bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detecting isolated cognitive relapses in persons with MS
Authors: Morrow Sarah A , Weinstock Zachary L , Mirmosayyeb Omid , Conway Devon , Fuchs Tom , Jaworski Michael G , Eckert Sveltlana , Hojnacki David H , Dwyer Michael G , Zivadinov Robert , Weinstock-Guttman Bianca , Benedict Ralph H B 
Published: September 2023

Background: The existence of isolated cognitive relapses (ICRs) in persons with MS (PwMS) has been debated. Objective: To examine relapses with decline on Symbol Digit Modalities Test (SDMT) but no change on Expanded Disability Status Scale (EDSS). Methods: This 3-year prospective cohort study identified PwMS experiencing a relapse with decrease on SDMT. Participants with SDMT decline/stable EDSS were labeled “ICR,” while those with a corresponding decrease on EDSS were classified “Relapse with Cognitive Decline (RCD).” Two definitions of SDMT decline were explored: (1) ⩾ 8 points, and (2) ⩾ 4 points. Logistic regression was used to analyze the relationship between ICR and RCD. Results: The full cohort had 592 participants: 83 experienced relapses; 22 (26.5%) had an SDMT decrease of ⩾ 8 points; 14 (63.6%) met ICR criteria. Logistic regression (X2(1) = 5.112, p = 0.024) using demographics and disease characteristics explained 28.4% of the variance in ICR versus RCD. Only the MS Neuropsychological Questionnaire was associated with ICR (odds ratio (OR): 8.6; 95% confidence interval (CI): 1.1–16.4) 40 relapsing participants with SDMT decrease of ⩾ 4 points were identified: 26 (65%) had a stable EDSS (ICR). Logistic regression did not find any variable predictive of ICR. Conclusion: This prospective study demonstrates evidence of ICR in PwMS.
The Role of Mechanical Thrombectomy for Acute Massive Pulmonary Embolism in a Patient With Unilateral Lung Transplant and Atrial Septal Defect
Authors: Altun Izzet , Zhao Yuanlong , Basnet Suresh , Raymond Aislynn , Fang Adam , Nezami Nariman 
Published: September 2023

Purpose: The risk of thromboembolic disease is high in patients with lung transplantation and is associated with significant morbidity and mortality with single healthy transplanted lung. We present a case involving successful endovascular management of life-threatening acute massive pulmonary embolism (PE) in a patient with single lung transplant and atrial septal defect (ASD). Case Report: A 65-year-old man with a history of interstitial lung disease status post single left orthotopic lung transplant in 2012 presented with acute massive PE and clot burden in the pulmonary arteries of the transplanted left lung. Severe right heart dysfunction, hemodynamic instability, and requirement for vasopressors persisted post systemic thrombolytic therapy. As a result, the patient underwent successful endovascular mechanical thrombectomy with immediate improvement in oxygen saturation and hemodynamic status. The procedure was performed without adverse outcomes or paradoxical embolization despite the presence of ASD. The right heart dysfunction resolved, the patient was extubated the next day, and was discharged to home 2 days post procedure. Conclusions: Endovascular mechanical thrombectomy was safely used to treat acute massive PE in a single transplanted lung in the presence of ASD. Clinical Impact Endovascular mechanical thrombectomy could be safely utilized to treat patients with lung transplant and acute massive or submassive pulmonary embolism. However, safely of mechanical thrombectomy should be determined in case-based scenarios and based on time interval from transplantation to when the thrombectomy is required.
Dentists’ Approaches to Treatment Decision-Making for People with Dementia: A Qualitative Study
Authors: Geddis-Regan A. , Abley C. , Exley C. , Wassall R. 
Published: September 2023

