bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer
Authors: Zhang Yixiao , Yi Jiawen , Sun Dan , Su Yanping , Zuo Yingting , Zhu Min , Zhang Shu , Huang Kewu , Guo Xiaojuan , Zhang Yuhui 
Published: September 2023

BackgroundAlthough computed tomography (CT)-defined emphysema is considered a predictor of lung cancer risk, it is not fully clear whether CT-defined emphysema is associated with the prognosis of lung cancer. We aimed to assess the clinical impact of CT-defined emphysema on the survival of lung cancer.MethodsIn the prospective cohort study of nonsmall cell lung cancer (NSCLC), the correlation between CT-defined emphysema and clinical variables was analysed. A multivariable Cox regression model was built to assess the association between CT-defined emphysema and overall survival (OS) for up to 8.8 years. The differences in survival analyses were derived by Kaplan–Meier analysis and log-rank testing. Low attenuation area (LAA%) was defined as the per cent of voxels below −950 HU.Results854 patients were included and CT-defined emphysema was present in 300 (35.1%) at diagnosis. Epidermal growth factor receptor (EGFR) wild-type (OR 1.998; p<0.001) and anaplastic lymphoma kinase (ALK) wild-type (OR 2.277; p=0.004) were associated with CT-defined emphysema. CT-defined emphysema remained a significant predictor of prognosis adjusting for age, sex, smoking history, tumour histology and Eastern Cooperative Oncology Group Performance Status (ECOG PS), whether in I-IIIA stage (adjusted hazard ratio (HR) 1.745; p=0.017) or in IIIB-IV stage (adjusted HR 1.291; p=0.022). Stratified analyses showed that OS rate among the driver oncogene groups with different CT-defined emphysema status differed significantly (log-rank p<0.001). Furthermore, patients with centrilobular emphysema (CLE) with LAA% >17% displayed poorer survival than those with LAA% ≤17% (median 432versus670 days; HR 1.564; p=0.020).ConclusionsCT-defined emphysema, especially CLE with LAA%>17%, is an independent predictor of NSCLC prognosis. Moreover, prospective studies are needed to further explore this association.
A bronchial gene signature specific for severe COPD that is retained in the nose
Authors: van Nijnatten Jos , Faiz Alen , Timens Wim , Guryev Victor , Slebos Dirk-Jan , Klooster Karin , Hartman Jorine E. , Kole Tessa , Choy David F. , Chakrabarti Arindam , Grimbaldeston Michele , Rosenberger Carrie M. , Kerstjens Huib , Brandsma Corry-Anke , van den Berge Maarten 
Published: September 2023

IntroductionA subset of COPD patients develops advanced disease with severe airflow obstruction, hyperinflation and extensive emphysema. We propose that the pathogenesis in these patients differs from mild–moderate COPD and is reflected by bronchial gene expression. The aim of the present study was to identify a unique bronchial epithelial gene signature for severe COPD patients.MethodsWe obtained RNA sequencing data from bronchial brushes from 123 ex-smokers with severe COPD, 23 with mild–moderate COPD and 23 non-COPD controls. We identified genes specific to severe COPD by comparing severe COPD to non-COPD controls, followed by removing genes that were also differentially expressed between mild–moderate COPD and non-COPD controls. Next, we performed a pathway analysis on these genes and evaluated whether this signature is retained in matched nasal brushings.ResultsWe identified 219 genes uniquely differentially expressed in severe COPD. Interaction network analysis identifiedVEGFAandFN1as the key genes with the most interactions. Genes were involved in extracellular matrix regulation, collagen binding and the immune response. Of interest were 10 genes (VEGFA,DCN,SPARC,COL6A2,MGP,CYR61,ANXA6,LGALS1,C1QAandC1QB) directly connected to fibronectin 1 (FN1). Most of these genes were lower expressed in severe COPD and showed the same effect in nasal brushings.ConclusionsWe found a unique severe COPD bronchial gene signature with key roles forVEGFAandFN1, which was retained in the upper airways. This supports the hypothesis that severe COPD, at least partly, comprises a different pathology and supports the potential for biomarker development based on nasal brushes in COPD.
Effects of pharmacological and non-pharmacological interventions on physical activity outcomes in COPD: a systematic review and meta-analysis
Authors: Megaritis Dimitrios , Hume Emily , Chynkiamis Nikolaos , Buckley Christopher , Polhemus Ashley M. , Watz Henrik , Troosters Thierry , Vogiatzis Ioannis 
Published: September 2023

