bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Intravenous Alteplase for Acute Ischaemic Stroke in Patients With Prestroke Symptomaticity: An Analysis of the Virtual International Stroke Trials Archive
Authors: Simon Jenny , Karliński Michał , Niewada Maciej ,   VISTA-Acute Collaboration
Published: January 2025

Background: Randomised controlled trials (RCTs) for intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS) historically excluded patients with pre‐existing disability. This tradition echoes in clinical practice, despite evidence suggesting IVT improves chances of returning to prestroke functional status. We investigated the role of pre‐existing symptomaticity by comparing IVT‐treated versus IVT‐withheld Modified Rankin Scale (mRS) 1 patients and mRS 0 versus mRS 1 IVT‐treated patients.Methods: The Virtual International Stroke Trials Archive (VISTA) has collated data from 38 AIS RCTs. Patients enrolled in trials whose investigative treatments reported no significant effect on outcomes or that were placebo‐treated were eligible, yielding 3175 individual patient records. 2454 patients had prestroke mRS 0, and 721 had prestroke mRS 1. The negligible number of patients with prestroke mRS ≥ 2 prompted focus on prestroke mRS 1 patients. Propensity score and logistic regression were used to compare intracranial haemorrhage (ICH), neurological improvement, mortality, and functional outcome within 90 days.Results: Of IVT‐treated patients, mRS 1 subjects were female in higher proportion and had a more frequent history of stroke than mRS 0 subjects. Of mRS 1 patients, IVT‐withheld subjects were older and had a more frequent history of stroke than IVT‐treated subjects. No significant differences were found for National Institutes of Health Stroke Scale (NIHSS) severity and other baseline parameters. IVT‐treated patients achieved significant neurological improvement more frequently than IVT‐withheld patients (40.5% vs. 27.9%, p = 0.028; adjusted odds ratio (aOR) 1.53, 95% confidence interval (95% CI): 1.18–1.88), with no significant differences in mortality and favourable functional outcome. ICH was numerically higher among IVT‐treated patients; however, this did not persist after matching and regression adjustment. Comparing IVT‐treated mRS 0 and mRS 1 patients revealed no significant differences.Conclusion: Our post hoc analysis of randomised data provides reassurance that IVT is safe and offers significant clinical benefit for AIS patients with pre‐existing symptomaticity, as measured by the NIHSS. The lack of marked improvement on the mRS substantiates that the NIHSS is a key secondary outcome measure to capture recovery trajectories in studies concerned with reperfusion therapies.
Impact of Weather and Holidays on Orthopedic Emergency Room Crowding, Fractures, and Polytraumas in a Third‐Level Referral Trauma Center in Europe
Authors: Andreani Lorenzo , Ipponi Edoardo , Pecchia Francesco , Balestrieri Giorgio , Tosi Edoardo , Marchetti Stefano , Parchi Paolo Domenico 
Published: January 2025

Background: Orthopedic trauma is a significant component of emergency department workloads worldwide. The relationship between weather conditions and injury rates is controversial in modern literature. Even less has been written to investigate bank holidays’ influence on contusions, dislocations, fractures, and even polytrauma. Our study aimed to assess whether meteorological factors and national holidays could vary the workloads in the orthopedic ER of a European third‐level trauma center.Materials and Methods: Our study consisted of a review of all the patients who underwent orthopedic evaluations in our institution’s orthopedic emergency room between 2019 and 2023. Days were divided depending on weather (cloudy or sunny vs. rainy or stormy), day type (regular working days vs. national public holidays vs. Saturdays and Sundays), and presence or absence of COVID‐19 restrictions. We also recorded the temperatures of each day. Cases were subdivided into three groups: cases without significant injuries (Group A), cases with isolated bone fractures, major tears or articular dislocations (Group B1), and polytrauma (Group B2).Results: Higher temperatures were associated with a significant increase in overall ER visits, isolated injuries, and polytrauma. Sunny or cloudy days had a significantly higher number of patients with all injury types compared to rainy or stormy days. Weekends saw a significant decrease in overall admissions and isolated injuries but a higher rate of polytrauma compared to weekdays. National holidays had a significantly lower number of admissions for all injury types compared to weekdays. Restrictions due to the pandemic significantly reduced overall ER visits.Conclusion: Temperatures, meteorological factors, and national holidays could vary the workloads in the orthopedic ER of a European third‐level trauma center.
National Trends in Pulmonary Embolism Visit in United State Emergency Departments and Associated Costs (2006–2018)
Authors: Aalam Ahmad , Bokhary Diyaa , Alsabban Awad , Bakhribah Ahmad 
Published: January 2025

