bluuebunny/crossref_metadata_2025_split huggingface dataset:
International comparisons of intraocular pressures, as measured by Tono-Pen and Goldmann applanation tonometry, in healthy adults: A meta-analysis
Authors: Keller William J. 
Published: March 2023

Background:
Investigate intraocular pressure (IOP), as measured by Tono-Pen (TP) and Goldmann applanation tonometry (GAT), in healthy adults. Provide an updated synthesis of multinational, primary studies, reported during the 10-year period 2011 to 2021 and offer an evidence-based benchmark, against which IOP can be evaluated across subject variables and pathologies. Three primary research questions are investigated: Is there a statistically significant difference between IOP measured by TP and GAT? If yes, is the difference clinically significant? Is measurement of IOP affected by the country or setting location, in which the measurements are made?

Methods:
An aggregate meta-analysis was conducted on 22 primary studies, from 15 different countries. IOP measurements were made from each healthy adult subject, with both the TP and GAT. Primary studies were identified and data extracted according to recommended preferred reporting items for systematic reviews and meta-analysis protocol guidelines. Meta-analysis summary results are reported as the point estimate of the raw mean difference of IOP.

Results:
Meta-analysis reveals a statistically significant difference in raw mean differences in IOP, when measured by TP and GAT, in the healthy adult population. Tono-Pen IOP measurements are higher than GAT IOP measurements. The point estimate for the summary effect size = −0.73 mm Hg, P = .03. The prediction interval for the true effect size, in 95% of all comparable populations, is −4.03 to 2.58 mm Hg. There is no clinically significance difference in IOP when measured by TP and GAT. Meta-regression analysis reveals statistically significant differences in measurement of IOP by countries, R
2 analog = 0.75, P = .001. There is no statistically significant difference in measurement of IOP as a function of measurement location setting, R
2 analog = −0.17, P = .65.

Conclusions:
IOP measured by TP are marginally higher compared to GAT, in the healthy adult population. However, from a clinical practice perspective, TP and GAT produce similar IOP measurements. There is evidence of significant variabilities in IOP measurements as a function of country. IOP measurements collected in a research laboratory setting are similar to IOP collected in a clinical setting. Results have implications for the primary care physician requiring a portable, inexpensive, reliable, and easily administered instrument to assess IOP.
Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis
Authors: Hou Lingyu , Li Ying , Wang Jianhua , Wang Yuqi , Wang Jingchao , Hu GuoJing , Ding Xiao Rong 
Published: March 2023

Background:
Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU).

Methods:
We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration’s Revman 5.3 software.

Results:
A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU.

Conclusion:
This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.
Using coword analysis and chord diagrams to examine the effect of nutritional counseling and support (DCNS) on patients with oral and oropharyngeal cancer
Authors: Tu Mei-Yu , Chien Tsair-Wei , Lin Cheng-Yao , Chou Willy 
Published: March 2023

Background:
Dietary counseling and nutritional support (DCNS) are generally accepted as being necessary for patients with oral cancer and oropharyngeal cancer (OC). However, there is no evidence that dietary counseling plays a significant role in weight loss. In this study, we examined the DCNS based on persistent weight loss during and after treatment in oral cancer and OC patients, as well as the effect of body mass index (BMI) on survival in both groups.

Methods:
A retrospective chart review was conducted on 2622 patients diagnosed with cancer between 2007 and 2020, including 1836 oral and 786 oropharyngeal patients. In comparison with the sample of patients treated by DCNS, differences in proportional counts for key factors associated with survival were compared between oral cancer and OC patients using the forest plot. An analysis of cowords was conducted to determine CNS associated with weight loss and overall survival. The Sankey diagram was used to display DCNS effectiveness. The log-rank test was used to evaluate the chi-squared goodness of fit test on the null assumption model of equal survival distributions between the groups.

