bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visceral Adiposity Index as a Measure of Cardiovascular Disease in Persons With Human Immunodeficiency Virus
Authors: Thomas Teressa S , Dunderdale Carolyn , Lu Michael T , Walpert Allie R , Shen Grace , Young Michele C H , Torriani Martin , Chu Jacqueline T , Haptu Hanna H , Manandhar Monica , Wurcel Alysse , Adler Gail K , Grinspoon Steven K , Srinivasa Suman 
Published: July 2023

Abstract

Background
Persons with well-treated human immunodeficiency virus (HIV) demonstrate a 2-fold higher risk of cardiovascular disease (CVD), which may be related to excess visceral adipose tissue (VAT). The visceral adiposity index (VAI) is a score to approximate VAT by combining biochemical measures with anthropometrics without quantification by imaging. We evaluated VAI in association with cardiometabolic factors among persons with HIV (PWH).

Methods
Forty-five PWH on antiretroviral therapy and virologically controlled with increased abdominal VAT (VAT area &gt;110 cm2 on CT) and no known CVD were included. VAI was calculated using standard sex-specific formulas. Coronary plaque was assessed using coronary CT angiography.

Results
Participants were predominantly male (73%), white (53%), and non-Hispanic (84%), with a mean age of 55 (standard deviation, 7) years. Among PWH, median VAI was calculated to be 4.9 (interquartile range [IQR], 2.8–7.3). Log VAI correlated with log VAT (r = 0.59, P &lt; .0001) and anthropometric measures (body mass index: r = 0.36, P = .02; waist circumference: r = 0.43, P = .004; waist-to-hip ratio: r = 0.33, P = .03). Participants with coronary plaque had a higher VAI compared to those without coronary plaque (median, 5.3 [IQR, 3.4–10.5] vs 2.8 [IQR, 1.8–5.0]; P = .004). VAI (area under the curve = 0.760, P = .008) performed better than the atherosclerotic CVD risk score to predict the presence of plaque in receiver operating characteristic analyses.

Conclusions
VAI may be a useful biomarker of metabolic dysfunction and increased CVD risk that may occur with VAT accumulation in PWH.

Clinical Trials Registration
NCT02740179.
“What’s My Line?”: Pseudo-Improvised Teaching When the Clinical Teaching Script Is Blank
Authors: Jarrett Elizabeth S. , Allen Katherine A. , Marmet Jordan , Klein Melissa , Moerdler Scott , Pitt Michael B. 
Published: July 2023

Abstract
Commitment to clinical education often requires significant forethought and attention to provide a comprehensive learning experience for trainees. In these settings, teaching is typically time-limited, prompted by a clinical scenario, and requires preparation. However, it is not uncommon for teachers to have insufficient time to prepare or to encounter a clinical scenario in which they have not yet developed a teaching script.
In this article, the authors share 5 categories of teaching techniques that instructors can pull from regardless of the prompt or busyness of the clinical setting and that are ideal for using when the teaching script is “blank.” They call this approach of having scenario-independent teaching techniques ready to be applied with minimal preparation, “pseudo-improvised teaching.”
Drawing from the literature, their own experience, and borrowing from improvisational theater, the authors share a toolkit of pseudo-improvised teaching techniques spanning from pathophysiology to clinical skills to work–life integration. In addition to highlighting several techniques, they describe models of meta-structure for teaching in which the use of themes for the day (i.e., longitudinal themes) and routines can ease some of the cognitive load felt by both learners and educators.
TCM monotherapy achieves significant efficacy in crizotinib-refractory advanced NSCLC with brain metastasis
Authors: Qin Jiqiu , Li Ru , Ma Hong , Ding Peng , Yang Qin , Hu Lilai , Wu Deliu , Xiong Shaoquan 
Published: July 2023

Rationale:
The morbidity and mortality of lung cancer rank the first among all kinds of cancer. In China, anaplastic lymphoma kinase-positive pulmonary tumors account for nearly 5% of non-small cell lung cancer (NSCLC), and these patients are quite likely to develop brain metastases, as high as around 45%. Although anaplastic lymphoma kinase-tyrosine kinase inhibitors crizotinib and alectinib have proved effective for controlling tumor metastases to the brain, drug resistance and disease progression cannot be ignored in the course of treatment.

