium. The system of radiation protection we employ today is robust and informed by the latest scientific consensus. It has helped reduce or eliminate unnecessary exposures to workers, patients, and the public while enabling the safe and beneficial uses of radiation and radioactive material in diverse areas such as energy, medicine, research, and space exploration. Periodic reviews and analyses of research on health effects of radiation by scientific bodies such as the National Academy of Sciences, National Council on Radiation Protection and Measurements, United Nations Scientific Committee on the Effects of Atomic Radiation, and the International Commission on Radiological Protection continue to inform radiation protection practices while new scientific information is gathered. As a public health agency, US EPA is keenly interested in research findings that can better elucidate the effects of exposure to low doses and low dose rates of radiation as applicable to protection of diverse populations from various sources of exposure. Professional organizations such as the Health Physics Society can provide radiation protection practitioners with continuing education programs on the state of the science and describe the key underpinnings of the system of radiological protection. Such efforts will help equip and prepare radiation protection professionals to more effectively communicate radiation health information with their stakeholders.
Meta-Analysis of Endoscopic Full-Thickness Resection Versus Endoscopic Submucosal Dissection for Complex Colorectal Lesions
Authors: Singh Sahib , Mohan Babu P. , Vinayek Rakesh , Dutta Sudhir , Dahiya Dushyant S. , Gangwani Manesh K. , Suresh Kumar Vishnu C. , Aswath Ganesh , Bhat Ishfaq , Inamdar Sumant , Sharma Neil , Adler Douglas G. 
Published: April 2024

Background:
Studies evaluating endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD) for complex colorectal lesions have shown variable results. We conducted a meta-analysis of the available data.

Methods:
Online databases were searched for studies comparing EFTR versus ESD for complex colorectal lesions. The outcomes of interest were resection rates, procedure time (min), and complications. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CI were calculated.

Results:
A total of 4 studies with 530 patients (n=215 EFTR, n=315 ESD) were included. The mean follow-up duration was 5 months. The mean age of the patients was 68 years and 64% were men. The EFTR and ESD groups had similar rates of en bloc resection (OR: 1.73, 95% CI: 0.60-4.97, P=0.31) and R0 resection (OR: 1.52, 95% CI: 0.55-4.14, P=0.42). The EFTR group had significantly reduced procedure time (SMD -1.87, 95% CI: -3.13 to -0.61, P=0.004), total complications (OR: 0.24, 95% CI: 0.13-0.44, P<0.00001), perforation (OR: 0.12, 95% CI: 0.03-0.39, P=0.0005) and postresection electrocoagulation syndrome (OR: 0.06, 95% CI: 0.01-0.48, P=0.008). Delayed bleeding was similar in the 2 groups (OR: 0.80, 95% CI: 0.30-2.12, P=0.66). Residual/recurrent lesions were significantly higher in the EFTR group (OR: 4.67, 95% CI: 1.39-15.66, P=0.01).

Discussion:
This meta-analysis of small studies with high heterogeneity showed that EFTR and ESD have comparable resection rates for complex colorectal lesions. EFTR is faster and has fewer complications, but it increases residual or recurrent lesions.
Craniofacial Fibrous Dysplasia: Experience at San José Hospital, Bogotá, Colombia
Authors: Cantini J. Ernesto , Vergel M. Fernanda , Tapiero Xiomara , Gómez-Ortega Viviana 
Published: April 2024

Introduction:
Fibrous dysplasia is a disorder in which normal bone is gradually replaced by immature fibro-osseous tissue, with an incidence of less than 7% of all benign bone tumors. The management of this disease is a challenge for plastic surgeons and neurosurgeons.

Goal:
To describe the diagnostic, therapeutic, and outcome approach of patients with craniofacial fibrous dysplasia seen at the Plastic Surgery Service of the Hospital San José in Bogotá, Colombia.

Methods:
This is a descriptive and retrospective case series study of patients diagnosed with monostotic and polyostotic fibrous dysplasia treated at the Plastic Surgery Department of Hospital San José during the period from January 1, 2010, to July 31, 2023.

Results:
All (n=10) of the patients had monostotic craniofacial fibrous dysplasia. The most affected bones in patients with monostotic fibrous dysplasia were zone I bones (n=10, 100%), followed by zone II bones (n=2, 20%). Patients with zone I and II involvement manifested throbbing headaches associated with phosphenes and tinnitus (n=8, 80%) and pain during occlusion associated with edema in the affected cheek (n=5, 50%). Physical examination showed that patients with orbital wall involvement (zone I bone) had ocular dystopia (n=7, 70%).
Regarding the treatment received by the patients, 90% (n=9) of the patients received surgical management as primary treatment, with orbitotomy, replacement, and/or remodeling of the roof and lateral wall of the orbit with bone graft, drilling, canthoplasty, ciliary suspension being the most frequently performed procedure (n=6, 60%). Of the patients, 20% (n=2) required reintervention.

