bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors and Temporal Trends of Withdrawal of Life-Sustaining Therapy After Acute Stroke in the Florida Stroke Registry
Authors: Alkhachroum Ayham , Zhou Lili , Asdaghi Negar , Gardener Hannah , Ying Hao , Gutierrez Carolina M. , Manolovitz Brian M. , Samano Daniel , Bass Danielle , Foster Dianne , Sur Nicole B. , Rose David Z. , Jameson Angus , Massad Nina , Kottapally Mohan , Merenda Amedeo , Starke Robert M. , O’Phelan Kristine , Romano Jose G. , Claassen Jan , Sacco Ralph L. , Rundek Tatjana 
Published: June 2023

OBJECTIVES:
Temporal trends and factors associated with the withdrawal of life-sustaining therapy (WLST) after acute stroke are not well determined.

DESIGN:
Observational study (2008–2021).

SETTING:
Florida Stroke Registry (152 hospitals).

PATIENTS:
Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Importance plots were performed to generate the most predictive factors of WLST. Area under the curve (AUC) for the receiver operating curve were generated for the performance of logistic regression (LR) and random forest (RF) models. Regression analysis was applied to evaluate temporal trends. Among 309,393 AIS patients, 47,485 ICH patients, and 16,694 SAH patients; 9%, 28%, and 19% subsequently had WLST. Patients who had WLST were older (77 vs 70 yr), more women (57% vs 49%), White (76% vs 67%), with greater stroke severity on the National Institutes of Health Stroke Scale greater than or equal to 5 (29% vs 19%), more likely hospitalized in comprehensive stroke centers (52% vs 44%), had Medicare insurance (53% vs 44%), and more likely to have impaired level of consciousness (38% vs 12%). Most predictors associated with the decision to WLST in AIS were age, stroke severity, region, insurance status, center type, race, and level of consciousness (RF AUC of 0.93 and LR AUC of 0.85). Predictors in ICH included age, impaired level of consciousness, region, race, insurance status, center type, and prestroke ambulation status (RF AUC of 0.76 and LR AUC of 0.71). Factors in SAH included age, impaired level of consciousness, region, insurance status, race, and stroke center type (RF AUC of 0.82 and LR AUC of 0.72). Despite a decrease in the rates of early WLST (< 2 d) and mortality, the overall rates of WLST remained stable.

CONCLUSIONS:
In acute hospitalized stroke patients in Florida, factors other than brain injury alone contribute to the decision to WLST. Potential predictors not measured in this study include education, culture, faith and beliefs, and patient/family and physician preferences. The overall rates of WLST have not changed in the last 2 decades.
Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*
Authors: Kawakami Daisuke , Fujitani Shigeki , Koga Hidenobu , Dote Hisashi , Takita Mumon , Takaba Akihiro , Hino Masaaki , Nakamura Michitaka , Irie Hiromasa , Adachi Tomohiro , Shibata Mami , Kataoka Jun , Korenaga Akira , Yamashita Tomoya , Okazaki Tomoya , Okumura Masatoshi , Tsunemitsu Takefumi 
Published: June 2023

OBJECTIVES:
This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes.

DESIGN:
Secondary analysis of the J-PICS study.

SETTING:
This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019.

PATIENTS:
Adult ICU patients who were expected to be on a ventilator for at least 48 hours.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively (p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence (p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence (r = –0.84, R2
= 0.71, p = 0.035) was observed in high-volume centers.

CONCLUSIONS:
The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.
Financial Toxicity Following Cancer in a Middle-Income Country with a Pluralistic Health System: Validation of the COST Questionnaire
Authors: Sakti Veni V. , Danaee Mahmoud , Yip Cheng-Har , Bustamam Ros S. A. , Saad Marniza , Gan Gin Gin , Tan Jerome , Lim Yueh Ni , Chong Flora L.T. , Munisamy Murallitharan , Mohd Farid Farahida , Sew Boon Lui , Kong Yek-Ching , Muniandy Nishalini , Bhoo-Pathy Nirmala 
Published: June 2023

Background:
Financial toxicity is the outcome of the objective financial burden and subjective financial distress experienced by patients receiving cancer treatment.

Objective:
To validate the English and Malay versions of the COmprehensive Score for financial Toxicity (COST) questionnaire in a multiethnic setting with a pluralistic healthcare system.

Intervention/methods:
A cross-sectional study was conducted on 720 adults with cancer from public and private hospitals across Malaysia. Reliability was estimated using Cronbach’s α for internal consistency. Construct validity was assessed by exploratory factor analysis. Criterion validity was tested using the European Organization for Research and Treatment of Cancer’s Quality of Life Questionnaire.