Patient concerns:
Most of the literature reports that traditional Chinese medicine (TCM) has produced satisfactory results in the treatment of cancer patients as an adjuvant treatment for various malignancies in a 53-year-old male patient who developed advanced NSCLC with brain metastases. As first-line crizotinib and erlotinib treatments were ineffective and the intracranial lesions progressed extensively, the patient chose to receive TCM treatment alone in the hope of prolonging his life and improving his quality of life.

Diagnoses:
A 53-year-old male patient who developed advanced NSCLC with brain metastasis. Because first-line crizotinib and alectinib have failed, and the intracranial lesions progressed in a large area.

Interventions:
The patient requested that the final therapeutic strategy be Chinese medicine as monotherapy for long-term treatment. The patient took 30 mL of the decoction 1 hour after a meal, 3 times a day. The patient was not treated with dehydrating agents or diuretics during the TCM treatment.

Outcomes:
The improvement was obvious after 3 months of treatment, and significant reduction of cranial lesions. During the follow-up period, the patient developed neither severe liver damage nor kidney damage.

Lessons:
This case is the first 1 in the world where TCM was introduced as monotherapy for severe conditions with extensive brain metastases and achieved remarkable efficacy.
Clinicopathological and prognostic significance of SMAD4 in non-small cell lung cancer: A meta-analysis and database validation
Authors: Li Zhiqiang , Huang Yunfei , Zhou Rongsheng , Li Zhicheng , Yan Qitao 
Published: July 2023

Background:
The relationship between SMAD family member 4 (SMAD4) and the clinicopathological and prognostic significance of non-small cell lung cancer (NSCLC) patients is unclear. Our aim was to investigate the association between SMAD4 expression and clinicopathological parameters and NSCLC prognosis.

Methods:
We searched articles in databases from inception to July 2022 to retrieve literature related to SMAD4 expression and the clinicopathological and/or prognostic significance of NSCLC patients. Odds ratios (ORs), hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. We evaluated the expression of SMAD4 and overall survival (OS) in NSCLC using the Kaplan–Meier plotter database.

Results:
Eight articles with 1461 NSCLC patients were included. SMAD4 expression was related to tumor differentiation (OR = 0.359, 95% CI: 0.238–0.543, P = .000), lymph node metastasis (OR = 0.469, 95% CI: 0.04–0.725, P = .001), tumor node metastasis stage (OR = 0.238, 95% CI: 0.156–0.362, P = .000) and good OS (HR = 0.592, 95% CI: 0.332–0.853, P = .000) in NSCLC. There was no significant association between SMAD4 expression and age (OR = 0.822, 95% CI: 0.515–1.312, P = .411) or sex (OR = 1.056, 95% CI: 0.675–1.653, P = .811). Furthermore, SMAD4 expression was lower in NSCLC, and a good prognosis in NSCLC (HR = 0.6, 95% CI = 0.51–0.72, P = 4.2 e-9) was shown to correlate with higher SMAD4 expression using the Kaplan–Meier Plotter database.

Conclusion:
SMAD4 expression is lower in NSCLC and correlated with lymph node metastasis, tumor differentiation, tumor node metastasis stage and good OS for NSCLC patients.
Polyarteritis nodosa initially presenting as concomitant peripheral neuropathy and myositis in unilateral limb: A case report
Authors: Han In Jun , Jeong Chang Hyeon , Choi Hyoseon 
Published: July 2023

Rationale:
We report the case of a patient who initially presented with peripheral neuropathy and myositis without typical organ involvement, such as the kidneys, skin, or gastrointestinal system, but was ultimately diagnosed with polyarteritis nodosa (PAN).

