bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of remote ischaemic preconditioning on myocardial injury after major abdominal surgery in patients at high risk for cardiovascular adverse events in China (RIPC-MAS): protocol for a randomised, sham-controlled, observer-blinded trial
Authors: Wang Fan , Liang Chu-Jun , Shi Jian-Kun , Huang Qing-Shan , Nassirou Bizo Mailoga , Wang Xi , Jin San-Qing , Zhao Yang 
Published: June 2023

IntroductionMyocardial injury after non-cardiac surgery (MINS) caused by an ischaemic mechanism is common and is associated with adverse short-term and long-term prognoses. However, MINS is a recent concept, and few studies have prospectively used it as a primary outcome. Remote ischaemic preconditioning (RIPC) is a non-invasive procedure that induces innate cardioprotection and may reduce MINS.Methods and analysisThis is a multicentre, randomised, sham-controlled, observer-blinded trial. Patients with a high clinical risk of cardiovascular events who are scheduled to undergo major abdominal surgery will be enrolled. A total of 766 participants will be randomised (1:1 ratio) to receive RIPC or control treatment before anaesthesia. RIPC will comprise four cycles of cuff inflation for 5 min to 200 mm Hg and deflation for 5 min. In the controls, an identical-looking cuff will be placed around the arm but will not be actually inflated. The primary outcome will be MINS, defined as at least one postoperative cardiac troponin (cTn) concentration above the 99th percentile upper reference limit of the cTn assay as a result of a presumed ischaemic mechanism. This trial will test the concentration of high-sensitivity cardiac troponin T (hs-cTnT). The secondary outcomes will be hs-cTnT levels reaching/above the prognostically important thresholds, peak hs-cTnT and total hs-cTnT release during the initial 3 days after surgery, length of hospital stay after surgery, length of stay in the intensive care unit, myocardial infarction, major adverse cardiovascular events, cardiac-related death, all-cause death within 30 days, 6 months, 1 year and 2 years after surgery, and postoperative complications and adverse events within 30 days after surgery.Ethics and disseminationThis study protocol (version 5.0 on 7 April 2023) was approved by the Ethics Committee of Sixth Affiliated Hospital of Sun Yat-sen University. The findings will be published in peer-reviewed journals.Trial registration numberNCT05733208.
Lung cancer survivors’ views on telerehabilitation following curative intent therapy: a formative qualitative study
Authors: Ha Duc M , Nunnery Mary A , Klocko Robert P , Haverhals Leah M , Bekelman David B , New Melissa L , Randhawa Simran K , Stevens-Lapsley Jennifer E , Studts Jamie L , Prochazka Allan V , Keith Robert L 
Published: June 2023

ObjectivesTo inform personalised home-based rehabilitation interventions, we sought to gain in-depth understanding of lung cancer survivors’ (1) attitudes and perceived self-efficacy towards telemedicine; (2) knowledge of the benefits of rehabilitation and exercise training; (3) perceived facilitators and preferences for telerehabilitation; and (4) health goals following curative intent therapy.DesignWe conducted semi-structured interviews guided by Bandura’s Social Cognitive Theory and used directed content analysis to identify salient themes.SettingOne USA Veterans Affairs Medical Center.ParticipantsWe enrolled 20 stage I–IIIA lung cancer survivors who completed curative intent therapy in the prior 1–6 months. Eighty-five percent of participants had prior experience with telemedicine, but none with telerehabilitation or rehabilitation for lung cancer.ResultsParticipants viewed telemedicine as convenient, however impersonal and technologically challenging, with most reporting low self-efficacy in their ability to use technology. Most reported little to no knowledge of the potential benefits of specific exercise training regimens, including those directed towards reducing dyspnoea, fatigue or falls. If they were to design their own telerehabilitation programme, participants had a predominant preference for live and one-on-one interaction with a therapist, to enhance therapeutic relationship and ensure correct learning of the training techniques. Most participants had trouble stating their explicit health goals, with many having questions or concerns about their lung cancer status. Some wanted better control of symptoms and functional challenges or engage in healthful behaviours.ConclusionsFeatures of telerehabilitation interventions for lung cancer survivors following curative intent therapy may need to include strategies to improve self-efficacy and skills with telemedicine. Education to improve knowledge of the benefits of rehabilitation and exercise training, with alignment to patient-formulated goals, may increase uptake. Exercise training with live and one-on-one therapist interaction may enhance learning, adherence, and completion. Future work should determine how to incorporate these features into telerehabilitation.
Critical Care Cycling to ImproveLowerExtremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients
Authors: Kho Michelle E , Reid Julie , Molloy Alexander J , Herridge Margaret S , Seely Andrew J , Rudkowski Jill C , Buckingham Lisa , Heels-Ansdell Diane , Karachi Tim , Fox-Robichaud Alison , Ball Ian M , Burns Karen E A , Pellizzari Joseph R , Farley Christopher , Berney Sue , Pastva Amy M , Rochwerg Bram , D'Aragon Frédérick , Lamontagne Francois , Duan Erick H , Tsang Jennifer L Y , Archambault Patrick , English Shane W , Muscedere John , Serri Karim , Tarride Jean-Eric , Mehta Sangeeta , Verceles Avelino C , Reeve Brenda , O'Grady Heather , Kelly Laurel , Strong Geoff , Hurd Abby H , Thabane Lehana , Cook Deborah J 
Published: June 2023

