bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elastography for Evaluation of Regression in Liver Fibrosis After Surgical Biliary Drainage for Benign Biliary Strictures
Authors: Rajendran Jayapal , Irrinki Santhosh , Gupta Vikas , Singh Virendra , Sinha Saroj Kanth. , lal Anupam , Kurdia Kailash , Das Ashim , Yadav Thakur Deen 
Published: September 2023

Background:
Hepatic fibrosis and secondary biliary cirrhosis are consequences of long-standing benign biliary strictures. Evidence on the reversibility of fibrosis after the repair is incongruous.

Methodology:
A prospective observational study on patients who underwent Roux-en-Y hepaticojejunostomy for benign biliary stricture. A liver biopsy was performed during repair and correlated with preoperative elastography. The improvement in liver functions and regression of fibrosis was compared with preoperative liver function tests and elastography.

Results:
A Total of 47 patients [mean age—38.9 y (Range: 21 to 66)] with iatrogenic benign biliary stricture were included. A strong female preponderance was noted. High strictures (type III and IV) comprised 72.7% of the study group. The median interval (injury to repair) was 7 months (2 to 72 mo). The median duration of jaundice was 3 months (1 to 20 mo). Both factors had a significant correlation with the stage of fibrosis (P=0.001 and P=0.03, respectively). Liver biopsy revealed stage I, II, III, and IV fibrosis in 26 (55.3%), 11 (23.4%), 2 (4.3%), and 2(4.3%), respectively. The remaining 6 (12.8%) had no fibrosis. The severity of fibrosis had a good correlation with preoperative liver stiffness measurement-value on FibroScan. Significant improvement in liver function tests (bilirubin—3.55±3.48 vs. 0.59±0.52; Albumin—3.85±0.61 vs. 4.14±0.37; ALP—507.66±300.65 vs. 167±132.07; P value 0.00) and regression of fibrosis (liver stiffness measurement; 10.42±5.91 vs. 5.85±3.01, P value 0.00) was observed after repair of the strictures.

Conclusion:
Improved biliary function and regression of liver fibrosis can be achieved with timely repair of benign biliary stricture and it is feasible to be evaluated using elastography.
JAK inhibitors for the treatment of inflammatory bowel disease: results of an international survey of perceptions, attitudes, and clinical practice
Authors: Honap Sailish , Irving Peter M. , Samaan Mark A. 
Published: September 2023

Background
Janus kinase inhibitors (JAKi) are small molecule drugs with demonstrated efficacy in inflammatory bowel disease (IBD). However, widespread utilisation may be hindered by safety concerns.

Aims
This is the first study assessing risk-benefit perceptions and clinical practices of those using JAKi for IBD.

Methods
A prospective, cross-sectional study was conducted using a 23-item survey distributed to IBD healthcare providers worldwide.

Results
Of 385 respondents from 48 countries, 72% were tertiary-centre based and 50% were gastroenterologists with ≥10 years experience. JAKi were commonly used outside market authorisation (31%), though many (17%) were unconfident discussing JAKi risk-benefit profile and 7% had never prescribed JAKi. If venous thromboembolism risks were present, 15% preferentially referred for surgery than initiate JAKi; 21% would do this even if the patient was already anticoagulated. For patients relapsing on dose reduction, 8% would switch treatment rather than dose escalate. Conversely, 45% felt that cardiovascular safety concerns from post-marketing studies were irrelevant to IBD. Despite the lack of detailed, long-term safety data, safety profiles of JAK1-selective drugs were perceived to be favourable to tofacitinib by most (62%).