RationaleThe effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes is not fully elucidated in patients with COPD. The objectives of the present study were to provide estimation of treatment effects of all available interventions on PA outcomes in patients with COPD and to provide recommendations regarding the future role of PA outcomes in pharmacological trials.Materials and methodsThis review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with PRISMA. Records were identified through searches of 12 scientific databases; the most updated search was performed in January 2023.Results74 studies published from 2000 to 2021 were included, with a total of 8140 COPD patients. Forced expiratory volume in 1 s % predicted ranged between 31% and 74%, with a mean of 55%. Steps/day constituted the most frequently assessed PA outcome in interventional studies. Compared to usual care, PA behavioural modification interventions resulted in improvements in the mean (95% CI) steps/day when implemented alone (by 1035 (576–1493); p<0.00001) or alongside exercise training (by 679 (93–1266); p=0.02). Moreover, bronchodilator therapy yielded a favourable difference of 396 (125–668; p=0.004) steps/day, compared to placebo.ConclusionsPA behavioural modification and pharmacological interventions lead to significant improvements in steps/day, compared to control and placebo groups, respectively. Compared to bronchodilator therapy, PA behavioural modification interventions were associated with a 2-fold greater improvement in steps/day. Large-scale pharmacological studies are needed to establish an intervention-specific minimal clinically important difference for PA outcomes as well as their convergent validity to accelerate qualification as potential biomarkers and efficacy end-points for regulatory approval.
Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach
Authors: Stanyer Emily C. , Brookes Jack , Pang Jia Rong , Urani Alexandre , Holland Philip R. , Hoffmann Jan 
Published: September 2023

Abstract
Background
There is a bidirectional link between sleep and migraine, however causality is difficult to determine. This study aimed to investigate this relationship using data collected from a smartphone application.

Methods
Self-reported data from 11,166 global users (aged 18–81 years, mean: 41.21, standard deviation: 11.49) were collected from the Migraine Buddy application (Healint Pte. Ltd.). Measures included: start and end times of sleep and migraine attacks, and pain intensity. Bayesian regression models were used to predict occurrence of a migraine attack the next day based on users’ deviations from average sleep, number of sleep interruptions, and hours slept the night before in those reporting ≥ 8 and < 25 migraine attacks on average per month. Conversely, we modelled whether attack occurrence and pain intensity predicted hours slept that night.

Results
There were 724 users (129 males, 412 females, 183 unknown, mean age = 41.88 years, SD = 11.63), with a mean monthly attack frequency of 9.94. More sleep interruptions (95% Highest Density Interval (95%HDI [0.11 – 0.21]) and deviation from a user’s mean sleep (95%HDI [0.04 – 0.08]) were significant predictors of a next day attack. Total hours slept was not a significant predictor (95%HDI [-0.04 – 0.04]). Pain intensity, but not attack occurrence was a positive predictor of hours slept.

Conclusions
Sleep fragmentation and deviation from typical sleep are the main drivers of the relationship between sleep and migraine. Having a migraine attack does not predict sleep duration, yet the pain associated with it does. This study highlights sleep as crucial in migraine management.
Recurrent superior orbital fissure syndrome associated with VEXAS syndrome
Authors: Myint Katie , Patrao Namritha , Vonica Oana , Vahdani Kaveh 
Published: September 2023

Abstract
Purpose
To describe a case of recurrent orbital inflammation and superior orbital fissure syndrome associated with VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome.

