bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Reasons for Statin Nonuse in Patients With Diabetes Using Deep Learning of Electronic Health Records
Authors: Sarraju Ashish , Zammit Alban , Ngo Summer , Witting Celeste , Hernandez‐Boussard Tina , Rodriguez Fatima 
Published: March 2023

Background
Statins are guideline‐recommended medications that reduce cardiovascular events in patients with diabetes. Yet, statin use is concerningly low in this high‐risk population. Identifying reasons for statin nonuse, which are typically described in unstructured electronic health record data, can inform targeted system interventions to improve statin use. We aimed to leverage a deep learning approach to identify reasons for statin nonuse in patients with diabetes.

Methods and Results
Adults with diabetes and no statin prescriptions were identified from a multiethnic, multisite Northern California electronic health record cohort from 2014 to 2020. We used a benchmark deep learning natural language processing approach (Clinical Bidirectional Encoder Representations from Transformers) to identify statin nonuse and reasons for statin nonuse from unstructured electronic health record data. Performance was evaluated against expert clinician review from manual annotation of clinical notes and compared with other natural language processing approaches. Of 33 461 patients with diabetes (mean age 59±15 years, 49% women, 36% White patients, 24% Asian patients, and 15% Hispanic patients), 47% (15 580) had no statin prescriptions. From unstructured data, Clinical Bidirectional Encoder Representations from Transformers accurately identified statin nonuse (area under receiver operating characteristic curve [AUC] 0.99 [0.98–1.0]) and key patient (eg, side effects/contraindications), clinician (eg, guideline‐discordant practice), and system reasons (eg, clinical inertia) for statin nonuse (AUC 0.90 [0.86–0.93]) and outperformed other natural language processing approaches. Reasons for nonuse varied by clinical and demographic characteristics, including race and ethnicity.

Conclusions
A deep learning algorithm identified statin nonuse and actionable reasons for statin nonuse in patients with diabetes. Findings may enable targeted interventions to improve guideline‐directed statin use and be scaled to other evidence‐based therapies.
Analysis of clinical diagnosis and treatment of intestinal volvulus
Authors: Fo Yuhong , Kang Xiaoyu , Tang Yongqiang , Zhao Lifang 
Published: March 2023

Abstract
Background
The aim of this study is to investigate the clinical characteristics and treatment experience of intestinal volvulus, and to analyze the incidence of adverse events and related risk factors of intestinal volvulus.

Methods
Thirty patients with intestinal volvulus admitted to the Digestive Emergency Department of Xijing Hospital from January 2015 to December 2020 were selected. The clinical manifestations, laboratory tests, treatment and prognosis were retrospectively analyzed.

Results
A total of 30 patients with volvulus were enrolled in this study, including 23 males (76.7%), with a median age of 52 years (33–66 years). The main clinical manifestations were abdominal pain in 30 cases (100%), nausea and vomiting in 20 cases (67.7%), cessation of exhaust and defecation in 24 cases (80%), and fever in 11 cases (36.7%). The positions of intestinal volvulus were jejunum in 11 cases (36.7%), ileum and ileocecal in 10 cases (33.3%), sigmoid colon in 9 cases (30%). All 30 patients received surgical treatment. Among the 30 patients underwent surgery, 11 patients developed intestinal necrosis. We found that the longer the disease duration (> 24 h), the higher the incidence of intestinal necrosis, and the higher the incidence of ascites, white blood cell count and neutrophil ratio in the intestinal necrosis group were significantly higher than those in the non-intestinal necrosis group (p < 0.05). After treatment, 1 patient died of septic shock after operation, and 2 patients with recurrent volvulus were followed up within 1 year. The overall cure rate was 90%, the mortality rate was 3.3%, and the recurrence rate was 6.6%.