Patient concerns:
A 62-year-old man presented with radicular pain in his right lower extremity. One week later, he complained of right ankle motor weakness and pain in the right posterior thigh, which led to admission. After 6 weeks of hospitalization, he newly experienced pain in his right testicle and anterior thigh.

Diagnosis:
The patient was initially diagnosed with polymyositis combined with sciatic neuropathy using magnetic resonance imaging, electrodiagnostic tests, and muscle biopsy. However, with the emergence of other systemic symptoms such as testicular pain, vasculitis was suspected, and the patient was reclassified as PAN using the 2007 European Medicines Agency algorithm and the American College of Rheumatology criteria.

Interventions:
The patient was treated with glucocorticoids for more than 6 months, and antiviral medication was prescribed to prevent hepatitis B virus reactivation.

Outcomes:
The patient’s radicular pain and pain in the right anterior and posterior thighs and testicle improved, and there were no signs of recurrence.

Lessons:
In patients presenting with radicular and focal muscle pain, it is crucial to consider the potential for PAN, as observed in this case report.
The efficacy of aprepitant for the prevention of postoperative nausea and vomiting: A meta-analysis
Authors: Liu Yingchao , Chen Xinli , Wang Xiaohua , Zhong Huohu , He Hefan , Liu Yibin , Liao Yuewen , Pan Zhigang , Hu Weipeng , Liu Weifeng , Zheng Feng 
Published: July 2023

Background:
Postoperative nausea and vomiting (PONV) is one of the common adverse reactions after surgery. Recent randomized controlled trials (RCTs) investigating antiemetic drugs suggest that aprepitant has the strongest antiemetic effect of any single drug. This meta-analysis aimed to explore the efficacy of aprepitant for preventing PONV based on the existing literature.

Methods:
To identify RCTs investigating the use of aprepitant for PONV prevention, we searched PubMed, Embase, and Cochrane Library databases for articles published prior to March 20, 2022. Seventeen RCTs were identified, with 3299 patients, meeting the inclusion criteria. PONV incidence, complete response, 80 mg aprepitant combined with dexamethasone and ondansetron, vomiting, nausea, and analgesic dose-response were the main outcomes measured.

Results:
Compared with the control group, PONV incidence was significantly reduced among those receiving aprepitant (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.26, 0.44; P < .0001), with a more complete response (OR: 1.35; 95% CI: 1.14, 1.59; P = .0004). Supplementation of 80 mg aprepitant in combination with dexamethasone and ondansetron substantially improved the effects of PONV (OR: 0.36; 95% CI: 0.16, 0.82; P = .01). Further, administration of 80 mg aprepitant was better at preventing vomiting than nausea (OR: 8.6; 95% CI: 3.84, 19. 29; P < .00001). No statistically significant difference between the dose-response of analgesics was identified (mean difference: −1.09; 95% CI: −6.48, 4.30; P = .69). The risk of bias was assessed independently by paired evaluators.

Conclusion:
Aprepitant effectively reduces the incidence of PONV; however, the effects of postoperative analgesia require further exploration.
The efficacy of Chinese herbal ointment in treating perianal eczema: A systematic review and meta-analysis
Authors: Zhang Hui , Lin Minghao , Zhang Yiwen , Liu Shilin , Li Andong , Li Guofeng 
Published: July 2023

Background:
Traditional Chinese herbal ointment has significant curative effect and few side effects in the treatment of perianal eczema (PE). Currently, there is no systematic evaluation on the treatment of PE with traditional Chinese medicine ointment. The current aim is to systematically evaluate the efficacy of traditional Chinese medicine ointment in the treatment of PE through meta-analysis.

Methods:
Randomized controlled trials on the treatment of PE with Chinese herbal plaster were included in the meta-analysis, which was searched in Chinese and English databases up to March 1, 2023. The search will be conducted in accordance with the object of PICOS framework. Two research will independently use EndnoteX9 to extract the data and evaluate the quality assessment of included trails. Meta-analysis was performed using Revman5.4.1 provided by Cochrane Collaboration; when the outcome indicator is a dichotomous variable, relative risk (RR) was used as the effect size; when the outcome indicator is a continuous variable, weighted mean difference (MD) was used as the effect size, each effect size should be expressed as 95% confidence interval (CI).

