bluuebunny/crossref_metadata_2025_split huggingface dataset:
A retrospective study on 198 mpox cases in South Florida: Clinical characteristics and outcomes with focus on human immunodeficiency virus status
Authors: Kim Myeongji , Acevedo Martinez Elsa , Suárez Moscoso Nathalie P , Niu Jinali , Abbo Lilian M , Rosa Rossana , Cifuentes Renzo , Eckardt Paula A 
Published: June 2023

Background Men who have sex with men (MSM) and persons living with human immunodeficiency virus (PLWH) were disproportionately affected by global mpox outbreak in 2022. In this retrospective review, we describe epidemiology and clinical characteristics of mpox infection in South Florida with a focus on human immunodeficiency virus (HIV) status. Methods This was a retrospective observational study of 198 adult patients with confirmed diagnosis of mpox between 01 January 2020, and 10 September 2022, in two large health systems in South Florida. A descriptive analysis was performed to summarize demographic, clinical and laboratory characteristics, and outcomes of the patients. Results Young male patients and PLWH were disproportionately represented among patients with mpox. HIV positive patients were less likely to have adenopathy and myalgia and were more likely to have oral or facial lesions. 22.7% of studied patients were diagnosed with one or more concurrent STI at the time of mpox diagnosis. Conclusions We suggest screening for sexually transmitted infections and HIV for patients diagnosed with mpox. We suggest prompt consultation or referral to infectious disease specialist if needed for the patients who are diagnosed with mpox especially in the severely immunocompromised host.
Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital
Authors: Jennison Toby , Ukoumunne Obioha C. , Lamb Sallie , Sharpe Ian , Goldberg Andy 
Published: June 2023

Background: Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements. Methods: A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements. Results: The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure. Conclusion: This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis. Level of Evidence: Level III, retrospective cohort study.
The impact of a pharmacist-led oral anticancer clinic on medication adherence and laboratory monitoring
Authors: Megeed Ayaa , Magas Hannah , Accursi Mallory , Burant Christopher J , Hansen Elizabeth 
Published: June 2023

Purpose To evaluate the impact that a pharmacist-managed oral anticancer clinic has on patient adherence to oral anticancer therapy in regard to medication adherence and adherence to lab monitoring. Methods A retrospective chart review was completed for patients prescribed abiraterone, enzalutamide, or ibrutinib within the study time period. The primary outcome was assessing medication adherence by comparing the medication possession ratio (MPR) before (Phase 1) and after (Phase 2) initiation of the pharmacist-led oral anticancer therapy clinic. The secondary outcome was assessing lab monitoring adherence by patients and providers in Phase 1 and Phase 2. This will be done by assessing whether labs were ordered at the appropriate time frame by oncology providers, as well as whether or not the patient came and got these labs drawn. This study will also examine outcomes related to the pharmacist-led oral anticancer therapy clinic (phase 2) for descriptive purposes. Results A total of 189 charts were analyzed with 134 excluded and 55 included (25 patients in phase 1 and 30 patients in phase 2). Independent sample t-test analyses revealed a statistically significant increase ( t(30.57) = −1.99; p = 0.027) in the MPR ratio between phase 1 (mean = 0.98, SD = 0.13) compared to phase 2 (mean = 1.04, SD = 0.08). For patient adherence to lab monitoring, there was a statistically significant improvement between phase 1 and phase 2 for patients on abiraterone (21.9% vs 67%; t(25) = −5.73; p < 0.001) and enzalutamide (35.7% vs. 90.5%; t(8) = −3.26; p = 0.006). However, for patients on ibrutinib, there was a slight decline in lab monitoring adherence between phase 1 and phase 2 but this effect was not statistically significant (56.2% vs. 51%; t(17) = 0.58; p = 0.283). Similar results were shown for provider adherence to lab monitoring. Descriptive outcomes showed that the pharmacist had, on average, 6.7 encounters per patient with the majority being phone and face-to-face appointments. Conclusions Data from this study demonstrated that a pharmacist-led oral anticancer clinic can improve MPR ratios and patient adherence to oral anticancer medication regimens. In addition, patient and provider lab monitoring adherence was improved for abiraterone and enzalutamide. Improvement in patient and provider lab monitoring adherence for ibrutinib was not shown, possibly due to the impact of the COVID-19 pandemic, relatively small sample size, and retrospective nature of this study. The results of this study support that overall, a pharmacist-led oral anticancer clinic can significantly improve patient outcomes, which aligns with previous smaller studies that have shown similar benefits.
Simultaneous tests and confidence bands for Stata estimation commands
Authors: Drukker David M. 
Published: June 2023