Conclusion
Laboratory examination, abdominal CT and dual-source CT are very important for the diagnosis of volvulus in patients with abdominal pain as the main symptom. Increased white blood cell count, neutrophil ratio, ascites and long course of disease are important for predicting intestinal volvulus accompanied by intestinal necrosis. Early diagnosis and timely intervention can save lives and prevent serious complications.
Successful pregnancy in the blind hemicavity of Robert’s uterus: a rare case report and brief literature review
Authors: Dong Lingling , Qin Shi , Che Ronghua , Pei Jindan , Hua Xiaolin 
Published: March 2023

Abstract
Background
Robert’s uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert’s uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert’s uterus.

Case presentation
A 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert’s uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.

Conclusions
Pregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.
Comparative efficacy of different combinations of acapella, active cycle of breathing technique, and external diaphragmatic pacing in perioperative patients with lung cancer: a randomised controlled trial
Authors: Chen Xiaoxue , Li Chuanzhen , Zeng Linjuan , Rong Tiehua , Lin Peng , Wang Qinglin , Guo Zhixing , Long Hao , Zhong Jiudi 
Published: March 2023

Abstract
Background
Acapella plus active cycle of breathing technique (ACBT), external diaphragm pacemaker (EDP) plus ACBT have been shown to facilitate the recovery of functional capacity and lung function in patients suffering from airway obstruction but the efficacy in perioperative patients with lung cancer has not been proven.

Methods
We conducted a three-arm, prospective, randomized, assessor-blinded, controlled trial in patients with lung cancer who underwent thoracoscopic lobectomy or segmentectomy in the department of thoracic surgery, China. Patients were randomly assigned (1:1:1) to receive Acapella plus ACBT, EDP plus ACBT, or ACBT group (control group) using SAS software. The primary outcome was functional capacity, measured by the 6-minute walk test (6MWT).

Results
We recruited 363 participants over 17 months: 123 assigned to the Acapella plus ACBT group, 119 to the EDP plus ACBT group, and 121 to the ACBT group. Statistically significant differences were noted for functional capacity between the EDP plus ACBT and control groups at each follow-up time (1-week follow-up: difference = 47.25 m, 95% CI, 31.56–62.93; P < 0.001; and 1-month follow-up: difference = 49.72 m, 95% CI, 34.04–65.41; P < 0.001), between the Acapella plus ACBT and control groups at postoperative week 1 (difference = 35.23 m, 95% CI, 19.30–51.16; P < 0.001) and postoperative month 1 (difference = 34.96 m, 95% CI, 19.03–50.89; P < 0.001), and between the EDP plus ACBT and Acapella plus ACBT groups at 1-month follow-up (difference = 14.76 m, 95% CI, 1.34–28.19; P = 0.0316).

Conclusion
EDP plus ACBT and Acapella plus ACBT significantly improved functional capacity and lung function in perioperative patients with lung cancer, compared with single-model ACBT, and the effects of EDP plus ACBT were clearly superior to those of other programs.

Trial registration
The study was registered in the clinical trial database (clinicaltrials.gov) on June 4, 2021 (No. NCT04914624).
The use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers may relate to the survival and walking ability in geriatric patients with hip fractures: a 1-year follow-up study
Authors: Chu Qining , Wang Liqiang , Chu Qingbo 
Published: March 2023

Abstract

Background
Many elder patients with hip fractures also suffered from hypertension. This study aims to explore the relationship between the use of ACEI or ARB and the outcomes of geriatric hip fractures.

Methods
All the patients were divided into four groups: non-users without hypertension, non-users with hypertension, ACEI users, and ARB users. The outcomes of patients in different groups were compared. LASSO regression and univariable Cox analysis were used for variable screening. Then Cox models and Logistics models were established to identify the relationships between the use of RAAS inhibitors and outcomes.

Results
ACER users (p = 0.016) and ARB users (p = 0.027) had a significantly lower survival probability than the non-users with hypertension. Non-users without hypertension, ACEI users, and ARB users may face lower 6-month and 1-year mortalities and higher 6-month and 1-year free walking rates compared with non-users with hypertension.

