bluuebunny/crossref_metadata_2025_split huggingface dataset:
A cadaveric study and clinical application of the free superficial circumflex iliac artery perforator flap reconstruction of limb soft tissue defects
Authors: Van Duong Tran , Hung Ngo Quoc , Khanh Hung Truong Nguyen , Trung Vo Thai , An Lam Quang 
Published: January 2024

Introduction In recent decades the superficial circumflex iliac artery perforator (SCIP) flap technique has gradually overcome the previous disadvantages of its pedicle and donor site to be widely applied in treating tissue's defects. This article investigates the vascular anatomy of the SCIP flap and evaluates the result of using the flap to reconstruct limb defects. Materials and Methods The study was performed in two parts. Firstly a cross-sectional descriptive anatomical study comprising 49 groin dissections in 25 cadavers, with contrast radiographic demonstration of the vascular anatomy. Secondly a retrospective case series of 51 free SCIP flaps in 49 patients. Surgical outcomes were evaluated using the Vancouver Scar Scale on the regional function and the aesthetics of implanted flap and donor sites. Results The results of anatomical analysis on cadavers showed the superficial circumflex iliac arteries were detected in all specimens with an average diameter of 1.4 ± 0.3 mm. The superficial subcutaneous venous systems were also recorded, including two veins (superficial circumflex vein and superficial epigastric vein) in 79.5% with an average diameter of 2.3 ± 0.6 mm. The flap results showed the alive flap rate was 90.2%, partial-necrosis flap was 3.9% and total necrosis of the flap in 5.9%. In the aesthetic evaluation, fine line scars were seen in 13/51 cases (25.5%), stretch scars in 33/51 cases (64.7%) and hypertrophic scars in 5/51 patients (9.8%), with no cases of keloid scars. Conclusion The SCIP flap is a reliable free-tissue transfer for reconstructing limb soft tissue defects. Moreover, the SCIP flap is an ideal flap with pleasing aesthetics because the donor-site scar is situated in a well-hidden site. Care must be taken when vein grafts are used to lengthen the flap as flap necrosis rates increase.
Indications for alternative endovascular techniques in carotid-cavernous fistulas: A 20-year single-center experience
Authors: Voldřich Richard , Charvát František , Netuka David 
Published: January 2024

Background While coiling is considered the standard treatment for carotid-cavernous fistulas (CCFs), studies demonstrating excellent results using new materials, especially flow diverter (FD) stents and liquid embolisates, are becoming more frequent. The indications and effectiveness of these alternative endovascular techniques remain unclear. Methods A total of 22 direct and 20 indirect CCFs were included in the study. These were further subdivided based on the embolic material used: coils versus FD stents for direct and coils versus liquid embolisates for indirect CCFs. The subgroups were subjected to statistical analysis. Results An angiographic cure was achieved in 88% of all CCFs, 93% of patients’ experienced clinical improvement or remained stable. Direct CCFs were treated with coiling (41%) or with both coils and FD stents (55%). One (4%) patient with a direct CCF was treated with FD stent alone. Statistical analysis comparing these subgroups revealed a significantly higher complete occlusion rate immediately after treatment in the coiling subgroup (67% vs. 23%, p = 0.0409). The occlusion rates at the last follow-up were similar (89% vs. 85%). Indirect CCFs were treated with coiling (35%) or liquid embolisates (65%). All three periprocedural ischemic complications were recorded within the liquid subgroup, resulting in a significantly higher clinical deterioration rate ( p = 0.0333). Conclusion FD stents in direct and liquid embolisates in indirect fistulas did not demonstrate better angiographic or clinical outcomes compared to convetional coiling. Liquid agents carried a higher risk of ischemic complications. Alternative embolization materials should be reserved for CCFs that cannot be treated with simple coiling.
Transradial artery access for carotid artery stenting: A pooled analysis
Authors: Batista Sávio , Oliveira Leonardo de Barros , Sousa Marcelo Porto , Pinheiro Agostinho C , Borges Jordana , Santana Laís , Bertani Raphael , Andreão Filipi Fim , Simões Adria , Almeida Filho José Alberto 
Published: January 2024

