bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peak serum lactate as a robust predictor of imminent death in life-sustaining treatment decisions: A study of 73,927 patients
Authors: Kim Dong Jung , Kim Hyun Joo , Chang Hyoung Woo 
Published: January 2025

Objective: The physician order for life-sustaining treatment has been implemented in clinical practice for several years. However, the determination that a patient is in the terminal phase of life, a prerequisite for the withdrawal of life-sustaining treatment, lacks objective criteria. This study aimed to evaluate whether hyperlactatemia could serve as a reliable objective indicator for determining the terminal phase. Methods: In this retrospective cohort study, we included 73,927 patients admitted to our institution from 2018 to 2023 who had at least one blood lactate measurement. We collected data on the highest blood lactate level measured during hospitalization, mortality, medical department, and intensive care unit (ICU) details. The primary endpoint was 30-day mortality, and we analyzed how well the highest lactate level during hospitalization predicted 30-day mortality across different age groups, medical departments, and ICUs. Results: Among the patients, 5493 died within 30 days of the maximum lactate measurement. The area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality based on the maximum lactate level was 0.870 (95% confidence interval [CI] 0.865–0.875) in all patients, indicating high accuracy. Setting the cutoff for the maximum lactate level at 20 mmol/L resulted in a precision of 87% and specificity of 99.8%. Subgroup analyses by age, medical department, and ICU yielded consistent results. Conclusions: Severe hyperlactatemia during hospitalization showed high precision and specificity for predicting 30-day mortality across various patient groups. These findings suggest that hyperlactatemia could serve as an objective auxiliary indicator for determining the terminal phase, potentially improving consistency in end-of-life decision-making in clinical practice.
The outcome of late open conversion after endovascular abdominal aortic repair
Authors: Nishiori Hironobu , Inui Tomohiko , Watanabe Michiko , Kohno Hiroki , Matsuura Kaoru , Ikeuchi Hiroki , Kanda Tomoyoshi , Ito Chihiro , Yamamoto Hiroaki , Shibata Yusuke , Yamamoto Takashi , Nagahama Maiko , Matsumiya Goro 
Published: January 2025

Background Endovascular abdominal aneurysm repair (EVAR) offers a less invasive approach to treating abdominal aortic aneurysms (AAA) compared to open repair. However, EVAR is associated with higher rates of reintervention. This study investigates the early and mid-term outcomes of patients who underwent late open conversion including aneurysmorrhaphy after EVAR at our institution. Methods We conducted a retrospective cohort study of 29 patients who underwent late open conversion for AAA dilatation after EVAR between April 2015 and March 2022 at Chiba University Hospital. Surgical strategies included an artificial graft replacement for Type Ia endoleak (EL), Type III EL from stent graft main body, ruptured cases, and aneurysmorrhaphy with branch ligation for Type II EL. Results The average time from EVAR to open conversion was 4.1 ± 2.3 years. There have been no reported cases of in-hospital mortality to date. Aneurysmorrhaphy demonstrated shorter operative times (239 ± 65 min) and lower red blood cell transfusion volumes (2.7 ± 4.2 units) compared to graft replacement. Postoperative complications included spinal cord ischemia in one patient and three patients requiring reintervention due to persistent or new ELs, who underwent angiography. The seven-year all-cause mortality rate was 78.5%. Among cases that underwent aneurysmorrhaphy, postoperative computed tomography scans showed a reduction in the maximum aortic diameter from 65 ± 6 mm preoperatively to 42 ± 10 mm postoperatively and 36 ± 11 mm at follow-up. Conclusions Late open conversion including aneurysmorrhaphy after EVAR appears to be safe and effective, with no in-hospital mortality and low complication rates. Careful preoperative planning and appropriate surgical techniques are essential for optimizing outcomes.
Enhancing safety monitoring in post-stroke rehabilitation through wearable technologies
Authors: Rech Kátia , da Cunha Maira Jaqueline , Salazar Ana Paula , Almeida Rosicler da Rosa , Pedrini Schuch Clarissa , Balbinot Gustavo 
Published: January 2025

