bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global trends and research hotspots of stroke and magnetic resonance imaging: A bibliometric analysis
Authors: Zhang Yuting , Chen Mengtong , Liu Chunlong , He Bingjie , Dang Hongbin , Li Jiamin , Chen Hanwei , Liang Zhenzhong 
Published: December 2023

Background:
In this study, we used CiteSpace and VOSviewer to create a bibliometric visualization of research papers relating to stroke and magnetic resonance imaging (MRI) between 2000 and 2022. To fully understand the trends and hotspots in MRI and stroke research and provide new perspectives for future studies.

Methods:
The Web of Science Core Collection was selected as the source of data for this paper. Using CiteSpace and VOSviewer, publications were analyzed for authors, countries, institutions, journals, references, and keywords.

Results:
We found 1423 papers after searching and removing duplicates, which indicated an upward trend over the previous 23 years. Fiebach J.B. is the most published author (21 publications), Hacke W. is the most cited author (213 citations), and the United States (449 publications) and Harvard University (86 publications) are the most prolific nations and institutions. Stroke is the journal with the most co-citations (1275) and the most papers (171) published. The most representative reference was the 1995 article by Marler et al, which received 115 citations and had the top 3 co-occurring keywords: stroke, magnetic resonance imaging, and MRI. The article by Nogueria et al showed the strongest citation burst at the end of 2022 (strength = 17.32). High-frequency keywords in recent years are time, association, functional connectivity, thrombectomy, and rehabilitation.

Conclusion:
This study provides a scientific perspective on stroke and MRI research, provides valuable information for researchers to understand the current status of research, hotspots, and trends, and guides future research directions.
Effectiveness of e-learning to promote oral health education: A systematic review and meta-analysis
Authors: Kaneyasu Yoshino , Shigeishi Hideo , Sugiyama Masaru , Ohta Kouji 
Published: December 2023

Background:
In recent times during and after the COVID-19 pandemic, e-learning is increasingly being used to give oral health education. However, the efficacy of e-learning in improving and promoting the oral hygiene and oral health knowledge, attitude and practice is unclear. Therefore, this systematic review and meta-analysis aim to clarify the effectiveness of e-learning compared to other conventional education methods for providing oral health.

Methods:
An electronic database search was performed on PubMed-Medline, Scopus, and CENTRAL (Central Register Cochrane of Controlled trials). Randomized controlled trials (RCTs), including cluster or group RCTs, were collected in this study. The risk of bias was assessed with the Cochrane Handbook for Systematic Reviews of Interventions. Five different meta-analyses were conducted for plaque index, gingival index, oral health knowledge, oral health attitude, and oral health practice using a random effects model.

Results:
A total of 282 articles were found through the database search; 19 articles were included in the qualitative synthesis and 9 articles in the quantitative synthesis. The meta-analysis found that compared with conventional education, e-learning exhibited no positive effect. However, the use of e-learning was superior to conventional education methods for oral health practice for adults in subgroup analysis.

Conclusions:
This paper could not indicate the effectiveness of e-learning in comparison with conventional education for oral health in total. However, for adults, it may be effective to get the oral health practice compared to the conventional education. Our study limitation is that there are only few studies that have assessed the effectiveness of e-learning. Therefore, numerous further high-quality studies should be conducted regarding the efficacy of e-learning compared with conventional education methods for oral health promotion.
Application of intravitreal aflibercept to treat bilateral exudative retinal detachment secondary to retinitis pigmentosa: Case report and review of literature
Authors: Kao Chia-Chen , Chen Kuo-Jen , Cheng Kai-Chun 
Published: December 2023

Rationale:
Exudative retinal detachment with macular edema is one of the complications of retinitis pigmentosa (RP). In this report, we present a case who treated with intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) in RP-related exudative retinal detachment and subsequently improved with favorable outcome.

Patient Concern:
A 49-year-old man, with a history of RP, had persistent blurred vision and was newly diagnosed with bilateral shallow exudative retinal detachment and macular edema.

Diagnosis:
Fluorescein angiography showed bilateral diffuse dye leakage with macular pooling, and systemic survey excluded the possibility of infection or autoimmune disease.

