bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating the Quality and Usability of Artificial Intelligence–Generated Responses to Common Patient Questions in Foot and Ankle Surgery
Authors: Anastasio Albert Thomas , Mills Frederic Baker , Karavan Mark P. , Adams Samuel B. 
Published: November 2023

Background: Artificial intelligence (AI) platforms, such as ChatGPT, have become increasingly popular outlets for the consumption and distribution of health care–related advice. Because of a lack of regulation and oversight, the reliability of health care–related responses has become a topic of controversy in the medical community. To date, no study has explored the quality of AI-derived information as it relates to common foot and ankle pathologies. This study aims to assess the quality and educational benefit of ChatGPT responses to common foot and ankle–related questions. Methods: ChatGPT was asked a series of 5 questions, including “What is the optimal treatment for ankle arthritis?” “How should I decide on ankle arthroplasty versus ankle arthrodesis?” “Do I need surgery for Jones fracture?” “How can I prevent Charcot arthropathy?” and “Do I need to see a doctor for my ankle sprain?” Five responses (1 per each question) were included after applying the exclusion criteria. The content was graded using DISCERN (a well-validated informational analysis tool) and AIRM (a self-designed tool for exercise evaluation). Results: Health care professionals graded the ChatGPT-generated responses as bottom tier 4.5% of the time, middle tier 27.3% of the time, and top tier 68.2% of the time. Conclusion: Although ChatGPT and other related AI platforms have become a popular means for medical information distribution, the educational value of the AI-generated responses related to foot and ankle pathologies was variable. With 4.5% of responses receiving a bottom-tier rating, 27.3% of responses receiving a middle-tier rating, and 68.2% of responses receiving a top-tier rating, health care professionals should be aware of the high viewership of variable-quality content easily accessible on ChatGPT. Level of Evidence: Level III, cross sectional study.
The Role of Elastography in Diagnosing Endometrial Pathology
Authors: Marshall Kathleen , Clem Douglas 
Published: November 2023

Objective: The aim of this review was to provide a summary of literature and research on the use of elastography and its effectiveness in diagnosing endometrial pathology. Materials and Methods: An online database search produced 16 research articles. Inclusion criteria consisted of ultrasound elastography of benign and malignant endometrial pathology. Priority was given to articles focused on endometrial hyperplasia, polyps, and endometrial carcinoma. Results: The difference in stiffness between endometrial carcinoma and benign endometrial pathology, including lesions and hyperplasia, is statistically significant. High rates of sensitivity and specificity are seen in using elastography to determine endometrial carcinoma from a benign endometrial pathology. Conclusion: Elastography can provide valuable information to aid in diagnosing endometrial carcinoma. Currently, the standard of care for diagnosing endometrial pathology is 2D ultrasound imaging with tissue sampling and histology. Elastography imaging of the endometrium offers the opportunity to diagnose endometrial pathology without invasive tissue sampling procedures. While this exciting development offers great potential, there must be universal, consistent approaches and studies of subgroups to be considered the standard of care.
The impact of outpatientversusinpatient management on health-related quality of life outcomes for patients with malignant pleural effusion: the OPTIMUM randomised clinical trial
Authors: Sivakumar Parthipan , Fitzgerald Deirdre B. , Ip Hugh , Rao Deepak , West Alex , Noorzad Farinaz , Wallace Deirdre , Haris Mohamed , Prudon Benjamin , Hettiarachchi Gihan , Jayaram Deepak , Goldring James , Maskell Nick , Holme Jayne , Sharma Neel , Ismail Iyad , Kadwani Owais , Simpson Sanchez , Read Catherine A. , Sun Xiaohui , Douiri Abdel , Lee Y.C. Gary , Ahmed Liju 
Published: November 2023

