bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa
Authors: Kennedy Sarah H. , Bekele Mahteme , Berlin Nicholas L. , Ranganathan Kavitha , Hamill Jennifer B. , Haileselassie Etsehiwot , Oppong Joseph , Newman Lisa A. , Momoh Adeyiza O. 
Published: May 2023

Objective:
Assess quality of life and mental health implications of mastectomy for breast cancer on sub-Saharan African women.

Background:
Mortality rates amongst women diagnosed with breast cancer in sub-Saharan Africa (SSA) are high, with disparities in survival relative to women in high income countries partly attributed to advanced disease at presentation. Fears of the sequelae of mastectomy are a prominent reason for presentation delays. There is a critical need to better understand the effects of mastectomy on women in SSA to inform preoperative counseling and education for women with breast cancer.

Methods:
Women with breast cancer in Ghana and Ethiopia undergoing mastectomy were followed prospectively. Breast related quality-of-life and mental health measures were evaluated preoperatively, three and six months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Bivariate and logistic regression analyses evaluated changes in these measures for the total cohort and between sites.

Results:
A total of 133 women from Ghana and Ethiopia were recruited. The majority of women presented with unilateral disease (99%) and underwent unilateral mastectomy (98%) with axillary lymph node dissection. Radiation was more common in Ghana (P<0.001). Across most BREAST-Q subscales, women from both countries reported significantly decreased scores at three months postoperative. At six months, the combined cohort reported decreased scores for breast satisfaction (mean difference, -3.4). Women in both countries reported similar improvements in anxiety and depression scores postoperatively.

Conclusions:
Women from Ghana and Ethiopia who underwent mastectomy experienced a decline in breast-related body image while also experiencing decreased levels of depression and anxiety.
Safety and Efficacy of Iltamiocel Cellular Therapy for the Treatment of Fecal Incontinence. Results of a Phase 1/2 Study
Authors: Knowles Charles , Canestrari Emanuele , Jankowski Ron , Cardello Kelly , Raval Manoj J. 
Published: May 2023

Objective:
To examine the safety and efficacy of iltamiocel, an investigational cellular therapy of autologous muscle-derived cells, as a treatment for fecal incontinence (FI) in adults.

Background:
Limited therapeutic options are available for patients with FI refractory to conservative treatments. Cell therapy using autologous muscle-derived cells represents a promising, minimally invasive approach for restoring anal sphincter function.

Methods:
In this multicenter, prospective, non-randomized study, 48 participants were treated with a single iltamiocel dose of 250×106 cells. The primary outcome was the incidence of product or procedure-related adverse events (AEs) and serious adverse events (SAEs). Secondary outcomes were changes in number of FI episodes, Cleveland Clinic Incontinence Score (CCIS), Fecal Incontinence Quality of Life (FIQL), and anorectal manometry at 3, 6, and 12 months compared to baseline.

Results:
No SAEs and only one product-related AE of inflammation at the injection site were reported. At 12 months, there was a reduction in median FI episodes (-6.0; 95% CI: −10.0, −1.0) and days with episodes (−4.0; 95% CI: −8.0, −1.0). A ≥50% reduction in FI episodes was observed in 53.7% of participants, and 24.4% had complete restoration of continence. Symptom severity and quality of life improved with mean CCIS reduction (-2.9; 95% CI: - 3.7, −2.1), and FIQL increased (2.2; 95% CI:1.4, 2.9). No significant changes were detected in anorectal manometry measurements. A history of episiotomy was significantly associated with treatment response in multivariate analysis.

Conclusion:
The administration of iltamiocel cellular therapy is safe. Iltamiocel shows promise for significantly improving fecal incontinence symptoms and quality of life.
Ostomy-Related Quality of Life in Puerto Ricans Living With Inflammatory Bowel Disease
Authors: Lojo Juan J. , de la Villa Ricardo , Vega-Torres Mayte M. , Torres Esther A. 
Published: May 2023

PURPOSE:
The aim of this study was to determine ostomy-related quality of life (QOL) in Hispanic Puerto Ricans living with an enteral stoma and inflammatory bowel disease (IBD). We analyzed possible associations between QOL and sex, diagnosis, and type and duration of stoma.