Interventions:
The patient was treated with intravitreal injection of aflibercept, one of the anti-VEGF agents, for bilateral eyes. Recurrent exudative retinal detachment and macular edema were noted, and repeated intravitreal injections of aflibercept in bilateral eyes were then arranged. Subsequently, bilateral macular edema and exudative retinal detachment subsided again, and the treatment course lasted for approximately 1 year.

Outcomes:
After 1 year, the exudative retinal detachment with macular edema was much improved. In the meanwhile, visual functional improvement was also achieved.

Lessons:
This case illustrated the possibility of intravitreal injection of anti-VEGF therapy for the treatment of this rare complication of RP, and it may be a newly explored alternative treatment.
Risk factors of systemic lupus erythematosus patients with pulmonary arterial hypertension: A systematic review and meta-analysis
Authors: Lun Xueping , Yang Jianguo , Liu Ying , Zhao Fuyu , Wei Zhiliang , Sun Yuying , Zhou Xinpeng 
Published: December 2023

Background:
To investigate the risk factors for the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE).

Methods:
The literature related to risk factors for the development of PAH in SLE patients was searched by the computer on China national knowledge infrastructure (CNKI), PubMed, and Embase, and the literature search was limited to the period of library construction to October 2022. Two researchers independently performed literature screening and literature information extracting, including first author, publication time, case collection time, sample size, and study factors, and used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the literature. The relationship between each clinical manifestation and laboratory index and the occurrence of PAH in SLE patients was evaluated based on the ratio (OR value) and its 95% CI.

Results:
A total of 24 publications were included, including 23 case-control studies and 1 cohort study with NOS ≥ 6, and the overall quality of the literature was high. The risk of PAH was higher in SLE patients who developed Raynaud phenomenon than in those who did not [OR = 2.39, 95% CI (1.91, 2.99), P < .05]; the risk of PAH was higher in SLE patients who were positive for anti-RNP antibodies than in those who were negative for anti-RNP antibodies [OR = 1.77, 95% CI (1.17, 3.2.65), P < .05]; the risk of PAH was higher in SLE patients with interstitial lung lesions than in those without combined interstitial lung lesions [OR = 3.28, 95% CI (2.37, 4.53), P < .05]; the risk of PAH was higher in SLE patients with combined serositis than in those without serositis [OR = 2.28, 95% CI (1.83, 2.84), P < .05]. The risk of PAH was higher in SLE patients with combined pericardial effusion than in those without pericardial effusion [OR = 2.97, 95% CI (2.37, 3.72), P < .05]; the risk of PAH was higher in SLE patients with combined vasculitis than in those without vasculitis [OR = 1.50, 95% CI (1.08, 2.07), P < .05]; rheumatoid factor-positive SLE patients had a higher risk of PAH than those with rheumatoid factor-negative [OR = 1.66, 95% CI (1.24, 2.24), P < .05].

Conclusion:
Raynaud phenomenon, vasculitis, anti-RNP antibodies, serositis, interstitial lung lesions, rheumatoid factor, and pericardial effusion are risk factors for the development of PAH in patients with SLE.
Acute severe hypoglycemia immediately after induction of anesthesia in an elderly patient with type 2 diabetes mellitus: A case report
Authors: Tian Qin , Yi Ming Liang , Wan Jia Lu , Yin Hong 
Published: December 2023

Rationale:
Acute severe hypoglycemia immediately following anesthesia induction is a rare but life-threatening complication that is frequently underdiagnosed due to insufficient awareness. Among the various physiological processes influenced by opioids, alterations in blood glucose levels induced by opioids are a side effect that is commonly overlooked. The significance of this report lies in emphasizing the neglected association between opioids and hypoglycemia and highlighting the importance of close glucose monitoring to prevent hypoglycemic events in the perioperative setting.

Patient concerns:
An 89-year-old man with type 2 diabetes mellitus experienced acute severe hypoglycemic episode immediately after general anesthesia induction. Baseline blood glucose level before starting anesthesia induction was 4.0 mmol/L. However, it decreased substantially to 0.96 mmol/L immediately after anesthesia induction.