Results:
Almost 41% of the patients (=1064/2262) received DCNS, with a frequency ranging from 1 to 44. Counts for 4 DCNS categories were 566, 392, 92, and 14, respectively, against BMI increases or decreases from much to less with counts of 3, 44, 795, 219, and 3, respectively. In the first year following treatment, DCNS decreased sharply to 50%. One year after hospital discharge, the overall weight loss increased from 3 to 9% (mean = −4%, standard deviation = 14%). Patients with a BMI above average had a significantly longer survival time (P < .001). Statistically, OC patients have a significantly higher survival rate than oral cancer patients.

Conclusion:
Despite receiving frequent DCNS, patients continued to lose body weight during and 1 year after treatment. The survival time of an individual with a BMI above average appears to be increased. Future studies should preferably use randomized trials to compare standard DCNS with more intensive DCNS, which includes earlier and/or prolonged treatment.
Cost-effectiveness analysis of herbal medicines in children with idiopathic short stature
Authors: Jang Soobin , Lee Sun Haeng , Kim Ye Ji , Lee Boram 
Published: March 2023

Background:
Herbal medicines have been used for a long time to treat idiopathic short stature (ISS) in children in East Asian countries. The aim of this study was to analyze the cost-effectiveness of 5 herbal medicines frequently used in clinical settings for children with ISS based on medical records.

Methods:
Patients with ISS who had been prescribed a 60-day supply of herbal medicines in 1 Korean medicine hospital were included in this analysis. Their height and height percentile were measured before and after treatment within 6-months. The average cost-effectiveness ratios (ACERs) of 5 herbal medicines for height (cm) and height percentile were calculated for boys and girls, respectively.

Results:
The ACERs per 1 cm height growth were USD 56.2 (Naesohwajung–Tang), USD 74.8 (Ogapi–Growth decoction), USD 86.6 (Gamcho–Growth decoction), USD 94.6 (Gwakhyangjeonggi–San plus Yukmijihwang–Tang), and USD 113.8 (Boyang–Growth decoction). The ACERs per 1 percentile height growth were USD 205 (Naesohwajung–Tang), USD 293 (Ogapi–Growth decoction), USD 470 (Gamcho–Growth decoction), USD 949 (Boyang–Growth decoction), and USD 1051 (Gwakhyangjeonggi–San plus Yukmijihwang–Tang).

Conclusion:
Herbal medicine might be a potential economical alternative treatment for ISS.
Hand-Schüller-Christian syndrome combined with empty sella syndrome: A case report and literature review
Authors: Ji Wei , Chen Xiaoyang 
Published: March 2023

Rational:
Hand-Schüller-Christian syndrome (HCS) is a rare disease with little clinical awareness, but the condition is more dangerous, and it combines with empty sella syndrome (ESS) which is extremely rare.

Presentation:
A 26-year-old male patient who had proptosis, headaches, and diabetes insipidus for more than 10 years, and chronic cough and wheeze for 8 years presented to our hospital due to an abrupt onset of chest pain for 2 days.

Diagnosis:
Hand-Schüller-Christian syndrome is diagnosed based on the typical clinical manifestations of diabetes insipidus and bilateral proptosis, magnetic resonance imaging (MRI) pituitary imaging and pathology. Empty sella syndrome is diagnosed based on hormonal indicators, clinical manifestations and MRI pituitary scan results. Type 1 respiratory failure and severe pneumonia can be diagnosed based on the results of clinical examination, chest imaging (including chest x-ray and computed tomography), pathology and blood gas analysis. Left pneumothorax can be diagnosed with chest imaging.

Interventions:
“Meropenem and Cefdinir” were given for antimicrobrial coverage, “Desmopressin acetate” for anti-diuretic treatment, “Forcodine” for cough relief, “Ambroxol and acetylcysteine” for phlegm reduction, and continuous closed chest drainage was performed.

Outcomes:
The patient discharged after cough, wheezing, headache and other symptoms improved, and vital signs were stable. The patient has been followed up once a month for 17 months ongoing after discharge. At present, symptoms such as cough, sputum, and wheezing have improved considerably, and the mMRC score of dyspnea is 2 points. The reexamination of the chest X-ray shows that the absorption of lung exudates is better than before, and there is no recurrence of pneumothorax.