DESIGN:
Prospective cohort study.

SUBJECTS AND SETTINGS:
The sample comprised 102 adults living with IBD and an ostomy; 60 of 101 (59.4%) were males, 44 of 102 (43.1%) had Crohn's disease, and 60 of 102 (58.9%) had an ileostomy. Participants were receiving care at the Center for IBD of the University of Puerto Rico in San Juan, Puerto Rico, between January 2012 and December 2014.

METHODS:
One-hundred two adults Puerto Ricans with IBD completed the Stoma Quality of Life (Stoma-QOL) questionnaire. Data were analyzed using frequency distributions for categorical variables and summary statistics for continuous variables. Independent-group t test and one-way analysis of variance, with the post hoc Tukey test, were used to determine group differences for the variables of age, sex, civil status, time living with an ostomy, type of ostomy, and IBD diagnosis. Results were analyzed according to the number of responses to each variable; the denominator varied for some variables.

RESULTS:
Having an ostomy for more than 40 months was significantly associated with a higher QOL score (59.0 vs 50.7; P = .05). Males had significantly higher scores than females (59.94 vs 50.23; P = .0019). Age, IBD diagnosis, and type of ostomy were not associated with the Stoma-QOL scores.

CONCLUSIONS:
The achievement (over 40 months) to attain improved ostomy-related QOL suggests that early training in the care of the ostomy and advanced planning when leaving home may enhance ostomy-related QOL. Lower QOL in women may represent an opportunity for a sex-specific educational intervention.
Frequency of Minor Shifts in Body Position and Pressure Injury Development
Authors: Efteli Elçin 
Published: May 2023

PURPOSE:
The purpose of this study was to evaluate the influence of minor shifts in body position on the development of pressure injuries.

DESIGN:
A prospective, comparative, descriptive study.

SUBJECTS AND SETTING:
The sample comprised 78 bedridden patients aged 18 years or older, free of pressure injuries, and hospitalized in the Neurology and Internal Medicine clinics and intensive care units. The study setting was a state hospital in Burdur Province, Southwest Turkey; data were collected between March and September 2018.

METHODS:
Patients were monitored once weekly until the end of their stay or until pressure injury development. Data were collected using a researcher-designed data collection form. Patients' ability to make minor shifts in body position was categorized between 0 and 3 per movement group.

RESULTS:
Twenty-one (26.9%) of 78 participants developed a pressure injury; 90.4% (n = 19) were stage 1 pressure injuries. Pressure injuries occurred in 94.1% of the patients who did not make shifts in body position versus 80% of the patients who performed shifts every 4 hours. No pressure injuries developed in those patients who moved every hour (P = .00).

CONCLUSIONS:
Study findings support the importance of making minor shifts in body position for prevention of pressure injury in bedridden patients.
Monitoring of Schools and Colleges of Pharmacy Based on NAPLEX Passage Rate
Authors: Shcherbakova Natalia , Pezzuto John M. 
Published: May 2023

AbstractIntroductionWe have evaluated two approaches of monitoring schools and colleges of pharmacy based on North American Pharmacist Licensure Examination® (NAPLEX®) passage rates. Historically, the Accreditation Council for Pharmacy Education (ACPE) has cited programs based on achieving a passage rate ≥2 SD standard deviations (SD) below the national average. Since the National Association of Boards of Pharmacy (NABP) no longer reports scores, this procedure is currently being reconsidered. Our supposition is that the failure rate of ≥2 SD below the average passage rate should be retained, but now, based on the national average passage rate. However, we further suggest this is not adequate, due to major variations in class size.CommentaryWe suggest the establishment of a ‘maximum acceptable failure count’, likely in the range of 20-25 failing graduates per class. Analyses of data from 2017-2019 indicate that this approach would lead to monitoring approximately 15% of existing programs that graduate approximately 40% of individuals failing NAPLEX, versus monitoring approximately 5% of programs that graduate approximately 9% of individuals failing NAPLEX.ImplicationsThe historical method of monitoring pharmacy programs with NAPLEX passage based on the national average ≥2 SD is not adequate, primarily due large variations in class size. In that accreditation standards are currently being revised (“Standards 2025”), this would be an ideal time to reconsider methods for selecting programs that warrant monitoring based on inadequate NAPLEX passage rates. We suggest the concept of ‘maximum acceptable failure count’ should be taken into account when identifying programs to be cited.
Retinoblastoma Detection via Image Processing and Interpretable Artificial Intelligence Techniques
Authors: Duraivenkatesh Surya , Narayan Aditya , Srikanth Vishak , Made Adamou Fode 
Published: May 2023

