bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of the Added Cancer Risk Derived From EVAR and CTA Follow-Up
Authors: Singh Bharti , Andersson Martin , Edsfeldt Andreas , Sonesson Björn , Gunnarsson Mikael , Dias Nuno V. 
Published: December 2023

Objective: The aim of this study was to assess the risk of radiation-induced cancer development in patients that have undergone an infrarenal EVAR, stratifying the relative contributions of the procedure and the preoperative and postoperative CTAs. Methods and Materials: The organ-specific absorbed radiation doses from CTA and the EVAR procedure were estimated from the radiation exposures of 95 and 45 male patients, respectively. Lifetime attributable risk (LAR) cancer predictions were calculated for 14 different organs. Life expectancy was assumed from a previous cohort of patients undergoing infra-renal EVAR. Results: The calculated total excess cancer risk was 0.0046, ie, 1 out of 220 patients will develop a neoplasm after being exposed to the ionizing radiation from the preoperative CTA, the EVAR and annual CTA examinations for 15 years. The procedure and the preoperative CTA contributed with 38% of the total excess risk, while the rest was derived from the follow-up. If the entire CTA based follow-up would have been eliminated, an excess risk of 0.0018 (1/560) would remain. Conclusions: 1 out of 219 patients who have undergone EVAR of an infra-renal AAA have a lifetime risk of developing cancer secondary to the radiation exposures related to the procedure and the CTAs used preoperatively and during follow-up. This risk derives mostly from the yearly postoperative CTAs, underlining the potential benefits of reducing or replacing their use. Clinical Impact A simulation-based estimation reinforced the potential deleterious effects of the radiation exposure for patients undergoing Endovascular Aneurysm Repair (EVAR) of Abdominal Aortic Aneurysms (AAA) and subsequently followed by yearly Computer Tomography Angiographies (CTAs). The risk could be as high as 1 out 219 patients developing a neoplasm after 15 years. The largest exposure derives from the follow-up CTAs and efforts to minimize their use as well as the intraoperative radiation are greatly needed. The simulation-based estimations done in this study reinforce potential deleterious effects of the radiation exposure for patients undergoing EVAR of AAA. Efforts should be done to minimize the intraoperative radiation and the number of CTAs used during follow-up.
The Semibranch: A New Tool for Complex Aortic Pathologies
Authors: Oberhuber Alexander , Simonte Gioele , Isernia Giacomo , Schäfers Johannes 
Published: December 2023

Purpose: To describe the semibranch as new tool to treat patients with thoracoabdominal, para- and juxtarenal aortic pathologies. Technique: The technique is demonstrated in 2 patients with aortic pathologies. First, a 76-year-old woman with a type Ia endoleak after endovascular repair of abdominal aneurysm (EVAR). Due to the short mainbody of the EVAR and suprarenal extension of the pathology, a 4-branched device with integrated bifurcation was chosen. To realize a branched device in small diameters of the suprarenal aorta, 2 semibranches, for the superior mesenteric artery (SMA) and the celiac trunc (CT), were planned. The second patient, a 75-year-old man, had a juxtarenal aneurysm. Due to small diameters of the aorta, semibranches for the SMA and the CT were planned. In both cases, a total transfemoral approach was used with a steerable sheath. Placement, cannulation of the semibranch, forwarding of the bridging stentgraft, and sealing was uneventful. All 4 semibranches were successful in sealing the aneurysm. Conclusion: The semibranch is another tool in the armamentarium of the endovascular interventionalist, which can expand the range of patients that can be treated. Especially patients with small aortic diameter or short distances between target vessels with the same offspring angle can profit from the semibranch design. Clinical Impact The semibranch is a new tool to treat thoracoabdominal as well para- and juxtarenal aortic pathologies. Due to its reduced length, packaging density can be higher and diameter of the stentgraft can be larger. It closes the gap in pathologies where fenestration are not suitable (kinked aortas) and there is not enough space for standard inner branches (small diameters).
Effect of Zingiber Officinale in the Management of Nausea and Vomiting Induced by Treatment With Cisplatin Associated With Radiotherapy: A Randomized Controlled Trial
Authors: Santos Kauanny Vitoria Gurgel dos , da Silva Romeika Lorena Mendes , Sarmento Ayane Cristine Alves , Medeiros Kleyton Santos de , Pessoa Renata Lima , Dantas Daniele Vieira , Dantas Rodrigo Assis Neves 
Published: December 2023

