bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between hormone therapy and the risk of lung cancer in postmenopausal women: a 16-year nationwide population-based study
Authors: Wu Chia-Chen , Chung Chi-Hsiang , Tzeng Nian-Sheng , Wu Min-Jung , Tsao Chang-Huei , Wu Ti-Hui , Chien Wu-Chien , Chen Hsin-Chien 
Published: February 2023

Abstract

Objective
Although an association between hormone therapy (HT) and the risk of developing lung cancer has been reported, the results on the topic are inconsistent. Our study objective was to investigate whether postmenopausal women who undergo HT exhibit a risk of developing lung cancer.

Methods
In this matched cohort study, we obtained the data of 38,104 postmenopausal women older than 45 years who were treated using HT between 2000 and 2015 from Taiwan's National Health Insurance Research Database, and 152,416 matched participants who were not treated using HT were enrolled as controls at a 1:4 ratio.

Results
We used a Cox proportional hazards regression model to identify the risk of developing lung cancer during 16 years of follow-up, and the results indicate no significant difference in the proportion of postmenopausal women treated using HT (P = 0.129) who developed lung cancer and that of those not treated using HT (0.866% [330 of 38,104] vs 0.950% [1,449 of 152,416]). After adjustment for age and other variables, the adjusted hazard ratio was 0.886 (95% CI, 0.666-1.305, P = 0.433), indicating no association between HT and lung cancer development in postmenopausal women. In a subgroup analysis, the risk of lung cancer was significantly lower in the women who were treated using HT when the HT cumulative dosage was ≥401 mg or when the therapy duration was ≥5 years compared with in those not treated using HT; the adjusted hazard ratios were 0.633 (95% CI, 0.475-0.930; P < 0.001) and 0.532 (95% CI, 0.330-0.934; P < 0.001), respectively, after adjustment.

Conclusions
Our results indicate that HT is not associated with the risk of lung cancer development in postmenopausal women; furthermore, a higher cumulative dosage and the long-term effects of HT reduce the risk of developing lung cancer.
Successful removal of heavy metals and environmental toxins using modern Mayr chelating detoxication in a patient: a model for prefertility treatment screening
Authors: Ogunsola Oluwole I. , Adeyi Atinuke , Ashiru Oladapo A. 
Published: February 2023

Introduction:
Heavy metals are naturally existing constituents of the earth that have a high specific density (above 5 g/cm3) and atomic weights (>40.4 Da). Once taken into the body, heavy metals are distributed in the blood and deposited in tissues. The contamination chain follows a cyclic order: from industry, to the atmosphere, soil, water, and foods, then humans. At Martlife detox clinic, a comprehensive treatment plan based on the Mayr method of detoxification designed for the removal of heavy metals is available. To begin with, a bio-energetic test which reveals the types of heavy metals present in the patient’s body is conducted. Thereafter, therapies targeted at extracting the heavy metals and neutralizing their effect on the reproductive organs are commenced.

Methods:
Patient A underwent a metal toxicity test using urine samples at Genova Diagnostics laboratory in the United States. Patient A afterward underwent a bioenergetics test followed by a detoxification plan during the following month at the Martlife Detox Clinic. We performed a repeat test after detoxication at the Genova Diagnostics laboratory to know the outcome of the detoxication.

Results:
Genova Diagnostics laboratory’s first metal toxicity test revealed significantly high values of copper, manganese, vanadium, rubidium, gadolinium, and cesium. It also revealed similar outcomes with the bioenergetics testing before the detoxication process began at Martlife Detox Clinic. The repeat test showed that the detoxication process was successful.

Conclusion(s):
Our findings conclude that the modern Mayr method effectively reduces toxic levels of heavy metals. The bioenergetics test, which is less invasive, cheaper, and faster than the urine test, can also be used to check for toxins in the body.
Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study
Authors: Ohayagha Chimdindu , Perrin Paul B. , Arango-Lasprilla Juan Carlos , Jones Shawn C. T. 
Published: February 2023

Objective:
Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born.

Setting/Participants:
A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States (n = 9435) versus other than the United States (n = 1260) was used.

Design/Main Measures:
Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale.

Results:
Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates.

Conclusion:
These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.
Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations
Authors: Yashkin Arseniy P. , Gorbunova Galina A. , Tupler Larry , Yashin Anatoliy I. , Doraiswamy Murali , Akushevich Igor 
Published: February 2023

Objective:
To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer's disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI.

Setting and Participants:
Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS).

Design:
Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data.

Results:
Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80).