BackgroundThe principal aim of malignant pleural effusion (MPE) management is to improve health-related quality of life (HRQoL) and symptoms.MethodsIn this open-label randomised controlled trial, patients with symptomatic MPE were randomly assigned to either indwelling pleural catheter (IPC) insertion with the option of talc pleurodesis or chest drain and talc pleurodesis. The primary end-point was global health status, measured with the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) at 30 days post-intervention. 142 participants were enrolled from July 2015 to December 2019.ResultsOf participants randomly assigned to the IPC (n=70) and chest drain (n=72) groups, primary outcome data were available in 58 and 56 patients, respectively. Global health status improved in both groups at day 30 compared with baseline: IPC (mean difference 13.11; p=0.001) and chest drain (mean difference 10.11; p=0.001). However, there was no significant between-group difference at day 30 (mean intergroup difference in baseline-adjusted global health status 2.06, 95% CI −5.86–9.99; p=0.61), day 60 or day 90. No significant differences were identified between groups in breathlessness and chest pain scores. All chest drain arm patients were admitted (median length of stay 4 days); seven patients in the IPC arm required intervention-related hospitalisation.ConclusionsWhile HRQoL significantly improved in both groups, there were no differences in patient-reported global health status at 30 days. The outpatient pathway using an IPC was not superior to inpatient treatment with a chest drain.
Mechanically assisted cough strategies: user perspectives and cough flows in children with neurodisability
Authors: Hov Brit , Andersen Tiina , Toussaint Michel , Mikalsen Ingvild B. , Vollsæter Maria , Brunborg Cathrine , Hovde Mathea , Hovland Vegard 
Published: November 2023

BackgroundMechanical insufflation–exsufflation (MI-E) is used to augment cough in children with neurodisability. We aimed to determine the user comfort and cough flows during three MI-E strategies, and to predict factors associated with improved comfort and cough flows.MethodsThis multicentre, crossover trial was done at four regional hospitals in Norway. Children with neurodisability using MI-E long termviamask were enrolled. In randomised order, they tested three MI-E setting strategies (in-/exsufflation pressure (cmH2O)/in (In)-versusexsufflation (Ex) time): 1) “A-symmetric” (±50/In=Ex); 2) “B-asymmetric” (+25– +30)/−40, In>Ex); and 3) “C-personalised”, as set by their therapist. The primary outcomes were user-reported comfort on a visual analogue scale (VAS) (0=maximum comfort) and peak cough flows (PCF) (L·min−1) measured by a pneumotachograph in the MI-E circuit.ResultsWe recruited 74 children median (IQR) age 8.1 (4.4–13.8) years, range 0.6–17.9, and analysed 218 MI-E sequences. The mean±sdVAS comfort scores were 4.7±2.96, 2.9±2.44 and 3.2±2.46 for strategies A, B and C, respectively (AversusB and C, p<0.001). The mean±sdPCF registered during strategies A, B and C were 203±46.87, 166±46.05 and 171±49.74 L·min−1, respectively (AversusB and C, p<0.001). Using low inspiratory flow predicted improved comfort. Age and unassisted cough flows increased exsufflation flows.ConclusionsAn asymmetric or personalised MI-E strategy resulted in better comfort scores, but lower PCF than a symmetric approach utilising high pressures. All three strategies generated cough flows above therapeutic thresholds and were rated as slightly to moderately uncomfortable.
Feasibility and value of a domiciliary spirometry programme in the assessment of severe asthma: a real-world evaluation
Authors: Williams Zander , Hull James H. , Ge Yueqi , Ming Jo , Roberts Cara , Rhamie Serena , Patel Pujan H. 
Published: November 2023

BackgroundDomiciliary spirometry (DS) is a novel tool that is widely employed in the assessment of respiratory disease. We assessed real-world feasibility, effectiveness and value of a physiologist-led home spirometry programme in patients with treatment-refractory severe asthma.MethodsPatients were referred and provided with a hand-held DS device. Patients completed baseline measurements in a physiologist-led virtual clinic and were instructed to provide further values during any periods of respiratory symptoms. Outcome measures included prevalence of new obstructed events, DS adherence and uptake of this approach.Results112 patients were enrolled from November 2020 to January 2023. 102 individuals, mean±sdage 44±13 years (86% female) with median (IQR) forced expiratory volume in 1 s % predicted 88% (77–97%), successfully recorded baseline spirometry values. During follow-up (24 months), 11 (11%) were identified with new obstructive spirometry and were subsequently able to be commenced on biologic therapy. Patient engagement was poor with median (IQR) of 4 (2–6) attempts of contact made before baseline values were recorded, and 2 (1–3) attempts required to record technically acceptable values. Continued DS use was suboptimal; 34% failed to use their device after baseline and only 10% continued at the end of the study period. The cost of DS measurements was greater than a single hospital-based visit but enables multiple event capture.ConclusionOverall, DS measurement uptake was poor, with a minority of patients continuing to use the device at the end of the study period. However, for those that engage, DS provides an alternative approach to traditional hospital-based spirometry measurements that can alter clinical management.
Effect of pre-use of Dexmedetomidine on the effective inhibitory dose of remimazolam tosilate on positive cardiovascular response in double-lumen endobronchial intubation: a clinical study
Authors: Wei Shiyou , Liu Xiaojuan , Chang Rui , Chen Xue , Zheng Tao , Wang Jingyun , Liu Huqing , Zhang Faqiang , Song Jiong , Lv Xin 
Published: November 2023

