bluuebunny/crossref_metadata_2025_split huggingface dataset:
The efficacy of tofacitinib combined with bDMARDs in the treatment of ankylosing spondylitis patients with inadequate response to bDMARDs: a retrospective study
Authors: Chang Jie , Wang Gang 
Published: January 2024

Abstract
Introduction
Ankylosing spondylitis(AS) is a chronic inflammatory rheumatic disease primarily affecting the spine and sacroiliac joints. While biologic disease-modifying antirheumatic drugs(bDMARDs) and targeted synthetic DMARDs(tsDMARDs) are popular treatments for AS, there is limited research on their combined use. This study examined a cohort of AS patients who demonstrated inadequate response to bDMARDs and subsequently initiated combination therapy with tofacitinib in conjunction with bDMARDs, assessing both the efficacy and safety profile of this therapeutic approach.

Methods
In this study, we retrospectively collected the electronic medical records (EMR) of 15 adult patients with AS who were admitted to the Fourth Affiliated Hospital Zhejiang University School of Medicine between January 2018 and June 2022. All patients had received at least one bDMARD treatment for more than three months and still exhibited moderate to high disease activity. Tofacitinib 5 mg bid was added to their original biological treatment. Treatment was continued for a minimum of 12 weeks following the initiation of combination therapy. Changes in ASDAS-CRP and BASDAI scores at week 12 were collected and analyzed from baseline, while changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at weeks 4, 8, and 12 were also collected and analyzed.

Results
After 12 weeks of treatment, the overall ASDAS-CRP score decreased significantly from a baseline of 3.82 ± 1.47 (2.83 ~ 4.99) to 1.47 ± 0.48 (0.75 ~ 2.44), with remission achieved by 7 patients (46.7%) and low disease activity achieved by 5 patients (33.3%). The overall BASDAI score also showed significant improvement, decreasing from a baseline of 5.11 ± 1.42 (3.25 ~ 7 0.75) to 1.28 ± 0.70(0.20 ~ 2.55). Additionally, both ESR and CRP levels decreased significantly during the course of treatment without any reported adverse events leading to discontinuation.

Conclusion
To a certain extent, our findings provide some evidence supporting the efficacy and safety of the combination of bDMARD and JAK inhibitor tofacitinib in AS patients with inadequate response to bDMARD monotherapy. It effectively controls disease activity while maintaining a relatively low and manageable incidence of adverse events. Further prospective randomized controlled trials with large sample sizes are anticipated to provide evidence-based medical support.
A decision support system to determine the amount of wergild and compensation based on forensic medicine clinical examinations
Authors: Habibi-Chenaran Sogand , Samadirad Bahram , Miandoab Amir Torab , Rezaei-Hachesu Peyman , Soltani Taha Samad 
Published: January 2024

Abstract
Background
Forensic medicine is crucial in ensuring that the law and justice are carried out as swiftly, effectively, clearly, and accurately as possible. The significant number and interactions of forensic clinical examination variables, the complexity of their differentiation, and the existence of multiple decision-making paths can lead to erroneous decisions that cause irreparable harm to individuals and society. This study aimed to develop and evaluate a decision support system for determining the amount of wergild and compensation based on forensic medicine clinical examinations and the severity of the patient’s injury.

Methods
A total of 264 data elements and decision-making rules were identified based on an analysis of information sources and focus group discussions. In addition, a decision tree was used to organize the decision-making rules. Then, a system was developed using algorithms for intelligent decision-making. We included 500 patients in our analysis. This system was ultimately evaluated based on the following criteria: precision and accuracy, sensitivity, specificity, usability, and documentation quality.

Results
The results indicated that the precision and accuracy, sensitivity, and specificity of the system were 100%. Furthermore, the documentation quality (completeness) increased from 78.2 to 100%. The average score for system usability was 4.35 out of 5, indicating a highly acceptable range.