Conclusion:
Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.
Comparison of Corneal Thickness Measurements After Customized Corneal Crosslinking Using High-Resolution Optical Coherence Tomography and Scheimpflug Tomography
Authors: Mendes Baiao Tiago , Wendelstein Jascha , Seiler Theo G. 
Published: February 2023

Purpose:
The aim of this study was to compare the evolution of corneal pachymetry after customized corneal crosslinking (CXL) between Scheimpflug-based and optical coherence–based corneal tomography (OCT).

Methods:
In this retrospective study, central corneal thickness (CCT), thinnest corneal thickness, and epithelial thickness of 33 eyes of 33 patients with keratoconus were measured preoperatively and 1, 3, and 12 months after customized CXL using the Pentacam HR and the MS-39. The mean pachymetry values of measurements were compared with a paired sample t test. Bland–Altman plots and 95% limits of agreement (LoA) were used to assess the agreement between the measurements of the 2 devices.

Results:
The mean age of the participants was 29.7 ± 11.4 years. At baseline, the mean CCT measurements were equal with Pentacam HR (478.30 ± 36.77 μm) and MS-39 (478.46 ± 38.01 μm). After CXL, CCT obtained by Pentacam HR was 460.65 ± 38.69 μm, 464.65 ± 44.45 μm, and 476.77 ± 39.85 μm, and by MS-39 was 478.18 ± 39.50 μm, 472.89 ± 40.92 μm, and 479.51 ± 39.20 μm at 1, 3, and 12 months, respectively. Pentacam HR measured significantly lower CCT (P < 0.05) at months 1 and 3 after CXL. The agreement was smallest between both devices at month 1 (95% LoA −59 to 24 μm) followed by month 3 (95% LoA: −41 to 23 μm). Epithelial thickness, measured with OCT alone, increased significantly at 1 month and regained preoperative levels at 3 months and thereafter.

Conclusions:
After CXL, corneal pachymetry significantly differs between OCT-based and Scheimpflug-based corneal tomography. Pentacam HR seems to underestimate pachymetry when haze is present.
Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease: A Diagnostic Accuracy Study for Pediatric Tuberculosis
Authors: Olbrich Laura , Nliwasa Marriott , Sabi Issa , Ntinginya Nyanda E. , Khosa Celso , Banze Denise , Corbett Elizabeth L. , Semphere Robina , Verghese Valsan P. , Michael Joy Sarojini , Graham Stephen M. , Egere Uzochukwu , Schaaf H. Simon , Morrison Julie , McHugh Timothy D. , Song Rinn , Nabeta Pamela , Trollip Andre , Geldmacher Christof , Hoelscher Michael , Zar Heather J. , Heinrich Norbert ,   on behalf of the RaPaed-AIDA-TB Consortium
Published: February 2023

Introduction:
An estimated 1.2 million children develop tuberculosis (TB) every year with 240,000 dying because of missed diagnosis. Existing tools suffer from lack of accuracy and are often unavailable. Here, we describe the scientific and clinical methodology applied in RaPaed-TB, a diagnostic accuracy study.

Methods:
This prospective diagnostic accuracy study evaluating several candidate tests for TB was set out to recruit 1000 children <15 years with presumptive TB in 5 countries (Malawi, Mozambique, South Africa, Tanzania, India). Assessments at baseline included documentation of TB signs and symptoms, TB history, radiography, tuberculin skin test, HIV testing and spirometry. Respiratory samples for reference standard testing (culture, Xpert Ultra) included sputum (induced/spontaneous) or gastric aspirate, and nasopharyngeal aspirate (if <5 years). For novel tests, blood, urine and stool were collected. All participants were followed up at months 1 and 3, and month 6 if on TB treatment or unwell. The primary endpoint followed NIH-consensus statements on categorization of TB disease status for each participant. The study was approved by the sponsor’s and all relevant local ethics committees.

Discussion:
As a diagnostic accuracy study for a disease with an imperfect reference standard, Rapid and Accurate Diagnosis of Pediatric Tuberculosis Disease (RaPaed-TB) was designed following a rigorous and complex methodology. This allows for the determination of diagnostic accuracy of novel assays and combination of testing strategies for optimal care for children, including high-risk groups (ie, very young, malnourished, children living with HIV). Being one of the largest of its kind, RaPaed-TB will inform the development of improved diagnostic approaches to increase case detection in pediatric TB.
Clinical Characteristics of Pulmonary Tuberculosis in Children Tested by Xpert MTB/RIF Ultra
Authors: Quan Shuting , Zou Tingting , Duan Li , Tian Xue , Wang Yacui , Zhu Yu , Fang Min , Shi Yan , Wan Chaomin , Sun Lin , Shen Adong 
Published: February 2023

Background:
The Xpert MTB/rifampicin Ultra (Xpert Ultra) assay improves the early diagnosis of active tuberculosis (TB) in children. Clinical evaluation is paramount for the interpretation of any positive Xpert Ultra test, especially those with low quantities of DNA.