Conclusion
Patients with the use of ACEI or ARB may face a better prognosis of hip fractures.
Association between depression and dysmenorrhea among adolescent girls: multiple mediating effects of binge eating and sleep quality
Authors: Li Yingzhen , Kang Baixue , Zhao Xueyan , Cui Xuena , Chen Jie , Wang Lijie 
Published: March 2023

AbstractBackgroundDysmenorrhea has a significant negative impact on teenagers’ quality of life, and its prevalence is increasing annually. Although studies have explored the factors affecting dysmenorrhea, it remains unclear how these factors interact with one another. This study aimed to explore the mediating role of binge eating and sleep quality between depression and dysmenorrhea.MethodsThis cross-sectional study recruited adolescent girls from the Health Status Survey of adolescents in Jinan, Shandong Province, and used multistage stratified cluster random sampling. Data was collected using an electronic questionnaire between March 9, 2022, and June 20, 2022. The Numerical Rating Scale and Cox Menstrual Symptom Scale were used to assess dysmenorrhea and the Patient Health Questionnaire-9 to assess depression. The mediation model was tested by Mplus 8.0, and the mediating effect was analyzed using the Product of Coefficients approach and the Bootstrap method.ResultsAmong the total of 7818 adolescent girls included in this study, the prevalence of dysmenorrhea is 60.5%. A significant positive association was found between dysmenorrhea and depression. Binge eating and sleep quality seemingly mediate this association. The mediating effect of sleep quality (21.31%) was greater than that of binge eating (6.18%).ConclusionsThe findings of this study point in the right direction for preventing and treating dysmenorrhea in adolescents. For adolescent dysmenorrhea, mental health should be considered and proactive steps taken for educating adolescents on healthy lifestyles to reduce negative consequences of dysmenorrhea. Longitudinal studies on the causal link and influence mechanisms between depression and dysmenorrhea should be conducted in the future.
Women on the frontline of Covid-19: understanding local women village health volunteers in the northern province of Thailand
Authors: Sukhampha Rangsan , Khwanriang Prin , Vaisamruat Krisana 
Published: March 2023

Abstract
Background
This paper investigates the role of local women village health volunteers, women on the frontline, during COVID-19 in the northern province of Thailand.

Methods
This research employs a qualitative method with grounded-based analysis of primary data from in-depth interviews of 40 local women village health volunteers that were selected by a purposeful sampling of 10 key informants per district, live in 4 sub-districts in Chiang Mai, the northern province of Thailand: Suthep Subdistrict, Mae Hia Subdistrict, Fa Ham Subdistrict, and Tha Sala Subdistrict.

Results
The role of local women village health volunteers during COVID-19 is diverse, such as community health caregivers, the Surveillance and Rapid Response Team (SRRT), health facilitators and mediators, and the manager of community health funds and resources mobilization. Volunteering for local women in community health services at the local level, participating based on personal desire and foreseeable opportunities, could create meaningful participation for the local women in terms of empowering them and as a driver of local community (health) development.

Conclusions
Findings reveal that understanding local women’s perspectives on their roles could be made through the lens of the intersection of femininity, social role, motivation, and their contribution to their community.
Time-dependent event accumulation in a cardiovascular outcome trial of patients with type 2 diabetes and established atherosclerotic cardiovascular disease
Authors: Bethel M. Angelyn , Sourij Harald , Stevens Susanna R. , Hannan Karen , Lokhnygina Yuliya , Adler Amanda I. , Peterson Eric D. , Holman Rury R. , Lopes Renato D. 
Published: March 2023

Abstract
Background
Estimating cardiovascular (CV) event accrual is important for outcome trial planning. Limited data exist describing event accrual patterns in patients with type 2 diabetes (T2D). We compared apparent CV event accrual patterns with true event rates in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS).

Methods
Centrally adjudicated event dates and accrual rates for a 4-point major adverse CV event composite (MACE-4; includes CV death, nonfatal myocardial infarction, nonfatal stroke, or unstable angina hospitalization), MACE-4 components, all-cause mortality (ACM), and heart failure hospitalization were compiled. We used three graphical methods (Weibull probability plot, plot of negative log of the Kaplan–Meier survival distribution estimate, and the Epanechnikov kernel-smoothed estimate of the hazard rate) to examine hazard rate morphology over time for the 7 outcomes.