Objective: evaluate the efficacy of Zingiber Officinale in the management of nausea and vomiting induced by treatment with cisplatin associated with radiotherapy in patients with uterine cervical neoplasms. Methods: a triple-blind, randomized, placebo-controlled trial. Interventions: Comparing the effects of ginger with institutional antiemetic therapy (ondansetron with dexamethasone). Patients with cervical cancer who started treatment with cisplatin with an indication of 40 mg/m² associated with radiotherapy, aged over 18 years, and with the ability to tolerate swallowing a capsule were recruited and equally allocated (1:1:1) into 3 groups of 16 patients each (the ginger capsules 250 mg group, ginger capsules 500 mg group, and placebo group). Nausea and vomiting were measured on baseline, 7 days after the first dose of medication and every seven consecutive days during a treatment break. Results: The 250 mg ginger group had an 8.0% greater chance of experiencing nausea within 24 h after the chemotherapy infusion than the placebo group, although there is no statistical significance ( P = .92986). The 500 mg ginger group showed a 63.9% reduction in nausea under the same conditions ( P = .40460). No change was detected in the occurrence of nausea episodes during the 6 weeks ( P = .8664) or between the groups ( P = .2817). No change was detected in acute or late vomiting during the 6 weeks ( P = .3510) or between the groups ( P = .8500 and P = .5389, respectively). Conclusion: Ginger supplementation does not reduce the intensity of acute and late nausea and vomiting. REBEC (RBR-47yx6p9).
A pilot recruitment strategy to enhance ethical and equitable access to Covid-19 pediatric vaccine trials
Authors: Muller William J , Jhaveri Ravi , Heald-Sargent Taylor , Macy Michelle L , Heard-Garris Nia , Shah Seema , Paquette Erin 
Published: December 2023

Background/Aims The SARS-CoV-2 pandemic disproportionately impacted communities with lower access to health care in the United States, particularly before vaccines were widely available. These same communities are often underrepresented in clinical trials. Efforts to ensure equitable enrollment of participants in trials related to treatment and prevention of Covid-19 can raise concerns about exploitation if communities with lower access to health care are targeted for recruitment. Methods To enhance equity while avoiding exploitation, our site developed and implemented a three-part recruitment strategy for pediatric Covid-19 vaccine studies. First, we publicized a registry for potentially interested participants. Next, we applied public health community and social vulnerability indices to categorize the residence of families who had signed up for the registry into three levels to reflect the relative impact of the pandemic on their community: high, medium, and low. Finally, we preferentially offered study participation to interested families living in areas categorized by these indices as having high impact of the Covid-19 pandemic on their community. Results This approach allowed us to meet goals for study recruitment based on public health metrics related to disease burden, which contributed to a racially diverse study population that mirrored the surrounding community demographics. While this three-part recruitment strategy improved representation of minoritized groups from areas heavily impacted by the Covid-19 pandemic, important limitations were identified that would benefit from further study. Conclusion Future use of this approach to enhance equitable access to research while avoiding exploitation should test different methods to build trust and communicate with underserved communities more effectively.
Effects of external diaphragm pacing combined with conventional rehabilitation therapies in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
Authors: Jiang Linhong , Sun Pingping , Li Peijun , Wu Weibing , Wang Zhenwei , Liu Xiaodan 
Published: December 2023

