bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of ticagrelor versus clopidogrel in Malaysian patients with coronary artery disease undergoing percutaneous coronary intervention (PCI): Does the age tertile affect the platelet reactivity?
Authors: Akkaif M A , Daud N A A , Noor D A M , Sha'aban A , Sk Abdul Kader M A , Wahab M J A , Ibrahim B 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous studies have shown that the prevalence of cardiovascular diseases is related to the patient's age and gender differences, but the effect of age on platelet function remains controversial. Platelet function should be tested and its efficacy correlates with the age of patients undergoing percutaneous coronary intervention (PCI) using vasodilator-associated stimulated phosphoprotein (VASP). VASP is a gold standard to assess P2Y12 receptor inhibition among patients using ticagrelor or clopidogrel.

Purpose
We sought to compare the effect of ticagrelor versus clopidogrel on the platelet function of patients undergoing PCI and the correlation of age in this effect.

Method
This study was a prospective, randomized, parallel design, an open-label investigation conducted on Malaysian patients undergoing PCI. It included 84 patients (40 patients taking ticagrelor, and 44 patients taking clopidogrel). The induced platelet reactivity was assessed by measuring total whole blood at one standardized time point after 4 hours of loading dose of ticagrelor 180 mg or clopidogrel with 600 mg and by age tertiles.

Result
The study population consisted of 23 (57.5%) patients in Tertile 1 &lt;60 years of age, 11 (27.5%) patients in Tertile 2 between 60-70 years of age and 6 (15.0%) patients in Tertile 3 &gt;70 years of age. The number of patients who used ticagrelor was 17 (38.64%) in Tertile 1, 21 (47.73%) in Tertile 2, and 6 (13.64%) in Tertile 3 of those who used clopidogrel. The results of platelet reactivity index was high in the patients who used clopidogrel compared to the ticagrelor group, which were 52.3% and 2.5 %, P &lt;0.001. This effect in the clopidogrel group included all age groups without exception and at different rates (52.9%, 52.4%, and 50%, P= 0.992), respectively, but this effect was numerical and not statistically significant. In contrast to the ticagrelor group, no numerical or significant effect was observed in all age groups (4.3%, 0.0%, and 0.0%, P= 0.259), respectively (Figure 1). In addition, the results of the current cross-sectional age classification study showed no statistical differences between the clopidogrel and ticagrelor groups based on non high platelet reactivity (NHPR) (P = 0.284, P = 0.270, P = 0.796 respectively) (Figure2).

Conclusion
Our study showed that age could not be considered a risk factor in the Malaysian population, as it did not significantly affect platelet aggregation in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).
Machine learning accurately quantifies epicardial adipose tissue from non-contrast CT images in coronary artery disease
Authors: Cheng N , Tan E W P , Leng S , Baskaran L , Teo L , Yew M S , Singh M , Huang W M , Chan M Y Y , Ngiam K Y , Vaughan R , Chua T , Tan S Y , Lee H K , Zhong L 
Published: January 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Industry Alignment Fund – Pre-positioning Programme

Background
Epicardial adipose tissue (EAT) is the visceral fat deposit within the pericardium that surrounds the heart and the coronary arteries. EAT volume measured from non-contrast CT (NCCT) has been demonstrated to be significantly associated with adverse cardiovascular risk,1 particularly in patients with coronary artery disease.2 However, routine measurement of EAT volume is still challenging in clinical practice, as it is a tedious manual process and prone to human error.

Purpose
We aimed to develop a fully automated AI toolkit (i.e., AI EAT) for the quantification of EAT from routine NCCT scans and assess its performance in reference to clinical ground truth.

Methods
This is a multicenter study which performs CT scans in 5000 Asian Admixture patients (APOLLO study NCT05509010). In the current stage of this study, NCCT data analysis were conducted in 551 patients with 26,037 images. AI EAT was developed via a novel deep learning framework using an ensemble region-based UNet. The region-based UNet uses 2 component UNet models to perform segmentation of pericardium at the apex region and non-apex region (middle and basal). EAT volume was obtained by automated thresholding of the voxels (-190 to -30 Hounsfield Unit) within the pericardium (Figure 1). The network was trained in 501 patients with 23,712 NCCT images and tested in 50 patients with 2,325 NCCT images. The performance of AI EAT was evaluated with respect to clinical ground truth using Dice similarity coefficient (DSC), Pearson correlation, and Bland-Altman analysis.