IntroductionIn-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults.Methods and analysisWe report a parallel group RCT of 360 patients in 17 medical-surgical ICUs and three countries. We include adults (≥18 years old), who could ambulate independently before their critical illness (with or without a gait aid), ≤4 days of invasive mechanical ventilation and ≤7 days ICU length of stay, and an expected additional 2-day ICU stay, and who do not fulfil any of the exclusion criteria. After obtaining informed consent, patients are randomised using a web-based, centralised system to either 30 min of in-bed cycling in addition to routine PT, 5 days per week, up to 28 days maximum, or routine PT alone. The primary outcome is the Physical Function ICU Test-scored (PFIT-s) at 3 days post-ICU discharge measured by assessors blinded to treatment allocation. Participants, ICU clinicians and research coordinators are not blinded to group assignment. Our sample size estimate was based on the identification of a 1-point mean difference in PFIT-s between groups.Ethics and disseminationCritical Care Cycling to improveLowerExtremity (CYCLE) is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (Project 1345). We will disseminate trial results through publications and conference presentations.Trial registration numberNCT03471247(Full RCT);NCT02377830(CYCLE Vanguard 46 patient internal pilot).
Viz LVO versus Rapid LVO in detection of large vessel occlusion on CT angiography for acute stroke
Authors: Delora Adam , Hadjialiakbari Christopher , Percenti Eryn , Torres Jordan , Alderazi Yazan J , Ezzeldin Rime , Hassan Ameer E , Ezzeldin Mohamad 
Published: June 2023

BackgroundEndovascular thrombectomy improves outcomes and reduces mortality for large vessel occlusion (LVO) and is time-sensitive. Computer automation may aid in the early detection of LVOs, but false values may lead to alarm desensitization. We compared Viz LVO and Rapid LVO for automated LVO detection.MethodsData were retrospectively extracted from Rapid LVO and Viz LVO running concurrently from January 2022 to January 2023 on CT angiography (CTA) images compared with a radiologist interpretation. We calculated diagnostic accuracy measures and performed a McNemar test to look for a difference between the algorithms’ errors. We collected demographic data, comorbidities, ejection fraction (EF), and imaging features and performed a multiple logistic regression to determine if any of these variables predicted the incorrect classification of LVO on CTA.Results360 participants were included, with 47 large vessel occlusions. Viz LVO and Rapid LVO had a specificity of 0.96 and 0.85, a sensitivity of 0.87 and 0.87, a positive predictive value of 0.75 and 0.46, and a negative predictive value of 0.98 and 0.97, respectively. A McNemar test on correct and incorrect classifications showed a statistically significant difference between the two algorithms’ errors (P=0.00000031). A multiple logistic regression showed that low EF (Viz P=0.00125, Rapid P=0.0286) and Modified Woodcock Score >1 (Viz P=0.000198, Rapid P=0.000000975) were significant predictors of incorrect classification.ConclusionRapid LVO produced a significantly larger number of false positive values that may contribute to alarm desensitization, leading to missed alarms or delayed responses. EF and intracranial atherosclerosis were significant predictors of incorrect predictions.
Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion
Authors: Pillai Presaad , Bush Steven J , Kusuma Yohanna , Churilov Leonid , Dowling Richard J , Luu Vu Dang , Davis Stephen M , Mitchell Peter J , Yan Bernard 
Published: June 2023