Background: Numerous randomized controlled trials (RCTs) have reported the benefits of external diaphragm pacing combined with conventional rehabilitation therapies (EDP-CRTs) on pulmonary function and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). However, evidence-based regarding its effects remains unclear. Objectives: This systematic review and meta-analysis aimed to evaluate the effects of EDP-CRTs versus CRTs on patients with COPD. Design: Systematic review and meta-analysis. Data sources and methods: We performed a systematic review and meta-analysis, searching PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, China Biology Medicine Disc, Chinese National Knowledge Infrastructure, Wan-Fang Database, and Chinese Scientific Journal Database from inception to 10 September 2023. RCTs investigating the effects of EDP-CRTs versus CRTs on COPD patients were included. The primary outcome was pulmonary function, including forced expiratory volume in 1 s (FEV1), the percentage of predicted values of FEV1 (FEV1%pred), and FEV1/forced vital capacity (FVC)%. Secondary outcomes included arterial blood gas analysis [the partial pressure of arterial oxygen (PaO2) and the partial pressure of arterial carbon dioxide (PaCO2)]; dyspnea [modified Medical Research Council Dyspnea Scale (mMRC)]; exercise capacity [6-min walking distance (6MWD)]; and quality of life [COPD assessment test (CAT)]. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0). The certainty of the evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system. Results: In total, 13 studies/981 participants were included. The pooled results revealed significant benefits of EDP-CRTs versus CRTs on the FEV1 [standardized mean difference (SMD) = 1.07, 95% confidence interval (CI) = 0.58–1.56], FEV1%pred [weighted mean difference (WMD) = 6.67, 95% CI = 5.69–7.64], the FEV1/FVC% (SMD = 1.24, 95% CI = 0.48–2.00), PaO2 (SMD = 1.29, 95% CI = 0.74–1.84), PaCO2 (SMD = −1.88, 95% CI = −2.71 to −1.04), mMRC (WMD = −0.55, 95% CI = −0.65 to −0.45), 6MWD (SMD = 1.63, 95% CI = 0.85–2.42), and CAT (WMD = −1.75, 95% CI = −3.16 to −0.35), respectively. Planned subgroup analysis suggested that EDP-CRTs had a better effect on FEV1, FEV1/FVC%, 6MWD, and CAT in the duration of 2–4 weeks. Conclusion: EDP-CRTs have better effects on pulmonary function, PaCO2, dyspnea, exercise capacity, and quality of life in COPD patients than CRTs, and the duration to achieve the most effective treatment is 2–4 weeks. Trial registration: This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (No. CRD42022355964).
Latin America consensus statement inflammatory bowel disease: importance of timely access to diagnosis and treatment
Authors: Steinwurz Flavio , Machado Marta Brenner , Veitia Guillermo , De Paula Juan Andres , Bautista Martinez Socrates , Vergara Beatriz Iade , Capdevielle Beatriz , Martinez Silva Francisca Ana , Ramirez Ana Luz 
Published: December 2023

Background: Inflammatory bowel diseases (IBDs) are chronic conditions that negatively interferes with the quality of life of the patients, on a physical, emotional, and social level. Its symptoms can vary including diarrhea, bleeding, abdominal pain, fever, and weight loss, depending on the type and location and severity of the disease. Despite evolving treatment, they do not always achieve control of the symptoms, so between 23% and 45% of people with idiopathic chronic ulcerative colitis, and up to 75% of those with Crohn’s disease, eventually, will need surgery. Objective: The increase in its incidence in Latin America has promoted a renewed interest on the part of the medical and scientific community in standardizing and unifying criteria for the proper diagnosis and management of the disease, which is part of the current discussions of various events; however, this interest has not yet been reflected in policies and initiatives by governments to address the disease. We decided to develop a consensus meeting in order to elucidate the actual situation of IBD care in our region. Design: The methodology employed to build the consensus document derived from a review of literature, evidence, and policies on IBD, followed by a process of validation and feedback with a group of 10 experts in the field. Methods: Nine experts from different countries in Latin America were reunited in web meetings on 2 days and voted on topics derived from the consensus document. A full agreement with 100% approval was needed, so topics were discussed to reach the consensus otherwise were removed. Results: There is still a lack of information about IBD in Latin America, therefore IBD continues to be an ‘invisible’ disease and is little recognized by decision-makers. Conclusion: This document describes the current situation of IBDs in the Latin American region, highlighting the main barriers and challenges in timely access to diagnosis and treatment, in order to demonstrate the need to promote the development and implementation of policies, in order to improve the quality of care of patients with IBD.
Defining the course of neurosarcoidosis according to presentation at onset and disease modifying treatment: a cohort study of 84 patients
Authors: Bekkour Inès , Courtin Edouard , Dulau-Metras Cécile , Duffau Pierre , Kremer Laurent , Mathey Guillaume 
Published: December 2023