Abstract
Background
Herein, the effect of pre-use of Dexmedetomidine(Dex) on the half-effective dose (ED50) and 95%-effective dose (ED95) of Remimazolam tosilate(RT) in inhibiting the positive cardiovascular response(CR) which means blood pressure or heart rate rises above a critical threshold induced by double-lumen bronchial intubation was evaluated.

Methods
Patients who underwent video-assisted thoracic surgery were divided into groups A (0), B (0.5 µg/kg), and C (1 µg/kg) based on different Dex doses. Group A included subgroups comprising young (A-Y) and elderly (A-O) patients. Neither groups B nor C included elderly patients due of the sedative effect of Dex. Based on the previous subject’s CR, the dose of RT was increased or decreased in the next patient using the sequential method. This trial would be terminated when the seventh crossover occurred, at which point the sample size met the stable estimate of the target dose. Heart rate (HR) and mean arterial pressure (MAP) were monitored throughout the trial, and sedation was assessed using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale. HR and MAP were recorded at baseline (T1), the end of Dex (T2), and the end of RT (T3), the maximum HR and MAP were recorded within 3 min of intubation from beginning to end (T4). There was a positive CR when the T4 levels rose above 15% of the baseline. The ED50/ED95 and corresponding confidence interval were calculated using probability regression.

Results
In total, 114 patients completed the trial. Without the use of Dex, the ED50/ED95 of TR inhibiting the positive CR caused by double-lumen bronchial intubation was 0.198/0.227 and 0.155/0.181 mg/kg in groups A-Y and A-O, respectively. The changes in vital signs from T1 to T3 were similar in the subgroups, indicating that the elderly patients were more sensitive to the dose of RT. The ED50/ED95 of RT inhibiting the positive CR caused by double-lumen endobronchial intubation was 0.122/0.150 and 0.068/0.084 mg/kg in groups B and C, respectively. And, the fluctuation of blood pressure from T3 to T4 was reduced by using Dex. RT was 100% effective in sedation with no significant inhibition of circulation. Apart from one case of hypotension occurred in group A-Y, two cases of low HR in group B, and one case of low HR in group C, no other adverse events were noted.

Conclusions
The optimal dose of RT to inhibit positive CR induced by double-lumen bronchial intubation in elderly patients was 0.18 mg/kg and 0.23 mg/kg in younger patients. When the pre-use dose of Dex was 0.5 µg/kg, the optimal dose to inhibit positive CR of RT was 0.15 mg/kg. And, when the pre-use dose of Dex was 1 µg/kg, the optimal dose of RT was 0.9 mg/kg.

Clinical trial registration
NCT05631028.
Efficacy of a modified FRAIL scale in predicting the peri-operative outcome of hepatectomy in older adults (aged ≥ 75 years): a model development study
Authors: Xu Lining , Wang Weiyu , Xu Yingying , Yang Bo 
Published: November 2023

Abstract
Background
The FRAIL scale for evaluating frailty consists of five items: fatigue, resistance, aerobic, illness, and loss of weight. However, it is difficult to obtain a specific weight loss value. Since the Timed Up and Go Test (TUGT) is simple, accurate, and easy to perform, we replaced weight loss with the TUGT in the FRAIL scale, with the remaining four items unchanged, and named it the FRAIT scale. The aim of this study was to determine the value of the FRAIT scale in predicting the peri-operative outcome of hepatectomy.

Methods
This model development study was conducted between January 2017 and December 2021. The reliability, validity and area under the curve (AUC) of the FRAIL/FRAIT scales were calculated. The frailty status of patients aged ≥ 75 years who underwent hepatectomy was measured using the FRAIL/FRAIT scales. Logistic regression was used to compare the relationship between FRAIL/FRAIT scores/grades and perioperative outcomes.