Introduction: Pulmonary embolism (PE) poses substantial morbidity and mortality risks, necessitating timely and accurate management in emergency departments (EDs).Objectives: This study explores the trends in PE presentations to US EDs from 2006 to 2018 and assesses the impact of different factors on management and cost.Methodology: This is a retrospective descriptive study conducted using the US Healthcare Cost and Utilization Project (HCUP) PE ED visits database. Data on ED visits, dispositions, and related costs were collected and analyzed.Results: From 2006 to 2018 there were more than 2 million PE ED visits in the US. There was an increase in visits per 100,000 persons from 42.17 in 2006–2008 to 64.27 in 2016–2018 (p value < 0.001). The proportion of uninsured patients declined from 5.07% to 4.70%, and the percentage of Medicaid‐insured patients increased. There was a decrease in the admission rates from 92.47% to 75.97% in 2016–2018 (p value < 0.001). The mean cost per admitted patient increased from $32,794 to $47,344 in 2016–2018 (p value < 0.001).Conclusion: From 2006 to 2018, PE ED visits in the US increased with a noticeable decrease in admission rates and length of stay, likely secondary to advancement in diagnostic and therapeutic modalities like computed tomography pulmonary angiography and novel oral anticoagulants. However, the observed rising healthcare costs pose challenges to sustainable management. Further research studies are needed to address cost‐effective strategies.
Transferrin Saturation, Serum Iron, and Ferritin in Heart Failure: Prognostic Significance and Proteomic Associations
Authors: Gan Sushrima , Azzo Joe David , Zhao Lei , Pourmussa Bianca , Dib Marie Joe , Salman Oday , Erten Ozgun , Ebert Christina , Richards A. Mark , Javaheri Ali , Mann Douglas L. , Rietzschel Ernst , Zamani Payman , van Empel Vanessa , Cappola Thomas P. , Chirinos Julio A. 
Published: January 2025

BACKGROUND:
Iron deficiency (ID) is currently defined as a serum ferritin level <100 or 100 to 299 ng/mL with transferrin saturation (TSAT) <20%. Serum ferritin and TSAT are currently used to define absolute and functional ID. However, individual markers of iron metabolism may be more informative than current arbitrary definitions of ID.

METHODS:
We assessed prognostic associations of ferritin, serum iron, and TSAT among 2050 participants with heart failure (HF) with reduced/mid-range (n=1821) or preserved (n=229) left ventricular ejection fraction enrolled in the PHFS (Penn HF Study), a prospective cohort study. We measured 4928 plasma proteins using an aptamer-based assay (SOMAScanv4) and assessed prognostic and proteomic associations of markers of iron metabolism.

RESULTS:

Ferritin concentrations were not associated with outcomes, whereas low TSAT and serum iron were associated with the risk of all-cause death (TSAT: standardized hazard ratio, 0.84 [95% CI, 0.76–0.93];
P
=0.001; serum iron: standardized hazard ratio, 0.87 [95% CI, 0.79–0.96];
P
=0.007). Similarly, TSAT was associated with the risk of death or HF-related admission (standardized hazard ratio, 0.89 [95% CI, 0.83–0.95];
P
=0.0006). Significant interactions between TSAT and HF with preserved ejection fraction status were found such that TSAT was more strongly associated with the risk of death and death or HF-related admission in HF with preserved ejection fraction. We identified 359 proteins associated with TSAT, including TFRC (transferrin receptor protein; β, −0.455;
P
<0.0001) and CRP (C-reactive protein; β, −0.355;
P
<0.0001). Pathway analyses demonstrated associations with lipid metabolism, complement activation, and inflammation. In contrast to the robust associations between TSAT and outcomes, ID and absolute ID defined by current criteria were not associated with death or death or HF-related admission. TSAT was associated with outcomes regardless of the presence of functional versus absolute ID.