Conclusion
The designed system was effective and beneficial for forensic clinical examinations and quantifying physical damage (wergild and compensation). Therefore, this system can be utilized in forensic medicine’s administrative and clinical processes, and its production and commercialization will result in an adequate market penetration rate. In addition, this will empower forensic medicine physicians and reduce decision-making errors.

Graphical Abstract
Comparison of Two Methods for Determining Item Characteristic Functions and Latent Variable Time-Course for Pharmacometric Item Response Models
Authors: Arrington Leticia , Karlsson Mats O. 
Published: January 2024

AbstractThere are examples in the literature demonstrating different approaches to defining the item characteristic functions (ICF) and characterizing the latent variable time-course within a pharmacometrics item response theory (IRT) framework. One such method estimates both the ICF and latent variable time-course simultaneously, and another method establishes the ICF first then models the latent variable directly. To date, a direct comparison of the “simultaneous” and “sequential” methodologies described in this work has not yet been systematically investigated. Item parameters from a graded response IRT model developed from Parkinson’s Progression Marker Initiative (PPMI) study data were used as simulation parameters. Each method was evaluated under the following conditions: (i) with and without drug effect and (ii) slow progression rate with smaller sample size and rapid progression rate with larger sample size. Overall, the methods performed similarly, with low bias and good precision for key parameters and hypothesis testing for drug effect. The ICF parameters were well determined when the model was correctly specified, with an increase in precision in the scenario with rapid progression. In terms of drug effect, both methods had large estimation bias for the slow progression rate; however, this bias can be considered small relative to overall progression rate. Both methods demonstrated type 1 error control and similar discrimination between model with and without drug effect. The simultaneous method was slightly more precise than the sequential method while the sequential method was more robust towards longitudinal model misspecification and offers practical advantages in model building.
Low-Dose Sulfonylurea Plus DPP4 Inhibitor Lower Blood Glucose and Enhance Beta-Cell Function Without Hypoglycemia
Authors: Cordiner Ruth L M , Bedair Khaled , Mari Andrea , Pearson Ewan 
Published: January 2024

Abstract

Context
Low-dose sulfonylureas (SUs) have been found to augment the classical incretin effect, increase glucose sensitivity and late phase incretin potentiation.

Objective
To evaluate potential synergy between low-dose SU plus a dipeptidyl peptidase 4 (DPP4) inhibitor.

Methods
Unblinded randomized crossover study at the Clinical Research Centre, University of Dundee. Thirty participants with T2DM (HbA1c &lt; 64 mmol/mol) were treated with diet or metformin. Participants completed 4, 14-day blocks in a random order: control, gliclazide 20 mg (SU), sitagliptin 100 mg (DPP4 inhibitor [DPP4i]), or combination (SUDPP4i). A mixed meal test was conducted after each intervention. The primary outcome was the effect of treatment on beta-cell glucose sensitivity. Secondary outcomes included frequency of glucose &lt;3 mmol/L on continuous glucose monitoring, subanalyses by genotype (KNCJ11 E23K), gender, and body mass index.

Results
SU combination with DPP4i showed additive effect on glucose lowering: mean glucose area under the curve (mean 95% CI) (mmol/L) was control 11.5 (10.7-12.3), DPP4i 10.2 (9.4-11.1), SU 9.7 (8.9-10.5), SUDPP4i 8.7 (7.9-9.5) (P &lt; .001). Glucose sensitivity mirrored the additive effect (pmol min−1 m−2 mM−1): control 71.5 (51.1-91.9), DPP4i 75.9 (55.7-96.0), SU 86.3 (66.1-106.4), SUDPP4i 94.1 (73.9-114.3) (P = .04). The additive effect was seen in men but not women. Glucose time in range &lt;3 mmol/L on continuous glucose monitoring (%) was unaffected: control 1 (2-4), DPP4i 2 (3-6), SU 1 (0-4), SUDPP4i 3 (2-7) (P = .65).