Results
The AUCs for predicting operation duration, intraoperative bleeding, complications, and death based on the FRAIL score were 0.692, 0.740, 0.709, and 0.733, respectively, and those based on the FRAIT score were 0.700, 0.745, 0.708, and 0.724, respectively. The AUCs for predicting operation duration, intraoperative bleeding, complications, and death based on the FRAIL grade were 0.693, 0.735, 0.695, and 0.755, respectively, and those based on the FRAIT grades were 0.700, 0.758, 0.699, and 0.750, respectively. The FRAIL score has three effective predictors (intraoperative bleeding, complications, and death), while the FRAIT score has four effective predictors (operation duration, intraoperative bleeding, complications, and death). The FRAIL grade has two effective predictors (intraoperative bleeding and death), while the FRAIT grade has three effective predictors (operation duration, intraoperative bleeding, and death).

Conclusions
This study describes a new and more effective tool for the assessment of preoperative frailty in older adults undergoing hepatectomy. The items of the FRAIT scale are easier to obtain than those of the FRAIL scale, and the predictive effect of the FRAIT scale is stronger than that of the FRAIL scale.
The evaluation of a rapid microfluidic immunofluorescence antigen test in detecting the infectiousness of COVID-19 patients
Authors: Ota Kenji , Kodama Hina , Kawamoto Yasuhide , Sasaki Daisuke , Mitsumoto-Kaseida Fujiko , Sakamoto Kei , Kosai Kosuke , Hasegawa Hiroo , Takazono Takahiro , Izumikawa Koichi , Mukae Hiroshi , Tun Mya Myat Ngwe , Morita Kouichi , Yanagihara Katsunori 
Published: November 2023

Abstract
Background
A test-based strategy against coronavirus disease 2019 (COVID-19) is one of the measures to assess the need for isolation and prevention of infection. However, testing with high sensitivity methods, such as quantitative RT-PCR, leads to unnecessary isolation, whereas the lateral flow antigen test shows low sensitivity and false negative results. The purpose of this study was to evaluate the performance of the LumiraDx SARS-CoV-2 Ag test (Lumira Ag), a rapid microfluidic immunofluorescence method, in assessing infectivity.

Methods
This study was performed from March 2022 to July 2022. A pair of nasopharyngeal swab samples were obtained from each patient with mild COVID-19. One swab was used for Lumira Ag testing, and the other for quantitative RT-PCR testing and virus culture.

Results
A total of 84 patients were included in the study. Among them, PCR, Lumira Ag test, and virus culture indicated positivity for 82, 66, and 24 patients, respectively. When comparing the Lumira Ag test to virus culture, its sensitivity was 100.0% (24/24), specificity, 30.0% (18/60); positive predictive value, 36.3% (24/66); and negative predictive value (NPV), 100.0% (18/18). The positive sample for virus culture was observed until the ninth day from the onset of symptoms, while the Lumira Ag test was observed until day 11.

Conclusions
The Lumira Ag test showed high sensitivity and NPV (100% each) compared to virus culture. A test-based strategy using the Lumira Ag test can effectively exclude COVID-19 infectiousness.
A novel mutation of the RPGRIP1L gene in a Chinese boy with Joubert syndrome with oculorenal involvement
Authors: Li Qian , Liu Qianying , Liu Suwen , Yu Lichun , Yang Zhenle , Wang Cong , Wang Jing , Sun Shuzhen 
Published: November 2023

Abstract
Background
Joubert syndrome (JS) is a rare genetically heterogeneous primary ciliopathy characterized by a pathognomonic cerebellar and brainstem malformation, the “molar tooth sign”, and variable organ involvement (such as eye, kidney, liver, and skeleton). Here, we present a case of JS in a Chinese boy.

Case presentation
An 11-year-old Chinese boy presented with neonatal asphyxiation and hypoxia, strabismus, subsequent developmental delay, ataxia and end-stage kidney disease (ESKD). Routine blood tests showed severe anemia, increasing blood urea nitrogen and creatinine, elevated parathyroid hormone, hypocalcemia, hypokalemia and metabolic acidosis. Urine tests showed mild proteinuria. Ultrasound showed two small kidneys. Brain magnetic resonance imaging (MRI) showed dysplasia of the cerebellar vermis and extension of the upper cerebellar feet with the “molar tooth sign”. Genetic analysis showed novel compound heterozygous mutations in the RPGRIP1L gene [p.L447fs*7(p.Leu447fsTer7) and p.G908V (p.Gly908Val)].