Background: Neurosarcoidosis is a rare manifestation of sarcoidosis with heterogeneous presentations. Patient management is challenging due to the current lack of knowledge about the long-term disease course. Objective: To identify specific disease courses of neurosarcoidosis according to the clinical and paraclinical presentations at onset. Methods: We conducted an observational multicenter cohort study by retrospectively collecting data from the medical records of 84 patients diagnosed with definite, probable, or possible neurosarcoidosis in three tertiary referral centers in France (Nancy, Strasbourg, and Bordeaux). We collected demographic characteristics, clinical and paraclinical data at the beginning of patient management, and during follow-up under the different treatment lines. Two expert neurologists determined disease course profiles. Results: The mean follow-up was 6.6 years. Almost every patient (96.4%) received steroids at some point of their follow-up. Tumor Necrosis Factor-alpha blockers were given in 10.7% as first-line treatment and in 33.3% during follow-up. Every patient presented with a relapsing disease, often monophasic (75%) and sometimes polyphasic with the recurrence of identical manifestations (11.9%). Patients developing new neurological symptoms during follow-up were a minority (13.1%). No patients exhibited a progressive course. Patients with isolated cranial nerves injury or aseptic meningitis always exhibited a monophasic course, and 62.5–75% of them had a full recovery after first-line treatments. This proportion was 15.6% in other forms of the disease. Those with peripheral presentations were more likely to present a polyphasic course than patients with other forms of neurosarcoidosis. Spinal cord presentations were monophasic, but resulted in sequelae and exhibited poor response to first-line treatments despite frequent use of TNF-alpha blockers. Conclusion: Identification of these disease course profiles, based on the initial clinical and paraclinical presentation, could guide the clinician to select the optimal therapeutic approach and follow-up modalities for their patients with neurosarcoidosis.
Board Informal Hierarchy and Digital Transformation: Evidence From Chinese Manufacturing Listed Companies
Authors: Yan Aiguo , Yu Mingtao 
Published: December 2023

Board informal hierarchy plays a crucial role in board governance and corporate strategic decision-making. The article empirically examines the impact of board informal hierarchy on corporate digital transformation based on relational contract theory, using a fixed-effects model with Shanghai and Shenzhen A-share listed manufacturing companies from 2012 to 2019 as research subjects. The findings of this study demonstrate a positive correlation between board informal hierarchy and digital transformation. Specifically, the presence of a chairman with the highest rank in the informal hierarchy strengthens this relationship, while the presence of a CEO with the highest rank weakens it. Mechanistic analysis shows that informal hierarchy accelerates digital transformation through three channels: improving board decision-making efficiency, mitigating management myopia, and facilitating information communication. This study extends existing research. On the one hand, this paper explores the drivers of digital transformation in manufacturing firms at the level of corporate governance and board characteristics. The findings provide empirical evidence to support the understanding of transformational change behaviors of manufacturing enterprises in the digital economy. On the other hand, it also opens up the “black box” of the internal operation of the board and provides valuable lessons for strengthening board governance. JEL Classification: D21; M12; Z13.
2023 IFFAS Award for Excellence Winner: Percutaneous vs Open Distal Chevron Osteotomy for the Treatment of Hallux Valgus: A Prospective Randomized Study
Authors: Choi Gi-Won , Yoon Hangseob , Park Kwang Hwan , Jo Joon , Lee Moses , Lee Jin Woo , Kim Hak Jun 
Published: December 2023