Conclusion
The study indicates that while clinical practice appears to be in keeping with international guidance, a significant minority remain deterred by safety concerns.
Three-dimensional computed tomography analysis of the atlanto-dental interval in a healthy Karachi population: a single-center retrospective cross-sectional study
Authors: Sultan Anum , Bhugio Sanobar , Shaikh Omer A. , Swaleh Faizan S. , Subhash Komal , Khan Yameena N. , Mala Ali , Hasibuzzaman Md. Al 
Published: September 2023

Background:
The atlantoaxial joint has a complex anatomical configuration and has a wide range of mobility. Traumatic, inflammatory, and neoplastic joint pathologies frequently affect this joint. The aim of this retrospective cross-sectional study was to evaluate the atlanto-dental intervals (ADI) in patients who underwent computed tomography (CT) scans of the neck and cervical spine in at a Tertiary Care Hospital in Karachi, Pakistan.

Methods:
This was a retrospective cross-sectional study conducted at a tertiary care hospital in Karachi between 1 January 2021 and 31 December 2021, following approval from the hospital ethical review committee. Patients above the age of 15 who underwent CT scans were included, while individuals with a history of cervical trauma, infection, rheumatoid arthritis, or congenital anomalies, as well as those younger than 15 years old, were excluded. CT scans were performed using a multidetector scanner utilizing a standardized protocol. Sagittal and coronal images were reconstructed. ADI measurements, including anterior ADI (AADI), posterior ADI (PADI), and lateral ADI (LADI) on both sides, were determined using appropriate bone window settings. A radiologist with a minimum of 3 years of experience analyzed the CT scans.

Results:
The mean age of the patients was 49.3±17.7 years (age range: 16–85 years). The mean AADI was 1.4±0.4 mm, with a range of 0.0–2.1 mm. The mean PADI was 19.1±1.9 mm, with a range of 13.8–24.6 mm. The mean left LADI measurement was 3.3±1.2 mm with a range of 1.2–10.0 mm, and the mean right LADI measurement was 3.2±1.1 mm with a range of 1.2–6.3 mm.

Conclusion:
Our study examined the ADI in patients who underwent CT scans of the neck and cervical spine in Karachi. The findings provide valuable insights into the relationship between ADI measurements, age, and sex. These results contribute to our understanding of the anatomical variations in this region, which may aid in the diagnosis and management of cervical spine disorders.
Evaluation of Physicians' Knowledge About Honey/Sucralfate Treatments in Children With Button Battery Ingestion
Authors: Akca Caglar Ayla , Derinoz Guleryuz Oksan , Tomar Güneysu Songül , Çolak Özlem 
Published: September 2023

Objectives
Ingestion of button batteries (BBs) causes serious mortality and morbidity. We aimed to evaluate the knowledge level of physicians working in pediatric emergency departments about the updated guidelines for BB ingestion and whether they used honey and sucralfate, which have proven positive effects in preventing mucosal damage, in their daily practice.

Methods
A “Google Form” questionnaire was prepared and used to evaluate the approach of physicians who worked in pediatric emergency department with questions about pediatric patients who were admitted with the suspicion of BB swallowing.

Results
A total of 263 physicians, 169 women (64.3%), with a mean age of 34.5 ± 7.3 years, participated in the study. Seventy-five percent of the participants were from tertiary care hospitals, and 60.8% had less than 5 years of pediatric emergency experience. Some 71.9% of the physicians who participated in the survey (n = 189) had no algorithm at their hospitals. Fifty-eight percent (n = 152) of the participants completely and correctly answered all our survey questions about battery swallowing. Fifty-eight (22.1%) of the participants administered sucralfate, and 12.2% (n = 32) used honey treatments in patients who swallowed BBs; 68.1% (n = 179) had never heard of the use of sucralfate, and 77.6% (n = 204) had never heard of honey applications before in the management of swallowed batteries.