Introduction: Globally, the number of people living with dementia (PLwD) is projected to increase substantially. Dentists will encounter an increasing number of PLwD retaining natural teeth who need dental care. Dental treatment planning can be complex for PLwD as both oral diseases and dental treatment can be detrimental to patients’ oral and social function and comfort. In addition, patients may lack the capacity to make decisions about their treatment, posing further challenges for dentists. Objective: This study aimed to explore dentists’ approach to treatment decision-making with or for PLwD. Methods: Semistructured one-to-one interviews were completed with 22 dentists between April 2020 and March 2021. Data generation and analysis followed the principles of constructivist grounded theory with data being collected and analyzed simultaneously using a maximum variation sample. Interviews were recorded, transcribed verbatim, and then analyzed, leading to a theoretical understanding of how dentists approach treatment decisions for PLwD. Results: Four data categories describe dentists’ approaches to treatment decision-making for PLwD. Dentists sought to provide individualized care for PLwD. However, they described planning care based on risk-benefit analyses that primarily considered biomedical factors and generic assumptions. There was an underemphasis on the psychological or social implications of dental care or its delivery. Furthermore, while some dentists attempted to involve patients in treatment decisions, they reported fewer attempts to identify the views and preferences of PLwD identified as lacking decisional capacity. In this scenario, dentists reported leading the decision-making process with little regard for patients’ known or identified preferences and minimal involvement of PLwD’s family. Conclusions: Dentists acknowledge the complexity in treatment decision-making for PLwD yet focused heavily on biomedical considerations, with an underemphasis on individuals’ preferences and autonomy. Considering psychosocial aspects of care alongside biomedical factors is essential to support holistic person-centered care for this growing patient cohort. Knowledge Transfer Statement: This study highlighted that dentists may only be considering biomedical aspects of care when considering what treatment is appropriate for people living with dementia. When making or supporting treatment decisions, dentists should explore patients’ preferences and actively consider relevant psychosocial factors. These can be actively identified through considered discussions with patients as well as their family members. Gathering this information should support more person-centered and value-concordant decision-making for people living with dementia.
Trends in hemorrhagic stroke incidence and mortality in a National Stroke Registry of a multi-ethnic Asian population
Authors: Lim Mervyn Jun Rui , Zheng Huili , Zhang Zheting , Sia Ching Hui , Tan Benjamin Yong-Qiang , Hock Ong Marcus Eng , Nga Vincent Diong Weng , Yeo Tseng Tsai , Ho Andrew Fu Wah 
Published: September 2023

Introduction: High-quality epidemiological data on hemorrhagic stroke (HS) and its subtypes, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), remains limited in Asian ethnicities. We investigated the trends in HS incidence and 30-day mortality from 2005 to 2019 in a multi-ethnic Asian population from a national registry. Patients and methods: Data on all stroke cases from the Singapore Stroke Registry from 2005 to 2019 were collected. Cases were defined using centrally adjudicated review of diagnosis codes. Death outcomes were obtained by linkage with the national death registry. Incidence (per 100,000 people) and 30-day mortality (per 100 people) were measured as crude and age-standardized rates. Trends were analyzed using linear regression. Results: We analyzed 19,017 cases of HS (83.9% ICH; 16.1% SAH). From 2005 to 2019, age-standardized incidence rates (ASIR) for HS remained stable from 34.4 to 34.5. However, age-standardized mortality rates (ASMR) decreased significantly from 29.5 to 21.4 ( p < 0.001). For ICH, ASIR remained stable while ASMR decreased from 30.4 to 21.3 ( p < 0.001); for SAH, ASIR increased from 2.7 to 6.0 ( p = 0.006) while ASMR remained stable. In subgroup analyses, HS incidence increased significantly in persons <65 years (from 18.1 to 19.6) and Malays (from 39.5 to 49.7). Discussion: From 2005 to 2019, ASIR of HS remained stable while ASMR decreased. Decreasing ASMR reflects improvements in the overall management of HS, consistent with global trends. Conclusion: Population health efforts to address modifiable risk factors for HS in specific demographic subgroups may be warranted to reduce incidence and mortality of HS.
Effects of allyl isothiocyanate fumigation on medicinal plant root knot disease control, plant survival, and the soil bacterial community
Authors: Li Yingbin , Lu Daqing , Xia Yan , Xu Xinjing , Huang Huichuan , Mei Xinyue , Yang Min , Li Jianqiang , Zhu Shusheng , Liu Yixiang , Zhang Zhiping 
Published: September 2023

Abstract
Background
Allyl isothiocyanate (AITC) is a natural product with high volatility that is used as a biofumigant to alleviate soil-borne plant diseases, and problems such as root knot nematodes (RKNs) that necessitate continuous cropping. However, little research has assessed the effects of AITC fumigation on medicinal plants.