Introduction Carotid artery stenting (CAS) through transradial access (TRA) is emerging as an alternative to carotid endarterectomy. However, the current evidence base is limited, mainly comprising single-center studies. Objective This systematic review and meta-analysis aim to assess the safety and effectiveness of TRA for CAS, providing evidence to support clinical decisions. Methods We conducted searches on PUBMED, Cochrane Library, Embase, and Web of Science databases, including studies on TRA for CAS. Studies with fewer than 20 patients, non-primary outcomes, and non-full-text articles were excluded. Results We analyzed 14 studies involving 1,166 patients who underwent CAS via TRA. Procedural success rate was high in 13 studies, with a 95% rate (95% CI; 92%–98%). Crossover to TFA access was observed in 12 studies at 6% (95% CI: 3%–9%). Transradial access failure was reported in four studies, with a rate of 0% (95% CI: 0%–0%). Cannulation failure resulted in a rate of 4% (95% CI: 2%–7%). Asymptomatic radial artery occlusion (ARAO) occurred at a rate of 2% based on eight studies (95% CI: 0%–5%). Forearm hematoma was reported in 10 studies, with an occurrence of 1% (95% CI: 0%–2%). Cerebral vascular attacks (CAV) within 30 days were assessed in 13 studies, indicating a 2% occurrence (95% CI: 1%–2%). Conclusion The findings suggest that TRA for CAS yields promising outcomes with high success rates and low complication rates. Further research should focus on randomized controlled trials and long-term outcomes to validate and extend findings.
A digital self-reported G8 screening tool: A comparison study
Authors: Arifin Trina , Ong Whee Sze , Chia Yu Ling Juliana , Chow Agnes Lai Yin , Chowdhury Anupama Roy , Chan Johan , Tan Wei Chong , Ramalingam Mothi Babu , Rajasekaran Tanujaa , Tan Tira J , Krishna Lalit , Lai Olive Shu Jun , Chen Simon Chern Jian , Kanesvaran Ravindran 
Published: January 2024

Background Geriatric assessment (GA) has been shown to be pivotal to the prognosis of elderly cancer patients. A G8 screening tool could act as a potential surrogate to identify patients who would benefit from further GA in a busy oncology clinic and a digital version would allow for a wider application. Objectives To develop a digital self-reported version of G8, and to compare its outcomes with in-person G8 administered by a healthcare professional. Methods A total of 483 cancer patients aged 70 years and older who received an in-person G8 assessment at the National Cancer Centre Singapore (NCCS) clinic, and another 544 who completed the digital self-reported G8 were analysed. Total G8 score ≤14 was defined as positive screen. Results Response rate of the digital self-reported G8 was 50%. Median G8 total score was lower among online screeners than in-person screeners (11 vs 12.5, p < 0.001). The odds of a G8 positive screen among online screeners was higher than that of in-person screeners on multivariable logistic regression analysis (odds ratio = 1.56, 95% CI 1.08-2.26). Some 20 in-person screeners had also completed the digital self-reported G8, and the agreement between their in-person and online G8 total scores was high (concordance correlation coefficient = 0.798, 95% CI 0.635-0.962). Conclusions A digital self-reported G8 is feasible. However, given the higher positive screen rate among the online screeners, replacement of the in-person G8 with the digital self-reported G8 should be implemented only after more conclusive evidence on the agreement between in-person and online G8 score is available.
‘It's not everybody's snapshot. It's just an insight into that world’: A qualitative study of multiple perspectives towards understanding the mental health experience and addressing stigma in healthcare students through virtual reality
Authors: Szekely Raul , Mason Oliver , Frohlich David , Barley Elizabeth 
Published: January 2024

Objective The resurgence of virtual reality (VR) technologies has led to their increased use in contemporary healthcare education. One promising application is simulating the experiences of individuals with mental health conditions (MHCs) to reduce stigma among future healthcare professionals. This study set out to explore what those impacted by, or involved in, the education of healthcare students think about using VR in this way. Methods One individual interview and five focus groups were conducted with healthcare students ( n = 7), healthcare educators ( n = 6), and lived experience experts ( n = 5). Before sharing their perspectives, participants familiarised themselves with VR equipment and immersive materials simulating MHCs. The constant comparative method and thematic analysis were used to analyse the data. Results Participants recognised the acceptability and utility of VR for addressing mental health stigma in healthcare students, emphasising the immersive nature of this technology. However, some participants raised concerns about the limited insight VR could provide into the experiences of patients with the same MHCs and its potential emotional impact on users. Participants recommended the incorporation of interactive, realistic environments with a person-centred focus into future VR-based stigma reduction interventions while stressing the importance of providing healthcare students with opportunities for reflection and support. Conclusions Healthcare students, healthcare educators, and lived experience experts highlighted both advantages and barriers associated with using VR to understand the experience of patients with MHCs. Furthermore, the recommendations put forward can inform the design, content, and delivery of VR-based stigma reduction interventions in healthcare education.
Mediating Role of Resilience and its Impact on Psychological Well-Being, and Mental Distress among Mental health Nurses
Authors: Hasan Abdalhadi , Alsulami Amal 
Published: January 2024