Lessons:
Consider whether isolated diabetic insipidus is related to HSC, and if so, conduct an MRI, a biopsy, and other examinations as soon as possible.
Effects of NBP injection on the inflammatory response, oxidative stress response and vascular endothelial function in patients with ACI: A systematic review and meta-analysis
Authors: Liu Xinxin , Ma Yingqi , Wang Yiguo , Zhang Qiming 
Published: March 2023

Background:
Acute cerebral infarction (ACI) is a common medical emergency. This study is the first systematic review of the use of Dl-3-n-butylphthalide (NBP) injection in the treatment of ACI. The purpose of this study was to systematically evaluate the effects of NBP injection on the inflammatory response, oxidative stress response and vascular endothelial function in patients with acute ACI. The objective is to provide reference for clinical application.

Methods:
From the establishment of the database until August 2022, we systematically searched EMbase, PubMed, Cochrane Library, Web of Science, CNKI, VIP, and Wanfang Database. RCTs and retrospective studies were included in this study, and the results that qualified for inclusion were screened by 2 researchers and cross-checked. After the relevant data were extracted, a meta-analysis was performed using RevMan5.3 software.

Results:
A total of 3307 patients with ACI from 34 studies were analyzed. The meta-analysis showed that the C-reactive protein levels in the NBP combined group were effectively reduced compared with those in the control group (MD = −3.75, 95% confidence intervals [95% CI] [−4.95, −2.56], P < .00001). Based on comparison with the control group, it is evident that combination treatment with NBP is more effective than control group in reducing the oxidative stress response of ACI (MD[superoxide dismutase levels] = 22.16, 95% CI [14.20,30.11], P < .00001; MD[malondialdehyde levels] = −1.97, 95% CI [−2.62, −1.32], P < .00001). Comparison with the control group shows that combination treatment with NBP is more effective in improving vascular endothelial function in ACI patients (MD[vascular endothelial growth factor levels] = 71.44, 95% CI [41.22, 101.66], P < .00001; MD[endothelin-1 levels] = −11.47, 95% CI [−17.39, −5.55], P = .0001; MD[nitric oxide levels] = 9.54, 95% CI [8.39, 10.68], P < .00001) than control group. The NBP combined group also showed a greater reduction in cerebral infarct volume (CIV) and cerebral infarct size (CIS) of ACI (MD[CIV] = −1.52, 95% CI [−2.23, −0.81], P < .0001; MD[CIS] = −2.79, 95% CI [−3.65, −1.94], P < .00001). The NBP combined group did not show an increase in the incidence of adverse reactions compared with the control group (odds ratio = 1.06, 95% CI [0.73, 1.53], P = .77).

Conclusion:
In summary, the use of NBP in combination with control group for ACI can reduce the degree of nerve damage, reduce inflammation and oxidative stress, improve vascular endothelial function, and reduce CIS and CIV in ACI patients, without increasing the incidence of clinical adverse events.
Optimising cylinder model dimensions for VARSKIN to simulate a droplet of radionuclide skin contamination using Geant4 Monte Carlo code
Authors: James Gregory , O’Brien Joseph , Thomson Bill 
Published: March 2023

Aim
VARSKIN provides a convenient way of calculating skin dose from predefined geometries but the models are limited to concentric shapes such as discs, cylinders and point sources. The aim of this article is to use the Geant4 Monte Carlo code to independently compare the cylindrical geometries available in VARSKIN to more realistic droplet models obtained from photography. It may then be possible to recommend an appropriate cylinder model that can be used to represent a droplet within acceptable accuracy.

Method
Geant4 Monte Carlo code was used to model various droplets of radioactive liquid on the skin based on photographs. The dose rates were then calculated to the sensitive basal layer 70 µm beneath the surface for three droplet volumes (10, 30 and 50 µl) and 26 radionuclides. The dose rates from the cylinder models were then compared against the dose rates from the ‘true’ droplet models.