Results
AITC significantly reduced the population of RKNs in soil (p < 0.0001) and showed an excellent RKN disease control effect within 6 months after sowing Panax notoginseng (p < 0.0001). The seedling survival rate of 2-year-old P. notoginseng was approximately 1.7-fold higher after soil treatment with AITC (p = 0.1008). 16S rRNA sequencing indicated that the AITC treatment affected bacterial richness rather than diversity in consecutively cultivated (CC) soil. Furthermore, biomarkers with statistical differences between AITC-treated and untreated CC soil showed that Pirellulales (order), Pirellulaceae (family), Pseudomonadaceae (family), and Pseudomonas (genus) played important roles in the AITC-treated group. In addition, the microbiome functional phenotypes predicted using the BugBase tool suggested that AITC treatment is more conducive to improving CC soil through changes in the bacterial community structure. Crucially, our research also suggested that AITC soil treatment significantly increases soil organic matter (p = 0.0055), total nitrogen (p = 0.0054), and available potassium (p = 0.0373), which promotes the survival of a succeeding medicinal plant (Polygonatum kingianum).

Conclusion
AITC is an ecologically friendly soil treatment that affects the top 10 bacterial richness but not diversity. It could also provide a basis for a useful agricultural soil management measure to alleviate soil sickness.
Comparing exercise determinants between Black and White older adults with heart failure
Authors: Kaushal Navin , Nemati Donya , Mann-Krzisnik Dylan , de la Colina Adrián Noriega 
Published: September 2023

Abstract
Background
Heart Failure is a leading cause of mortality among older adults. Engaging in regular exercise at moderate-to-vigorous intensity has been shown to improve survival rates. Theory-informed methodologies have been recommended to promote exercise, but limited application of theoretical framework has been conducted for understanding racial disparities among older adults with heart failure. This study aimed to use the Health Belief Model to compare exercise behavior determinants between Black and White older adults diagnosed with heart failure.

Methods
The HF-ACTION Trial is a multi-site study designed to promote exercise among individuals with heart failure that randomized participants to an experimental (three months of group exercise sessions followed by home-based training) or control arm. The present study used structural equation modeling to test the change in Health Belief Model constructs and exercise behavior across 12 months among older adults.

Results
Participants (n = 671) were older adults, 72.28 (SD = 5.41) years old, (Black: n = 230; White, n = 441) diagnosed with heart failure and reduced ejection fraction. The model found perceived benefits, self-efficacy, perceived threats, and perceived barriers to predict exercise behavior among Black and White older adults. However, among these constructs, only perceived benefits and self-efficacy were facilitated via intervention for both races. Additionally, the intervention was effective for addressing perceived barriers to exercise only among White participants. Finally, the intervention did not result in a change of perceived threats for both races.

Conclusions
Among health belief model constructs, perceived threats and barriers were not facilitated for both races in the experimental arm, and the intervention did not resolve barriers among Black older adults. Racial differences need to be considered when designing interventions for clinical populations as future studies are warranted to address barriers to exercise among Black older adults with heart failure.
Surgical treatment of preauricular fistulas: a 12-year single-center clinical observation
Authors: Li Ke , Hao Yan , Zhao Jiuzhou , Zhou Leping , Wu Yongyan , Zeng Xianhai , Gao Wei , Zhang Xiangmin 
Published: September 2023

Abstract
Objective
This study aimed to assess the effects of surgical timing and approach on operative duration, postoperative suture removal time, and postoperative recurrence rate in the management of preauricular fistula. A 12-year single-center clinical observation was conducted to analyze the potential effects of different surgical strategies on these critical outcomes.

Methods
The clinical data from 576 (782 ears) patients who underwent surgical resection for preauricular fistulas were examined in this retrospective study. The patients were classified into various groups based on differences in operative duration, surgical techniques and the use of intraoperative magnifying equipment. Furthermore, the specific data on operative duration, postoperative suture removal time, and postoperative recurrence rate were also recorded.

Results
The average operative duration for 782 ears and the average time required for postoperative suture removal were determined to be (34.57 ± 4.25) min and (3.62 ± 0.76) days, respectively. Among the cases examined, recurrence occurred in 13 ears, but all of them were cured after a second surgery, resulting in a recurrence rate of 1.67% (13/782). Interestingly, the operative and postoperative suture removal time was prolonged during the infection period (P < 0.05). The postoperative recurrence rate was significantly higher in the absence of magnifying equipment, as compared to those with the use of a microscope with 2.5× magnification (P < 0.05). No statistically significant differences were noted in the recurrence rate when comparing different anesthesia methods and types of surgical incisions, as well as the intraoperative use of methylene blue, and partial removal of cartilage of the pedicle (P > 0.05).