CONCLUSIONS:
Low TSAT, but not ferritin concentrations, is significantly associated with adverse outcomes in HF. Low TSAT is more strongly associated with outcomes in HF with preserved ejection fraction. Pathways related to inflammation and lipid metabolism are associated with low TSAT in HF.
Quantifying the Ozone Radiative Feedback on Planetary-Wave and Zonal-Mean Variability during the Southern Hemisphere Stratospheric Polar Vortex Breakdown
Authors: Anil Meryl C. , Hegglin Michaela I. , Shepherd Theodore G. , Polichtchouk Inna , Stockdale Timothy N. 
Published: January 2025

Abstract
Stratospheric ozone has been shown to impact stratospheric variability and subseasonal-to-seasonal (S2S) prediction via its strong radiative properties. Previous research investigating the impact of interactive ozone in atmospheric models, compared with the use of a prescribed climatology, has focused largely on the zonal-mean impacts. Here, we employ a process-based diagnostic to quantify the impact of interactive ozone on high-latitude stratospheric variability in the Southern Hemisphere during the vortex breakdown period using two seasonal hindcast ensembles (one with and one without interactive ozone) initialized on 1 October over a period of 29 years. We focus on the amplitudes of waves (i.e., the longitudinal deviations from the zonal mean) and of zonal-mean deviations from the ensemble mean, for both temperatures and zonal winds. The effect is quantified as a function of day of year, considering the strong nonstationarity during this season, and we focus on the lower stratosphere, a region crucial for stratosphere–troposphere coupling. For both the waves and the zonal mean, we show that interactive ozone provides a positive radiative feedback on the variability. This increases the variances of both the waves and the zonal-mean deviations. Also, the ozone–temperature correlations are strengthened. The feedback acts most strongly on zonal wavenumbers 1 and 2. Interactive ozone is found to increase the predictable signal of the final warming date, bringing it closer to reanalysis, even though the anomaly correlation coefficient is reduced. This reflects the limitations of the anomaly correlation coefficient as a metric of skill in the presence of a signal deficit.

Significance Statement
The stratosphere is known to impact the troposphere during periods of high variability through stratosphere–troposphere coupling. This coupling has been shown to impact weather prediction on the subseasonal-to-seasonal (S2S) time scales (2 weeks to a season), important for decision-making in sectors including water, food, and energy. Our study analyzes the importance of stratospheric ozone, specifically its radiative feedback, in impacting the stratospheric variability (focusing on the variability of temperature and zonal winds) on S2S time scales by comparing model results that include and omit this feedback. We show that the ozone radiative feedback increases both temperature and zonal wind variability and thus increases the range of possibilities explored by the model, which can potentially lead to impacts on S2S prediction.
Extrusion foaming of semi-conductive poly (lactic acid)/carbon nanotube nanocomposites: Processing and foam microstructure correlations
Authors: Estaji Sara , Jafari Aidin , Farahani Saba , Saeidi Ardeshir , Nobre Marcos A. L. , Hemmati Farkhondeh , Khonakdar Hossein Ali 
Published: January 2025

In this study, semiconductive poly (lactic acid) (PLA)/carbon nanotube (CNT) nanocomposites have been simultaneously subjected to melt-compounding and foaming using a continuous and single-step extrusion foaming process. The extrusion foaming process with the ability to be developed on an industrial scale is a complex process for a biopolymer in the presence of nanoparticles, chemical foaming agent, and chain extender, and to control it, knowledge about the phenomena occurring during the process and the structural properties of the foam is required. Although the extrusion foaming of PLA has been studied before, the simultaneous effects of chain extender content and nanoparticle loading on the microstructure and phenomena during the PLA extrusion foaming process have not been thoroughly investigated. The results of this study show that the two investigated variables have a strong interaction with each other. Increasing the chain extender content has led to a change in the rheological properties of the melt, as a result, it has been significantly effective in the nanoparticle dispersion state. Besides, the loading of nanoparticles has a powerful effect on the intensity of the chain extension reaction of PLA chains by the chain extender additive. The lightest extruded foams (with a void fraction of 0.52) with the highest cell density (5 × 106 cells/cm3), the smallest cell size (about 50 and 200 µm for number- and volume-average cell diameters), and the most uniform cell size distribution have been obtained in the middle values of the chain extender content (5 phr) and the lowest values of the nanoparticle loading (0.25 phr).
Machine Learning and Political Events: Application of a Semi-supervised Approach to Produce a Dataset on Presidential Cabinets
Authors: González-Bustamante Bastián 
Published: January 2025