Results:
The results of meta-analysis showed that: The total effective rate of PE (RR: 1.22, 95% CI: 1.15, 1.30, P < .01; I
2 = 32%, Q = 0.17). The cure rate of PE (RR: 3.37, 95% CI: 2.30, 4.94, P < .01; I
2 = 21% Q = 0.26). The recurrence rate of PE (RR: 0.25, 95% CI: 0.13, 0.48, P < .01; I
2 = 31%Q = 0.23). Itchy points (MD: 0.04, 95% CI: −0.19, 0.27; I
2 = 26%) Skin damage area (MD: −0.37, 95% CI: −0.56, −0.19; I
2 = 26%). Skin damage form (MD: −0.59, 95% CI: −0.81. −0.36; I
2 = 0%).

Conclusion:
A total of 11 articles were included in this study for meta-analysis, and the results showed that Chinese medicine ointment is more helpful in improving the skin lesion area and skin damage form, significantly improve the response rate and cure rate, reduce the recurrence rate. Chinese herbal ointment has guiding significance for clinical practice which deserve to use ointments by further experimental and clinical investigation.
Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions
Authors: Roberts Sanford E. , Rosen Claire B. , Keele Luke J. , Kaufman Elinore J. , Wirtalla Christopher J. , Syvyk Solomiya , Reilly Patrick M. , Neuman Mark D. , McHugh Matthew D. , Kelz Rachel R. 
Published: July 2023

Introduction:
Many emergency general surgery (EGS) conditions can be managed both operatively or nonoperatively; however, it is unknown whether the decision to operate affects Black and White patients differentially.

Methods:
We identified a nationwide cohort of Black and White Medicare beneficiaries, hospitalized for common EGS conditions from July 2015 to June 2018. Using near-far matching to adjust for measurable confounding and an instrumental variable analysis to control for selection bias associated with treatment assignment, we compare outcomes of operative and nonoperative management in a stratified population of Black and White patients. Outcomes included in-hospital mortality, 30-day mortality, nonroutine discharge, and 30-day readmissions. An interaction test based on a t test was used to determine the conditional effects of operative versus nonoperative management between Black and White patients.

Results:
A total of 556,087 patients met inclusion criteria, of which 59,519 (10.7%) were Black and 496,568 (89.3%) were White. Overall, 165,932 (29.8%) patients had an operation and 390,155 (70.2%) were managed nonoperatively. Significant outcome differences were seen between operative and nonoperative management for some conditions; however, no significant differences were seen for the conditional effect of race on outcomes.

Conclusions:
The decision to manage an EGS patient operatively versus nonoperatively has varying effects on surgical outcomes. These effects vary by EGS condition. There were no significant conditional effects of race on the outcomes of operative versus nonoperative management among universally insured older adults hospitalized with EGS conditions.
Stroke Volume Measurements by Echocardiography and Ultrasonic Cardiac Output Monitor in Children
Authors: Fremuth Jiri , Huml Michal , Pomahacova Tereza , Kobr Jiri , Kormunda Stanislav , Sykora Josef 
Published: July 2023

Objectives
Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children.

Methods
A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias.

Results
Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.
The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs.

Conclusions
Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.
Deep Learning–Based Motion Correction in Projection Domain for Coronary Computed Tomography Angiography: A Clinical Evaluation
Authors: Shuai Tao , Zhong Sihua , Zhang Guozhi , Wang Ziwei , Zhang Yu , Li Zhenlin 
Published: July 2023

Objective
This study aimed to evaluate the clinical performance of a deep learning-based motion correction algorithm (MCA) in projection domain for coronary computed tomography angiography (CCTA).

