bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prior polymyalgia rheumatica is associated with sonographic vasculitic changes in newly diagnosed patients with giant cell arteritis
Authors: Hemmig Andrea K , Aschwanden Markus , Berger Christoph T , Kyburz Diego , Mensch Noemi , Staub Daniel , Stegert Mihaela , Imfeld Stephan , Daikeler Thomas 
Published: August 2023

Abstract

Objectives
To investigate the hypothesis that a history of PMR is associated with a more severe and damaging disease course in newly diagnosed GCA patients.

Methods
This was a retrospective analysis of GCA patients diagnosed between December 2006 and May 2021. We compared vascular ultrasound findings (presence of vasculitis and vascular stenosis) in GCA patients with and without prior PMR.

Results
Forty-nine of 311 GCA patients (15.8%) had prior PMR in a median of 30.6 (IQR 7.1–67.3) months before GCA diagnosis. Patients with prior PMR more often had large vessel vasculitis (LVV) (51.0% vs 25.0%, P &lt; 0.001) and stenosis within the vasculitic segments (18.4% vs 3.1%, P &lt; 0.001) on ultrasound. In multivariable analysis, prior PMR remained significantly associated with LVV (odds ratio 7.65, 95% CI: 2.72, 23.97, P &lt; 0.001). Polymyalgic symptoms at GCA diagnosis in the patients without prior PMR were not associated with a higher prevalence of LVV (P = 0.156).

Conclusion
Patients with a diagnosis of PMR before GCA diagnosis had two times more often large vessel involvement and significant more vasculitic stenoses on ultrasound examination than patients without prior PMR. Pre-existing PMR is an independent risk factor for more extensive and advanced ultrasound findings at GCA diagnosis. The contribution of subclinical vasculitis to disease associated damage should be further studied.
Acoustic innovations in courtship sounds generated by hybridization in cichlid fish
Authors: Parmentier Eric , Raick Xavier , Leblanc Nicolas , Santoni-Guichard Ghjuvan , Banse Marine , Jean de Dieu Da Sié , Van Damme Arthur 
Published: August 2023

Abstract
During courtship, prezygotic barriers are thought to maintain the diversity of species since differences in phenotypic traits and reproductive behaviours are likely to be involved in maintaining species boundaries. However, introgressive hybridization has been reported in many different taxa and the resulting hybrids usually possess phenotypic features, including behaviours, that are intermediate between those of the parents. The outcome of hybrids may depend on the interactions between the intrinsic viability of the hybrids, the ecological environment of the species, and the fitness of hybrids in that ecological context. In cichlids, the mechanism of hybridization is increasingly documented as an important factor in their evolutionary radiation since it may provide novel gene combinations that promote speciation and adaptive radiation by generating new transgressive phenotypes. Cichlid species are separated mostly by pre-mating isolating mechanisms. Like colour patterns, acoustic communication is involved in sexual selection, but this pattern has been much less studied and the outcome of hybridization on acoustic features has never been examined. To gain novel insights into the evolution of their acoustic communication behaviour, we performed a hybrid cross between Chindongo saulosi and Maylandia estherae. Qualitative examination of courtship showed that the three groups possess the same sequence of behaviours. However, sounds produced during courtship showed specific signatures since all three groups differ at the level of sound duration and pulse period, with both features being intermediate in hybrids in comparison to the two parent species. Colour patterns in hybrids were also different from those of the parent species. These results show that hybridization can affect at least two kinds of prezygotic barriers, which may be important in the cichlid evolutionary process. However, playback experiments are required to test the strength of these features in sexual selection.
Simple steps towards improving safety in obstetric airway management
Authors: Critchley Julia D. , Ferguson Cassandra , Kidd Emily , Ward Patrick , McNarry Alistair F. , Theodosiou Catherine A. , Alexander Nicki 
Published: August 2023

BACKGROUND
Guidelines from the Obstetric Anaesthetists’ Association and Difficult Airway Society state that ’a videolaryngoscope should be immediately available for all obstetric general anaesthetics’.

OBJECTIVE
To report the incidence of videolaryngoscopy use, and other airway management safety interventions, in an obstetric population before and after various quality improvement interventions.