AbstractRetinoblastoma (RB) is a treatable ocular melanoma that is diagnosed early and subsequently cured in the United States but has a poor prognosis in low- and middle-income countries (LMICs). This study outlines an approach to aid health-care professionals in identifying RB in LMICs. Transfer learning methods were utilized for detection from fundus imaging. One hundred and forty RB+ and 140 RB-images were acquired from a previous deep-learning study. Next, five models were tested: VGG16, VGG19, Xception, Inception v3, and ResNet50, which were trained on the two-hundred-and-eighty image dataset. To evaluate these models, the Dice Similarity Coefficient (DSC) and Intersection-over-Union (IoU) were used. Explainable AI techniques such as SHAP and LIME were implemented into the best-performing models to increase the transparency of their decision-making frameworks, which is critical for the use of AI in medicine. We present that VGG16 is the best at identifying RB, though the other models achieved great levels of prediction. Transfer learning methods were effective at identifying RB, and explainable AI increased viability in clinical settings.
Intermuscular Adiposity is Associated with Coronary Microvascular Dysfunction Independently of Body Mass Index and Modifies its Effect on Adverse Cardiovascular Outcomes
Authors: Souza Ana C. , Amelie S. Troschel , Jan P. Marquardt , Filipe A. Moura , Sanjay Divakaran , Jon Hainer , Ron Blankstein , Sharmila Dorbala , Marcelo F. Di Carli , Florian J. Fintelmann , Viviany R. Taqueti 
Published: May 2023

AbstractBackground:Skeletal muscle (SM) fat infiltration, or intermuscular adipose tissue (IMAT), reflects muscle quality and is associated with inflammation, a key determinant in cardiometabolic disease. Coronary flow reserve (CFR), a marker of coronary microvascular dysfunction (CMD), is independently associated with BMI, inflammation and risk of heart failure, myocardial infarction and death. We sought to investigate the relationship between skeletal muscle quality, CMD and cardiovascular outcomes.Methods:Consecutive patients (N=669) undergoing evaluation for CAD with cardiac stress PET demonstrating normal perfusion and preserved left ventricular ejection fraction were followed over median 6 years for major adverse cardiovascular events (MACE), including death and hospitalization for myocardial infarction or heart failure. CFR was calculated as stress/rest myocardial blood flow and CMD defined as CFR<2. Subcutaneous adipose tissue (SAT), SM and IMAT areas (cm2) were obtained from simultaneous PET attenuation correction CTs using semi-automated segmentation at the twelfth thoracic vertebra (T12) level.Results:Median age was 63 years, 70% were female and 46% nonwhite. Nearly half of patients were obese (46%, BMI 30-61) and BMI correlated highly with SAT and IMAT (r=0.84 and 0.71, respectively, p<0.001) and moderately with SM (r=0.52, p<0.001). Decreased SM and increased IMAT, but not BMI or SAT, remained independently associated with decreased CFR (adjusted p=0.03 and p=0.04, respectively). In adjusted analyses, both lower CFR and higher IMAT were associated with increased MACE [HR 1.78 (1.23-2.58) per -1U CFR and 1.53 (1.30-1.80) per +10 cm2IMAT, adjusted p=0.002 and p<0.0001, respectively], while higher SM and SAT were protective [HR 0.89 (0.81-0.97) per +10 cm2SM and 0.94 (0.91-0.98) per +10 cm2SAT, adjusted p=0.01 and 0.003, respectively]. Every 1% increase in fatty muscle fraction [IMAT/(SM+IMAT)] conferred an independent 2% increased odds of CMD [CFR<2, OR 1.02 (1.01-1.04), adjusted p=0.04] and a 7% increased risk of MACE [HR 1.07 (1.04-1.09), adjusted p<0.001]. There was a significant interaction between CFR and IMAT, not BMI, such that patients with both CMD and fatty muscle demonstrated highest MACE risk (adjusted p=0.02).Conclusion:Increased intermuscular fat is associated with CMD and adverse cardiovascular outcomes independently of BMI and conventional risk factors. The presence of CMD and skeletal muscle fat infiltration identified a novel at-risk cardiometabolic phenotype.
How does ChatGPT4 preform on Non-English National Medical Licensing Examination? An Evaluation in Chinese Language
Authors: Fang Changchang , Ling Jitao , Zhou Jing , Wang Yue , Liu Xiaolin , Jiang Yuan , Wu Yifan , Chen Yixuan , Zhu Zhichen , Ma Jianyong , Yan Ziwei , Yu Peng , Liu Xiao 
Published: May 2023