Results
Plots for all outcomes showed real-time constant event hazard rates for the duration of the follow-up, confirmed by Weibull shape parameters. The Weibull shape parameters for ACM (1.14, 95% CI 1.08–1.21) and CV death (1.08, 95% CI 1.01–1.16) were not sufficiently > 1 as to require non-constant hazard rate models to accurately depict the data. The time lag between event occurrence and event adjudication being completed, the adjudication gap, improved over the course of the trial.

Conclusions
In TECOS, the nonfatal event hazard rates were constant over time. Small increases over time in the hazard rate for fatal events would not require complex modelling to predict event accrual, providing confidence in traditional modelling methods for predicting CV outcome trial event rates in this population. The adjudication gap provides a useful metric to monitor within-trial event accrual patterns.

Clinical trial registration

Clinicaltrials.gov NCT00790205.
Exosome inspired photo-triggered gelation hydrogel composite on modulating immune pathogenesis for treating rheumatoid arthritis
Authors: Rui Ke , Tang Xiaoxuan , Shen Ziwei , Jiang Chao , Zhu Qiugang , Liu Shiyi , Che Nan , Tian Jie , Ling Jue , Yang Yumin 
Published: March 2023

AbstractAlthough exosome therapy has been recognized as a promising strategy in the treatment of rheumatoid arthritis (RA), sustained modulation on RA specific pathogenesis and desirable protective effects for attenuating joint destruction still remain challenges. Here, silk fibroin hydrogel encapsulated with olfactory ecto-mesenchymal stem cell-derived exosomes (Exos@SFMA) was photo-crosslinked in situ to yield long-lasting therapeutic effect on modulating the immune microenvironment in RA. This in situ hydrogel system exhibited flexible mechanical properties and excellent biocompatibility for protecting tissue surfaces in joint. Moreover, the promising PD-L1 expression was identified on the exosomes, which potently suppressed Tfh cell polarization via inhibiting the PI3K/AKT pathway. Importantly, Exos@SFMA effectively relieved synovial inflammation and joint destruction by significantly reducing T follicular helper (Tfh) cell response and further suppressing the differentiation of germinal center (GC) B cells into plasma cells. Taken together, this exosome enhanced silk fibroin hydrogel provides an effective strategy for the treatment of RA and other autoimmune diseases.
Safety and feasibility of laparoscopic resection of abdominal neuroblastoma without image-defined risk factors: a single-center experience
Authors: Chang Saishuo , Lin Yu , Yang Shen , Yang Wei , Cheng Haiyan , Chang Xiaofeng , Zhu Zhiyun , Feng Jun , Han Jianyu , Ren Qinghua , Wang Huanmin , Qin Hong 
Published: March 2023

Abstract
Objective
To explore the criteria, safety and efficacy of laparoscopic surgery in pediatric neuroblastoma (NB).

Methods
A retrospective study of 87 patients with NB without image-defined risk factors (IDRFs) between December 2016 and January 2021 at Beijing Children’s Hospital was conducted. Patients were divided into two groups according to the surgical procedure.

Results
Between the 87 patients, there were 54 (62.07%) cases in the open surgery group and 33 (37.93%) cases in the laparoscopic surgery group. There were no significant differences between the two groups regarding demographic characteristics, genomic and biological features, operating time or postoperative complications. However, in terms of intraoperative bleeding (p = 0.013) and the time to start postoperative feeding after surgery (p = 0.002), the laparoscopic group was obviously better than the open group. Furthermore, there was no significant difference in the prognosis between the two groups, and no recurrence or death was observed.

Conclusion
For children with localized NB who have no IDRFs, laparoscopic surgery could be performed safely and effectively. Surgeons who are skilled in this can help children reduce surgical injuries, speed up postoperative recovery, and obtain the same prognosis as open surgery.
Immunohistochemical visualization of lymphatic vessels in human dura mater: methodological perspectives
Authors: Vera Quesada César Luis , Rao Shreyas Balachandra , Torp Reidun , Eide Per Kristian 
Published: March 2023

Abstract
Background
Despite greatly renewed interest concerning meningeal lymphatic function over recent years, the lymphatic structures of human dura mater have been less characterized. The available information derives exclusively from autopsy specimens. This study addressed methodological aspects of immunohistochemistry for visualization and characterization of lymphatic vessels in the dura of patients.