DESIGN
Prospective data collection was undertaken over 18 months, divided into three separate 6-month periods: June to November 2019; March to August 2021; January to June 2022. These periods relate to evaluation of specific quality improvement interventions.

SETTING
The project was carried out in a large tertiary referral obstetric unit.

PATIENTS
We identified 401 pregnant women (> 20 weeks’ gestation) and postnatal women (up to 48 h post delivery) undergoing an obstetric surgical procedure under general anaesthesia.

INTERVENTION(S)
To standardise practice, an intubation checklist was introduced in December 2020 and multidisciplinary staff training in August 2021.

MAIN OUTCOME MEASURES
Primary outcome measures were use of a Macintosh-style videolaryngoscope and tracheal intubation success. Secondary outcome measures were use of an intubation checklist; low flow nasal oxygen; and ramped patient positioning.

RESULTS
Data from 334 tracheal intubations (83.3% of cases) were recorded. Videolaryngoscope use increased from 60% in 2019, to 88% in 2021, to 94% in 2022. Tracheal intubation was successful in all patients, with 94% first pass success overall and only 0.9% requiring three attempts. Use of secondary outcome measures also increased: low flow nasal oxygen from 48% in 2019 to 90% in 2022; ramped positioning from 95% in 2021 to 97% in 2022; and checklist use from 63% in 2021 to 92% in 2022.

CONCLUSIONS
We describe the successful adoption of simple safety measures introduced into routine practice. These comprised videolaryngoscopy, ramped positioning and low flow nasal oxygen. Their introduction was supported by the implementation of an intubation checklist and multidisciplinary team training.
Pronator Quadratus Muscle Flap for Prevention of Flexor Tendon Rupture after Distal Radius Volar Plating
Authors: Husain Tarik M. , Jabbour Jacob I. , Sudduth Jack D. , Lessard Anne-Sophie , Patete Carissa L. , Panthaki Zubin J. , Salloum Gabe E. 
Published: August 2023

Background:
Flexor tendon rupture is a serious but rare complication that can occur after volar plating of distal radius fractures. This study aims to introduce a novel surgical technique that uses a pronator quadratus (PQ) muscle flap transposition to protect the flexor tendons from rupture or irritation and evaluate its outcomes.

Methods:
A retrospective review was conducted on 204 patients with unstable distal radius fractures who underwent a standard volar flexor carpi radialis approach with extended release of the PQ muscle during exposure. A PQ muscle flap was harvested and transposed over the distal edge of the plate after open reduction and internal fixation of the distal radius. Postoperatively, patients were evaluated for flexor tendon irritation and rupture. Patients who had this injury before the use of the PQ flap were compared with the patients who received the PQ flap.

Results:
Of the 204 patients, 119 received the PQ flap, and 85 did not. The mean follow-up time was 30.4 months. Among the patients who did not receive the PQ flap, five (5.9%) required plate removal or conservative treatment for tendon irritation or rupture. In contrast, only one patient (0.8%) who received the PQ flap required plate removal for flexor tendon irritation.

Conclusions:
The PQ muscle flap is a quick and effective surgical technique that reduces the risk of flexor tendon rupture or irritation during distal radius fracture fixation. The PQ muscle flap acts as a buffer between the plate and tendon and is more effective than not transposing the muscle.
Risk Factors for Fibrous Ingrowth in Eyes Requiring Primary Keratoplasty
Authors: Ramirez David A. , Walling Abigail L. , Fortenbach Christopher R. , Witsberger Emily , Frey Kendra , Jiang Lai , Syed Nasreen A. , Zimmerman M. Bridget , Greiner Mark A. , Sales Christopher S. 
Published: August 2023

Purpose:
The aim of this study was to define risks for corneal transplantation associated with fibrous ingrowth among first-time transplant recipients.

Methods:
We performed a retrospective case–control study of patients with a histopathologic diagnosis of fibrous ingrowth between 2002 and 2019. Patients with fibrous ingrowth from a first corneal specimen were included. Those with incomplete records were excluded. A 1:2 case–control ratio was used. Controls were matched using surgical indication, surgery year, transplantation method, sex, and age.