Conclusion
The use of methylene blue, partial removal of the cartilage of the pedicle, and surgical incision during preauricular fistula resection did not affect the operative duration, postoperative suture removal time, and postoperative recurrence rate. Therefore, surgeons can select their preferred approaches based on their individual practices and patient-specific situations. However, the use of magnifying equipment during surgery is associated with a reduced risk of recurrence.
Active surveillance should be considered for select men with Grade Group 2 prostate cancer
Authors: Pekala Kelly R. , Bergengren Oskar , Eastham James A. , Carlsson Sigrid V. 
Published: September 2023

Abstract
Background
Treatment decisions for localized prostate cancer must balance patient preferences, oncologic risk, and preservation of sexual, urinary and bowel function. While Active Surveillance (AS) is the recommended option for men with Grade Group 1 (Gleason Score 3 + 3 = 6) prostate cancer without other intermediate-risk features, men with Grade Group 2 (Gleason Score 3 + 4 = 7) are typically recommended active treatment. For select patients, AS can be a possible initial management strategy for men with Grade Group 2. Herein, we review current urology guidelines and the urologic literature regarding recommendations and evidence for AS for this patient group.

Main body
AS benefits men with prostate cancer by maintaining their current quality of life and avoiding treatment side effects. AS protocols with close follow up always allow for an option to change course and pursue curative treatment. All the major guideline organizations now include Grade Group 2 disease with slightly differing definitions of eligibility based on risk using prostate-specific antigen (PSA) level, Gleason score, clinical stage, and other factors. Selected men with Grade Group 2 on AS have similar rates of deferred treatment and metastasis to men with Grade Group 1 on AS. There is a growing body of evidence from randomized controlled trials, large observational (prospective and retrospective) cohorts that confirm the oncologic safety of AS for these men. While some men will inevitably conclude AS at some point due to clinical reclassification with biopsy or imaging, some men may be able to stay on AS until transition to watchful waiting (WW). Magnetic resonance imaging is an important tool to confirm AS eligibility, to monitor progression and guide prostate biopsy.

Conclusion
AS is a viable initial management option for well-informed and select men with Grade Group 2 prostate cancer, low volume of pattern 4, and no other adverse clinicopathologic findings following a well-defined monitoring protocol. In the modern era of AS, urologists have tools at their disposal to better stage patients at initial diagnosis, risk stratify patients, and gain information on the biologic potential of a patient’s prostate cancer.
Diabetes knowledge and associated factors in adolescents and young adults with type 1 diabetes in Ouagadougou (Burkina Faso)
Authors: Zemba Daniel , Sagna Yempabou , Traore Solo , Zoungrana Lassane , Somé D. Patricia , Kissou S. Aimée , Guira Oumar , Yaméogo Téné Marceline 
Published: September 2023

Abstract
Background
Type 1 diabetes (T1D) in youth is becoming a public health problem in Sub-Saharan Africa, including Burkina Faso. However, little is known about the level of knowledge of these patients on T1D. This study aimed to evaluate the knowledge of diabetes in adolescents and young adults about the disease, and identify the factors associated in Burkina Faso.

Methods
A cross-sectional survey was conducted from April to June 2020 among youth with T1D, aged 10 to 30 years, and regularly followed in the internal medicine department of Yalgado Ouedraogo University Hospital of Ouagadougou, Burkina Faso. Data were collected using the French AJD (Aide aux Jeunes Diabétiques) validated diabetes knowledge and skills (DKS) questionnaire designed to test participants’ accuracy in knowledge about six different themes of T1D, as generalities of diabetes, hypoglycemia and hyperglycemia, management of insulin treatment, and self-monitoring blood glucose (SMBG). DKS level was determined by calculating the scores, and univariate and multivariate logistic regression were used to explore factors influencing DKS scores. This level was classified as insufficient or low ≤ 25/50, regular 26–39/50, and adequate or good ≥ 40/50.