Results
The AI EAT quantification process took less than 10 seconds per subject, compared with 20-30 minutes for expert readers. Compared to clinical ground truth, our AI EAT achieved a DSC of 0.96±0.01 and 0.91±0.02 for pericardium and EAT segmentations, respectively. There was strong agreement between the AI EAT and clinical ground truth in deriving the EAT volume (r=0.99, P&lt;0.001) with minimal error of 7±5%.

Conclusion
End-to-end deep learning system accurately quantifies epicardial adipose tissue in standard NCCT images without manual segmentation.
Designer Benzodiazepines Gidazepam and Desalkygidazepam (Bromonordiazepam): What Do We Know?
Authors: Maskell Peter D , Wilson Gemma , Manchester Kieran R 
Published: January 2023

AbstractDesigner benzodiazepines are one of the primary new psychoactive substance (NPS) threats around the world, being found in large numbers in postmortem, driving under the influence of drugs and drug-facilitated sexual assault cases. Even though when compared to many other NPS types, such as opioids and cathinones, there are relatively few designer benzodiazepines being monitored. Recently, a new NPS benzodiazepine has been reported in Europe, the USA and Canada, desalkygidazepam, also known as bromonordiazepam. This substance is a metabolite of the prodrug gidazepam, a drug licensed for use in Ukraine and Russia under the name Gidazepam IC®. In the paper, we review what is currently known about the use, pharmacology and analytical detection of gidazepam, its metabolite desalkygidazepam and their other possible metabolites.
Ovarian goiter detected during post-operative follow-up of papillary thyroid cancer: a case report
Authors: Murayama Daisuke , Toda Soji , Okubo Yoichiro , Hayashi Hiroyuki , Iwasaki Hiroyuki 
Published: January 2023

Abstract
A 70-year-old female without any past medical history underwent total thyroidectomy and central neck dissection for papillary thyroid cancer (PTC) (pT3bN1aM0 pStage II). Her post-operative thyroglobulin (Tg) level remained high (around 100 ng/mL), which increased to 366 ng/mL 5 years after surgery. Computed tomography revealed metastasis to the left III and right Vb and VI lymph nodes and an incidental ovarian tumor. Transvaginal ultrasonography and magnetic resonance imaging suspected malignancy, resulting in total hysterectomy and bilateral adnexal resection. A pathological diagnosis of ovarian goiter with no malignancy was then established. For lymph node metastasis of PTC, right neck dissection and left III lymph node resection were performed. Post-operative blood examination showed a significant decrease in the Tg level (5.9 ng/mL). In conclusion, systemic imaging or I-131 remnant ablation should be performed after total thyroidectomy, as evident in the present case in which Tg levels did not decrease after total thyroidectomy.
Climate change and energy transition impact on employment transition in the Ghanaian energy sector
Authors: Kusi-Appiah Francisca , Essandoh Afia Serwaa 
Published: January 2023

Abstract
The measures put in place by energy policymakers and regulators to reduce CO2 emissions encourage the switch from fossil fuels to the use of low-carbon fuels, particularly renewables. The research starts with a detailed content analysis of the climate change policies of Ghana within the electricity sector as well as a doctrinal analysis of the laws passed to implement climate change policies. The article then examines the energy transition measures implemented in Ghana over the years even though Ghana has just launched its National Energy Transition (NET) Framework. The article confirms that Ghana has implemented a variety of measures to promote energy transition although Ghana did not have a comprehensive energy transition policy. The research shows that fossil fuels dominate the electricity market but the patronage of renewables is vigorously promoted. In the wake of the transition from fossil fuel to low-carbon, the subsistence of the employment of workers in the energy sector comes under immense pressure with some employees becoming redundant. Employing empirical research methods, this article examines the employment transition during the energy transition, particularly in the electricity sector of Ghana. This article corroborates the fact that the introduction of renewables has created new jobs in the electricity sector but there is no clear link between the gradual energy transition from 2011 to 2021 on employment losses. In addition, the research shows that more women were employed in the electricity sector within the period installed renewable energy capacity increased although there is no direct link between the two. The article concludes that the new NET Framework will vigorously promote renewables in the energy sector but fossil fuels will provide the majority of the jobs in the Ghanaian energy sector for a while, therefore capacity building is needed to accelerate a sustainable employment transition during the energy transition.
Psychologically informed health care
Authors: Dekker Joost , Sears Samuel F , Åsenlöf Pernilla , Berry Katherine 
Published: January 2023