Results:
Seventy-eight eyes (76 patients) were included and matched with 160 control eyes. The incidence of fibrous ingrowth found on a first corneal transplant was 0.6% per year. The most common keratoplasty indications were pseudophakic corneal edema (n = 25, 32%) and aphakic corneal edema (n = 15, 19%). Cases were more likely to have a history of ocular trauma (odds ratio [OR], 2.94; 95% CI, 1.30–6.30; P = 0.007), uveitis (OR, 2.73; 95% CI, 1.12–6.63; P = 0.022), retinal detachment or previous retinal surgery (OR, 2.40; 95% CI, 1.34–4.30; P = 0.003), glaucoma tube-shunt surgery (OR, 2.70; 95% CI, 1.29–5.65; P = 0.007), aphakia (OR, 3.02; 95% CI, 1.61–5.67; P = 0.0004), or iris derangement (OR, 10.52; 95% CI, 5.45–20.30; P <0.0001). A multivariate logistic regression model using iris derangement, history of ocular trauma, history of uveitis, and history of cataract surgery demonstrated 81% sensitivity and 66% specificity in predicting presence of fibrous ingrowth.

Conclusions:
A history of ocular trauma, uveitis, retinal detachment or previous retinal surgery, glaucoma tube-shunt surgery, aphakia, and iris derangement are risks for detecting fibrous ingrowth among first-time keratoplasty recipients. Patients with these conditions should be monitored closely for corneal decompensation.
Determinants of Clinical Outcomes After Infectious Scleritis
Authors: Oh Glenn J. , Khalili Ashley , Hammersmith Kristin M. , Nagra Parveen K. , Rapuano Christopher J. , Syed Zeba A. 
Published: August 2023

Purpose:
The aims of this study were to describe the clinical course of microbial infectious scleritis and identify factors associated with poor visual outcomes.

Methods:
Data from 26 eyes of 26 patients with culture-proven bacterial or fungal scleritis presenting at a single tertiary center from January 1, 2007, to July 1, 2021, were reviewed. Thirty-six variables were analyzed for associations with poor vision [best-corrected visual acuity (BCVA) <20/200] or loss of vision (no light perception vision or requirement for enucleation or evisceration) at final visit.

Results:
The mean age at initial presentation was 67.1 ± 14.0 (range: 34–92) years with a mean follow-up of 2.1 ± 2.2 (0.05–8.45) years. The mean presenting logarithm of minimal angle of resolution (logMAR) BCVA was 1.3 ± 1.0 (∼20/400) and mean final logMAR BCVA was 1.6 ± 1.2 (∼20/800). Fourteen eyes (53.8%) exhibited poor vision and 7 (26.9%) had loss of vision at final follow-up. History of necrotizing scleritis and poor presenting vision were associated with poor final vision (OR = 19.1; P = 0.017 and OR = 7.5; P = 0.047, respectively), whereas fungal scleritis was associated with loss of vision (odds ratio [OR] = 30.3, P = 0.013). Subconjunctival antimicrobial treatment was inversely associated with loss of vision (OR = 0.06, P = 0.023). There was no difference in vision between medical and combined medical–surgical management, although infection resolution time was shorter for combined intervention (16.8 ± 10.6 vs. 53.7 ± 33.8 days; P = 0.005).

Conclusions:
Infectious scleritis is often successfully treated, but loss of vision or eye removal is common. Poor baseline vision, history of necrotizing scleritis, and fungal etiology were prognostic for worse clinical outcomes. Surgical intervention was associated with quicker resolution compared with medical treatment alone.
Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study
Authors: McLaughlin Danielle E. , Savatovsky Eleonore J. , O’Brien Robert C. , Vanner Elizabeth A. , Munshi Hounsh K. , Pham Anh H. , Grajewski Alana L. 
Published: August 2023

Précis:
Monitoring visual fields (VFs) through virtual reality devices proved to have good inter-test and test-retest reliability, as well as easy usability, when self-administered by individuals with and without VF defects in a remote setting.

Purpose:
To assess the reliability of remote, self-administered VF monitoring using a virtual reality VF (VRVF) device in individuals without ocular disease and with stable VF defects.