Diagnosis:
The patient exhibited normal serum insulin, C-peptide, and cortisol levels, alongside unremarkable renal and hepatic function. After excluding other causes of hypoglycemia, we speculate that opioids were the culprits due to the temporal association and the rapid decline in blood glucose levels.

Interventions:
Forty milliliters of 50% dextrose were administered intravenously followed by an infusion of 5% dextrose.

Outcomes:
Recovery from anesthesia, extubation, and postoperative recovery were unremarkable. No further hypoglycemic episodes occurred during hospitalization.

Lessons:
A precipitous and rapid decline in blood glucose following anesthesia induction is extremely uncommon. When a clinical anesthesiologist detects an abnormally low bispectral index during general anesthesia, hypoglycemia should be suspected. Instituting glucose monitoring in these situations can enable a timely diagnosis, forestalling the onset of life-threatening severe hypoglycemia.
Sudden bilateral deafness in a patient with vertebrobasilar artery occlusion: A case report
Authors: Zhang Ying , Zhao Xin , Zhou Ming , Chang Pengfei , Liu Tao , Li Yang 
Published: December 2023

Rationale:
Sudden bilateral deafness is often associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury, but very rarely to cerebrovascular disease. This is a rare case of sudden bilateral deafness in a patient with the vertebrobasilar artery occlusion.

Patient concerns:
A 46-year-old man was admitted to a local hospital for sudden bilateral deafness, the patient suffered inarticulate speech and walking unsteadily 6 days later.

Diagnoses:
Difusion-weighted magnetic resonance imagin demonstrated acute cerebral infarction in the pons and bilateral cerebellum; Magnetic resonance angiography showed vertebrobasilar artery occlusion.

Interventions:
Aspirin and clopidogrel were given for antiplatelet therapy, revascularization was obtained by endovascular treatment.

Outcomes:
The symptoms of dysarthria, ataxia and weakness gradually improved and were discharged 14 days after admission revascularization. After 3 months telephone followed-up the patient was self-cared.

Lessons:
Deafness sometimes can be an early warning sign of impending vertebrobasilar ischemic stroke. Early recognition of deafness with acute ischemic stroke should allow special management, and misdiagnosis may result in significant morbidity, or even mortality.
A bidirectional two-sample Mendelian randomization using the gut microbiota to reveal potential therapeutic targets for primary sclerosing cholangitis
Authors: Liang Xiru , Wang Ziwei , Shu Qiuai , Huang Xindi , Wang Jinhai , Wu Jian , Liu Na , Xie Ning 
Published: December 2023

Background
Previous studies indicate that gut microbiota correlates to primary sclerosing cholangitis (PSC), but the causation is still unclear. We sought to reveal the causal relationship between gut microbiota and PSC with a bidirectional two-sample Mendelian randomization (MR) analysis.

Methods
The large-scale genome-wide association study (GWAS) summary statistics and a bidirectional two-sample MR study were used to assess the causality between gut microbiota and PSC. Multiple sensitivity analyses were used to identify the robustness of our results.

Results
Three microbial taxa causally correlated to PSC. Genus Ruminococcaceae UCG002 (OR: 1.855, 95% CI: 1.068–3.220, P = 0.028) increased the risk of PSC. Class Betaproteobacteria (OR: 0.360, 95% CI: 0.171–0.758, P = 0.007), and genus Ruminiclostridium6 (OR: 0.474, 95% CI: 0.219–0.820, P = 0.011) had protective effects on PSC. In addition, we found the causal relationship of PSC with higher abundance of genus Dialister (beta: 0.059, 95% CI: 0.017–0.102, P = 0.006), genus Veillonella (beta: 0.065, 95% CI: 0.016–0.113, P = 0.009), class Melainabacteria (beta: 0.073, 95% CI: 0.012–0.133, P = 0.019), and order Gastranaerophilales (beta: 0.072, 95% CI: 0.011–0.113, P = 0.133).