Results:
Overall, 362 respondents answered the English language questionnaire and 358 answered the Malay version. Both versions achieved high reliability (Cronbach’s α: .91 and 0.96, respectively). Exploratory factor analysis via the parallel analysis method identified a single factor solution with eigenvalues of 6.244 and 6.544, explaining 56.80% and 59.50% of variances, respectively. Low positive correlations and strong negative correlations were observed with global health status and financial difficulty, respectively. Subgroup analyses indicated that both versions performed well across diverse patient groups.

Conclusion:
The English and Malay versions of COST are psychometrically robust in measuring financial toxicity in multiethnic settings with pluralistic health systems and across diverse subgroups of cancer patients with varying clinical characteristics.

Implications for Practice:
The COST tool should be useful in accurately identifying patients with cancer who experience financial toxicity in Malaysian settings and potentially other similar settings.

What is Foundational:
Early identification of patients experiencing financial toxicity using validated tools in oncology practice would enable timely intervention.
Can magnetic resonance imaging differentiate muscle invasion (T2) and lamina propria invasion (T1) urothelial carcinoma of the bladder? A systematic review and meta-analysis of Vesical Imaging-Reporting and Data System accuracy
Authors: Jazayeri Seyed Behzad , Dehghanbanadaki Hojat , Hosseini Mahdie , Taghipour Pourya , Bacchus Michael W. , Di Valerio Elizabeth A. , Sarabchian Elnaz , Balaji K.C. , Bandyk Mark 
Published: June 2023

AbstractBackgroundVesical Imaging-Reporting and Data System (VI-RADS) was developed as a structured reporting tool to anticipate the possibility of muscle invasion. This study is aimed to investigate the diagnostic accuracy of VI-RADS for discriminating T2 from T1 bladder cancer.Materials and methodsScopus, Web of Science, PubMed, and Embase were searched on October 4, 2021, for studies with the following characteristics: (1) bladder cancer patient population, (2) VI-RADS as an index test, (3) retransurethral resection of bladder tumor/cystectomy as a reference, and (4) adequate VI-RADS score data for T1 and T2 lesions. The analyses were performed using the binary regression model of MIDAS in Stata.ResultsSix studies with 624 magnetic resonance imaging reports were included. The receiver operating characteristics curve for differentiation of T2 from T1 bladder cancer showed an area under the curve of 0.93 (95% confidence interval [CI], 0.91–0.95) for a VI-RADS ≥3 and 0.75 (95% CI, 0.71–0.79) for a VI-RADS ≥4. A VI-RADS ≥3 showed high sensitivity of 93% (95% CI, 85%–97%), specificity of 61% (95% CI, 30%–86%), positive likelihood ratio of 2.4 (95% CI, 1.1–5.3), and negative likelihood ratio of 0.11 (95% CI, 0.05–0.24). A total of 10.4% of T2 lesions were scored as VI-RADS 2, while 10% of T1 lesions were scored as VI-RADS 4 or 5.ConclusionsThe VI-RADS ≥3 has high accuracy and sensitivity for detecting muscle invasion in borderline populations of T1 or T2 bladder cancer. Thus, the VI-RADS could be a good non-invasive screening test for the detection of T2 urothelial lesions.
Time Trends in Histopathological Findings in Mammaplasty Specimens in a Dutch Academic Pathology Laboratory
Authors: Stutterheim Hannah W. , ter Hoeve Natalie D. , Maarse Wiesje , van der Wall Elsken , van Diest Paul J. 
Published: June 2023

Background:
Reduction mammaplasties are often performed at a relatively young age. Necessity of routine pathological investigation of the removed breast tissue to exclude breast cancer has been debated. Past studies have shown 0.05%–4.5% significant findings in reduction specimens, leading to an ongoing debate whether this is cost-effective. There is also no current Dutch guideline on pathological investigation of mammaplasty specimens. Because the incidence of breast cancer is rising, especially among young women, we re-evaluated the yield of routine pathological investigation of mammaplasty specimens over three decades in search of time trends.

Methods:
Reduction specimens from 3430 female patients examined from 1988 to 2021 in the UMC Utrecht were evaluated. Significant findings were defined as those that may lead to more intensive follow-up or surgical intervention.

Results:
Mean age of patients was 39 years. Of the specimens, 67.4% were normal; 28.9% displayed benign changes; 2.7%, benign tumors; 0.3%, premalignant changes; 0.8%, in situ; and 0.1%, invasive cancers. Most patients with significant findings were in their forties (P < 0.001), the youngest patient being 29 years. Significant findings increased from 2016 onward (P = 0.0001), 86.8% found after 2016.