Conclusion
Low-dose sulfonylurea plus DPP4i has a potent glucose-lowering effect through augmentation of beta-cell function. A double-blind randomized controlled trial would formalize efficacy and safety of this combination, which may avoid negative aspects of SU.
The European Network for the Study of Adrenal Tumors Staging System (2015): A United States Validation
Authors: Jannello Letizia Maria Ippolita , Incesu Reha-Baris , Morra Simone , Scheipner Lukas , Baudo Andrea , de Angelis Mario , Siech Carolin , Tian Zhe , Goyal Jordan A , Luzzago Stefano , Mistretta Francesco A , Ferro Matteo , Saad Fred , Shariat Shahrokh F , Chun Felix K H , Briganti Alberto , Tilki Derya , Ahyai Sascha , Carmignani Luca , Longo Nicola , de Cobelli Ottavio , Musi Gennaro , Karakiewicz Pierre I 
Published: January 2024

Abstract

Objective
To test the ability of the 2015 modified version of the European Network for the Study of Adrenal Tumors staging system (mENSAT) in predicting cancer-specific mortality (CSM), as well as overall mortality (OM) in adrenocortical carcinoma (ACC) patients of all stages, in a large-scale, and contemporary United States cohort.

Methods
We relied on the Surveillance, Epidemiology, and End Results (SEER) database (2004–2020) to test the accuracy and calibration of the mENSAT and subsequently compared it to the 8th edition of the American Joint Committee on Cancer staging system (AJCC).

Results
In 858 ACC patients, mENSAT accuracy was 74.7% for 3-year CSM predictions and 73.8% for 3-year OM predictions. The maximum departures from ideal predictions in mENSAT were +17.2% for CSM and +11.8% for OM. Conversely, AJCC accuracy was 74.5% for 3-year CSM predictions and 73.5% for 3-year OM predictions. The maximum departures from ideal predictions in AJCC were −6.7% for CSM and −7.1% for OM.

Conclusion
The accuracy of mENSAT is virtually the same as that of AJCC in predicting CSM (74.7% vs 74.5%) and OM (73.7% vs 73.5%). However, calibration is lower for mENSAT than for AJCC. In consequence, no obvious benefit appears to be associated with the use of mENSAT relative to AJCC in US ACC patients.
European common frogs determine migratory direction by inclination magnetic compass and show diurnal variation in orientation
Authors: Shakhparonov Vladimir V. , Bolshakova Alisa A. , Koblikova Eugenia O. , Tsoi Julia A. 
Published: January 2024

ABSTRACT
Animals can use two variants of the magnetic compass: the ‘polar compass’ or the ‘inclination compass’. Among vertebrates, the compass type has been identified for salmon, mole rats, birds, turtles and urodeles. However, no experiments have been conducted to determine the compass variant in anurans. To elucidate this, we performed a series of field and laboratory experiments on males of the European common frog during the spawning season. In field experiments in a large circular arena, we identified the direction of the stereotypic migration axis for a total of 581 frogs caught during migration from river to pond or in a breeding pond. We also found that motivation of the frogs varied throughout the day, probably to avoid deadly night freezes, which are common in spring. The laboratory experiments were conducted on a total of 450 frogs in a T-maze placed in a three-axis Merritt coil system. The maze arms were positioned parallel to the natural migration axis inferred on the basis of magnetic field. Both vertical and horizontal components of the magnetic field were altered, and frogs were additionally tested in a vertical magnetic field. We conclude that European common frogs possess an inclination magnetic compass, as for newts, birds and sea turtles, and potentially use it during the spring migration. The vertical magnetic field confuses the frogs, apparently as a result of the inability to choose a direction. Notably, diurnal variation in motivation of the frogs was identical to that in nature, indicating the presence of internal rhythms controlling this process.
Predictive Value of a New Muscle Parameter in Patients with Resectable Gastric Cancer: A Pooled Analysis of Three Prospective Trials
Authors: Zhong Qing , Huang Jiao-Bao , Lu Jun , Xue Li-Wei , Lin Guang-Tan , Xie Jian-Wei , Lin Jian-Xian , Zheng Chao-Hui , Huang Chang-Ming , Li Ping 
Published: January 2024

Abstract
Background
Sarcopenia is closely associated with gastric cancer (GC) prognosis. However, its exact definition remains controversial.