Methods:
In this study, 391 children with suspected TB who were tested with Xpert Ultra were enrolled. The clinical characteristics and Xpert Ultra results were further analyzed.

Results:
The sensitivity and specificity of Xpert Ultra were 45.0% (149/331) and 96.7% (58/60), respectively. Children with higher semiquantitative scales of Xpert Ultra showed higher percentages of a positive MTB culture, positive acid-fast bacilli staining, severe type of disease, fever, cough and expectoration, a higher white blood cell count and higher C-reactive protein concentrations (all P < 0.01). Among 44 children with an Xpert Ultra trace result, there were no differences in clinical characteristics between confirmed cases and unconfirmed TB cases.

Conclusions:
The prevalence of trace is relatively high and can be considered positive in paucibacillary children. Clinical presentations are associated with bacterial load quantified by Xpert Ultra. The interpretation of Xpert Ultra trace results based on clinical information is important for the diagnosis of TB.
Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases
Authors: Al Dhaheri Fatima A. , El Dannan Huda , Hashim Muhammad Jawad , Alshehi Shooq , Al-Jburi Farah , Antali Aisha , Al Jasmi Noora , Al Khouri Shaima , Al Hajjar Mohamad , Abbas Thikra , ElGhoudi Ahmed , Al Hassani Moza 
Published: February 2023

Background:
The literature describing clinical presentation, disease course and outcomes of SARS-CoV-2 in infants remains scarce.

Methods:
We conducted a retrospective study across 2 major pediatric referral centers evaluating the demographics, clinical and laboratory characteristics, management and outcomes of COVID-19 among newborns and infants in the United Arab Emirates (UAE). Clinical and biochemical markers were evaluated for their accuracy in predicting intensive care unit (ICU) transfer and death.

Results:
A total of 576 COVID-19-positive infants were evaluated with a mean age of 164 days. The mean duration of symptoms was 1.48 days. Fever was present in 36.5% of the cohort, while 44.3% had nasal congestion. Eight infants (of 575; 1.39%) required transfer to the ICU for impending respiratory failure and 2 required invasive ventilation. Symptomatic (fever, nasal congestion) infants were not more likely to be transferred to the ICU (Chi-squared test, P = 0.77). ICU transfer was associated with a higher chance of receiving antibiotics (70.6% vs 35.4%; Chi-squared test, P = 0.003). On multivariate analysis, none of the clinical parameters (age, symptoms, laboratory tests) predicted transfer to the ICU. No deaths were reported during the observation period.

Conclusions:
Infants with SARS-CoV-2 infection have a benign clinical course with favorable outcomes. Less than 2% require ICU transfer. Clinical vigilance is required as none of the admission parameters predicted ICU transfer.
Outcomes in Pediatric Central Line–associated Bloodstream Infections Treated With Antimicrobial Locks: A 14-Year Retrospective Analysis
Authors: Walker Lorne W. , Visweswaran Shyam , Nowalk Andrew J. 
Published: February 2023

Background:
Central line–associated bloodstream infections (CLABSI) are the most common healthcare-associated infection in children. Antimicrobial lock therapy (ALT) is a recommended component of CLABSI treatment; however, studies characterizing pediatric ALT-based CLABSI therapy are few.

Methods:
All CLABSI treated with ALT at a single tertiary-care pediatric hospital for years 2004–2018 were identified by retrospective chart review and demographic, clinical, microbiological and pharmacy data were extracted. Three clinical outcomes were defined: CLABSI clearance, central venous catheter (CVC) removal and infection recurrence. Factors associated with these outcomes were examined and patterns in pathogen occurrence were described.

Results:
During the study period, 1188 CLABSI treated with ALT were identified. In all, 969 (85%) CLABSI initially cleared. In the CLABSI with initial clearance, CVCs were retained a median of 63 days after infection onset, and 20% recurred. Skin-colonizing microbes (Staphylococcus aureus, coagulase-negative Staphylococci) were more likely to produce monomicrobial infections, whereas bowel-colonizing microbes (Escherichia coli, Enterococci) were more associated with polymicrobial infections. In a multivariate model, infection history, resistant pathogens and CVC type were strongly correlated with infection recurrence, whereas bone marrow transplant status, neutrophil count and line type were correlated with CVC removal.