Conclusions:
FD is a slowly progressive benign fibro-osseous disease that requires a timely, individualized, and multidisciplinary diagnosis and treatment to obtain favorable clinical and surgical results.
The mainstay of treatment is surgery as a preventive measure since it is important to avoid future functional alterations that, depending on the location of the dysplasia, would cause a high risk of alteration of adjacent structures.
Treatment discontinuation in older people with multiple sclerosis
Authors: Zhu Wen , Xia Zongqi 
Published: April 2024

Purpose of review
The aim of this review was to examine the evidence for disease-modifying therapies (DMTs) discontinuation in older people with multiple sclerosis (MS). We first summarized aging-associated biological changes that influence MS progression and DMT effectiveness, and then summarized recent evidence in evaluating clinical outcomes of discontinuing DMTs in older people with MS.

Recent findings
Recent findings provide mixed evidence regarding the outcomes of DMT discontinuation in older people with MS. Retrospective observational studies suggested older age and longer stable duration on DMT before DMT discontinuation were associated with lower risk of relapse in people with MS. However, one randomized clinical trial did not demonstrate the noninferiority of DMT discontinuation.

Summary
The available clinical evidence examining DMT discontinuation in older people with MS remains inconclusive. More robust evidence from clinical trials and real-world data will be necessary to guide clinical decisions regarding DMT discontinuation in older people with MS.
Rest the Brain to Learn New Gait Patterns after Stroke
Authors: Krishnan Chandramouli , Augenstein Thomas E. , Claflin Edward S. , Hemsley Courtney R , Washabaugh Edward P. , Ranganathan Rajiv 
Published: April 2024

AbstractBackgroundThe ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these prior studies could have been confounded by the presence of significant motor impairments and/or have not focused on motor acuity tasks (i.e., tasks focusing on the quality of executed actions) that have direct functional relevance to rehabilitation.MethodsTwenty-five participants (10 stroke; 15 controls) were recruited for this prospective, case-control study. Participants learned a novel foot-trajectory tracking task on two consecutive days while walking on a treadmill. On day 1, participants learned a new gait pattern by performing a task that necessitated greater hip and knee flexion during the swing phase of the gait. On day 2, participants repeated the task with their training leg to test retention. An average tracking error was computed to determine online and offline learning and was compared between stroke survivors and uninjured controls.ResultsStroke survivors were able to improve their tracking performance on the first day (p=0.033); however, the amount of learning in stroke survivors was lower in comparison with the control group on both days (p≤0.05). Interestingly, the offline gains in motor learning were higher in stroke survivors when compared with uninjured controls (p=0.011).ConclusionsThe results suggest that even high-functioning stroke survivors may have difficulty acquiring new motor skills related to walking, which may be related to the underlying neural damage caused at the time of stroke. Furthermore, it is likely that stroke survivors may require longer training with adequate rest to acquire new motor skills, and rehabilitation programs should target motor skill learning to improve outcomes after stroke.
Biologically informed machine learning modeling of immune cells to reveal physiological and pathological aging process
Authors: Zhang Cangang , Ren Tao , Zhao Xiaofan , Su Yanhong , Wang Qianhao , Zhang Tianzhe , He Boxiao , Wu Ling-Yun , Sun Lina , Zhang Baojun , Xia Zheng 
Published: April 2024

AbstractThe immune system undergoes progressive functional remodeling from neonatal stages to old age. Therefore, understanding how aging shapes immune cell function is vital for precise treatment of patients at different life stages. Here, we constructed the first transcriptomic atlas of immune cells encompassing human lifespan, ranging from newborns to supercentenarians, and comprehensively examined gene expression signatures involving cell signaling, metabolism, differentiation, and functions in all cell types to investigate immune aging changes. By comparing immune cell composition among different age groups, HLA highly expressing NK cells and CD83 positive B cells were identified with high percentages exclusively in the teenager (Tg) group, whereas CD4_CTL precursors were exclusively enriched in the supercentenarian (Sc) group. Notably, we found that the biological age (BA) of pediatric COVID-19 patients with multisystem inflammatory syndrome accelerated aging according to their chronological age (CA). Besides, we proved that inflammatory shift-myeloid abundance and signature correlate with the progression of complications in Kawasaki disease (KD). Finally, based on those age-related immune cell compositions, we developed a novel BA prediction model, PHARE (https://xiazlab.org/phare/), which applies to both scRNA-seq and bulk RNA-seq data. Overall, our study revealed changes in immune cell proportions and function associated with aging, both in health and disease, and provided a novel tool for successfully capturing features that accelerate or delay aging.
Population growth poses a significant threat to forest ecosystems: a case study from the Hindukush-Himalayas of Pakistan
Authors: Alam Naveed , Ullah Zahid , Ahmad Bilal , Ali Ahmad , Syed Kashmala 
Published: April 2024