Results
Sixty-three participants with a mean age of 19.05 years and a sex ratio (W/M) of 1.17 were included in our study. The mean HbA1c level was 9.79%, and 43 (68.23%) patients had an insufficient DKS level. The mean global DKS score of correct answers was 23.63/50. The percentage of correct answers was respectively 50% for the item “generalities of diabetes”, 32.4% for the item “hypoglycemia and hyperglycemia”, 67.72% for the item “diet”, 37.34% for the item “management of insulin treatment” and 44.97% for the item “SMBG”. In univariate analysis, a better patient DKS level was associated with university education and long duration of diabetes care follow-up (> 10 years, p < 0.05). Only increasing age remain associated with a better knowledge score (p < 0.05) in multivariate analysis.

Conclusion
This study is an important first step in identifying areas for intervention efforts about therapeutic education for youth with type I diabetes in Burkina Faso.
KIF15 missense variant is associated with the early onset of idiopathic pulmonary fibrosis
Authors: Hollmén Maria , Laaka Atte , Partanen Juulia J. , Koskela Jukka , Sutinen Eva , Kaarteenaho Riitta , Ainola Mari , Myllärniemi Marjukka 
Published: September 2023

Abstract
Background
Idiopathic pulmonary fibrosis (IPF) has an unknown aetiology and limited treatment options. A recent meta-analysis identified three novel causal variants in the TERT, SPDL1, and KIF15 genes. This observational study aimed to investigate whether the aforementioned variants cause clinical phenotypes in a well-characterised IPF cohort.

Methods
The study consisted of 138 patients with IPF who were diagnosed and treated at the Helsinki University Hospital and genotyped in the FinnGen FinnIPF study.
Data on > 25 clinical parameters were collected by two pulmonologists who were blinded to the genetic data for patients with TERT loss of function and missense variants, SPDL1 and KIF15 missense variants, and a MUC5B variant commonly present in patients with IPF, or no variants were separately analysed.

Results
The KIF15 missense variant is associated with the early onset of the disease, leading to progression to early-age transplantation or death. In patients with the KIF15 variant, the median age at diagnosis was 54.0 years (36.5–69.5 years) compared with 72.0 years (65.8–75.3 years) in the other patients (P = 0.023). The proportion of KIF15 variant carriers was 9- or 3.6-fold higher in patients aged < 55 or 65 years, respectively. The variants for TERT and MUC5B had similar effects on the patient’s clinical course, as previously described. No distinct phenotypes were observed in patients with the SPDL1 variant.

Conclusions
Our study indicated the potential of KIF15 to be used in the genetic diagnostics of IPF. Further studies are needed to elucidate the biological mechanisms of KIF15 in IPF.
Reducing the harms of xylazine: clinical approaches, research deficits, and public health context
Authors: Zagorski Claire M. , Hosey Rebecca A. , Moraff Christopher , Ferguson Aaron , Figgatt Mary , Aronowitz Shoshana , Stahl Natalie E. , Hill Lucas G. , McElligott Zoe , Dasgupta Nabarun 
Published: September 2023

Abstract
Objectives
Xylazine has emerged as a consistent part of the unregulated drug supply in recent months. We discuss major domains of xylazine’s harm, current knowledge deficits, clinical and harm reduction strategies for minimizing harm, and xylazine’s public health and policy context. As an interdisciplinary team from across the USA, we have pooled our knowledge to provide an overview of xylazine’s current and emerging contexts.

Methods
To inform this essay, the pertinent literature was reviewed, clinical knowledge and protocols were shared by multiple clinicians with direct expertise, and policy and public health context were added by expert authors.

Results
We describe xylazine’s major harm domains—acute poisoning, extended sedation, and wounds, along with anemia and hyperglycemia, which have been reported anecdotally but lack as clear of a connection to xylazine. Current successful practices for xylazine wound care are detailed. Understanding xylazine’s epidemiology will also require greater investment in drug checking and surveillance. Finally, approaches to community-based wound care are discussed, along with an orientation to the larger policy and public health context.

Conclusions
Addressing the harms of xylazine requires interdisciplinary participation, investment in community-based harm reduction strategies, and improved drug supply surveillance. The relatively unique context of xylazine demands buy-in from public health professionals, harm reduction professionals, clinicians, basic science researchers, policymakers and more.