Objective Current clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Technology enables monitoring of exercise and therapy intensity, but safety concerns could also be addressed. This study explores functional mobility in post-stroke individuals using wearable technology to quantify movement smoothness—an indicator of safe mobility. Design Observational cohort study. Setting A movement analysis and rehabilitation laboratory. Participants A total of 56 chronic post-stroke individuals and 51 healthy controls. Intervention Participants performed the mobility test while wearing an inertial measurement unit attached to their waist. Thirty-two healthy participants also engaged in a steady-state walking task. Main measures Functional mobility smoothness by examining angular velocities in the yaw, pitch, and roll axes, employing the spectral arc length metrics. Results Our findings reveal that post-stroke individuals extend the duration of the timed-up-and-go test (≈9 s and 23 s longer compared to the controls) to ensure safe mobility—greater mobility smoothness ( p < 0.001). Notably, for mild and severe impairments, post-stroke mobility demonstrated ≈8% and ≈11% greater smoothness in pitch movements, respectively ( p = 0.025 and p = 0.002). In the roll direction, mobility was ≈12% smoother in cases of severe strokes ( p = 0.006). Conclusion This study addresses a crucial gap in the understanding of mobility smoothness in chronic stroke survivors using wearable technology. Our study suggests the potential utility of spectral arc length to predict challenging mobility situations in real-world situations. We highlight the potential for automated monitoring of safety offering promising avenues for real-time, real-life monitoring.
A conceptual and statistical framework for delineating the timing of a stratigraphic transition: Holocene-Anthropocene boundary as a case study
Authors: Ön Zeki Bora , Ateş Mustafa Efe , Kaiser Jérôme 
Published: January 2025

The AWG (Anthropocene Working Group) proposed 1952 CE as the onset of the Anthropocene, marked by the detonation of the first hydrogen bomb, and designates Crawford Lake’s sediments in Canada as the potential stratotype. While the proposal for the Anthropocene as an epoch has been rejected by the SQS (Subcommision on Quaternary Stratigraphy), ongoing discussions regarding this debate remain unresolved. Here, we explore the possible biases and pitfalls of selecting the onset date from a singular site as the GSSP (Global boundary Stratotype Section and Point) for a chronostratigraphic boundary, using the potential Holocene-Anthropocene boundary as an example. We address the challenges of identifying changes in anthropogenic markers, along with the inherent measurement and age uncertainties, by employing a multilevel Bayesian change point analysis integrated with an errors-in-variables approach applied to proxy data. Our analysis utilizes plutonium isotopes ((239+240)Pu), SCPs (spheroidal carbonaceous fly-ash particles), and radiocarbon (F14C) records from multiple locations established to evidence global anthropogenic imprints. Key findings include the identification of a population-level change point for (239+240)Pu at 1953 CE (1951.5–1954.5). While the standard practice for defining the onset date of a stratigraphic boundary typically involves selecting the date from the stratotype, our results suggest that 1953 CE should be the preferred date to define the onset of a potential Anthropocene Epoch. However, 1952 CE, which coincides with the first H-bomb test, cannot be statistically rejected as an alternative. Geographical clustering of SCPs data highlights regional variations in proxy signatures, while F14C results emphasize a lag of 5.5–9 years corresponding to carbon residence time. Our research contributes to discussions surrounding the delineation of a potential boundary between the Holocene and Anthropocene Epochs. Additionally, it provides methodological insights into identifying change points in multiple datasets and temporal lags in the environmental impacts of human activities.
Uncovering the State of Current Data on Quadriceps Tendon Autograft Use Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction at ≥5 Years After Surgery: A Systematic Review and Meta-analysis
Authors: Kurkowski Sarah C. , Thimmesch Michael J. , Murphy Meredith , Kuechly Henry A. , Emmert Andrew S. , Grawe Brian 
Published: January 2025