Introduction Mental health nurses (MHNs) are categorized as demanding specialists with high levels of stress, and their career is recognized as a high-risk career Objective The study aims to assess the relationships between psychological well-being (PWB), mental distress, and resilience among MHNs. Also, it aims to identify the significant predictors of the psychologic well-being of MHNs. Methods The study utilized a cross-sectional survey design with a random sample of 250 MHNs who were requested to complete DASS 21, Ryff's scale of PWB and Connor Davidson's resilience scale. Results The results revealed that two-thirds of nurses reported either a severe or extreme level of stress (n = 166, 66%), and more than half experienced a severe to extreme level of anxiety (n = 140, 56%). Approximately 25% of MHNs reported a severe to extreme level of depression (n = 62, 25%). The results also indicated that there is a statistically significant negative relationship between PWB subscales and DASS 21. The results indicate that the depression subscale is significantly varied based on the demographic characteristics of nurses. Similarly, this is the case for the anxiety and stress subscales. Conclusion The study showed that MHNs’ resilience intervenes with perceived mental distress. Enhancing MHNs resilience would improve PWB and mental health. The study results conclude that MHNs with a high level of resilience reported lower mental distress and a better working environment. Thus, MHNs should be introduced to crisis intervention in order to improve resilience levels.
Age-dependent seasonality in the incidence of stroke: A 21-year population-based study
Authors: Libruder Carmit , Yaari Rami , Fluss Ronen , Hershkovitz Yael , Ram Amit , Tanne David , Huppert Amit , Zucker Inbar 
Published: January 2024

Introduction: Seasonality in the incidence of stroke has been examined in numerous studies, yet data on whether it differs with age are limited. To fill this gap, we utilized a largescale dataset from Israel. Patients and methods: We retrieved data of all hospitalizations for ischemic stroke (IS), transient ischemic attack (TIA) and intra cerebral hemorrhage (ICH) from 2000 to 2020. We maintained separate datasets for IS/TIA and ICH, divided into five age groups: 18–49, 50–59, 60–69, 70–79, and 80+. We modeled the monthly incidence using a generalized additive model. The seasonal effect was defined by the rate ratio (RR) of each month compared to the annual mean. Results: The analysis included 317,586 and 23,789 events of IS/TIA and ICH respectively. We found an interaction between age and seasonality, accounting for a phase shift with age in the seasonal pattern of IS/TIA incidence. For cases under 70 years, the peak was during summertime and the RRs increased with decreasing age, reaching 1.11 (95% CI 1.09–1.13) at the youngest age group. In contrast, among the elderly, a winter peak was observed and the RRs increased with age to 1.07 (95% CI 1.06–1.08) at the oldest age group. For ICH, a winter/autumn peak was identified and the RRs increased with age to 1.20 (95% CI 1.16–1.24). Conclusions: Our finding of age-dependent seasonal patterns in the occurrence of stroke, suggests closer monitoring of cardiovascular risk factors during wintertime among elderly individuals. The mechanism governing the seasonal phase shift with age in IS/TIA incidence, requires further investigation.
Emergency Medical Services dispatcher recognition of stroke: A systematic review
Authors: Wenstrup Jonathan , Hestoy Bartal Hofgaard , Sagar Malini Vendela , Blomberg Stig Nikolaj Fasmer , Christensen Hanne , Christensen Helle Collatz , Kruuse Christina 
Published: January 2024

Purpose: Stroke treatments are time-sensitive, and thus early and correct recognition of stroke by Emergency Medical Services is essential for outcomes. This is particularly important with the adaption of mobile stroke units. In this systematic review, we therefore aimed to provide a comprehensive overview of Emergency Medical Services dispatcher recognition of stroke. Methods: The review was registered on PROSPERO and the PRISMA guidelines were applied. We searched PubMed, Embase, and Cochrane Review Library. Screening and data extraction were performed by two observers. Risk of bias was assessed using the QUADAS-2 instrument. Findings: Of 1200 papers screened, 24 fulfilled the inclusion criteria. Data on sensitivity was reported in 22 papers and varied from 17.9% to 83.0%. Positive predictive values were reported in 12 papers and ranged from 24.0% to 87.7%. Seven papers reported specificity, which ranged from 20.0% to 99.1%. Six papers reported negative predictive value, ranging from 28.0% to 99.4%. In general, the risk of bias was low. Discussion: Stroke recognition by dispatchers varied greatly, but overall many patients with stroke are not recognised, despite the initiatives taken to improve stroke literacy. The available data are of high quality, however Asian, African, and South American populations are underrepresented. Conclusion: While the data are heterogenous, this review can serve as a reference for future research in emergency medical dispatcher stroke recognition and initiatives to improve prehospital stroke recognition.
The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders
Authors: Leonardi Matilde , Martelletti Paolo , Burstein Rami , Fornari Arianna , Grazzi Licia , Guekht Alla , Lipton Richard B. , Mitsikostas Dimos Dimitrios , Olesen Jes , Owolabi Mayowa Ojo , Ruiz De la Torre Elena , Sacco Simona , Steiner Timothy J. , Surya Nirmal , Takeshima Takao , Tassorelli Cristina , Wang Shuu-Jiun , Wijeratne Tissa , Yu Shengyuan , Raggi Alberto 
Published: January 2024