Case presentation
VEXAS syndrome is a recently identified multi-system inflammatory disease of late adult onset. The authors describe the case of a 76-year-old man who presented with recurrent episodes of orbital inflammation, with superior orbital fissure syndrome, dacryoadenitis and orbital myositis. He had a constellation of systemic disorders including recurrent chest infections, congestive cardiac failure, pulmonary emboli and skin rashes. The underlying diagnosis of VEXAS syndrome was confirmed by genetic testing, which revealed the UBA1 mutation.

Conclusion
VEXAS syndrome should be considered in the differential diagnosis of orbital inflammatory disease associated with multi-system inflammatory disorders.
Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature
Authors: Wang Ke , Wen Li , Xie Li , Zhao Maoyu , Liu Xi , Luo Xiaolin , Jin Jun , Qin Zhexue 
Published: September 2023

Abstract
Background
Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening.

Case presentation
A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period.

Conclusions
Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.
Using decision tree analysis to identify population groups at risk of subjective unmet need for assistance with activities of daily living
Authors: Jaehn Philipp , Fügemann Hella , Gödde Kathrin , Holmberg Christine 
Published: September 2023

Abstract
Background
Identifying predictors of subjective unmet need for assistance with activities of daily living (ADL) is necessary to allocate resources in social care effectively to the most vulnerable populations. In this study, we aimed at identifying population groups at risk of subjective unmet need for assistance with ADL and instrumental ADL (IADL) taking complex interaction patterns between multiple predictors into account.

Methods
We included participants aged 55 or older from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Subjective unmet need for assistance was defined as needing any help or more help with ADL (analysis 1) and IADL (analysis 2). Analysis 1 was restricted to participants indicating at least one limitation in ADL (N = 1,957). Similarly, analysis 2 was restricted to participants indicating at least one limitation in IADL (N = 3,801). Conditional inference trees with a Bonferroni-corrected type 1 error rate were used to build classification models of subjective unmet need for assistance with ADL and IADL, respectively. A total of 36 variables representing sociodemographics and impairments of body function were used as covariates for both analyses. In addition, the area under the receiver operating characteristics curve (AUC) was calculated for each decision tree.

Results
Depressive symptoms according to the PHQ-8 was the most important predictor of subjective unmet need for assistance with ADL. Further classifiers that were selected from the 36 independent variables were gender identity, employment status, severity of pain, marital status, and educational level according to ISCED-11. The AUC of this decision tree was 0.66. Similarly, depressive symptoms was the most important predictor of subjective unmet need for assistance with IADL. In this analysis, further classifiers were severity of pain, social support according to the Oslo-3 scale, self-reported prevalent asthma, and gender identity (AUC = 0.63).

Conclusions
Reporting depressive symptoms was the most important predictor of subjective unmet need for assistance among participants with limitations in ADL or IADL. Our findings do not allow conclusions on causal relationships. Predictive performance of the decision trees should be further investigated before conclusions for practice can be drawn.
Listening and learning: a qualitative study of Scottish care home staff experiences of managing COVID-19 between March 2020-August 2022
Authors: Burton Jennifer Kirsty , Drummond Maria , Gallacher Katie I , Quinn Terence J 
Published: September 2023

Abstract
Background
The serious outcomes of outbreaks of COVID-19 in care homes have been described internationally. The experiences of professionals working through outbreaks has received less attention, missing opportunities to acknowledge and learn lessons. Our aim was to explore the experiences of care home staff in Scotland of managing COVID-19 within their homes to help inform understanding and future practice.

Methods
From April to August 2022, 34 individual semi-structured interviews were conducted with care home staff working in homes which experienced an outbreak(s) of COVID-19. Reflexive thematic methods were used to analyse verbatim deidentified transcripts.