Background: The use of quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction has been increasing since 2014. Studies have shown that QT is comparable to hamstring tendon (HT) and bone–patellar tendon–bone (BTB) autografts in terms of outcomes, although QT autograft has lower rates of donor site morbidity. Systematic reviews and meta-analyses have been previously conducted on this topic, although none have focused solely on data of patients at least 5 years out from surgery. Hypothesis/Purpose: The purpose of this meta-analysis was to demonstrate that QT may not be superior to BTB and HT autografts and that long-term studies must be performed before recommending QT over other graft choices. It was hypothesized that there would be less available data at ≥5 years of follow-up for patients with QT than those with HT and BTB autografts, and that patient-reported outcomes would be similar between all 3 graft choices. Study Design: Meta-analysis; Level of evidence, 4. Methods: The PubMed/MEDLINE, Scopus (Elsevier), Embase, and Cochrane Library databases were queried for studies that reported on QT, BTB, or HT outcomes at ≥5 years after ACL reconstruction (ACLR). In total, 27 studies were included; patient and outcome data were collected from each. Summary odds ratios were calculated for each outcome and compared between all graft types. Results: The sheer volume of available patient data on QT autografts at ≥5 years after ACLR is vastly different from what is available on HT and BTB autografts (which have almost 3 times the amount of patient data as compared with QT). HT had the highest failure rate (12.7%), followed by QT (9.1%) and BTB (6.4%); summary odds ratios favored BTB over both QT and HT in terms of failure rate. Patient-reported outcomes were comparable between graft types, although some comparisons were not adequately powered. Conclusion: This meta-analysis reveals critical information on the current state of the literature surrounding QT use in ACLR. Most notably, additional mid-term and long-term patient data are needed on those undergoing ACLR with QT autograft. There is not enough long-term outcome data on QT to recommend it over HT or BTB for primary ACLR.
High Intensity Physician-Based Service Use for Mental Health Concerns in a General-Population Sample of Children and Youth: Utilisation des services de haute intensité dispensés par des médecins pour les problèmes de santé mentale dans un échantillon d’enfants et de jeunes de la population générale
Authors: Edwards Jordan , Wang Li , Fuller Anne E. , Anderson Kelly K. , de Oliveira Claire , Georgiades Katholiki 
Published: January 2025

Objective To examine factors associated with high intensity physician-based mental health care services in a population-based sample of children and youth in Ontario, Canada. Methods Data from the 2014 Ontario Child Health Study (OCHS) were linked at the person-level to longitudinal health administrative databases containing physician contacts in outpatient settings, emergency departments and hospitals. Our analytical sample (15.8% of 9,301, n = 1,423) included children and youth with at least one physician-based contact for a mental health concern in the 24-month period post-OCHS. Over the same follow-up period, we classified high intensity service use as those in the top 10th and fifth percentiles of physician-based mental health service cost contributors. Costs were assessed using physician billing data, as well as estimated emergency department visit and hospitalization costs. Results Among those with at least one contact, being older (PR: 1.15, 95% CI: 1.04, 1.25), having more severe symptoms of mental ill-health (PR: 1.04, 95% CI: 1.01, 1.06) and having a history of mental health service use (PR: 3.99, 95% CI: 1.37, 11.61), were positively associated with high-intensity service use, while living in a rural setting (PR: 0.35, 95% CI: 0.15, 0.30) was negatively associated. Findings were largely consistent between the top 10th and fifth percentiles. Notably, among youth ages 14–17 years, self-reported prior suicide attempt was positively associated with high-intensity (top fifth percentile) service use (PR: 6.09, 95% CI: 1.41, 26.26). Conclusions Our findings suggest older age, non-rural residency, mental health symptom severity and suicidal behaviour are important factors associated with high-intensity physician-based mental health service use. Our findings will inform efforts to better identify children and youth who may benefit from early and personalized interventions. Plain Language Summary Title Understanding Children and Youth with the Greatest Mental Health Related Service Needs.
Impact of Anticholinergic Burden and Clinical-Demographic Characteristics on Incident Dementia in Parkinson Disease
Authors: Pham Nguyen Thanh Phuong , Thibault Dylan , Gray Shelly L. , Weintraub Daniel , Willis Allison W. 
Published: January 2025