Conclusions:
Over three decades, 1.2% of mammaplasty specimens displayed significant findings on routine pathology examination, with an incidence rising to 2.1% from 2016 onward. The main reason for this recent increase is probably attributable to super-specialization by the pathologists. While awaiting formal cost-effectiveness studies, the frequency of significant findings for now seems to justify routine pathological examination of mammaplasty reduction specimens.
A Single-center Comparison of Unipedicled and Bipedicled Diep Flap Early Outcomes in 98 Patients
Authors: Ahmed Zahra , Ioannidi Lydia , Ghali Shadi , Hamilton Stephen , Shtarbanov Petko , Mosahebi Afshin , Nikkhah Dariush 
Published: June 2023

Background:
The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled and bipedicled DIEP flaps on donor and recipient site outcomes in the same patient cohort.

Methods:
This is a retrospective cohort study comparing DIEP flap outcomes between 2019 and 2022.

Results:
There were 98 patients, categorized differently for recipient or donor site. The recipient groups were unilateral unipedicled (N = 52), bilateral unipedicled (N = 15), and unilateral bipedicled (N = 31), and donor site groups were unipedicled (N = 52) and bipedicled (N = 46, including bilateral unipedicled and unilateral bipedicled). Bipedicled DIEP flaps had 1.15 times greater odds of donor site complication (95% CI, 0.52–2.55). Adjusting for operative time that was longer in bipedicled DIEP flaps (P < 0.001), odds ratio decreased, and there was a lower probability of donor site complication for bipedicled flaps (OR, 0.84; 95% CI, 0.31–2.29). Odds of recipient area complication was not significantly different between groups. Unilateral unipedicled DIEP flaps had significantly higher rates of revisional elective surgery than unilateral bipedicled DIEP flaps (40.4% versus 12.9%; P = 0.029).

Conclusions:
We demonstrate no significant difference in donor site morbidity between unipedicled and bipedicled DIEP flaps. Bipedicled DIEP flaps do have slightly higher rates of donor site morbidity, which can be partly explained by longer operative times. There is no significant difference in recipient site complications, and bipedicled DIEP flaps can reduce rates of further elective surgery.
Aesthetic Units and Zones of Adherence, Relevance to Planning Incisions in Body Contouring Surgery
Authors: Kirwan Laurence 
Published: June 2023

Background:
Aesthetic units (AUs) and zones of adherence (ZAs) have been previously noted in the face and torso. A systematic classification of common AUs and ZAs has not been previously described for the torso and extremities. Contour and scars are equally important in obtaining the best result. Therefore, the six principles to consider in body contouring surgery (BCS) are that the resulting scar be anchored at a zone of adhesion; at the interface of AUs; concealed within flexion or extension skin creases, or placed according to conventional usage and experience; positioned on the medial aspect of a limb; hidden when nude, topless, or in a variety of clothing such as one-piece and two-piece swimsuits, crop tops, short sleeves, etc; and positioned to avoid a contracture across a flexion joint crease or a dehiscence across the extension aspect of a joint.

Methods:
Images of male and female massive weight loss (MWL) patients with a history of MWL were reviewed and analyzed.

Results:
AUs and Zas are described and codified. An algorithm is provided to aid in planning incisions for BCS.

Conclusion:
With the increase in BCS after MWL, a classification of AUs and ZAs is considered useful in planning surgery and optimizing the aesthetic result.
Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads: A Nationwide Online Survey in China
Authors: Fu Leiwen , Wang Bingyi , Tian Tian , Zhou Xinyi , Lu Zhen , Sun Yinghui , Zheng Weiran , Gao Yanxiao , Lin Yi-Fan , Li Hui , Zou Huachun 
Published: June 2023

Abstract
Little is known about sexual behavior and satisfaction among men who have sex with men (MSM) with detectable HIV viral loads (VL) in China. This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China, as well as potential predictors. This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat. Data were collected on sociodemographics, sexual behavior, HIV clinical information, sexual satisfaction and mental health. Descriptive statistics, logistic regression and multivariable logistic regression were performed. MSM with detectable HIV VL (VL+) or VL not sure were more likely to report inconsistent condom use, even with HIV-negative/unknown-status regular male partners. Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL (VL−). Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+ or VL not sure MSM. A total of 58.3% of participants reported being sexually satisfied. MSM living with HIV who were currently employed, had experienced anal sex in the prior 6 months, had VL− HIV status, or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction. The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need. Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.
Prevalence, length, and patterns of Anterior Loop among the South Indian population: A comparative study between Panoramic Radiography and Cone Beam Computed Tomography
Authors: Mathew Anju , N Mohan 
Published: June 2023

Abstract

Purpose:
To assess the prevalence, length, and patterns of the anterior loop of the inferior alveolar nerve by panoramic radiography and cone beam computed tomography (CBCT).