Conclusion
It was determined that the physicians who managed pediatric battery swallowing cases had deficiencies in their treatment approaches, they had no protocol in their institutions, and the use of mucosal damage mitigation and neutralization treatments, such as honey and sucralfate, was insufficient.
Actions to Avoid in Pain Management and Sedoanalgesia Procedures in Pediatric Emergencies
Authors: Khodayar-Pardo Parisá , Miguez-Navarro María Concepción , Martín Espín Irene ,   the Analgesia and Sedation Working Group of the Spanish Society of Pediatric Emergency Medicine
Published: September 2023

Objectives
The aim of this study was to show the process of elaboration and the results obtained of the list of “do not do” recommendations for pain management and sedoanalgesia procedures in pediatric patients within the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergencies (Grupo de Trabajo de Analgesia y Sedación de la Sociedad Española de Urgencias de Pediatría [GTAS-SEUP]).

Methods
The process of drawing up the list was carried out in 3 phases: (1) “brainstorming,” open to all members of the GTAS-SEUP; (2) selection of recommendations, after a modified Delphi methodology; and (3) drafting and consensus of the final document.

Results
Initially, 57 proposed recommendations were obtained, which were reduced to 39 by unifying those that were similar. Of the 14 “do not do” in pain management, 6 were accepted: 3 in the first round and 3 in the second round. Of the 25 “do not do” recommendations for sedoanalgesia procedures, 6 were accepted: 4 in the first round and 2 in the second round. The final text consisted of 12 actions to avoid, 6 referring to pain management and 6 to sedoanalgesia procedures.

Conclusions
The list of “do not do” recommendations for pain management and sedoanalgesia procedures in the pediatric patient is a consensual tool, within the GTAS-SEUP. These recommendations promote an improvement in the quality of care offered to these patients, based on avoiding unnecessary measures, which can sometimes be harmful.
Unintentional Monotherapy in Rheumatoid Arthritis Patients Receiving Tofacitinib and Drug Survival Rate of Tofacitinib
Authors: Inanc Nevsun , Abacar Kerem Y. , Ozturk Mehmet A. , Tufan Abdurrahman , Karadeniz Hazan , Sari Ismail , Can Gercek , Erez Yesim , Pehlivan Yavuz , Dalkilic Huseyin E. , Ocak Tugba , Cefle Ayse , Yazici Ayten , Senel Abdurrahman S. , Akar Servet , Durak-Ediboğlu Elif , Koca Suleyman S. , Piskin-Sagir Rabia , Yilmaz Sema , Gulcemal Semral , Soysal-Gunduz Ozgul , Basibuyuk Canberk S. , Alkan Serdar , Cesur Teoman Y. , Onen Fatos 
Published: September 2023

Objective
To determine the rate of unintentional monotherapy (UM; switching to monotherapy from combination therapy of patients' own volition) in rheumatoid arthritis patients receiving tofacitinib and to evaluate tofacitinib survival rate.

Methods
This national, multicenter study included patients' data from the TURKBIO Registry. Demographics, clinical characteristics, disease duration and activity, comorbidities, and treatments were analyzed.

Results
Data of 231 rheumatoid arthritis patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy on their own volition (UM); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The rate of comorbidities at the time of data retrieval was higher in the UM group than in the combination group (83.3% vs. 60.3%, p = 0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p = 0.039; odds ratio, 3.29; 95% confidence interval, 1.06–10.18). The combination and UM groups did not differ regarding remission rate assessed by Disease Activity Score 28-joint count C-reactive protein (60.5% and 70%, respectively; p = 0.328). Drug survival rates of the UM and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with 1- and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the UM group.

Conclusions
Although 13.4% of the study population started monotherapy unintentionally, drug survival and remission rates of the UM and combination groups were not different. Comorbidity was a factor affecting transition from combination therapy to monotherapy.
Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice
Authors: McCarthy Margaret , Jevotovsky David , Mann Devin , Veerubhotla Akhila , Muise Eleanor , Whiteson Jonathan , Rizzo John Ross 
Published: September 2023

Abstract

Purpose
Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity.

Design and Methods
This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings.

Results
The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress.

Clinical Relevance
If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services.