BackgroundFirst pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related strokes have different clot composition compared with non-AF strokes, which may impact thrombectomy reperfusion results. We compared FPE rates in AF and non-AF stroke patients to evaluate if AF-related strokes had higher FPE rates.MethodsWe conducted a post-hoc analysis of the DIRECT-SAFE trial data, including patients with retrievable clots on the initial angiographic run. Patients were categorized into AF and non-AF groups. The primary outcome was the presence or absence of FPE (single-pass, single-device resulting in complete/near complete reperfusion) in AF and non-AF groups. We used multivariable logistic regression to examine the association between FPE and AF, adjusting for thrombolysis pre-thrombectomy and clot location.ResultsWe included 253 patients (67 with AF, 186 without AF). AF patients were older (mean age: 74 years vs 67.5 years, p=0.001), had a higher proportion of females (55% vs 40%, p=0.044), and experienced more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) score: 17 vs 14, p=0.009) than non-AF patients. No differences were observed in thrombolytic agent usage, time metrics, or clot location. AF patients achieved a higher proportion of FPE compared with non-AF patients (55.22% vs 37.3%, adjusted odds ratio 2.00 (95% CI 1.13 to 3.55), p=0.017).ConclusionsAF-related strokes in LVO patients treated with EVT were associated with FPE. This highlights the need for preparedness for multiple passes and potential adjuvant/rescue therapy in non-AF-related strokes.
High variability in physician estimations of flow-diverting stent deployment versus PreSize Neurovascular software simulation: a comparison study
Authors: Rai Ansaar T , Boo SoHyun , Downer Jonathan , DuPlessis Johannes , Rautio Riitta , Sinisalo Matias , Pekkola Johanna , Carraro do Nascimento Vinicius , Given Curtis , Patankar Tufail 
Published: June 2023

BackgroundPhysician variablity in preoperative planning of endovascular implant deployment and associated inaccuracies have not been documented. This study aimed to quantify the variability in accuracy of physician flow diverter (FD) planning and directly compares it with PreSize Neurovascular (Oxford Heartbeat Ltd) software simulations.MethodsEight experienced neurointerventionalists (NIs), blinded to procedural details, were provided with preoperative 3D rotational angiography (3D-RA) volumetric data along with images annotated with the distal landing location of a deployed Surpass Evolve (Stryker Neurovascular) FD from 51 patient cases. NIs were asked to perform a planning routine reflecting their normal practice and estimate the stent’s proximal landing using volumetric data and the labeled dimensions of the FD used. Equivalent deployed length estimation was performed using PreSize software. NI- and software-estimated lengths were compared with postprocedural observed deployed stent length (control) using Bland–Altman plots. NI assessment agreement was assessed with the intraclass correlation coefficient (ICC).ResultsThe mean accuracy of NI-estimated deployed FD length was 81% (±15%) versus PreSize’s accuracy of 95% (±4%), demonstrating significantly higher accuracy for the software (p<0.001). The mean absolute error between estimated and control lengths was 4 mm (±3.5 mm, range 0.03–30.2 mm) for NIs and 1 mm (±0.9 mm, range 0.01–3.9 mm) for PreSize. No discernable trends in accuracy among NIs or across vasculature and aneurysm morphology (size, vessel diameter, tortuousity) were found.ConclusionsThe study quantified experienced physicians’ significant variablity in predicting an FD deployment with current planning approaches. In comparison, PreSize-simulated FD deployment was consistently more accurate and reliable, demonstrating its potential to improve standard of practice.
Carotid artery direct access for intracranial stenting of a stroke patient with an aberrant left common carotid artery and right aorta
Authors: Fu Weilun , Liu Xinke , Yang Bo , Yan Zhaoyang , Jia Baixue , He Ying , Ma Ning 
Published: June 2023

A right aortic arch is present in 0.1% of the population and can occur in isolation or be associated with congenital heart disease.1 Moreover, the most common form of right aortic arch in adults is associated with an aberrant left subclavian artery.1 An aberrant left common carotid artery that originated from the ascending aorta with the right aorta is very rare. In this situation, carotid direct access was considered to avoid access challenge due to a large curve from the ascending aorta to the left common carotid artery.2 3 Here we demonstrate carotid artery direct access for intracranial stenting of a stroke patient with aberrant left common carotid artery and right aorta. Manual compression with a long time under general anesthesia to avoid post-procedural puncture site hematoma is recommended (video 1).Video 1 Carotid artery direct access
Good death from cancer–the patient view: systematic review of qualitative studies
Authors: Wang Guiyun , Xiao Jinnan , Chen Zhihan , Huang Chongmei , Deng Yinghua , Tang Siyuan 
Published: June 2023

Background and objectiveAn in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer.MethodsThis systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data.ResultsA total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients’ internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts.ConclusionA good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients’ positive perspectives and behaviours are recommended to improve their quality of life and death.
T-cell Therapies Targeting Multiple Cancer Antigens: The Power of Many
Authors: Uslu Ugur , June Carl H. 
Published: June 2023