Category: Bunion: Midfoot/Forefoot Introduction/ Purpose: This study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. Methods: Seventy-one patients with hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35). The primary outcome was the hallux valgus angle 12 months postoperatively. The secondary outcomes were other radiographic parameters including inter-metatarsal angle, medial sesamoid position, first metatarsal shortening, and first metatarsal declination angle, and functional outcomes, such as foot and ankle outcome score (FAOS), foot functional index (FFI), pain visual analog scale (VAS), patient satisfaction, shoe restriction, and metatarsophalangeal (MTP) joint range of motion. Radiological and clinical outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively. The VAS for pain was evaluated preoperatively and at 1 day, 2 weeks, 6 weeks, and 3, 6, and 12 months postoperatively. Results: At year 1 post-operation, there were no significant differences between the groups in any radiographic parameters, except the first metatarsal declination angle. The mean first metatarsal declination angle was significantly lower in the open group than that in the percutaneous group. The FAOS, FFI, patient satisfaction, and shoe restriction did not differ significantly between the groups. However, the percutaneous group had a significantly lower VAS score for pain on day 1 post-operation than the open group. The mean range of motion of the first MTP joint decreased significantly only in the open group. Conclusion: Radiological and clinical outcomes following percutaneous distal chevron osteotomy were comparable to those of open distal chevron osteotomy. However, the percutaneous group had an advantage over the open group as it showed a lower immediate postoperative pain level and better range of motion of the first MTP joint.
AI-Based Foot X-Ray Reading in Real-World: Evaluating the Accuracy of Assistive Decisions for Diagnosing Foot & Ankle Disorders
Authors: Kim Yoon-Chung , Choi Youn-Ho 
Published: December 2023

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Evaluation of plain radiographs is of fundamental importance in the diagnosis and treatment planning of foot and ankle disorders. These assessments are essential, but can be difficult for the following reasons: First, many angles must be measured using various reference lines. Second, there may be inter-observer differences in the measurements. Consistent and standardized measurement methods are required to increase the efficiency and accuracy of radiographic readings. Several recent studies have reported good results using deep learning (DL) models for medical image analysis. It is expected that efficiency and accuracy can be increased through radiographic readings using DL. This study aims to develop a DL model that recognizes the bones of the foot and ankle in plain radiographs and automatically measures angles frequently used for diagnosis. Methods: The DL model was developed using two architectures: segmenting objects by locations (SOLO) for bone segmentation and Global Universal U-Net (GU2Net) for reference line detection. The angles measured were hallux valgus angle (HVA) and 1st- 2nd intermetatarsal angle (IMA) on anterior-posterior (AP) X-ray; calcaneal pitch angle (CPA) and lateral Meary's angle (LMA) on lateral X-ray. Only data obtained from external test set were used for statistical analysis to evaluate the model's performance. The test set used a total of 558 images collected from January 2022 to September 2022. Angles measured by the DL model were compared with angles measured manually by human researchers. The intraclass correlation coefficient (ICC) was used to evaluate the accuracy of angle measurements. The error between the angle measured by the DL model and the angle measured by human researchers was evaluated using root mean square error (RMSE) and mean absolute difference (MAE). Results: As shown in the attached table, the ICCs of HVA were 0.957 (right) and 0.933 (left). The ICCs of IMA were 0.881 (right) and 0.902 (left). The ICCs of LMA were 0.895 (right) and 0.937 (left). The ICCs of CPA were 0.918 (right) and 0.868 (left). All ICCs were greater than 0.8, indicating excellent correlations between angles measured with the DL model and angles measured manually (ground truth). For RMSE and MAE, the left IMA was the smallest (1.50 and 1.16, respectively), and the right LMA was the largest (4.50 and 2.47, respectively). Conclusion: The DL model in our study was able to perform various angle measurements in both AP and lateral X-rays with considerable accuracy. Through additional model training and development, it is expected that it will be useful for analyzing various foot and ankle disorders such as hallux valgus, flatfoot, pes cavus and other alignment deformities.