Abstract
The term “psychologically informed health care” refers to the comprehensive integration of psychological principles into health care. Psychologically informed health care has the potential to lead to a transformation of care, resulting in truly transdisciplinary care. To facilitate its future development, we discuss key characteristics of this approach. These include the direct mode (psychologists assessing and treating patients themselves) and indirect mode (psychologists working through other health care providers) of integrating psychological principles into healthcare; the range of health domains targeted using this approach; transdisciplinary care, transcending traditional disciplinary boundaries; and the positioning of care. We describe a framework for transdisciplinary care, which we refer to as the Framework for Catalytic Collaboration. This framework comprises six dimensions: setting, disciplines, patients/clients, mode of psychological care, primary components of care, and primary targets of care. We also provide four brief illustrations of psychologically informed health care. Finally, we discuss future directions, including the need for professional recognition of the indirect mode, financing of the indirect mode, cross-disciplinary training and trans-disciplinary research.
Cultural adaptations to a telephone genetic counseling protocol and booklet for Latina breast cancer survivors at risk for hereditary breast and ovarian cancer
Authors: Gómez-Trillos Sara , Graves Kristi D , Fiallos Katie , Schwartz Marc D , Peshkin Beth N , Hamilton Heidi , Sheppard Vanessa B , Vadaparampil Susan T , Campos Claudia , Cupertino Ana Paula , Alzamora Maria C , Lynce Filipa , Hurtado-de-Mendoza Alejandra 
Published: January 2023

Abstract
Telephone genetic counseling (TGC) is accepted as standard clinical care for people seeking hereditary cancer risk assessment. TGC has been shown to be non-inferior to in-person genetic counseling, but trials have been conducted with a predominantly highly educated, non-Hispanic White population. This article describes the process of culturally adapting a TGC protocol and visual aid booklet for Spanish-preferring Latina breast cancer survivors at risk for hereditary breast and ovarian cancers. The adaptation process included two phases. Phase 1 involved a review of the literature and recommendations from an expert team including community partners. Phase 2 included interviews and a pilot with the target population (n = 14) to collect feedback about the adapted protocol and booklet following steps from the Learner Verification and Revision Framework. We describe the adaptation process and report the main adaptations following the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions (FRAME). Adaptations in Phase 1 were responsive to the target population needs and characteristics (e.g., delivered in Spanish at an appropriate health literacy level, addressing knowledge gaps, targeting cultural values). Phase 2 interviews were crucial to refine details (e.g., selecting words) and to add components to address GCT barriers (e.g., saliva sample video). Cultural adaptations to evidence-based TGC protocols can increase the fit and quality of care for historically underserved populations. As TGC visits become routine in clinical care, it is crucial to consider the needs of diverse communities to adequately promote equity and justice in cancer care.
PATTERN AND CHARACTERISTICS OF DRUSEN SUBTYPES IN CHINESE AND INDIAN POPULATIONS IN SINGAPORE
Authors: Takahashi Kengo , Song Youngseok , Cheong Kai Xiong , Fenner Beau J. , Teo Kelvin Yi Chong , Chee Miao Li , Li Hengtong , Tham Yih-Chung , Cheung Chui Ming Gemmy , Cheng Ching-Yu , Wong Tien Yin , Yanagi Yasuo , Tan Anna C. S. 
Published: January 2023

Purpose:
To report the pattern and characteristics of drusen subtypes in Asian populations and the association with choroidal thickness.

Methods:
This is the cross-sectional analysis of the population-based cohort study. Two thousand three hundred and fifty-three eyes of 1,336 Chinese and Indian participants aged older than 50 years, eyes with best-corrected visual acuity better than 20/60, and without other retinal diseases were recruited. Pachydrusen, reticular pseudodrusen, soft and hard drusen were graded on both color fundus photographs, and optical coherence tomography imaging with automated segmentation yielding and measurements of choroidal thickness.