Materials and Methodology:
A prospective study was conducted on 300 mental foramen regions by exposing them to panoramic radiography and CBCT scan. Two individual observers evaluated the images to assess the presence of an anterior loop, the mean length of the loop, and the most frequent pattern of the loop in our population.

Result Analysis:
The prevalence of the anterior loop for male patients and female patients by panoramic radiography was 34% and 32% on the right side and 30% and 36% on left side, respectively. By CBCT, the corresponding values were 69% and 72% on the right and left side, respectively, for male patients, and 73% and 81% on the right and left side, for female patients, respectively.

Conclusion:
The results from our study strongly emphasize the need for CBCT imaging before planning for procedures in the mental foramen region because the prevalence, length, and pattern of loop significantly varies with respect to age, sex, and population.
Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease
Authors: Taskin Yilmaz Feride , Celik Selda , Anataca Gulden , Mercan Sakar Emine 
Published: June 2023

ABSTRACT

BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores (P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling (P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.
Using the Alluvial diagram to display variable characteristics for COVID-19 patients and research achievements on the topic of COVID-19, epidemiology, pathogenesis, and vaccine (CEPV): Bibliometric analysis
Authors: Yen Po-Tsung , Chien Tsair-Wei , Chou Willy , Tsai Kang-Ting 
Published: June 2023

Background:
An Alluvial diagram illustrates the flow of values from one set to another. Edges (or links/connections) are the connections between nodes (or actors/ vertices). There has been an increase in the use of Alluvial deposits in medical research in recent years. However, there was no illustration of such research on the way to draw the Alluvial for the readers. Our objective was to demonstrate how to draw the Alluvial in Microsoft Excel by using 2 examples, including variable characteristics for COVID-19 patients and research achievements (RAs) on the topic of COVID-19, epidemiology, pathogenesis, and vaccine (CEPV), and provide an easy and friendly method of drawing the Alluvial in MS Excel.

Methods:
Blood samples were collected and analyzed from 485 infected individuals in Wuhan, China. An operational decision tree and 2 Alluvial diagrams were shown to be capable of identifying variable characteristics in COVID-19 patients. A second example is the 100 top-cited articles downloaded from the Web of Science core collection (WoSCC) on the CEPV topic. On the Alluvial diagram, the mean citations (=citations/publications) and x-index were used to identify the top 5 members with the highest RAs in each entity (country, institute, journal, and research area). Two examples (i.e., blood samples taken from 485 infected individuals in Wuhan, China, and 100 top-cited articles on the CEPV topic) were illustrated and compared with traditional visualizations without flow relationships between nodes.

Results:
The top members in entities with the x-index are U Arab Emirates (242), Jama-J. Am. Med. Assoc. (27.18), Lancet (58.34), San Francisco Va Med (178), and Chaolin Huang (189) in countries, institutes, departments, and authors, respectively. The most cited article with 1315 citations was written by Huang and his colleagues and published by Lancet in 2021.

Conclusion:
This study generates several Alluvial diagrams as demonstrations. The tutorial material and MP4 video provided in the Excel module allow readers to draw the Alluvial on their own in an easy and friendly manner.
Multiple system atrophy with oculomotor abnormalities as a prominent manifestation: A case series
Authors: Wei Yuanxiao , Chen Ju , Lu Cancan , Jiang Yijing , Liu Zhiqiang , Zhang Wenzhao , Fang Liqun 
Published: June 2023

Rationale:
Multiple system atrophy (MSA) is a group of adult-onset sporadic neurodegenerative diseases, mainly classified as MSA-C and MSA-P types. Due to the diversity of clinical symptoms, diagnosis faces a significant challenge. In the present case, we report a patient with isolated vertigo as the first presentation and abnormalities of the oculomotor system as the characteristic manifestations.

Case concern:
A 64-year-old male had dizziness for 1 year, aggravated for 4 months, with accompanying symptoms of unsteady walking. Physical examination revealed spontaneous nystagmus, abnormal ataxic movements, and a broad basal gait. Video nystagmography revealed saccade intrusions and macrosaccadic oscillations, and opsoclonus. Magnetic resonance imaging (MRI) was unremarkable early, and positron emission tomography-computed tomography (PET-CT) announced a reduction in the volume of the cerebellum and brainstem.

Diagnosis:
The diagnosis of the possibility of MSA type-C, peripheral neuropathy, hypertension, and lacunar cerebral infarction was performed.

Conclusion:
Atypical early clinical presentation may lead to delays, and identifying the critical problem through the patient simple clinical status requires long-term clinical experience and various ancillary examination tools.