Conclusion
RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
Laparoscopic Abdominal Surgery Under Thoracic Epidural Anesthesia in Patients with Interstitial Lung Disease: Retrospective Observational Cohort Study
Authors: Elhadidi Amro , Fawzy Anas 
Published: September 2023

Background:
Patients with interstitial lung disease who present with abdominal disease carry a perioperative risk of morbidity and mortality, including the risks of general anesthesia and postoperative pulmonary complications. We investigated the efficacy of laparoscopic surgery in such patients under epidural anesthesia.

Materials and Methods:
All patients with interstitial lung disease who underwent laparoscopic abdominal surgery were retrospectively studied. At 30 days, our primary end point was acute exacerbation of pulmonary complications. The second end point was nonpulmonary complications and 30-day hospital mortality.

Results:
Eighteen patients were enrolled in this study after reviewing their medical and surgical records. Our study revealed that none of the patients suffered from acute pulmonary exacerbations, and only 1 patient experienced a nonpulmonary event. There was no reported mortality. The conversion rate was low, with 1 patient necessitating conversion from laparoscopic to open surgery, which was conducted under epidural anesthesia. No conversions from epidural to general anesthesia were performed.

Conclusion:
Epidural anesthesia is safe in a patient with interstitial lung disease, and laparoscopic surgery can be completed with low rate of conversion and, with minor complications.
Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging
Authors: Hobden Georgina , Moore Margaret Jane , Mair Grant , Pendlebury Sarah T. , Demeyere Nele 
Published: September 2023

Background:
Executive function (EF) impairments are prevalent post stroke and are associated with white matter (WM) damage on MRI. However, less is known about the relationship between poststroke EF and WM damage on CT imaging.

Objective:
To investigate the relationship between poststroke EF and WM damage associated with stroke lesions and WM hypointensities (WMHs) on clinically acquired CT imaging.

Method:
This study analyzed data from the Oxford Cognitive Screening Program, which recruited individuals aged ≥18 years with a confirmed stroke from an acute stroke unit. The individuals completed a follow-up assessment 6 months post stroke. We included individuals with a CT scan showing a visible stroke who completed follow-up EF assessment using the Oxford Cognitive Screen–Plus rule-finding task. We manually delineated stroke lesions and quantified then dichotomized WM damage caused by the stroke using the HCP-842 atlas. We visually rated then dichotomized WMHs using the Age-Related White Matter Changes Scale.

Results:
Among 87 stroke survivors (Mage = 73.60 ± 11.75; 41 female; 61 ischemic stroke), multivariable linear regression showed that stroke damage to the medial lemniscus (B = –8.86, P < 0.001) and the presence of WMHs (B = –5.42, P = 0.005) were associated with poorer EF 6 months post stroke after adjusting for covariates including age and education.

Conclusion:
Poorer EF was associated with WM damage caused by stroke lesions and WMHs on CT. These results confirm the importance of WM integrity for EF post stroke and demonstrate the prognostic utility of CT-derived imaging markers for poststroke cognitive outcomes.
Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services
Authors: Hagan Alexander J. , Bailey Simon , Verity Sarah J. 
Published: September 2023

Background:
Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent.

Objective:
To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK.

Method:
We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data.

Results:
Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate.

Conclusion:
We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.
Immune Responses in Checkpoint Myocarditis Across Heart, Blood, and Tumor
Authors: Blum Steven M. , Zlotoff Daniel A. , Smith Neal P. , Kernin Isabela J. , Ramesh Swetha , Zubiri Leyre , Caplin Joshua , Samanta Nandini , Martin Sidney C. , Tirard Alice , Sen Pritha , Song Yuhui , Barth Jaimie , Slowikowski Kamil , Nasrallah Mazen , Tantivit Jessica , Manakongtreecheep Kasidet , Arnold Benjamin Y. , McGuire John , Pinto Christopher J. , McLoughlin Daniel , Jackson Monica , Chan PuiYee , Lawless Aleigha , Sharova Tatyana , Nieman Linda T. , Gainor Justin F. , Juric Dejan , Mino-Kenudsen Mari , Sullivan Ryan J. , Boland Genevieve M. , Stone James R. , Thomas Molly F. , Neilan Tomas G. , Reynolds Kerry L. , Villani Alexandra-Chloé 
Published: September 2023