Methods
This study included computed tomography images and clinical data of patients from three prospective studies. The skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SMRA) were analyzed, and a new muscle parameter, skeletal muscle gauge (SMG), was obtained by multiplying the two parameters. The values of the three indices for predicting the prognosis of patients with GC were compared.

Results
The study included 717 patients. The findings showed median values of 42 cm2/m2 (range, 36.8–48.2 cm2/m2) for SMI, 45 HU (range, 41–49 HU) for SMRA, and 1842 (range, 1454–2260) for SMG. Postoperatively, 111 patients (15.5%) experienced complications. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) were 74.3%, 68.2%, and 70%, respectively. Univariate logistic analysis showed that postoperative complications were associated with SMI (odds ratio [OR] 0.94; 95% confidence interval [CI] 0.92–0.96), SMRA (OR, 0.87; 95% CI 0.84–0.90), and SMG (OR 0.99; 95% CI 0.98–0.99). After a two-step multivariate analysis, only SMG (OR 0.98, 95% CI 0.97–0.99) was an independent protective factor of postoperative complications. Multivariate analysis showed that SMG also was an independent protective factor of OS, DFS, and RFS. The patients were divided into low-SMG (L-SMG) group and high-SMG (H-SMG) groups. Chemotherapy benefit analysis of the patients with stage II low SMG showed that the OS, DFS, and RFS of the chemotherapy group were significantly better than those of the non-chemotherapy group (p < 0.05).

Conclusion
The prospective large sample data showed that the new muscle parameter, SMG, can effectively predict the short-term outcome and long-term prognosis of patients with resectable gastric cancer. As a new muscle parameter index, SMG is worthy of further study.
Perforated gastric ulcer causing mediastinal emphysema: A case report
Authors: Dai Zhi-Cheng , Gui Xun-Wu , Yang Feng-He , Zhang Hao-Yuan , Zhang Wen-Feng 
Published: January 2024

BACKGROUND
Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons. It can be spontaneous or secondary to chest trauma, esophageal perforation, medically induced factors, etc. Its common symptoms are chest pain, tightness in the chest, and respiratory distress. Most mediastinal emphysema patients have mild symptoms, but severe mediastinal emphysema can cause respiratory and circulatory failure, resulting in serious consequences.
CASE SUMMARY
A 75-year-old man, living alone, presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol. Due to the remoteness of his residence and lack of neighbors, the patient was found by his nephew and brought to the hospital the next morning after the disease onset. Computed tomography (CT) showed free gas in the abdominal cavity, mediastinal emphysema, and subcutaneous pneumothorax. Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated. Therefore, we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia. An operative incision of the muscle layer of the patient's abdominal wall was made, and a large amount of subperitoneal gas was revealed. And a continued incision of the peritoneum revealed the presence of a perforation of approximately 0.5 cm in the gastric antrum, which we repaired after pathological examination. Postoperatively, the patient received high-flow oxygen and cough exercises. Chest CT was performed on the first and sixth postoperative days, and the mediastinal and subcutaneous gas was gradually reduced.
CONCLUSION
After gastric perforation, a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm, and upper gastrointestinal angiography can clarify the site of perforation. In patients with mediastinal emphysema, open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure. In addition, thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.
“Putting the power back into community”: A mixed methods evaluation of a chronic hepatitis B training course for the Aboriginal health workforce of Australia’s Northern Territory
Authors: Hosking Kelly , De Santis Teresa , Vintour-Cesar Emily , Wilson Phillip Merrdi , Bunn Linda , Garambaka Gurruwiwi George , Wurrawilya Shiraline , Bukulatjpi Sarah Mariyalawuy , Nelson Sandra , Ross Cheryl , Stuart-Carter Kelly-Anne , Ngurruwuthun Terese , Dhagapan Amanda , Binks Paula , Sullivan Richard , Ward Linda , Schroder Phoebe , Tate-Baker Jaclyn , Davis Joshua S. , Connors Christine , Davies Jane ,   On behalf of the Hep B PAST partnership
Published: January 2024