Conclusions:
Optimal therapeutic approaches to pediatric CLABSI remain uncertain, including the utility of ALT. Prior reports of ALT use in children have been smaller in size and largely described hematology-oncology or hemodialysis populations. We describe trends in pediatric CLABSI, including efficacy among solid organ transplant recipients and children with short-gut syndrome. These data provide guidance on selecting CLABSI for optimal ALT use.
An early report of exoscope-assisted otologic surgery
Authors: Zhang Bang-Yan , Ho Valerie Wai-Yee , Tsai Tzong-Yun , Chan Kai-Chieh 
Published: February 2023

Background:
Exoscope has been used in otoneurologic surgery in several reports. However, most ear surgeries are performed using either microscope or endoscopy today. The purpose of this study is to present our subjective and objective experience of using this instrument in our institution.

Methods:
Sixteen ears with different severity and condition in 15 consecutive patients were enrolled. A questionnaire with 12 questions was sent to different participants, including surgeons, residents, medical students, and scrub nurses in the operation room. The total score and average score of each item were calculated and analyzed.

Results:
Exclusive exoscopic operation was performed on 13 patients with 14 procedures. A combination of endoscopy-exoscope and microscope-exoscope was used in one patient, respectively. There were no complications. Hearing recovery or disease extirpation was achieved in most patients. Twenty participants in the operation room filled out the questionnaire. There was no significant difference between the different groups. High ratings were reported in terms of image quality, stereoscopic effects, magnification rate, and the same field of view as the surgeon. Worse ratings were reported in items related to limited working space, increase in eye strain by video observation, and focusing difficulty.

Conclusion:
Exoscopic ear surgery is feasible, safe, and effective in managing various otologic conditions involving external ear, middle ear, mastoid, and lateral skull base. Its high-definition image quality, stereoscopic effects, sufficient magnification, reliability and teaching value made it a potential instrument in general ear surgeries. Further improvements to current drawbacks can be anticipated.
Canadian Academy of Sport and Exercise Medicine Position Paper: The Clinician’s Role in Addressing and Preventing Maltreatment in Sport—10-year Anniversary
Authors: Stirling Ashley E. , Taylor Anika R. , Mountjoy Margo L. , Cruz E. Laura , Bridges Eileen J. 
Published: February 2023

Abstract:
In 2011, the Canadian Academy of Sport and Exercise Medicine released their first position paper on Abuse, Harassment, and Bullying in Sport. Since this time, there have been significant advancements within the global sport landscape, including the emergence of regulatory bodies and initiatives aimed at prioritizing athletes' health and well-being. While the shift to a more proactive approach for safeguarding athletes is evident and promising, athletes continue to be affected by cases of maltreatment. To advance safe sport, it is critical that all supporters of safe and healthy performance are aware of their roles and responsibilities for preventing and addressing maltreatment, including the Canadian sport medicine community. In this updated position statement, recent advancements in research on issues of maltreatment are summarized and specific recommendations are provided on how the medical community can contribute to appropriately identifying, treating, and preventing harm in sport, as well as their role in advocating for the health and well-being of athletes in their care.
Return to Sport after Arthroscopic Rotator Cuff Repair of Full-Thickness Rotator Cuff Tears: A Systematic Review
Authors: Alben Matthew G. , Gambhir Neil , Papalia Aidan G. , Bostrom Nicholas , Larose Gabriel , Virk Mandeep S. , Rokito Andrew S. 
Published: February 2023

Objective:
Perform a systematic literature review regarding return to sport (RTS) outcomes after arthroscopic rotator cuff repair (aRCR) for full-thickness rotator cuff tears (FTRCTs).

Data Sources:
Systematic review of all articles in PubMed, Medline, and Excerpta Medica Database (EMBASE) was conducted in April 2022 using a combination of keywords: “rotator cuff repair,” “RCR,” “complete,” “full-thickness,” “tear,” “RCT,” “injury,” “shoulder,” “arthroscopic,” “return to sport,” “RTS,” “sport,” “return to play,” and “athlete.” Cohorts were included from all articles reporting RTS after aRCR for FTRCTs. Studies that were non-English, failed to distinguish between partial and FTRCT outcomes, or treated FTRCTs by open RCR, mini-open RCR, debridement, or nonsurgical management were excluded. Abstracted data included study design, surgical techniques, concomitant procedures, demographics, FTRCT type and size, patient-reported outcomes, type of sport, competition level, time to return, and reasons for failing to RTS.

Main Results:
11 studies were reviewed, with inclusion of 463 patients (385 athletes; mean age 47.9). RTS varied considerably in rate and timing, with 50.0% to 100% of patients returning on average between 4.8 to 14 months. In addition, 31 patients returned to a higher level of sport, 107 returned to or near preinjury level, and 36 returned to a lower level of competition or failed to RTS entirely.

Conclusions:
The ability for athletes to RTS after aRCR for FTRCTs is likely multifactorial, demonstrating high variability in return rates and time to RTS. Given the paucity of available literature, future studies are warranted to provide a more definitive consensus.