Methods
Dura biopsies were obtained from the right frontal region of the patients with idiopathic normal pressure hydrocephalus (iNPH) who underwent shunt surgery as part of treatment. The dura specimens were prepared using three different methods: Paraformaldehyde (PFA) 4% (Method #1), paraformaldehyde (PFA) 0.5% (Method #2), and freeze-fixation (Method #3). They were further examined with immunohistochemistry using the lymphatic cell marker lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1), and as validation marker we used podoplanin (PDPN).

Results
The study included 30 iNPH patients who underwent shunt surgery. The dura specimens were obtained average 16.1 ± 4.5 mm lateral to the superior sagittal sinus in the right frontal region (about 12 cm posterior to glabella). While lymphatic structures were seen in 0/7 patients using Method #1, it was found in 4/6 subjects (67%) with Method #2, while in 16/17 subjects (94%) using Method #3. To this end, we characterized three types of meningeal lymphatic vessels: (1) Lymphatic vessels in intimate contact with blood vessels. (2) Lymphatic vessels without nearby blood vessels. (3) Clusters of LYVE-1-expressing cells interspersed with blood vessels. In general, highest density of lymphatic vessels were observed towards the arachnoid membrane rather than towards the skull.

Conclusions
The visualization of meningeal lymphatic vessels in humans seems to be highly sensitive to the tissue processing method. Our observations disclosed most abundant lymphatic vessels towards the arachnoid membrane, and were seen either in close association with blood vessels or remote from blood vessels.
Morphology analysis of the C2 pediculoisthmic component and feasibility of safe C2 pedicle screw placement: comparison of multiplanar reconstruction versus traditional radiographic methods
Authors: Wu YueLin , Liang ZhaoQuan , Bao JunHao , Wen Ling , Zhang Li 
Published: March 2023

Abstract
Background
Preoperatively evaluating the feasibility of safe C2 pedicle screw placement is the key to avoiding iatrogenic vertebral artery injury. However, it has not been verified whether the conventional CT measurements of C2 pediculoisthmic component (PIC) are reliable and accurate, and the results may lack validity. The purpose of this study is to analyze the evaluative performance of conventional CT measurements and to create an accurate predictor of morphometrics of C2 PIC.

Methods
A total of 304 C2 PICs were measured in 152 consecutive patients who underwent CT examination of the cervical spine between April 2020 and December 2020. We obtained the morphometric parameters of C2 PIC by measuring minimum PIC diameter (MPD) in CT multiplanar reconstruction versus conventional measurements of transverse PIC width (TPW), oblique PIC width (OPW) and definition of high-riding vertebral artery (HRVA). The outer diameter measured less than 4 mm in MPD was regarded as the standard of precluding safe C2 pedicle screw insertion. The evaluative performance of the conventional CT measurements was assessed, and the correlation between conventional CT measurements and measurements in CT multiplanar reconstruction was calculated.

Results
The parameters in OPW and MPD were measured significantly larger than those in TPW, and the preclusion of C2 pedicle screw placement evaluated from TPW and HRVA was significantly higher than that evaluated from OPW and MPD. The sensitivity of TPW was 93.09%, and the specificity was 79.31%. The sensitivity and specificity of OPW were 97.82% and 82.76%. The sensitivity of HRVA was 88.36%, and the specificity was 96.55%. Strong agreement with the highest correlation coefficient (0.879) and determination coefficient (0.7720) suggested that the outer diameter of OPW could be useful for the precise prediction of MPD.

Conclusions
CT MPR allows accurate measurement of the narrowest section of the C2 PIC. The outer diameter of OPW could be simply measured and be useful for precise prediction of MPD, which makes C2 pedicle screw placement more safely than the conventional measurement of TPW and HRVA.