Stata estimation commands that implement frequentist methods produce an output table that contains multiple tests and multiple confidence intervals. Presumably, the multiple tests and multiple confidence are designed to help determine which parameters are responsible for a possible rejection of the overall null hypothesis of no effect. When taken by itself, each test and each confidence interval provides valid inference about the null hypothesis of no effect for each parameter at the specified error rate. However, simultaneously using two or more of these tests or confidence intervals provides inference at an error rate that exceeds the one specified. In this article, I discuss the sotable command, which provides p-values that are adjusted for the multiple tests and a confidence band that can be used to simultaneously test multiple parameters for no effect after almost all frequentist estimation commands. I also provide an introduction to the literature on simultaneous inference.
Spinal Cathepsin S promotes visceral hypersensitivity via FKN/CX3CR1/p38 MAPK signaling pathways
Authors: Sun Pei , Lin Wei , Weng Yuxuan , Gong Jin , Huang Yang , Tang Ying , Lin Chun , Chen Aiqin , Chen Yu 
Published: June 2023

Background Irritable bowel syndrome (IBS) is one of the typical representatives of chronic functional visceral pain that lacks effective treatment. Recently, attention has been given to the role of microglia in IBS, particularly the activation of spinal microglia and the subsequent release of Cathepsin S (Cat S), a proteolytic enzyme. However, the specific role of spinal Cat S in IBS remains to be elucidated. The purpose of this study is to investigate the mechanisms underlying the regulation of visceral hypersensitivity in IBS-like rats by Cat S. Methods An IBS-like rat model was developed, and visceral sensitivity was tested via the electromyographic (EMG) response to colorectal distention (CRD) and pain threshold. Western blot and immunofluorescence were used to examine the expressions of proteins. The effects of inhibitors or neutralizing antibodies on visceral pain and the downstream molecular expressions were detected. The open-field test was performed to evaluate locomotor activity and anxiety-like behaviors in rats. Results We discovered that spinal Cat S was upregulated and colocalized with microglia in IBS-like rats. Treatment with LY3000328, a selective inhibitor of Cat S, dose-dependently down-regulated EMG amplitude and Fractalkine (FKN) expression, indicating that Cat S regulated visceral hypersensitivity via activating FKN in IBS-like rats. Furthermore, the expressions of FKN, CX3CR1, and p-p38 MAPK were elevated in IBS-like rats whereas inhibition of these molecules could alleviate visceral pain. Moreover, pharmacological inhibitor experiments suggested the activation of CX3CR1 by FKN facilitated p38 MAPK phosphorylation, which in turn promoted Cat S expression in IBS-like rats. Conclusions Neonatal adverse stimulation might enhance the expression of spinal microglial Cat S, thereby activating the FKN/CX3CR1/p38 MAPK pathway and lead to visceral hypersensitivity in IBS-like rats. As a selective inhibitor of Cat S, LY3000328 could become a potential therapeutic option for IBS.
Phase I pilot safety and feasibility of a novel restraint device for critically ill patients requiring mechanical ventilation
Authors: Kamdar Biren B , Fine Janelle M , Pavini Marie T , Ardren Sara S , Burns Stephanie , Bates Jason HT , McGinnis Ryan S , Pandian Vinciya , Lin Benjamin H , Needham Dale M , Stapleton Renee D 
Published: June 2023

Background: Mechanically ventilated Intensive Care Unit (ICU) patients often require wrist restraints, contributing to immobility and agitation, over-sedation, and delirium. The Exersides® Refraint® (Healthy Design, LLC), a novel restraint alternative, may be safe and facilitate greater mobility than traditional restraints. Objective: This National Institutes of Health Small Business Technology Transfer (STTR) Program Grant-funded single-site Phase I feasibility study evaluated Exersides® safety and feasibility in anticipation of a multi-site Phase II randomized controlled trial (RCT). Methods: In two academic ICUs, mechanically ventilated adults ⩾25 years old who were non-comatose, required restraints and had an expected stay of ⩾2 days were enrolled to wear Exersides® and traditional wrist restraints for 4 h on day 1, in a randomized order, and in the reverse order on day 2. Main outcomes were Exersides® safety (i.e., patient/clinician lacerations/injuries), feasibility (i.e., ⩾90% of required data collected), and patient/family/clinician feedback. Results: Eight patients were enrolled; one no longer required restraints at initiation, yielding seven subjects (median [interquartile range (IQR)] age 65 [55, 70] years, 86% men). All seven wore Exersides®, averaging (SD) 2.5 (1.0) hours per session, with no safety events reported. Across restraint time periods, 92% and 100% of Richmond Agitation-Sedation Scale (RASS) and wrist actigraphy data, respectively, were collected. Feedback was positive (more movement and comfortable than traditional restraints) and constructive (bulky, intimidating to apply). Conclusions: This pilot study provided key safety and feasibility data for a Phase II RCT evaluating Exersides® versus traditional wrist restraints. Feedback motivated minor device modifications before RCT initiation.
The effect of synbiotics in patients with NAFLD: a systematic review and meta-analysis
Authors: Cai Jiacheng , Dong Jia , Chen Dahua , Ye Hua 
Published: June 2023