AbstractThe World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.
Emergency department contribution to HCV elimination in the Iberian Peninsula
Authors: Buti Maria , Vaz-Pinto Inês , Magno Pereira Vítor , Casado Marta , Llaneras Jordi , Barreira Ana , Esteves Catarina , Guimarães Mafalda , Gorgulho Ana , Mourão Tomás , Xavier Elisa , Jasmins Luís , Reis Ana Paula , Faria Nancy , Freitas Bruno , Andrade Graça , Camelo-Castillo Anny , Rodríguez-Maresca Manuel Ángel , Carrodeguas Alba , Medina Diogo , Esteban Rafael 
Published: January 2024

Abstract
Background
Undiagnosed cases of hepatitis C virus (HCV) infection result in significant morbidity and mortality, further transmission, and increased public health costs. Testing in emergency departments (EDs) is an opportunity to expand HCV screening. The goal of this project was to increase the proportion of eligible patients screened for HCV in urban areas.

Methods
An opportunistic automated HCV screening program was implemented in the EDs of 4 public hospitals in Spain and Portugal at different periods between 2018 and 2023. HCV prevalence was prospectively evaluated, and single-step or reflex testing was used for confirmation in the same sample.

Results
More than 90% of the population eligible for testing were screened in the participating centers. We found HCV antibody seroprevalence rates ranging from 0.6 to 3.9%, with between 19 and 53% of viremic individuals.

Conclusions
Opportunistic HCV screening in EDs is feasible, does not disrupt ED activities, is highly effective in increasing diagnosis, and contributes to WHO’s HCV elimination goals.
Long-term follow-up of a bilateral acute posterior multifocal placoid pigment epitheliopathy following COVID-19 infection: a case report
Authors: Lund-Andersen Casper , Klefter Oliver Niels , Schneider Miklos 
Published: January 2024

Abstract
Background
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory eye disorder that is characterized by the presence of multiple placoid lesions in the posterior pole of the eye. Relentless placoid chorioretinitis (RPC) is an inflammatory chorioretinopathy that combines clinical features of APMPPE and serpiginous chorioretinitis, which is a progressive condition with a high risk of visual disability. Patients with COVID-19 can develop various ocular manifestations, however, there have been limited reports of APMPPE and RPC associated with the infection.
We report a case of a patient who developed APMPPE after a COVID-19 infection and subsequently progressed into RPC.

Case presentation
A 17-year-old male presented with a one-week history of painless gradual visual loss in both eyes. Two months prior to the visual symptoms, the patient had a SARS CoV-2 infection, confirmed by polymerase chain reaction test. Clinical findings with fundoscopy, optical coherence tomography and fluorescein angiography were consistent with APMPPE. Due to the severely affected vision in both eyes, the patient was started on 50 mg oral prednisolone daily, after which vision began to improve rapidly. Two months after symptom onset during steroid taper, the impression of continued inflammatory activity and new lesions in the retinal periphery of both eyes suggested RPC. Adalimumab 40 mg every other week was initiated with 12.5 mg prednisolone daily followed by slow tapering. Vision improved and five months after the start of the adalimumab treatment, the steroid was discontinued and there were no signs of active inflammation. The patient has been followed for a total of 21 months since presentation, had full visual recovery and good tolerance of the immunosuppressive treatment.

Conclusion
COVID-19 might cause long-lasting activity of APMPPE. The scarcity of reports compared with the number of confirmed COVID-19 infections worldwide suggests a rare entity. The association of APMPPE with a variety of infections may suggest a common immunological aberrant response that might be triggered by various factors. Further examinations and case reports are needed to understand the role of biological therapy in the treatment of such cases.