AbstractBackgroundChatGPT, an artificial intelligence (AI) system powered by large-scale language models, has garnered significant interest in the healthcare. Its performance dependent on the quality and amount of training data available for specific language. This study aims to assess the of ChatGPT’s ability in medical education and clinical decision-making within the Chinese context.MethodsWe utilized a dataset from the Chinese National Medical Licensing Examination (NMLE) to assess ChatGPT-4’s proficiency in medical knowledge within the Chinese language. Performance indicators, including score, accuracy, and concordance (confirmation of answers through explanation), were employed to evaluate ChatGPT’s effectiveness in both original and encoded medical questions. Additionally, we translated the original Chinese questions into English to explore potential avenues for improvement.ResultsChatGPT scored 442/600 for original questions in Chinese, surpassing the passing threshold of 360/600. However, ChatGPT demonstrated reduced accuracy in addressing open-ended questions, with an overall accuracy rate of 47.7%. Despite this, ChatGPT displayed commendable consistency, achieving a 75% concordance rate across all case analysis questions. Moreover, translating Chinese case analysis questions into English yielded only marginal improvements in ChatGPT’s performance (P =0.728).ConclusionChatGPT exhibits remarkable precision and reliability when handling the NMLE in Chinese language. Translation of NMLE questions from Chinese to English does not yield an improvement in ChatGPT’s performance.
Low-cost predictive models of dementia risk using machine learning and exposome predictors
Authors: Camacho Marina , Atehortúa Angélica , Wilkinson Tim , Gkontra Polyxeni , Lekadir Karim 
Published: May 2023

AbstractDiagnosing dementia, a syndrome that currently affects more than 55 million people worldwide, remains a particularly challenging and costly task. It may involve undertaking several medical tests such as brain scans, cognitive tests and genetic tests to determine the presence and degree of cognitive decline. These procedures are associated with long procedures, subjective evaluations and high costs. As a result, patients are often diagnosed at a late stage, when symptoms become highly pronounced. Therefore, there is an urgent need for developing new strategies for early, accurate and cost-effective dementia screening and risk prediction. To overcome current limitations, we explored readily available exposome predictors for identifying individuals at risk of dementia and compared traditional statistical modeling and advanced machine learning.From approximately 500,000 participants from the UK Biobank, 1523 participants diagnosed with dementia after their baseline assessment visit were included in our study. An equal number of healthy participants were randomly selected as the control group by matching statistical age mean and sex distribution. This resulted in a total of 3046 participants being selected for our study; 2740 participants from 19 of the 22 UK Biobank assessment centers were used for internal validation, and 306 participants from the remaining three centers were selected for external validation. We include data from the participants’ baseline visit and selected 128 low-cost exposome factors related to life course exposures that may be easily acquired through simple questionnaires. Subsequently, data imputation was performed to account for missing patient data. Two different predictive models were assessed for discriminating between participants that remained healthy and participants diagnosed with dementia after the baseline visit, i.e. (1) a classical logistic regression linear classifier and (2) a machine learning ensemble classifier based on XGBoost. We interpreted the results by estimating feature importance within the predictive models.Our results demonstrate that machine learning models based on exposome data can reliably identify individuals that will be diagnosed with dementia. The XGBoost based model outperforms logistic regression model, achieving a mean AUC of 0.88 in the external validation tests. We identified novel exposome factors that might be combined as potential markers for dementia, such as facial aging, the frequency of use of sun/ultraviolet light protection, and the length of mobile phone use. Finally, we propose a novel neurocognitive assessment test that could be used as an online tool to screen individuals at risk of dementia for enrolment in preventive interventions and future clinical trials.
The plasma metabolome of long COVID-19 patients two years after infection
Authors: López-Hernández Yamilé , Aquino Joel Monárrez , García López David Alejandro , Zheng Jiamin , Borrego Juan Carlos , Torres-Calzada Claudia , Elizalde-Díaz José Pedro , Mandal Rupasri , Berjanskii Mark , Martínez-Martínez Eduardo , López Jesús Adrián , Wishart David S. 
Published: May 2023