Conclusion
In the present study, we identified novel compound heterozygous mutations in the RPGRIP1L gene in a Chinese boy. The clinical and genetic findings of this study will expand the understanding of JS.
Job stress, a source of hypertension among workers in Sub-Saharan Africa: a scoping review
Authors: Khonde Kumbu Rodrigue , Matondo Hervé , Labat Aline , Kianu Bernard , Godin Isabelle , Kiyombo Guillaume , Coppieters Yves 
Published: November 2023

Abstract
Background
Hypertension remains one of the leading risk factors for cardiovascular disease. Contrasting with the high-income countries where the rates of hypertension decline, it increases in Sub-Saharan African countries. The age group most affected by hypertension is the working population. Several studies carried out in Europe, North America, and Asia, underline the influence of job stress on the occurrence of hypertension. The objective of this review was to explore current knowledge about hypertension and job stress in Sub-Saharan Africa.

Methods
We conducted a scoping review using Arksey and O’Malley’s framework to synthesize findings. We searched in PubMed, Scopus, and ProQuest databases. The inclusion criteria were peer-reviewed manuscripts published on March 1, 2023, conducted among workers in Sub-Saharan Africa, reported hypertension and job stress, and using quantitative methodologies. Data were assessed independently by two researchers.

Results
In total, 295 articles were identified from databases. Of these, only 12 articles met the inclusion criteria and were included in the review (9 cross-sectional studies and 3 case–control studies). These studies focused on sectors reported as stressful (health, banking, education, and industries). The prevalence of hypertension varied from 14.3% to 45.9%, with a high proportion of hypertensive participants (35.4%-70.6%) who were unaware that they had hypertension. Job stress was significantly associated with hypertension (OR = 2.4 [1.5–4.4]) and stress management was inversely associated with hypertension (r = -0.14, p < 0.05). However, no study reported an existing workplace health promotion program implemented, especially regarding cardiovascular disease risk factors.

Conclusion
Data available in the literature show that stressful working conditions may be associated with hypertension. We are faced with an increasing prevalence of hypertension among workers in Sub-Saharan Africa, where a large proportion of them are unaware that they have hypertension. Thus, there is a need to implement workplace prevention and health promotion strategies in Sub-Saharan Africa.
Prevalence and associated factors of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China
Authors: Chen Xu , Liu Yuan , Liu Meilin , Min Fanli , Tong Jiao , Wei Wei , Sun Lizhou , Zhang Teng , Meng Qian 
Published: November 2023

AbstractBackgroundInsomnia is the most common sleep disorder in the general population, especially among pregnant women, and it is considered a major public health issue. Not only can it cause mental and physical problems in pregnant women, but it may also affect the growth of the fetus. However, there are few reports on the prevalence and influencing factors of insomnia symptoms in third-trimester women in China. The objective of this study was to assess the prevalence of insomnia symptoms among pregnant women in the third trimester in a moderately developing region of China and to further explore the associated factors of insomnia symptoms from various aspects.MethodsA cross-sectional survey was conducted among eligible pregnant women in the third trimester from December 2022 to February 2023. Data on socio-demographic characteristics, clinical characteristics, and behavioral and psychological characteristics of pregnant women were collected through a structured questionnaire. The Chi-square test and multivariate logistics regression were applied to explore the associated factors of insomnia symptoms.ResultsA total of 535 pregnant women in the third trimester were included in this study, and the prevalence of insomnia symptoms was 59.8%. Multivariate logistic regression analysis revealed that pregnant women who lived together with elders (OR: 0.58, 95%CI: 0.40–0.86), had low perceived stress (OR: 0.58, 95%CI: 0.35–0.97), had no threatened abortion (OR: 0.55, 95%CI: 0.32–0.93) and had good doctor-patient communication (OR: 0.66, 95%CI: 0.45–0.98) were more likely to stay away from insomnia symptoms. However, pregnant women with anxiety symptoms (OR: 2.27, 95%CI: 1.28–4.03), fear of childbirth (OR: 1.63, 95%CI: 1.11–2.40) and a high experience of COVID-19 fear (OR: 1.61, 95%CI: 1.03–2.54) tended to have insomnia symptoms.ConclusionsThe prevalence of insomnia symptoms in pregnant women is high in Lianyungang city in eastern China in the third trimester. Insomnia symptoms is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of insomnia symptoms in the third trimester and to focus on pregnant women with risk factors for insomnia symptoms.