Background
Chronic hepatitis B (CHB) is endemic in the Aboriginal and Torres Strait Islander population of Australia’s Northern Territory. Progression to liver disease can be prevented if holistic care is provided. Low health literacy amongst health professionals is a known barrier to caring for people living with CHB. We co-designed and delivered a culturally safe “Managing hepatitis B” training course for the Aboriginal health workforce. Here, we present an evaluation of the course.

Objectives
1. To improve course participants CHB-related knowledge, attitudes, and clinical practice.
2. To evaluate the “Managing hepatitis B” training course.
3. To enable participants to have the skills and confidence to be part of the care team.

Methods
We used participatory action research and culturally safe principles. We used purpose-built quantitative and qualitative evaluation tools to evaluate our “Managing hepatitis B” training course. We integrated the two forms of data, deductively analysing codes, grouped into categories, and assessed pedagogical outcomes against Kirkpatrick’s training evaluation framework.

Results
Eight courses were delivered between 2019 and 2023, with 130 participants from 32 communities. Pre- and post-course questionnaires demonstrated statistically significant improvements in all domains, p<0.001 on 93 matched pairs. Thematic network analysis demonstrated high levels of course acceptability and significant knowledge acquisition. Other themes identified include cultural safety, shame, previous misinformation, and misconceptions about transmission. Observations demonstrate improvements in post-course engagement, a deep understanding of CHB as well as increased participation in clinical care teams.

Conclusions
The “Managing hepatitis B” training course led to a sustained improvement in the knowledge and attitudes of the Aboriginal health workforce, resulting in improved care and treatment uptake for people living with CHB. Important non-clinical outcomes included strengthening teaching and leadership skills, and empowerment.
Exploring pathways to optimise care in malignant bowel obstruction (EPOC): Protocol for a three-phase critical realist approach to theory-led intervention development for shared decision-making
Authors: Bravington Alison , Boland Jason W. , Greenley Sarah , Lind Michael , Murtagh Fliss E.M. , Patterson Michael , Pearson Mark , Johnson Miriam J. 
Published: January 2024

Introduction
Malignant bowel obstruction is a distressing complication of cancer, causing pain, nausea and vomiting, and often has a poor prognosis. Severe and rapidly developing symptoms, a lack of robust clinical guidelines and the need for multidisciplinary input make treatment decision-making challenging. Sharing decision-making with people with malignant bowel obstruction and their caregivers can be difficult, and inconsistent communication creates serious deficiencies in care by amplifying patients’ distress and uncertainty. Little attention has been paid to the implicit influences on this process–for example, the role of discipline-related norms and the beliefs of decision-makers. This study will explore how these processes work and develop interventions to improve shared decision-making.

Methods and analysis
Exploring Pathways to Optimise Care (EPOC) is a three-phase study set within a critical realist framework: (i) realist review, to develop explanatory theory describing collaborative decision-making in the management of malignant bowel obstruction; (ii) an in-depth interview study using modified grounded theory to explore the active ingredients of this collaboration in practice settings; and (iii) the presentation to stakeholders (practitioners, patients and caregivers) of integrated results from Phase I (theory developed from the literature) and Phase II (theory developed from current practice) as a basis for intervention mapping. We aim to produce recommendations to address the challenges, and to develop a set of tools to (i) aid interaction around shared decision-making and (ii) aid interprofessional interaction around the management of this condition.
Registration details: The realist review is registered with PROSPERO (CRD42022308251).