Background: Nonalcoholic fatty liver disease (NAFLD) is the highest incidence of chronic liver disease worldwide, seriously endangering human health, and its pathogenesis is still unclear. In the recent years, increasing evidence has shown that intestinal flora plays an important role in the occurrence and development of NAFLD. Synbiotics can alter gut microbiota and may be a treatment option for NAFLD in the future. Objectives: To systematically investigate the therapeutic effect of synbiotic supplementation on NAFLD patients. Design: A systematic review and meta-analysis were conducted. Data sources and methods: We conducted a search on four databases (PubMed, Embase, Cochrane Library, and Web of Science) to identify relevant studies. Eligible studies were then screened, and data from the included studies were extracted, combined, and analyzed. Result: This study analyzed 10 randomized controlled trials involving 634 patients with NAFLD. The results showed that synbiotic supplementation could significantly reduce the level of alanine aminotransferase (mean difference (MD) = −8.80; (95% CI [−13.06, −4.53]), p < 0.0001), aspartate aminotransferase (MD = −9.48; 95% CI [−12.54, −6.43], p < 0.0001), and γ-glutamyl transferase (MD = −12.55; 95% CI [−19.40, −5.69], p = 0.0003) in NAFLD patients. In the field of metabolism, synbiotic supplementation could significantly reduce the level of total cholesterol (MD = −11.93; 95% CI [−20.43, −3.42], p = 0.006) and low-density lipoprotein cholesterol (MD = −16.2; 95% CI [−19.79, −12.60], p < 0.0001) and increase the level of high-density lipoprotein cholesterol (MD = 1.56; 95% CI [0.43, 2.68], p = 0.007) in NAFLD patients. In addition, synbiotic supplementation could significantly reduce liver stiffness measurement indicator (MD = −1.09; 95% CI [−1.87, −0.30], p = 0.006) and controlled attenuation parameter indicator (MD = −37.04; 95% CI [−56.78, −17.30], p = 0.0002) in NAFLD patients. Conclusion: Based on the current evidence, synbiotic supplementation can improve liver function, adjust lipid metabolism, and reduce the degree of liver fibrosis in patients with NAFLD, but these effects need to be confirmed by further studies.
Instrumental dead space and proximal working channel connector design in flexible ureteroscopy: a new concept
Authors: Kwok Jia-Lun , De Coninck Vincent , Pietropaolo Amelia , Juliebø-Jones Patrick , Ventimiglia Eugenio , Tailly Thomas , Alexander Schmid Florian , Hunziker Manuela , Poyet Cédric , Traxer Olivier , Eberli Daniel , Keller Etienne Xavier 
Published: June 2023

Objective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods: IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results: IDS significantly varied between flexible ureteroscope models, ranging from 1.1 ml for the Pusen bare scopes, to 2.3 ml for Olympus scopes with their 4-way connector ( p < 0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854 mm and significantly correlated with measured IDS ( R2 = 0.82, p < 0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5 ml; p < 0.001). Conclusions: IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties.
The Effects of the Levels of Hypoxia in the Olfactory Nervous System in Mouse Model
Authors: Kim Boo-Young , Park Ju Yeon , Bae Jung Ho 
Published: June 2023

Purpose Intermittent hypoxia (IH) results in low-grade inflammation, sympathetic overactivity, and oxidative stress. However, the specific effects of IH on olfaction have not yet been directly assessed and remain unclear. Therefore, the purpose of this study was to investigate the cytotoxic effects of IH exposure on the mouse olfactory epithelium and the relationship between the concentration of hypoxia and the degree of destruction of the olfactory system. Methods Thirty mice were randomly divided into six groups: control (room air for 4 weeks), recovery control (room air for 5 weeks), IH 5% oxygen concentration, IH 7% oxygen concentration, recovery 5% hypoxia, and recovery 7% hypoxia groups. Mice in the two hypoxia groups were exposed to 5% and 7% oxygen for 4 weeks. Mice in the two recovery groups were exposed to room air for 1 week after 4 weeks of hypoxia period. Results Based on, the olfactory marker protein ( OMP), Olfr1507, ADCY3, and GNAL were lower, whereas S100b and NGFRAP1 messenger RNA (mRNA) levels were higher in the 5% hypoxia group than those in the control group in the olfactory neuroepithelium. In the brain tissue, the changes in RNA analysis for Olfr 1507, OMP, ADCY, and GNAL mRNA were not typical. However, NeuN and GFAP levels were decreased under 5% hypoxia in the brain tissue. In the recovery state, CNPase, S100b and NeuN levels were increased significantly in both the olfactory neuroepithelium and brain tissue in the 5% hypoxia group. The change in RNA activity in PCR was much higher in the 5% hypoxia group than in the 7% hypoxia group. Conclusions Our findings suggest that IH damages the olfactory neuroepithelium and brain tissue in mouse model. The activity of olfactory marker genes and neurogenesis in the olfactory neuroepithelium were decreased. The levels of oxygen may be affect changes in the olfactory neuroepithelium. The olfactory ensheathing cell may be a major factor in the recovery of the olfactory neuroepithelium.
Development and Validation of a Predictive Risk Algorithm for Bleeding in Individuals on Long-term Hemodialysis: An International Prospective Cohort Study (BLEED-HD)
Authors: Madken Mohit , Mallick Ranjeeta , Rhodes Emily , Mahdavi Roshanak , Bader Eddeen Anan , Hundemer Gregory L. , Kelly Dearbhla M. , Karaboyas Angelo , Robinson Bruce , Bieber Brian , Molnar Amber O. , Badve Sunil V. , Tanuseputro Peter , Knoll Gregory , Sood Manish M. 
Published: June 2023