Results:
Nine hundred and fifty-five Chinese and 381 Indians were included in the final analysis. The pattern of pachydrusen, soft drusen, hard drusen, and reticular pseudodrusen was 14.0%, 3.7%, 12.5%, and 0.2%, respectively. Mean choroidal thickness was the thickest in eyes with pachydrusen (298.3 μm; 95% confidence interval: 290.5–306.1), then eyes with hard (298.1 μm; 95% confidence interval: 290.6–305.5) and soft drusen (293.7 μm; 95% confidence interval: 281.9–305.4) and thinnest in eyes without drusen (284.6 μm; 95% confidence interval: 280.5–288.7). Systemic associations of the various drusen subtypes also differed.

Conclusion:
Patterns, characterization and choroidal thickness of drusen subtypes, and their associations provide insights into the Asian phenotypic spectrum of age-related macular degeneration and the underlying pathogenesis.
Adipose-Derived Stem Cell Extracellular Vesicles Improve Wound Closure and Angiogenesis in Diabetic Mice
Authors: Wang Jiang-Wen , Zhu Yuan-Zheng , Ouyang Jing-Ying , Nie Jia-Ying , Wang Zhao-Hui , Wu Shu , Yang Juan-Min , Yi Yang-Yan 
Published: January 2023

Background:
Currently, there is a lack in therapy that promotes the reepithelialization of diabetic wounds as an alternative to skin grafting. Here, the authors hypothesized that extracellular vesicles from adipose-derived stem cells (ADSC-EVs) could accelerate wound closure through rescuing the function of keratinocytes in diabetic mice.

Methods:
The effect of ADSC-EVs on the biological function of human keratinocyte cells was assayed in vitro. In vivo, 81 male severe combined immune deficiency mice aged 8 weeks were divided randomly into the extracellular vesicle–treated diabetes group (n = 27), the phosphate-buffered saline–treated diabetes group (n = 27), and the phosphate-buffered saline–treated normal group (n = 27). A round, 8-mm-diameter, full-skin defect was performed on the back skin of each mouse. The wound closure kinetics, average healing time, reepithelialization rate, and neovascularization were evaluated by histological staining.

Results:
In vitro, ADSC-EVs improved proliferation, migration, and proangiogenic potential, and inhibited the apoptosis of human keratinocyte cells by suppressing Fasl expression with the optimal dose of 40 μg/mL. In vivo, postoperative dripping of ADSC-EVs at the dose of 40 μg/mL accelerated diabetic wound healing, with a 15.8% increase in closure rate and a 3.3-day decrease in average healing time. ADSC-EVs improved reepithelialization (18.2%) with enhanced epithelial proliferation and filaggrin expression, and suppressed epithelial apoptosis and Fasl expression. A 2.7-fold increase in the number of CD31-positive cells was also observed.

Conclusion:
ADSC-EVs improve diabetic wound closure and angiogenesis by enhancing keratinocyte-mediated reepithelialization and vascularization.

Clinical Relevance Statement:
ADSC-EVs could be developed as a regenerative medicine for diabetic wound care.
Admission maximum amplitude–reaction time ratio: Association between thromboelastography values predicts poor outcome in injured children
Authors: Abou Khalil Elissa , Gaines Barbara A. , Morgan Katrina M. , Leeper Christine M. 
Published: January 2023

INTRODUCTION
Thromboelastography (TEG)-derived maximum amplitude–reaction time (MA-R) ratio that accounts for both hypocoagulable and hypercoagulable changes in coagulation is associated with poor outcomes in adults. The relationship between these TEG values and outcomes has not been studied in children.

METHODS
In a retrospective cohort study, a level I pediatric trauma center database was queried for children younger than 18 years who had a TEG assay on admission between 2016 and 2020. Demographics, injury characteristics, and admission TEG values were recorded. The MA-R ratio was calculated and divided into quartiles. Main outcomes included mortality, transfusion within 24 hours of admission, and thromboembolism. A logistic regression model was generated adjusting for age, Injury Severity Score, injury mechanism, admission shock, and Glasgow Coma Scale.