Materials and Methods:
Individuals without ocular disease and with stable defects were recruited. All participants had a baseline standard automated perimetry (SAP) test. Participants tested remotely on a VRVF device for 4 weeks (examinations V1, V2, V3, and V4), with the last 3 unassisted. The mean sensitivities of VRVF results were compared with each other and to SAP results for reliability.

Results:
A total of 42 eyes from 21 participants were tested on the VRVF device. Participants tested consistently although external factors impacted outcomes. VRVF results were in reasonable agreement with the baseline SAP. Examinations performed by the cohort with stable defects evinced better agreement with SAP examinations (V2, P = 0.79; V3, P = 0.39; V4, P = 0.35) than those reported by the cohort without ocular disease (V2, P = 0.02; V3, P = 0.15; V4, P = 0.22), where the null hypothesis is that the instruments agree. Fixation losses were high and variable in VRVF examinations compared with those of SAP, particularly in certain test takers. Participants considered the device comfortable and easy to use.

Conclusions:
Self-administered, remote VF tests on a VRVF device showed satisfactory test-retest reliability, good inter-test agreement with SAP, and acceptability by its users. External factors may impact at-home testing and age and visual impairment may hinder fixation. Future studies to expand the sample size and understand inconsistencies in fixation losses are recommended.
The Relationship of Early Sleep Improvement With Response to Pharmacotherapy in Unipolar Psychotic Depression
Authors: Vos Cornelis F. , Birkenhäger Tom K. , Nolen Willem A. , van den Broek Walter W. , ter Hark Sophie E. , Schellekens Arnt F.A. , Verkes Robbert-Jan , Janzing Joost G.E. 
Published: August 2023

Abstract

Background
Since insomnia and depression are interrelated, improved sleep early in antidepressant pharmacotherapy may predict a positive treatment outcome. We investigated whether early insomnia improvement (EII) predicted treatment outcome in psychotic depression (PD) and examined if there was an interaction effect between EII and treatment type to assess if findings were treatment-specific.

Methods
This study is a secondary analysis of a randomized trial comparing 7 weeks treatment with the antidepressants venlafaxine, imipramine and venlafaxine plus the antipsychotic quetiapine in PD (n = 114). Early insomnia improvement, defined as ≥20% reduced insomnia after 2 weeks, was assessed by the Hamilton Rating Scale for Depression (HAM-D-17). Associations between EII and treatment outcome were examined using logistic regressions. Subsequently, we added interaction terms between EII and treatment type to assess interaction effects. The predictive value of EII was compared with early response on overall depression (≥20% reduced HAM-D-17 score after 2 weeks).

Results
EII was associated with response (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.7–23.4; P = <0.001), remission of depression (OR, 6.1; 95% CI, 1.6–22.3; P = 0.009), and remission of psychosis (OR, 4.1; 95% CI, 1.6–10.9; P = 0.004). We found no interaction effects between EII and treatment type on depression outcome. Early insomnia improvement and early response on overall depression had a comparable predictive ability for treatment outcome.

Conclusions
Early insomnia improvement was associated with a positive outcome in pharmacotherapy of PD, regardless of the medication type. Future studies are needed to confirm our findings and to examine the generalizability of EII as predictor in treatment of depression.
Student Self-assessment: Reflecting on Physician Assistant Educator's Perceptions and Current Practices in Physician Assistant Training
Authors: Ditoro Rachel , Bernstein Joshua 
Published: August 2023

Purpose
The purpose of this study was to examine relationships between physician assistant (PA) educators' perspectives on students' self-assessment (SA) accuracy and students' use of SA education practices and types of abilities assessed.

Methods
Using correlation analysis and a novel, online survey, PA educators were asked about their perceptions of students' SA accuracy in relation to SA educational activities and assessed abilities.

Results
A total of 308 educators responded. Most respondents used at least one type of SA activity, with feedback and practice being the most common types and comparative assessment, the least common type. Most respondents indicated that students self-assess noncognitive abilities more than cognitive abilities, with SA of communication skills occurring most. Spearman's correlation coefficient was used for correlation analysis with a significant, small correlation noted between the frequency of activities and educators' overall perceptions of students' SA accuracy (r = 0.15, P = .02) and SA accuracy of cognitive abilities (r = 0.17, P = .02). Educators' perceptions of students' SA accuracy were positively skewed, regardless of student training level (ie, didactic and clinical training phases). A mild predictive relationship exists between overall perception of students' SA accuracy and how frequently educators use SA activities (r = 0.29, P = .05).