Purpose Anticholinergic medication use measured via the Anticholinergic Cognitive Burden (ACB) scale has been associated with an increased dementia incidence in older adults but has not been explored specifically for Parkinson disease dementia (PDD). We used adjusted Cox models to estimate the risk of incident PDD associated with demographic factors, clinical characteristics, and time-varying total ACB in a longitudinal, deeply-phenotyped prospective PD cohort. Major findings 56.5% of study participants were taking ACB-scale drugs at enrollment. Increasing age, motor symptom burden and psychosis were associated with PDD risk. Female sex and educational achievement were protective against PDD. ACB categories were not associated with PDD overall, but depression and impulse control disorder were strongly associated with PDD in a subsample with high baseline ACB. Conclusions Patient and clinical factors modify PDD risk. PD drug safety and drug-disease interaction studies may require considering multiple mechanisms and including dose-based, prospectively acquired medication exposure measures.
Prospective Study of lncRNA NORAD for Predicting Cerebrovascular Events in Asymptomatic Patients with Carotid Artery Stenosis
Authors: Fan Yan , Ma Yan , Wang Rui , Wang Lili 
Published: January 2025

Background Carotid artery stenosis (CAS) may cause many cerebrovascular diseases, and a biomarker for screening and monitoring is needed. This study focused on the clinical significance of long-chain non-coding RNA (lncRNA) non-coding RNA activated by DNA damage (NORAD) in patients with CAS and aimed to search for potential biomarkers of CAS. Methods Eighty-six asymptomatic patients with CAS and 60 healthy individuals were enrolled, with corresponding clinical data and serum samples collected. The expression of NORAD was detected by reverse transcription-quantitive PCR (RT-qPCR). All patients were followed up for 2 years to collected the occurrence data of cerebrovascular events, and Kaplan-Meier and Cox regression were used for data analysis. Receiver operator characteristic curve was used to analyze the diagnostic value of NORAD in distinguishing CAS patients from healthy people, and to evaluate the prediction accuracy of NORAD. Results NORAD is overexpressed in the serum of CAS patients, and associated with patients’ hypertension, TC, LDL-C levels and stenosis degree. NORAD has high sensitivity (88.37%) and specificity (80.00%) in the identification of CAS patients (AUC = 0.917). NORAD was independently related to the occurrence of cerebrovascular events (HR = 2.435, P = .003). a logistic regression risk model for predicting cerebrovascular events was constructed with the parameters including NORAD, TC and LDL. Conclusion NORAD can be used as a diagnostic and prognostic biomarker for CAS, and NORAD, total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) can be independently correlated to predict cerebrovascular events.
Analysis of Risk Factors and the Establishment of a Predictive Model for Thrombosis in Patients with Immune Thrombocytopenia
Authors: Liang Hui , Duan Lingxue , Long Manyu , Tie Songyuan , Sun Changyan , Ma Sha , Wang Jing , Wang Shuya 
Published: January 2025

Objectives To explore the risk factors for thrombi occurring in patients with immune thrombocytopenia (ITP) and establish a risk prediction model to better predict the risk of thrombosis in patients with ITP. Methods We retrospectively analyzed 350 ITP patients who had been hospitalized in the First People's Hospital of Yunnan Province between January 2024 and June 2024. For all patients, we recorded demographic characteristics and clinical data, analyzed the risk factors for thrombosis in ITP patients and then developed a risk prediction model. Results Stepwise logistic regression analysis indicated that a high D-dimer level, a low PC (platelet count) and a high Padua score were independent risk factors for thrombosis in ITP patients. According to multivariate analysis, a predictive model for thrombus risk showed that the area; the area under the ROC curve (AUC) was 0.673 (95% CI: 0.615-0.730) and the maximum Youden index, sensitivity and specificity were 0.272, 47.0% and 80.2%, respectively. Conclusion A high D-dimer level, low PC, and high Padua score were shown to be independent risk factors for thrombosis in ITP patients. Also, the study showed that these three risk factors might be used as a risk predictors for thrombosis in ITP patients to some extent.
“Triple and Plan” (TriPla) regimen for long lasting new generation intravitreal anti-VEGF
Authors: Beretta Federico , Sacconi Riccardo , Querques Lea , Prascina Francesco , Zucchiatti Ilaria , Bandello Francesco , Querques Giuseppe 
Published: January 2025

Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) medications are the primary treatment for neovascular age-related macular degeneration (nAMD). However, frequent administrations pose significant burdens on patients, healthcare providers, and systems. The treat-and-extend (T&E) regimen, which adjusts treatment intervals based on patient response, aims to reduce injection frequency while maintaining disease control. The “Triple and Plan” (TriPla) regimen, developed during the COVID-19 pandemic, further optimizes treatment by scheduling three consecutive injections, thus minimizing clinic visits while ensuring adequate treatment. Newer agents such as Faricimab, Aflibercept 8 mg, and Brolucizumab offer longer-lasting effects, potentially extending treatment intervals. Faricimab, targeting both Ang-2 and VEGF-A, requires fewer injections and visits under the TriPla regimen compared to traditional T&E. Aflibercept 8 mg, with its higher concentration, promises extended intervals up to 16 weeks, reducing the injection frequency. Brolucizumab, notable for its small size and effective tissue penetration, also offers prolonged therapeutic effects but requires careful monitoring due to potential adverse events. In the first two years of treatment, patients using the TriPla regimen with these new drugs would undergo a slightly higher number of injections but with fewer clinic visits compared to the T&E regimen. The TriPla approach optimizes scheduling and reduces the workload on specialists, potentially improving patient care and healthcare system efficiency. These advancements in treatment regimens and drug formulations present significant benefits in managing nAMD, balancing effective disease control with reduced healthcare burdens.
Detection of microplastics in pterygium tissue: Implications for environmental hazards
Authors: Choi Yun-Hee , Park Nayoon , Park Seul-Ah , Kim Juyang , Jung Jaehak , Choi Yoon-Hyeong , Kim Dong Hyun 
Published: January 2025

Purpose This study aimed to report a case of microplastics (MPs) detection in a pterygium patient's tissue. Case report A pterygium specimen was obtained from the right eye of a 43-year-old woman by surgical removal of a recurred pterygium. The number, morphology, and material type of the MPs in pterygium were identified using Raman microscopy and scanning electron microscopy. Ten MPs were detected in the pterygium, which corresponded to polyethylene (PE) (n = 7), polystyrene (PS) (n = 2), and polypropylene (PP) (n = 1). The size of MPs ranged from 5–9 µm (n = 5, PE or PS), 10–19 µm (n = 4, PE), and 50–99 µm (n = 1, PP). All MPs were transparent and irregular fragments. Conclusions This study demonstrated the detection of MPs in the pterygium tissue. Our findings suggest that environmental hazards, such as MP, may be commonly exposed to the ocular surface.
Murphy's Law in cataract surgeries: A retrospective analysis
Authors: Singh Bhangu Jaskaran , Stewart Christopher , Bakhiet Tamsin , Ho Derek Kwun-hong , Parmar Tina , Tolley Suzanne , Williams Gwyn Samuel 
Published: January 2025

Objective Around 400,000 cataract operations are performed annually in the UK, with a complication rate of 1.95% and the associated financial costs at over £13 million. Cataract operations are occasionally cancelled when patients cannot attend. To fully utilize theatre time, agreeable patients may be directly sent for surgery from assessment clinics. This study investigates the validity of “Murphy's Law” in ophthalmology, namely, whether there is an increase in complication rates amongst these ‘add-on’ cases. Design & Participants Retrospective study to compare data of add-on phacoemulsification operations against the departmental baseline. Methods Chi-square test was used to determine whether the complication rates differed significantly. 1-sided p-value of <0.05 was considered to be significant. Results 227 ‘add-on’ cases were identified, of which 3 complications occurred. Departmental baseline of 4289 operations resulted in 44 complications. These represented complication rates of 1.32% and 1.03%, respectively. The level of surgical difficulty between the two groups were comparable. Statistical comparison of these complication rates demonstrated a p-value of 0.67, indicating that Murphy's Law is not significant. Conclusions This is the first study of its kind to examine the rates of adverse outcomes in unscheduled ‘add-on’ cataract surgeries, a commonly deployed method to maximize eye theatre time usage. Our data suggested no significant difference in complication rates between the add-on operations and local baseline. Thus, we demonstrated that the practice of same day proceeding from pre-operative assessment clinic to the operating table is a safe option to optimize theatre time use, should a surgery cancellation arise.