ABSTRACTBackgroundOne of the major challenges currently faced by global health systems is the prolonged COVID-19 syndrome (also known as “long COVID”) which has emerged as a consequence of the SARS-CoV-2 epidemic. The World Health Organization (WHO) recognized long COVID as a distinct clinical entity in 2021. It is estimated that at least 30% of patients who have had COVID-19 will develop long COVID. This has put a tremendous strain on still-overstretched healthcare systems around the world.MethodsIn this study, our goal was to assess the plasma metabolome in a total of 108 samples collected from healthy controls, COVID-19 patients, and long COVID patients recruited in Mexico between 2020 and 2022. A targeted metabolomics approach using a combination of LC-MS/MS and FIA MS/MS was performed to quantify 108 metabolites. IL-17 and leptin concentrations were measured in long COVID patients by immunoenzymatic assay.ResultsThe comparison of paired COVID-19/post-COVID-19 samples revealed 53 metabolites that were statistically different (FDR < 0.05). Compared to controls, 29 metabolites remained dysregulated even after two years. Notably, glucose, kynurenine, and certain acylcarnitines continued to exhibit altered concentrations similar to the COVID-19 phase, while sphingomyelins and long saturated and monounsaturated LysoPCs, phenylalanine, butyric acid, and propionic acid levels normalized. Post-COVID-19 patients displayed a heterogeneous metabolic profile, with some showing no symptoms while others exhibiting a variable number of symptoms. Lactic acid, lactate/pyruvate ratio, ornithine/citrulline ratio, sarcosine, and arginine were identified as the most relevant metabolites for distinguishing patients with more complicated long COVID evolution. Additionally, IL-17 levels were significantly increased in these patients.ConclusionsMitochondrial dysfunction, redox state imbalance, impaired energy metabolism, and chronic immune dysregulation are likely to be the main hallmarks of long COVID even two years after acute COVID-19 infection.
SARS-CoV-2 specific cellular and humoral immunity after bivalent BA.4/5 COVID-19 vaccination in previously infected and non-infected individuals
Authors: Urschel Rebecca , Bronder Saskia , Klemis Verena , Marx Stefanie , Hielscher Franziska , Abu-Omar Amina , Guckelmus Candida , Schneitler Sophie , Baum Christina , Becker Sören L. , Gärtner Barbara C. , Sester Urban , Widera Marek , Schmidt Tina , Sester Martina 
Published: May 2023

AbstractKnowledge is limited as to how prior SARS-CoV-2 infection influences cellular and humoral immunity after booster-vaccination with bivalent BA.4/5-adapted mRNA-vaccines, and whether vaccine-induced immunity correlates with subsequent infection. In this observational study, individuals with prior infection (n=64) showed higher vaccine-induced anti-spike IgG antibodies and neutralizing titers, but the relative increase was significantly higher in non-infected individuals (n=63). In general, both groups showed higher neutralizing activity towards the parental strain than towards Omicron subvariants BA.1, BA.2 and BA.5. In contrast, CD4 or CD8 T-cell levels towards spike from the parental strain and the Omicron subvariants, and cytokine expression profiles were similar irrespective of prior infection. Breakthrough infections occurred more frequently among previously non-infected individuals, who had significantly lower vaccine-induced spike-specific neutralizing activity and CD4 T-cell levels. Thus, the magnitude of vaccine-induced neutralizing activity and specific CD4 T-cells after bivalent vaccination may serve as a correlate for protection in previously non-infected individuals.