Results
The table gives the optimum cylinder dimensions that best approximate a true droplet shape for each volume. The mean bias and 95% confidence interval (CI) from the true droplet model are also quoted.

Conclusion
The evidence from the Monte Carlo data suggests that different droplet volumes require different cylinder aspect ratios to approximate the true droplet shape. Using the cylinder dimensions in the table in software packages such as VARSKIN, dose rates from radioactive skin contamination are expected to be within ± 7.4% of a ‘true’ droplet model at 95% CI.
Well-differentiated gastro-entero-pancreatic neuroendocrine tumors with positive FDG-PET/CT: a retrospective chart review
Authors: Haidar Mohamad , Al Mahmasani Layal , Chehade Laudy , Elias Charbel , El Jebai Malak , Temraz Sally , Charafeddine Maya , Al Darazi Monita , Shamseddine Ali 
Published: March 2023

Purpose
Rarely, well-differentiated gastro-entero-pancreatic neuroendocrine tumors (GEP NETs) can have positive uptake on 18F-fluorodeoxyglucose-PET/computerized tomography (18F-FDG-PET/CT), with or without a positive 68Ga-PET/CT. We aim to evaluate the diagnostic role of 18F-FDG-PET/CT in patients with well-differentiated GEP NETs.

Methods
We retrospectively reviewed a chart of patients diagnosed with GEP NETs between 2014 and 2021, at the American University of Beirut Medical Center, who have low (G1; Ki-67 ≤2) or intermediate (G2; and Ki-67 >2–≤20) well-differentiated tumors with positive findings on FDG-PET/CT. The primary endpoint is progression-free survival (PFS) compared to historical control, and the secondary outcome is to describe their clinical outcome.

Results
In total 8 out of 36 patients with G1 or G2 GEP NET met the inclusion criteria for this study. The median age was 60 years (range 51–75 years) and 75% were male. One patient (12.5%) had a G1 tumor whereas 7 (87.5%) had G2, and seven patients were stage IV. The primary tumor was intestinal in 62.5% of the patients and pancreatic in 37.5%. Seven patients had both 18F-FDG-PET/CT and 68Ga-PET/CT positive and one patient had a positive 18F-FDG-PET/CT and negative 68Ga-PET/CT. Median and mean PFS in patients positive for both 68Ga-PET/CT and 18F-FDG-PET/CT were 49.71 months and 37.5 months (95% CI, 20.7–54.3), respectively. PFS in these patients is lower than that reported in the literature for G1/G2 NETs with positive 68Ga-PET/CT and negative FDG-PET/CT (37.5 vs. 71 months; P = 0.0217).

Conclusion
A new prognostic score that includes 18F-FDG-PET/CT in G1/G2 GEP NETs could identify more aggressive tumors.
Comparison of 99mTc-methylenediphosphonate and 68Ga-BPAMD PET/computed tomography imaging in bone metastasis
Authors: Vatsa Rakhee , Kaur Damanpreet , Shekhar Shashank Singh , Chhabra Anupriya , Chakraborty Sudipta , Dash Ashutosh , Shukla Jaya , Mittal Bhagwant Rai 
Published: March 2023

Objective
Bone is considered as the third most common site of metastases, besides lung and liver. Early detection of skeletal metastases aids in better management of skeletal-related events. In the present study cold kit-based 2,2′,2′′-(10-(2-((diphosphonomethyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl) triacetic acid (BPAMD) was labeled with 68Ga. The radiolabeling parameters and clinical evaluation in patients with suspected bone metastases were compared with routinely used 99mTc-methylenediphosphonate (99mTc-MDP).