RESULTS
In total, 657 children were included, of which 70% were male and 75% had blunt mechanism injury. The median (interquartile range) age was 11 (4–14) years, the median (interquartile range) Injury Severity Score was10 (5–22), and in-hospital mortality was 7% (n = 45). Of these patients, 17% (n = 112) required transfusion. Most R and MA values were within normal limits. On unadjusted analysis, the lowest MA-R ratio quartile was associated with increased mortality (15% vs. 4%, 5%, and 4%, respectively; p < 0.001) and increased transfusion need (26% vs. 12%, 16%, and 13%, respectively; p = 0.002) compared with higher quartiles. In the logistic regression models, a low MA-R ratio was independently associated with increased in-hospital mortality (odds ratio [95% confidence interval], 4.4 [1.9–10.2]) and increased need for transfusion within 24 hours of admission (odds ratio [95% confidence interval], 2.0 [1.2–3.4]) compared with higher MA-R ratio. There was no association between MA-R ratio and venous thromboembolic events (venous thromboembolic event rate by quartile: 4%, 2%, 1%, and 3%).

CONCLUSION
Although individual admission TEG values are not commonly substantially deranged in injured children, the MA-R ratio is an independent predictor of poor outcome. Maximum amplitude–reaction time ratio may be a useful prognostic tool in pediatric trauma; validation is necessary.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Greater spatial access to care is associated with lower mortality for emergency general surgery
Authors: McCrum Marta L. , Allen Chelsea M. , Han Jiuyin , Iantorno Stephanie E. , Presson Angela P. , Wan Neng 
Published: January 2023

BACKGROUND
Emergency general surgery (EGS) diseases are time-sensitive conditions that require urgent surgical evaluation, yet the effect of geographic access to care on outcomes remains unclear. We examined the association of spatial access with outcomes for common EGS conditions.

METHODS
A retrospective analysis of twelve 2014 State Inpatient Databases, identifying adults admitted with eight EGS conditions, was performed. We assessed spatial access using the spatial access ratio (SPAR)—an advanced spatial model that accounts for travel distance, hospital capacity, and population demand, normalized against the national mean. Multivariable regression models adjusting for patient and hospital factors were used to evaluate the association between SPAR with (a) in-hospital mortality and (b) major morbidity.

RESULTS
A total of 877,928 admissions, of which 104,332 (2.4%) were in the lowest-access category (SPAR, 0) and 578,947 (66%) were in the high-access category (SPAR, ≥1), were analyzed. Low-access patients were more likely to be White, male, and treated in nonteaching hospitals. Low-access patients also had higher incidence of complex EGS disease (low access, 31% vs. high access, 12%; p < 0.001) and in-hospital mortality (4.4% vs. 2.5%, p < 0.05). When adjusted for confounding factors, including presence of advanced hospital resources, increasing spatial access was protective against in-hospital mortality (adjusted odds ratio, 0.95; 95% confidence interval, 0.94–0.97; p < 0.001). Spatial access was not significantly associated with major morbidity.

CONCLUSION
This is the first study to demonstrate that geospatial access to surgical care is associated with incidence of complex EGS disease and that increasing spatial access to care is independently associated with lower in-hospital mortality. These results support the consideration of spatial access in the development of regional health systems for EGS care.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.
Perampanel: Medical Alternative for Essential Tremor?
Authors: Díaz-Feliz Lola , Feliz-Feliz Cici , Del Val Javier , Ruiz-López Marta , García-Ruiz Pedro J. 
Published: January 2023

Objectives
The aim of this study was to assess the safety and efficacy of perampanel in patients with refractory essential tremor (ET).

Methods
We recruited patients from our movement disorders clinic with the diagnosis of severe refractory ET, and perampanel 4 mg at night was initiated.
Assessments were conducted at baseline and after 1 month of treatment with perampanel 4 mg/d. Details about tolerance and effectiveness were collected. Clinical evaluation was conducted with the Fahn-Tolosa-Marín scale, and statistical analysis was carried out with Wilcoxon matched pairs signed rank test.

Results
This study included 18 patients with severe ET (11 females, 7 males; mean age: 75.1 ± 12.03 years; mean duration of ET: 17.4 ± 17.03 years). Perampanel significantly improved patients' average score with refractory ET (P ≤ 0.0001). This improvement has been occasionally quite relevant. However, a proportion of patients did not tolerate perampanel because of several adverse effects including dizziness, ataxia, irritability, and instability.

Conclusions
Perampanel had a markedly positive antitremor effect in patients with ET and could be an alternative treatment. However, this drug is not devoid of adverse effects.