Abstract
In this issue, Tsimberidou and colleagues report the results of a first-in-human clinical trial using a personalized, multi-target, endogenous T-cell therapy in patients with metastatic solid tumors. This, and results of other recently published clinical trials, confirms the rationale of multi-target approaches that can increase tumor responses and counteract tumor heterogeneity and mechanisms of immune evasion.
See related article by Tsimberidou et al., p. 925 (4).
Case Visit Activity Report An. S Patients with Short Stature Pulmonary Tuberculosis Through Family Medicine Approach
Authors: Butar Butar Ananda Josua Triagus Pahala , Sevilla Paulina , Mosso Justhina Ensly , Novendy Novendy 
Published: June 2023

Tuberculosis can occur in all age groups adults and children. Tuberculosis (TB) in children occurs in children aged 0-14 years and most common at ages 1-14 years. In the working area of the Cikupa Health Center, there are patients a daughter named An.S who was diagnosed with a new case of pulmonary tuberculosis and has stature short based on results plotting so that need done intervention through family doctor visit. Solving the problem pulmonary tuberculosis infection with short stature in An. S. A female patient, An.S , aged 2 years and 8 months, came with a complaint Cough with fever for 2 weeks. In addition, high growth was also obtained age-appropriate body The patient has received antibiotics and concoction but complaints do not improve. The patient's grandmother also had similar complaints. In this case, an intervention using a family medicine approach with Mandala of Health For get diagnosis holistic And done governance in a manner comprehensive. After the intervention of An.S showed improvement and is currently undergoing treatment. Height has increased from 84 cm to 86 cm also weight from 11.2 kg to 13 kg. The family has understood about TB disease and is willing to do screening and implement PHBS. Known sources of tuberculosis infection in An. S suspected of coming from the patient's grandmother. TB infection experienced by patients has an impact on inhibiting the patient's growth so that the patient's height does not increase. After comprehensive treatment and education, the patient's family understands tuberculosis, disease transmission and prevention so that it is hoped that the treatment will be carried out completely and can catch up with age-appropriate growth.
Knowledge and Adaptation Practices: Baseline Data for the Development of Climate Change Engagement Model
Authors: Corpuz Alma M. 
Published: June 2023

Climate change (CC) will continue to harm the environment if mitigation efforts are slow. Raising the CC knowledge and awareness of individuals is crucial in prompting significant mitigating action or adaptation practices. In addition, empowering young people will potentially ignite more innovative strategies that are helpful in decelerating the impacts of CC. The study aimed to determine students’ knowledge of CC and their adaptive practices. Based on the findings, a model to engage students in CC action was developed. The respondents were 132 students in a State University in Region III enrolled in AY 2022-2023. Data were gathered using a validated self-made questionnaire. Findings revealed that while most respondents were knowledgeable of the concept of climate change (62.88%), a sizable percentage were still misinformed. In addition, the respondents knew the causes of CC such as the emission of greenhouse gases (87.12%), deforestation (57.58%), and excessive fertilizer use (37.88%) but some causes of climate change were unknown to them. Moreover, most of them were cognizant of the consequences of climate change which include excessive rain (96.21%), flood (95.45%), and melting of snow (94.70%). But the response to “drought” as one of the consequences of climate change was only known to a few students (47.73%). As to the knowledge of the health effects of climate change, most students knew CC raises respiratory, water-borne, and skin diseases but some expressed their lack of knowledge about other diseases such as the possibility of triggering cancer and mental health issues. Moreover, students have developed CC adaptive practices such as consuming more fruits and vegetables than meat and conserving energy use at home, but they were observed to be inconsistent in some areas such as in practicing the 3Rs and in throwing away less food. The F-value of 0.021 and 0.82 p-value, to compare the CC adaptive practices of the respondents with respect to gender, support the acceptance of the null hypothesis. Gender is not a determinant of CC adaptive practices. This indicates that gender is not a barrier to CC action. The study concludes that students have limited knowledge about climate change, especially on the health impacts. Also, the students’ CC adaptive practices imply lack of commitment to act on CC. The study recommends strengthening the integration of climate change into school policies, research, extension, and instruction and a strong support of school stakeholders in their implementation. A climate change engagement model is an output of this study which may be considered by schools in prompting students to participate in CC action. A future study may include the factors that hinder students’ consistent involvement in CC action despite their awareness and knowledge about the negative consequences.