Findings
There was no singular experience of COVID-19 outbreaks within care homes. We identified four broad groupings of homes with outbreaks (significant outbreaks, managed outbreaks, outbreaks in remote/rural homes & outbreaks in homes supporting younger adults), with overlaps in timing and severity and variation in the support received and impact. The national response to the COVID-19 pandemic resulted in fundamental change to care home relationships. Staff responded by adaptation in uncertainty. However, they were challenged by emerging inequalities influencing residents’ care. There were tensions between staff experience and evolving external approaches to regulation and oversight. All this change resulted in psychological impacts on staff. However, there was also widespread evidence of compassionate leadership and teamwork in their responses. Effective sources of support were underpinned by respectful relationships and continuity, tailored to individual contexts.

Conclusions
The lived experiences of care home staff during the COVID-19 pandemic provide valuable insights applicable beyond the pandemic context. This includes: recognition of the specialism, complexity and diversity of care home practice; the value afforded by embedding genuine representation and involvement in planning, policy-making and research; the need for individualising to people in their contexts and the value of fostering respectful relationships across professional groups to support residents.
Typologies of interactions between abortion seekers and healthcare workers in Australia: a qualitative study exploring the impact of stigma on quality of care
Authors: Makleff Shelly , Belfrage Madeleine , Wickramasinghe Sethini , Fisher Jane , Bateson Deborah , Black Kirsten I. 
Published: September 2023

Abstract
Background
Abortion stigma involves the stereotyping of, discrimination against, and delegitimization of those who seek and provide abortion. Experiences of abortion care are shaped by stigma at the meso (e.g., lack of local providers) and macro (e.g., abortion regulations) levels. Yet abortion stigma and quality of care are often examined separately. This study sought to articulate the impact of abortion stigma on quality of care in the context of healthcare interactions. It did so by characterizing the features of stigmatizing and non-stigmatizing care in the context of macro-level stigma and other structural factors that influence abortion-seeking experiences, including the coronavirus pandemic’s influence on the health system.

Methods
This qualitative study comprised in-depth interviews with people who sought abortion across Australia between March 2020 and November 2022, recruited through social media and flyers in clinics. Thematic analysis drew on concepts of micro, meso, and macro stigma and person-centered care. We developed typologies of the interactions between abortion seekers and healthcare workers by analytically grouping together negative and positive experiences to characterize features of stigmatizing and and non-stigmatizing care in the context of macro-level influences.

Results
We interviewed 24 abortion seekers and developed five typologies of stigmatizing care: creating barriers; judging; ignoring emotional and information needs; making assumptions; and minimizing interactions. There are five corresponding positive typologies. Macro-level factors, from abortion regulations to rural and pandemic-related health system pressures, contributed to poor experiences in care.

Conclusions
The positive experiences in this study illustrate how a lack of stigma enables patient-centered care. The negative experiences reflect the interrelationship between stigmatizing beliefs among healthcare workers, macro-level (policy and regulatory) abortion stigma, and structural health service limitations exacerbated during the pandemic. Interventions are needed to reduce stigmatizing interactions between abortion seekers and healthcare workers, and should also consider macro-level factors that influence the behaviors of healthcare workers and experiences of abortion seekers. Without addressing stigma at multiple levels, equitable access to high-quality abortion care will be difficult to achieve. Efforts to integrate stigma reduction into quality improvement have relevance for maternal and reproductive health services globally.
The risk of acute kidney injury in colorectal cancer survivors: an english population-based matched cohort study
Authors: Andresen Kirsty , Carreira Helena , Strongman Helen , McDonald Helen I. , Benitez-Majano Sara , Mansfield Kathryn E. , Nitsch Dorothea , Tomlinson Laurie A. , Bhaskaran Krishnan 
Published: September 2023

Abstract
Background
Colorectal cancer survival has improved in recent decades but there are concerns that survivors may develop kidney problems due to adverse effects of cancer treatment or complications of the cancer itself. We quantified the risk of acute kidney injury (AKI) in colorectal cancer survivors compared to people with no prior cancer.