Methods
A total of 192 patients who underwent CCTA examinations were included and divided into 2 groups based on the average heart rate (HR): group 1, 82 patients with HR of <75 beats per minute; group 2, 110 patients with HR of ≥75 beats per minute. The CCTA images were reconstructed with and without MCA. The subjective image quality was graded in terms of vessel visualization, sharpness, diagnostic confidence, and overall image quality using a 5-point scale, where cases with all scores of ≥3 were deemed interpretable. Objective image quality was measured through signal-to-noise ratio and contrast-to-noise ratio in regions relative to the vessels. The image quality scores for 2 reconstructions and effective dose between 2 groups were compared.

Results
The mean effective dose was similar between 2 groups. Neither group showed significant difference on objective image quality for 2 reconstructions. Images reconstructed with and without MCA were both found interpretable for group 1, whereas the subjective image quality was significantly improved by the MCA for all 4 metrics in group 2, with the interpretability increased from 80.91% to 99.09%. Compared with group 1, group 2 showed similar interpretability and diagnostic confidence, despite inferior overall image quality.

Conclusions
In CCTA examinations, the deep learning–based MCA is capable of improving the image quality and diagnostic confidence for patients with increased HR to a similar level as for those with low HR.
Minimum and Optimal CA19-9 Response After Two Months Induction Chemotherapy in Patients with Locally Advanced Pancreatic Cancer
Authors: Seelen Leonard W.F. , Doppenberg Deesje , Stoop Thomas F. , Nagelhout Anne , Brada Lilly J.H. , Bosscha Koop , Busch Olivier R. , Cirkel Geert A. , den Dulk Marcel , Daams Freek , van Dieren Susan , van Eijck Casper H.J. , Festen Sebastiaan , Groot Koerkamp Bas , Haj Mohammad Nadia , de Hingh Ignace H.J.T. , Lips Daan J. , Los Maartje , de Meijer Vincent E. , Patijn Gijs A. , Polée Marco B. , Stommel Martijn W.J. , Walma Marieke S. , de Wilde Roeland F. , Wilmink Johanna W. , Molenaar I. Quintus , van Santvoort Hjalmar C. , Besselink Marc G. ,   for the Dutch Pancreatic Cancer Group
Published: July 2023

Objective:
This nationwide multicenter study aimed to define clinically relevant thresholds of relative serum CA19-9 response after 2 months induction chemotherapy in patients with locally advanced pancreatic cancer (LAPC).

Summary Background Data:
CA19-9 is seen as leading biomarker for response evaluation in patients with LAPC, but early clinically useful cut-offs are lacking.

Methods:
All consecutive patients with LAPC after 4 cycles (m)FOLFIRINOX or 2 cycles gemcitabine-nab-paclitaxel induction chemotherapy (±radiotherapy) with CA19-9 ≥5 U/mL at baseline were analyzed (2015–2019). The association of CA19-9 response with median OS (mOS) was evaluated for different CA19-9 cut-off points. Minimum and optimal CA19-9 response were established via log-rank test. Predictors for OS were analyzed, using cox regression analysis.

Results:
Overall, 212 patients were included of whom 42 (19.8%) underwent resection. Minimum CA19-9 response demonstrating a clinically significant mOS difference (12.7 vs. 19.6 mo) was seen at ≥40% CA19-9 decrease. The optimal cut-off for CA19-9 response was ≥60% decrease (21.7 vs. 14.0 mo, P=0.021). Only for patients with elevated CA19-9 levels at baseline (n=184), CA19-9 decrease ≥60% (HR=0.59, 95%CI 0.36–0.98, P=0.042) was independently associated with prolonged OS, as were SBRT (HR=0.42, 95%CI 0.25–0.70; P=0.001), and resection (HR=0.25, 95%CI 0.14–0.46, P<0.001), and duration of chemotherapy (HR=0.75, 95%CI 0.69–0.82, P<0.001).

Conclusion:
CA19-9 decrease of ≥60% following induction chemotherapy as optimal response cut-off in patients with LAPC is an independent predictor for OS when CA19-9 is increased at baseline. Furthermore, ≥40% is the minimum cut-off demonstrating survival benefit. These cut-offs may be used when discussing treatment strategies during early response evaluation.