Conclusion
Our study reveals the causality between gut microbiota and PSC, providing new insights into the pathological mechanisms of PSC and facilitating the development of novel biomarkers and disease-modifying therapeutics for PSC from the perspective of gut microbiota.
Factors associated with delays in presentation and treatment of gonorrhea, Massachusetts 2015-2019
Authors: Elder Heather , Platt Laura , Leach Dylan , Sheetoh Cordelia , Ramirez Victor M. , Molotnikov Lauren , Hernandez Brenda , Roosevelt Kathleen , Hsu Katherine K. 
Published: December 2023

ABSTRACTBackgroundRates of gonorrhea are increasing across the United States. Understanding and addressing contributing factors associated with longer time to diagnosis and treatment may shorten the duration of infectiousness which in turn may limit transmission.MethodsWe used Massachusetts data from the CDC Sexually Transmitted Disease Surveillance Network collected between July 2015 and September 2019, along with routinely reported surveillance data, to assess time from gonorrhea symptom onset to presentation to care, and time from presentation to care to receipt of treatment. Factors associated with longer time to presentation (TTP) and time to treatment (TTT) were assessed using Cox proportional hazard models with a constant time variable.ResultsAmong symptomatic patients (n = 672), 31% did not receive medical care within 7 days of symptom onset. Longer TTP was associated with younger age, female gender, reporting cost as a barrier to care, and provider report of proctitis. Among patients with symptoms and/or known contact to gonorrhea (n = 827), 42% did not receive presumptive treatment. Longer TTT was associated with female gender, non-Hispanic Other race/ethnicity, and clinics with less gonorrhea treatment experience. Among asymptomatic patients without known exposure to STI (n = 235), 26% did not receive treatment within 7 days. Longer TTT was associated with STD clinic/family planning/reproductive health clinics and a test turnaround time of ≥3 days.ConclusionsDelays in presentation to care and receipt of treatment for gonorrhea are common. Factors associated with longer TTP and TTT highlight multiple opportunities for reducing the infectious period of patients with gonorrhea.
Rapid antiretroviral therapy in primary HIV-1 infection enhances immune recovery
Authors: Thornhill John Patrick , Fox Julie , Martin Genevieve Elizabeth , Hall Rebecca , Lwanga Julianne , Lewis Heather , Brown Helen , Robinson Nicola , Kuldanek Kristen , Kinloch Sabine , Nwokolo Nneka , Whitlock Gary , Fidler Sarah , Frater John 
Published: December 2023

Objective:
We present findings from a large cohort of individuals treated during primary HIV infection (PHI) and examine the impact of time from HIV-1 acquisition to antiretroviral therapy (ART) initiation on clinical outcomes. We also examine the temporal changes in the demographics of individuals presenting with PHI to inform HIV-1 prevention strategies.

Methods:
Individuals who fulfilled the criteria of PHI and started ART within 3 months of confirmed HIV-1 diagnosis were enrolled between 2009 and 2020. Baseline demographics of those diagnosed between 2009 and 2015 (before preexposure prophylaxis (PrEP) and universal ART availability) and 2015–2020 (post-PrEP and universal ART availability) were compared. We examined the factors associated with immune recovery and time to viral suppression.

Results:
Two hundred four individuals enrolled, 144 from 2009 to 2015 and 90 from 2015 to 2020; median follow-up was 33 months. At PHI, the median age was 33 years; 4% were women, 39% were UK-born, and 84% were MSM. The proportion of UK-born individuals was 47% in 2009–2015, compared with 29% in 2015–2020. There was an association between earlier ART initiation after PHI diagnosis and increased immune recovery; each day that ART was delayed was associated with a lower likelihood of achieving a CD4+ cell count more than 900 cells/μl [hazard ratio 0.99 (95% confidence interval, 95% CI 0.98–0.99), P = 0.02) and CD4/CD8 more than 1.0 (hazard ratio 0.98 (95% CI 0.97–0.99).

Conclusion:
Early initiation of ART at PHI diagnosis is associated with enhanced immune recovery, providing further evidence to support immediate ART in the context of PHI. Non-UK-born MSM accounts for an increasing proportion of those with primary infection; UK HIV-1 prevention strategies should better target this group.
HIGH AND UNSUSTAINABLE COST OF CONTROLLING THE DENGUE VECTOR AEDES AEGYPTI IN THE PERUVIAN AMAZON
Authors: Durand Salomón , Paredes Arles , Pacheco Carlos , Fernandez Ray , Herrera Jose , Cabezas Cesar 
Published: December 2023