Methods
Retrospective matched cohort study using electronic health record primary care data from the Clinical Practice Research Datalink GOLD linked to hospital data in England (HES-APC). Individuals with colorectal cancer between 1997–2018 were individually matched on age, sex, and GP practice to people with no prior cancer. We used Cox models to estimate hazard ratios for an incident hospital diagnosis of AKI in colorectal cancer survivors compared to individuals without cancer, overall and stratified by time since diagnosis adjusted for other individual-level factors (adj-HR).

Results
Twenty thousand three hundred forty colorectal cancer survivors were matched to 100,058 cancer-free individuals. Colorectal cancer survivors were at increased risk of developing AKI compared to people without cancer (adj-HR = 2.16; 95%CI 2.05–2.27). The HR was highest in the year after diagnosis (adj-HR 7.47, 6.66–8.37), and attenuated over time, but there was still increased AKI risk > 5 years after diagnosis (adj-HR = 1.26, 1.17–1.37). The association between colorectal cancer and AKI was greater for younger people, men, and those with pre-existing chronic kidney disease.

Conclusions
Colorectal cancer survivors were at increased risk of AKI for several years after cancer diagnosis, suggesting a need to prioritise monitoring, prevention, and management of kidney problems in this group of cancer survivors.
Clinical profile and outcomes of pediatric hypertrophic cardiomyopathy in a South Indian tertiary care cardiac center: a three decade experience
Authors: Mukhtar Gousia , Sasidharan Bijulal , Krishnamoorthy Kavassery Mahadevan , Kurup Harikrishnan K. N. , Gopalakrishnan Arun , SasiKumar Deepa , P Sankara Sarma , Valaparambil Ajit Kumar , Sivasubramonian Sivasankaran , Sivadasanpillai Harikrishnan 
Published: September 2023

Abstract
Introduction
Although much research has been done on adult hypertrophic cardiomyopathy, data on pediatric hypertrophic cardiomyopathy is still limited.

Methods and results
The study enrolled all patients with cardiomyopathy who presented to us between 1990 to 2020 and were younger than 18 yrs. During the thirty-year study period, we identified 233 cases of pediatric cardiomyopathy. Sixty-three cases (27%) had hypertrophic cardiomyopathy. Out of the 63 HCM cases, 12% presented in the neonatal period and 37% presented in the first year of life. The median age of presentation was 7 yrs (Range 0.1–18 yrs). Sixteen patients had proven syndromic, metabolic, or genetic disease (25%). LV outflow obstruction was present in 30 patients (47%). Noonan syndrome was present in 9 of the 63 patients (14%). Dyspnea on exertion was the most common mode of presentation. Cardiac MRI was done in 28 patients, out of which 17 had late gadolinium enhancement (LGE). Mid myocardial enhancement was the most common pattern. Four patients had LGE of more than 15%. Over a mean follow-up period of 5.6 years (0.1–30 years), twenty-one were lost to follow-up (33%). Among the patients whose outcome was known, eleven died (26%), and thirty-one (73%) were alive. The 5-year survival rate of HCM patients was 82%, and the 10-year survival rate was 78%. Seven died of sudden cardiac death, three from heart failure, and one from ventricular arrhythmias. Sustained ventricular arrhythmias were seen in three patients and atrial arrhythmias in two. First-degree AV block was seen in 10 patients (15%) and bundle branch blocks (BBB) in five (8%). Eight patients required ICD or transplant (12.7%). Two patients underwent ICD for primary prevention, and one underwent PPI for distal AV conduction disease. Among the various clinical, echocardiographic, and radiological risk factors studied, only consanguinity showed a trend towards higher events of death or ventricular arrhythmias (P-value 0.08).

Conclusion
More than one-third of our HCM cohort presented in infancy. LV outflow tract obstruction is common (47%). Mid myocardial enhancement was the most common pattern of late gadolinium enhancement. SCD was the most common cause of death. The outcome in our HCM cohort is good and similar to other population cohorts. Only Consanguinity showed a trend towards higher events of death or ventricular arrhythmias.