Conclusion
Although respondents indicated they used practice and feedback activities, providing instruction on how to self-assess and using comparative evaluations to calibrate SAs will improve accuracy. Further research is needed to understand why educators perceive PA students' SA abilities as more accurate, regardless of training level.
Differentiating Gastrointestinal Stromal Tumors From Leiomyomas of Upper Digestive Tract Using Convolutional Neural Network Model by Endoscopic Ultrasonography
Authors: Liu Jing , Huang Jia , Song Yan , He Qi , Fang Weili , Wang Tao , Zheng Zhongqing , Liu Wentian 
Published: August 2023

Background:
Gastrointestinal stromal tumors (GISTs) and leiomyomas are the most common submucosal tumors of the upper digestive tract, and the diagnosis of the tumors is essential for their treatment and prognosis. However, the ability of endoscopic ultrasonography (EUS) which could correctly identify the tumor types is limited and closely related to the knowledge, operational level, and experience of the endoscopists. Therefore, the convolutional neural network (CNN) is used to assist endoscopists in determining GISTs or leiomyomas with EUS.

Materials and Methods:
A model based on CNN was constructed according to GoogLeNet architecture to distinguish GISTs or leiomyomas. All EUS images collected from this study were randomly sampled and divided into training set (n=411) and testing set (n=103) in a ratio of 4:1. The CNN model was trained by EUS images from the training set, and the testing set was utilized to evaluate the performance of the CNN model. In addition, there were some comparisons between endoscopists and CNN models.

Results:
It was shown that the sensitivity and specificity in identifying leiomyoma were 95.92%, 94.44%, sensitivity and specificity in identifying GIST were 94.44%, 95.92%, and accuracy in total was 95.15% of the CNN model. It indicates that the diagnostic accuracy of the CNN model is equivalent to skilled endoscopists, or even higher than them.

Conclusion:
While identifying GIST or leiomyoma, the performance of CNN model was robust, which is highlighting its promising role in supporting less-experienced endoscopists and reducing interobserver agreement.
Role of Duodenal Bulb Biopsy in Diagnosing Suspected Celiac Disease in Adult Patients
Authors: Deb Anasua , Moond Vishali , Thongtan Thanita , Deliwala Smit , Chandan Saurabh , Mohan Babu P. , Adler Douglas G. 
Published: August 2023

Background and Aims:
Current guidelines recommend multiple biopsies from the first (D1) and second (D2) part of duodenum to establish a diagnosis of celiac disease. In this meta-analysis we aimed to find whether D1 biopsy can increase the diagnostic yield of adult celiac disease.

Methods:
Literature databases were searched until January 2023 for studies reporting diagnosis of celiac disease in the adult population using D1 biopsy. Meta-analysis was done using a random-effects model. Heterogeneity was assessed by I2% and 95% prediction interval statistics. Measured outcomes were diagnostic yield with D1 and D2 biopsies and from 4 versus 2 biopsy samples.

Results:
A total of 16 studies were included in the final analysis. The pooled diagnostic rate of celiac disease from D1 biopsy was 77.4% [95% CI (64.7-86.5, I2 94%)] and from D2 biopsy was 75.3% [60.8-85.7, I2 96%]. The pooled rate of increase in diagnostic yield with D1 biopsy was 6.9% I [4.6-10.2, I2 66%]. The pooled diagnosis rate with 2 biopsy samples were 77.3% [50-92, I2 93%] and 86.4% I [58.4-96.7, I2 87%] from D1 and D2 respectively, whereas that with 4 biopsy samples were 83.3% [49.8-96.2, I2 76%] and 70.5% I [51-84.6, I2 96%] from D1 and D2, respectively, the difference being non-significant.

Conclusion:
Our study demonstrates that taking 4 biopsy samples does not incur any additional diagnostic value over taking 2 biopsy samples from each duodenum segment. Although biopsy from the D1 and D2 has similar diagnostic yield in the adult population, there was an overall increase in diagnostic yield with D1 biopsy, especially in those with a patchy disease distribution.