AbstractImmune checkpoint inhibitors (ICIs) are widely used anti-cancer therapies that can cause morbid and potentially fatal immune-related adverse events (irAEs). ICI-related myocarditis (irMyocarditis) is uncommon but has the highest mortality of any irAE. The pathogenesis of irMyocarditis and its relationship to anti-tumor immunity remain poorly understood. We sought to define immune responses in heart, tumor, and blood during irMyocarditis and identify biomarkers of clinical severity by leveraging single-cell (sc)RNA-seq coupled with T cell receptor (TCR) sequencing, microscopy, and proteomics analysis of 28 irMyocarditis patients and 23 controls. Our analysis of 284,360 cells from heart and blood specimens identified cytotoxic T cells, inflammatory macrophages, conventional dendritic cells (cDCs), and fibroblasts enriched in irMyocarditis heart tissue. Additionally, potentially targetable, pro-inflammatory transcriptional programs were upregulated across multiple cell types. TCR clones enriched in heart and paired tumor tissue were largely non-overlapping, suggesting distinct T cell responses within these tissues. We also identify the presence of cardiac-expanded TCRs in a circulating, cycling CD8 T cell population as a novel peripheral biomarker of fatality. Collectively, these findings highlight critical biology driving irMyocarditis and putative biomarkers for therapeutic intervention.
Effects of speculum lubrication on cervical smears for cervical cancer screening: a double blind randomized clinical trial
Authors: Ilika Chito P. , Eleje George U. , Chiemeka Michael E. , Ilika Frances N. , Ikechebelu Joseph I. , Ilika Valentine C. , Ugwu Emmanuel O. , Ofor Ifeanyichukwu J. , Ogelle Onyecherelam M. , Umeononihu Osita S. , Mamah Johnbosco E. , Olisa Chinedu L. , Ezeigwe Chijioke O. , Nwankwo Malarchy E. , Ofojebe Chukwuemeka J. , Okafor Chidinma C. , Ekwebene Onyeka C. , Nnabuchi Obinna K. , Okafor Chigozie G. 
Published: September 2023

ABSTRACTBackgroundSpeculum lubrication may help to reduce the pain experienced during Pap-smears collection and hence increase uptake of cervical cancer screening and repeat testing but there are fears of its interference with cytological results.AimTo determine and compare adequacy of cervical cytology smears and mean pain scores of women undergoing cervical cancer screening with or without speculum lubrication.MethodsThis was a randomized controlled study of 132 women having cervical cancer screening at a tertiary hospital in Nigeria. Sixty-six participants each were randomly assigned to the ‘Gel’ and ‘No Gel’ groups respectively. Pap-smears were collected from each participant with lubricated speculum (‘Gel group’) or non-lubricated speculum (‘No Gel group’). The primary outcome measures were; the proportion of women with unsatisfactory cervical cytology smears and the mean numeric rating scale pain scores while the secondary outcome measures were the proportion of women that are willing to come for repeat testing and the cytological diagnosis of Pap-smear results.ResultsThe baseline socio-demographic variables were similar in both groups. There was no significant difference in the proportion of unsatisfactory cervical smear results between the two groups (13.6% vs. 21.2% p = 0.359). However, the mean pain scores were significantly lower in the gel group than in the no gel group (45.04 vs 87.96; p<0.001). An equal proportion of the participants in each group (90.9% vs. 90.9%; p>0.999) were willing to come for repeat cervical smears in the future.ConclusionSpeculum lubrication did not affect the adequacy of cervical-smears but significantly reduced the pain experienced during Pap-smear collection. Also, it did not significantly affect willingness to come for repeat cervical smears in the future.The Trial was registered withPan-African Clinical Trial Registrywith unique identification/registration no:PACTR2020077533364675.