AbstractHuman population growth and associated increases in anthropogenic activities pose a significant threat to forest ecosystems by diminishing the natural ecosystem services these systems provide. Malam Jabba is located in District Swat Pakistan’s Hindukush-Himalayan temperate zone, which is renowned for ecotourism and skiing and is rich in timber-producing tree species, medicinal plants, and unique biodiversity; however, the majority of Swat Valley’s population relies on Malam Jabba forests for their timber & fuelwood requirements. We examined how the deforestation rate increased with increasing human population density in Pakistan’s Malam Jabba area of the Hindukush-Himalayas. To identify the forest cover, remote sensing, and geographic information systems were used (RS & GIS). The study area’s vegetation was analyzed with the Normalized Divergence Vegetation Index (NDVI) using multitemporal satellite images for the years 1980, 2000, and 2020. The deforestation rate from 1980 to 2020 was then determined using the decay model, and the MATLAB program was used to predict the deforestation rate for the following two decades in relation to the anticipated growth in the human population. Our result revealed that, in the last two decades, the average rate of deforestation increased from 0.7% to 1.93% per year, while the human population of District Swat increased from 1.2 to 2.3 million at a rate of 9% per year. The decay model predicts that the study area’s deforestation rate will increase to 2.5% per year over the next two decades due to the forecasted 11.6% per year population growth rate. Human population growth in District Swat, Pakistan has seriously threatened the nearby forest ecosystems, and a future increase in human population will further accelerate anthropogenic activities like unsustanible tourism, fuel and timber wood collection and urbanization. Based on our results, we recommend that: (i) in addition to reforestation programs and sustainable use of forest resources, the government should implement a long-term forest management plan (ii) where the density of forest cover can be sustained at an equilibrium level dependent of population growth pressure (iii) and areas with extreme human pressure should be designated as most important for in situ conservation approach.
Laboratory-based surveillance of non-tuberculous mycobacterial pulmonary disease in Japan
Authors: Hamaguchi Yuko , Morimoto Kozo , Mitarai Satoshi 
Published: April 2024

AbstractBackgroundIntractable pulmonary diseases with non-tuberculous mycobacteria (NTM-PDs) and antimicrobial resistance have become increasingly concerning worldwide. Nevertheless, a surveillance system for NTM has not been established in most countries, thus requiring repeated, intermittent, and time-consuming cross-sectional nationwide surveys.MethodsTo establish a nationwide surveillance system for NTM-associated diseases, we aimed to develop a prototype computer system primarily designed to continuously estimate NTM-PD incidence using a bacteriological case-defining algorithm through an automatic process of integrating bacteriological data collected from microbiology laboratories across Japan. To validate the accuracy of our study results, we compared the distribution of pulmonary TB cases between our laboratory data and the national surveillance data, which is representative of the Japanese population.ResultsOur estimates implied a 17.7% increase in NTM-PD incidence from 15.8 [14.9–16.8] in 2013 to 19.2 [18.2–20.4] in 2017, per 100,000 population. Moreover, 93.0% of the identified NTM-PD cases were dominated by theMycobacterium avium-intracellularecomplex, and the proportion ofM. abscessusspecies exceeded that ofM. kansasiifor the first time in Japan. We also revealed significant age and sex differences in NTM-PDs. Notably, we found similar characteristics between our laboratory data and national surveillance data covering almost the entire Japanese population.ConclusionThese findings, despite being laboratory-based, are extrapolatable to the general population in Japan and provide evidence that supports our system as a viable alternative to the nationwide NTM surveillance system.
Endovascular thrombectomy for acute ischemic stroke with a large infarct area: an updated systematic review and meta-analysis of randomized controlled trials
Authors: Ravipati Shivani , Amjad Ayesha , Zulfiqar Komal , Biju Hannah , Hassan Wajeeh , Jafri Haider Mumtaz , Husnain Ali , Tahir Ibrahim , Aslam Muaaz , Afzal Sharib , Ehsan Muhammad , Cheema Huzaifa Ahmad , Ayyan Muhammad , Rehman Wajeeh Ur , Dani Sourbha S. 
Published: April 2024

AbstractBackgroundSince the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone.MethodsWe searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs).ResultsOur meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up.. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69).ConclusionEndovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients with acute ischemic stroke with a large infarct area (ASPECTS 3-5) compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.
Evaluating self-triage accuracy of laypeople, symptom-assessment apps, and large language models: A framework for case vignette development using a representative design approach (RepVig)
Authors: Kopka Marvin , Napierala Hendrik , Privoznik Martin , Sapunova Desislava , Zhang Sizhuo , Feufel Markus A. 
Published: April 2024

AbstractMost studies evaluating symptom-assessment applications (SAAs) rely on a common set of case vignettes that are authored by clinicians and devoid of context, which may be representative of clinical settings but not of situations where patients use SAAs. Assuming the use case of self-triage, we used representative design principles to sample case vignettes from online platforms where patients describe their symptoms to obtain professional advice and compared triage performance of laypeople, SAAs, and Large Language Models (LLMs) on representative versus standard vignettes. We found performance differences in all three groups depending on vignette type (OR = 1.27 to 3.41, p < .001 to .035) and changed rankings of best-performing SAAs and LLMs. Based on these results, we argue that our representative vignette sampling approach (that we call the RepVig Framework) should replace the practice of using a fixed vignette set as standard for SAA evaluation studies.