Background: Individuals with kidney disease are at a high risk of bleeding and as such tools that identify those at highest risk may aid mitigation strategies. Objective: We set out to develop and validate a prediction equation (BLEED-HD) to identify patients on maintenance hemodialysis at high risk of bleeding. Design: International prospective cohort study (development); retrospective cohort study (validation). Settings: Development: 15 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018); Validation: Ontario, Canada. Patients: Development: 53 147 patients; Validation: 19 318 patients. Measurements: Hospitalization for a bleeding event. Methods: Cox proportional hazards models. Results: Among the DOPPS cohort (mean age, 63.7 years; female, 39.7%), a bleeding event occurred in 2773 patients (5.2%, event rate 32 per 1000 person-years), with a median follow-up of 1.6 (interquartile range [IQR], 0.9-2.1) years. BLEED-HD included 6 variables: age, sex, country, previous gastrointestinal bleeding, prosthetic heart valve, and vitamin K antagonist use. The observed 3-year probability of bleeding by deciles of risk ranged from 2.2% to 10.8%. Model discrimination was low to moderate (c-statistic = 0.65) with excellent calibration (Brier score range = 0.036-0.095). Discrimination and calibration of BLEED-HD were similar in an external validation of 19 318 patients from Ontario, Canada. Compared to existing bleeding scores, BLEED-HD demonstrated better discrimination and calibration (c-statistic: HEMORRHAGE = 0.59, HAS-BLED = 0.59, and ATRIA = 0.57, c-stat difference, net reclassification index [NRI], and integrated discrimination index [IDI] all P value <.0001). Limitations: Dialysis procedure anticoagulation was not available; validation cohort was considerably older than the development cohort. Conclusion: In patients on maintenance hemodialysis, BLEED-HD is a simple risk equation that may be more applicable than existing risk tools in predicting the risk of bleeding in this high-risk population.
Patients, carers and healthcare providers’ perspectives on a patient-owned surveillance system for diabetic foot ulcer care: A qualitative study
Authors: Lo Zhiwen Joseph , Chong Bryan , Tan Elaine , Ooi Desmond , Liew Huiling , Hoi Wai Han , Cho Yuan Teng , Wu Kyle , Surendra Naren Kumar , Mammadova Maleyka , Nah Audrey , Goh Victor , Car Josip 
Published: June 2023

Objective Digital health has recently gained a foothold in monitoring and improving diabetes care. We aim to explore the views of patients, carers and healthcare providers (HCPs) regarding the use of a novel patient-owned wound surveillance application as part of outpatient management of patients with diabetic foot ulcers (DFUs). Methods Semi-structured online interviews were conducted with patients, carers and HCPs in wound care for DFUs. The participants were recruited from a primary care polyclinic network and two tertiary hospitals in Singapore, within the same healthcare cluster. Purposive maximum variation sampling was used to select participants with differing attributes to ensure heterogeneity. Common themes relating to the wound imaging app were captured. Results A total of 20 patients, 5 carers and 20 HCPs participated in the qualitative study. None of the participants have used a wound imaging app before. Regarding a patient-owned wound surveillance app, all were open and receptive to the system and workflow for use in DFU care. Four major themes emerged from patients and carers: (1) technology, (2) application features and usability, (3) feasibility of using the wound imaging application and (4) logistics of care. Four major themes were identified from HCPs: (1) attitudes towards wound imaging app, (2) preferences regarding functionality, (3) perceived challenges for patients/carers and (4) perceived barriers for HCPs. Conclusion Our study highlighted several barriers and facilitators from patients, carers and HCPs regarding the use of a patient-owned wound surveillance app. These findings demonstrate the potential of digital health and areas to improve and tailor a DFU wound app suitable for implementation in the local population.