This paper describes the creation of a novel dataset on ministerial turnover and resignation calls in 12 presidential cabinets in Latin America from the mid-1970s to the early 2020s. The indicators on resignation calls and reallocations of cabinet members are entirely novel. Both constitute a relevant empirical contribution not only to the study of political dynamics in presidential systems and cabinet politics but also to public opinion and public policy topics. We focus on the creation of the dataset using optical recognition algorithms on press report archives together with machine learning models. The models permitted the training of ensemble semi-supervised classifiers over a period of almost 50 years. Subsequently, we provide a number of measurement validity checks to cross-validate the dataset by comparing it with similar existing data and an exploratory analysis.
Simulated Patient as a Learner: Medical Volunteers Gain Knowledge by Participating in a Wilderness Medicine Training Session
Authors: Comp Geoffrey , Foggia Michael , Blentlinger Cody , Bhattarai Bikash , Popescu Cornel , Ferrari Andrea 
Published: January 2025

Introduction —A multifaceted approach to wilderness medicine education and training is necessary to provide a high-quality learning experience, often requiring innovative instructional techniques. Using volunteers to act as patients in medical education is a well-established practice that helps teach crucial skills. However, more is needed to know if there is potential knowledge acquisition through participation. This study examined the educational benefits for medical students serving as a simulated patient (SP), hypothesizing that these individuals will improve self-assessed knowledge and confidence and demonstrate improved performance of injury-management skills while participating in a medical education course. Methods —A descriptive feasibility pilot study was conducted with 10 SPs to assess knowledge and skill acquisition. Study participants were evaluated before and after participating as an SP in 2 scenarios involving hemorrhage control and wrist injury assessment and management, with a subjective confidence survey and an objective skill and knowledge demonstration, as measured by a critical action checklist. Results —The subjects all reported self-assessed knowledge improvement from the pre- to postintervention survey, with an average increase of 17 points. They also demonstrated improved objective skill and knowledge demonstration, with an average increase of 4.6 points for the wrist injury scenario and 2.5 points for the hemorrhage control scenario. Conclusions —This study demonstrated that volunteer medical students acting as SPs in a medical training course passively acquire knowledge and improve their medical skills and self-perceived confidence. The findings contribute to a broader understanding of medical education, suggesting that participating as SPs offers educational benefits. The results encourage consideration of simulated patient roles as a valuable adjunct to medical education, warranting further scholarly exploration to substantiate and expand on these preliminary findings.
Low rates of dislocation and reoperation following robotic-assisted total hip arthroplasty for femoral neck fracture
Authors: O’Donnell Jeffrey A , Buchalter Daniel B , Borsinger Tracy M , Chandi Sonia K , Neitzke Colin C , Westrich Geoffrey H , Gausden Elizabeth B 
Published: January 2025

Introduction: Total hip arthroplasty (THA) is widely used for active, elderly patients with femoral neck fractures (FNF). Compared to THA for osteoarthritis, THA for FNF is associated with a higher incidence of dislocation and reoperation. Robotic assistance may improve component positioning and leg-length restoration in THA, but its use in FNF has not been described. The objective of this study was to assess the feasibility and perioperative outcomes of robotic-assisted THA (rTHA) for FNF. Methods: A retrospective review identified 93 patients undergoing 94 THAs for FNF from 2016 to 2023. 18 patients treated with MAKOplasty rTHA were compared to 76 non-rTHA. There were 69 (73%) women, the mean age was 71 years, and the mean follow-up was 3 years. Results: There was no significant difference in operative time between rTHA and non-rTHA cohorts (100 vs. 108 minutes, p = 0.19), and sub-analysis of acute FNFs (< 6 weeks), showed no difference in the meantime from presentation to surgery (18 vs. 25 hours, p = 0.24). There was no significant difference in mean leg-length discrepancy (LLD) ( p = 0.19), number of outliers for acetabular anteversion ( p = 0.80), or inclination ( p = 0.55). There were no postoperative dislocations or reoperations in the rTHA cohort, compared to 4 dislocations (5%) and 6 reoperations (8%) in the non-rTHA cohort ( p = 1.00 and 0.59, respectively). Conclusions: In this series of THA for FNF, robotic assistance did not significantly delay the time to surgery or increase the operative time compared to non-rTHA. At a mean follow-up of 3 years, there were no postoperative dislocations or reoperations in the rTHA cohort.
A real-world study to evaluate effectiveness of mepolizumab in treating severe asthma in Taiwan (REMIT)
Authors: Cheng Shih-Lung , Lin Shu-Min , Peng Chung-Kan , Chan Ming-Cheng , Shen Sheng-Yeh , Kuo Ping-Hung , Lai Chien-Hao , Lan Chou-Chin , Chen Chung-Yu , Lin Ching-Hsiung , Liao Kuang-Ming , Feng Po-Hao , Wu Jiin-Torng , Wei Yu-Feng , Xu Xiaomeng , Alfonso-Cristancho Rafael , Lai Tina , Navarro Aldo , Milea Dominique , Perng Diahn-Warng 
Published: January 2025