Methodology
The kit components of MDP were incubated with

at room temperature for 10 min, followed by radiochemical purity testing using thin-layer chromatography. For radiolabeling of BPAMD, the cold kit components reconstituted in 400 μL of HPLC grade water were transferred and incubated with 68GaCl3 in the reactor vessel of the fluidic module at 95°C for 20 min. Radiochemical yield and purity were determined with instant thin-layer chromatography using 0.5 M sodium citrate as mobile phase. For clinical evaluation, patients (n = 10) with suspected bone metastases were enrolled. 99mTc-MDP and 68Ga-BPAMD scans were performed on two different days in random order. Imaging outcomes were noted and compared.

Results
Radiolabeling of both tracers is facile using cold kit, although BPAMD requires heating. The radiochemical purity was observed to be greater than 99% for all preparations. Both MDP and BPAMD detected skeletal lesions; however, additional lesions were detected in total of seven patients which were not visualized clearly on 99mTc-MDP scan.

Conclusion
BPAMD can be easily tagged with 68Ga using cold kits. The radiotracer is suitable and efficient for detection of bone metastases using PET/computed tomography.
Out-of-pocket costs and affordability of upper limb prostheses
Authors: Resnik Linda J. , Borgia Matthew , Clark Melissa A. , Ni Pengsheng 
Published: March 2023

Background:
Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians.

Objectives:
Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse.

Study design:
Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans.

Methods:
Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated.

Results:
Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14–0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment.

Conclusions:
Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.
Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission
Authors: Boltz Marie , Kuzmik Ashley , Resnick Barbara , BeLue Rhonda , Jao Ying-Ling , Paudel Anju , Behrens Liza , Leslie Doug , Sinvani Liron , Galvin James E. 
Published: March 2023

Background:
Hospitalized persons with dementia are at risk of delirium with behavioral symptoms, predisposing them to a higher rate of complications and caregiver distress. The purpose of this study was to examine the relationship between delirium severity in patients with dementia upon admission to the hospital and the manifestation of behavioral symptoms, and to evaluate the mediating effects of cognitive and physical function, pain, medications, and restraints.

Methods:
This descriptive study used baseline data from 455 older adults with dementia enrolled in a cluster randomized clinical trial that tested the efficacy of family centered function-focused care. Mediation analyses were conducted to determine the indirect effect of cognitive and physical function, pain, medications (antipsychotics, anxiolytics, sedative/hypnotics, narcotics, and number of medications), and restraints on behavioral symptoms, controlling for age, sex, race, and educational level.

Results:
The majority of the 455 participants were female (59.1%), had an average age of 81.5 (SD=8.4), were either white (63.7%) or black (36.3%), and demonstrated one or more behavioral symptoms (93%) and delirium (60%). Hypotheses were partially supported in that physical function, cognitive function, and antipsychotic medication partially mediated the relationship between delirium severity and behavioral symptoms.

Conclusion:
This study provides preliminary evidence identifying antipsychotic use, low physical function, and significant cognitive impairment as specific targets for clinical intervention and quality improvement in patients with delirium superimposed on dementia at hospital admission.
A Case of Oral Cenesthopathy Treated With the Combination of Brexpiprazole and Mirtazapine
Authors: Umezaki Yojiro , Motomura Haruhiko , Egashira Rui , Toyofuku Akira , Naito Toru 
Published: March 2023

Objectives
Oral cenesthopathy is an uncomfortable and bizarre oral sensation without corresponding organic findings. Although some treatment options, including antidepressants and antipsychotic drugs, have been reported to be effective, the condition remains refractory. Here, we report a case of oral cenesthopathy treated with brexpiprazole, a recently approved D2 partial agonist.

Methods and Results
A 57-year-old woman presented with a complained of softened incisors. Furthermore, she could not perform housework because of the discomfort. The patient did not respond to aripiprazole. However, she responded to a combination of mirtazapine and brexpiprazole. The visual analog scale score for the patient's oral discomfort decreased from 90 to 61. The patient's condition improved enough to resume housework.

Conclusions
Brexpiprazole and mirtazapine may be considered for the treatment of oral cenesthopathy. Further investigations are warranted.