ABSTRACTObjectivesVector control is the method of prevention and control of dengue outbreaks used in Peru. With the objective of calculating the costs incurred in vector control, an estimation of the costs ofAedes aegypticontrol of the Regional Health Directorate of Loreto, during the execution of the regional plan for surveillance and control ofA. aegyptiwas carried out.Materials and methodsDocumentation was reviewed, and interviews were conducted with stakeholders about the costs ofA. aegypticontrol interventions in its adult and larval stages, during 2017 and 2018.ResultsIt was found that the costs incurred in the control of the dengue vector in the Loreto Region in the two years studied amount to: 3,807,858 and 4,066,380 soles during 2017 and 2018 respectively, 1’175,264 and 1’1210,232 dollars at the exchange rate of 2017 and 2018, however, the effect of the control activities is short-lived.ConclusionsThe high cost involved in vector control with the methods currently used and the short duration of its effect makes it unsustainable so studies should be conducted to find other more efficient methods of dengue control.
Excessive daytime sleepiness among dental students: A meta-analysis of prevalence
Authors: Wilches-Visbal Jorge Homero , Angulo-Luna Alex Antonio , Campo-Arias Adalberto 
Published: December 2023

IntroductionExcessive daytime sleepiness is highly prevalent and variable in health students. However, a meta-analysis that synthesizes the prevalence of this symptom in dental students has yet to be reported.ObjectiveTo compute the pooled prevalence of sleepiness in dental students.MethodA systematic review and meta-analysis of studies published between 2000 and 2023 was developed in Spanish, English, and Portuguese, with the keywords sleepiness, excessive drowsiness, Epworth scale for drowsiness, and dental students in all three languages. Original articles and degree theses that reported the frequency of sleepiness with a cut-off point for the Epworth scale for sleepiness greater than ten were included. The sample sizes and the number of students positive for sleepiness were observed, and the prevalence, raw and adjusted for sample size, was calculated.ResultsSeven articles were included with participant samples between 128 and 325 students, totaling 1,546. Students were positive on the Epworth scale for sleepiness between 43 and 189, with a sum of 671. The pooled prevalence was 42.7% (95% CI 40.3-45.2).Conclusionsdrowsiness is present in four out of ten dental students. It is necessary to systematize the factors associated with drowsiness and establish a relationship with the academic performance of dental students.
Fracture risk among stroke survivors according to post-stroke disability status and stroke type
Authors: Lee Dagyeong , Cho In Young , Chang Won Hyuk , Yoo Jung Eun , Choi Hea Lim , Park Jun Hee , Shin Dong Wook , Han Kyungdo 
Published: December 2023

AbstractBackgroundStroke survivors face physical and cognitive challenges, including impaired coordination and balance, which can lead to an increased dependency and a higher risk of falls. We aimed to investigate the impact of post-stroke disability status and stroke type on the risk of fracture at various sites compared to a matched comparison group.MethodThis retrospective cohort study used data from the Korean National Health Insurance System database (2010-2018) and included a total of 223,358 stroke patients and a 1:1 matched comparison group. Stroke survivors were grouped based on the presence and severity of their post-stroke disability and stroke type. The primary outcome was the incidence of newly diagnosed fracture. Cox proportional hazard regression analyses were used to calculate the hazard ratios of fractures after adjusting for potential confounders.ResultsStroke survivors had an increased risk of overall fractures compared to the matched comparison group (adjusted hazard ratio [aHR] 1.40, 95% confidence interval [CI] 1.37-1.43). Specifically, the risk of hip fractures was even greater for stroke survivors: aHR 2.42, 95% CI 2.30-2.55. The risk of vertebral fractures (aHR 1.29, 95% CI 1.25-1.34) and other fractures (aHR 1.19, 95% CI 1.15-1.23) also was higher than that of the control group. The risk of hip fractures was highest among stroke survivors with severe post-stroke disability (aHR 4.82, 95% CI 4.28-5.42), while the risk of vertebral or other fractures was highest among those with mild post-stroke disability. There was no significant difference in fracture risk between hemorrhagic and ischemic stroke survivors when stratified by disability status.ConclusionOur findings showed an increased risk of subsequent fractures among stroke survivors, particularly those with post-stroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.