Background: REMIT is the first real-world study of mepolizumab effectiveness in patients with severe asthma (SA) in Taiwan. Objectives: The primary objective evaluated changes in clinically significant exacerbations (CSEs; defined as use of oral corticosteroids (OCS) or emergency department (ED) visits and/or hospitalizations) in the 12 months pre- and post-mepolizumab treatment. Secondary objectives assessed changes in the number of CSEs requiring ED visits/hospitalizations and daily maintenance OCS (mOCS) dosage 12 months pre- and post-mepolizumab treatment. Three- and four-component clinical remissions were analyzed based on OCS-free, exacerbation-free, and asthma control (± stability in lung function). Design: REMIT was a retrospective, observational, self-controlled study analyzing patients in Taiwan with SA who were newly prescribed subcutaneous mepolizumab 100 mg Q4W. Methods: Data were extracted from records of 15 medical centers in Taiwan for patients indexed between November 1, 2018 and October 31, 2020. Results: A total of 170 patients were included: mean age at index date, 58.7 years; 53.5% female; 100% Chinese; 7.1% with chronic rhinosinusitis with nasal polyps, 1.8% with eosinophilic granulomatosis with polyangiitis, 1.2% with hypereosinophilic syndrome; and 55.7% with blood eosinophil count >300/µL. Pre-treatment, 71.2% had ⩾2 exacerbations, and 28.7% were on mOCS; 75.3% had no prior biologic treatment, and 24.7% had switched from other biologics. Most patients (80.0%) completed ⩾10 mepolizumab doses. Following the first mepolizumab administration (index date), CSEs reduced by 46.0% (rate ratio (RR): 0.545, 95% confidence interval (CI): 0.418–0.710; p < 0.0001) in the 12 months post-index. Exacerbations requiring ED visits/hospitalization reduced by 46.9% (RR: 0.531, 95% CI: 0.349–0.808; p = 0.0031). Median mOCS dose reduced by 100% by end of study and 81.8% of patients discontinued mOCS post-treatment. After 1 year of mepolizumab treatment, 28% and 23% patients achieved three- and four-component clinical remission, respectively. Conclusion: Mepolizumab use in a patient population in Taiwan with SA significantly reduced CSEs and mOCS use in routine clinical practice.
Mycobacterium porcinum panniculitis in a cat from northern California
Authors: Lee Mary Ann , Woerde Dennis J , Reagan Krystle L , Wolf Tatiana G , Sykes Jane E 
Published: January 2025

Case summary A 9-year-old male castrated domestic shorthair cat from northern California was evaluated for a 12-month history of dermal and subcutaneous dermatitis in the inguinal region. Histopathologic examination of a biopsy revealed severe, chronic, multifocal to coalescing pyogranulomatous dermatitis and panniculitis, accompanied by ulceration and central necrosis. Aerobic bacterial culture of lesions yielded mycobacterial growth. Empiric antimicrobial therapy was initiated with doxycycline and marbofloxacin pending culture and susceptibility. Culture of a biopsy followed by rpoB gene sequencing at a mycobacterial reference laboratory yielded Mycobacterium porcinum after 6 weeks. Ten months after initial antimicrobial administration, the lesions resolved. Relevance and novel information To date, in cats, M porcinum panniculitis has been reported from Ohio, Massachusetts and British Columbia in North America; two additional cases were reported from southeastern Australia. In humans, M porcinum infections have been reported from several states in the USA, predominantly in the Midwest and coastal south, but not from the west. This report extends the known spatial distribution of M porcinum to the western USA and strengthens its association with panniculitis in cats. It also demonstrates the need for prolonged incubation for diagnosis of some rapidly growing mycobacteria infections using culture.