bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial
Authors: Zumbansen Anna , Kneifel Heike , Lazzouni Latifa , Ophey Anja , Black Sandra E. , Chen Joyce L. , Edwards Dylan , Funck Thomas , Hartmann Alexander Erich , Heiss Wolf-Dieter , Hildesheim Franziska , Lanthier Sylvain , Lespérance Paul , Mochizuki George , Paquette Caroline , Rochon Elizabet , Rubi-Fessen Ilona , Valles Jennie , Wortman-Jutt Susan , Thiel Alexander ,   on behalf of the NORTHSTAR-study group
Published: March 2022

Background & objective Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery ( P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/ P = .015). There was no significant rTMS effect in the chronic aphasia group. Conclusions The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration https://clinicaltrials.gov/ct2/show/NCT02020421 .
Posterior Approach With Small Incision Is a Safe Alternative to Anterior Approach for Hamstring Autograft Harvest in Adolescents
Authors: Aitchison Alexandra H. , Schlichte Lindsay M. , Heath Madison R. , Fabricant Peter D. , Green Daniel W. 
Published: March 2022

Background: There are potential drawbacks and complications associated with using the anterior approach to harvest the hamstring tendon as an autograft source for anterior cruciate ligament (ACL) and medial patellofemoral ligament (MPFL) reconstruction. A posterior harvest technique has been described as an alternative to an anterior approach in skeletally mature patients. The 2 approaches have not been compared in adolescents. Purpose: We sought to compare the incision size and harvested tendon length produced by anterior and posterior hamstring harvest techniques in an adolescent population. Methods: After obtaining consent, we prospectively collected data on a consecutive series of 115 adolescents undergoing ACL or MPFL reconstruction, including the length of the incision and of the harvested hamstring tendon. Demographic information including age, sex, and body mass index (BMI) was collected at the time of surgery. Results: The mean age at the time of surgery was 14.3 ± 1.8 years (range: 9–21 years), and 43% (N = 50) of participants were male. Of the 115 hamstring autografts, 26 were harvested anteriorly and 89 were harvested posteriorly. Neither mean semitendinosus length nor mean gracilis length was significantly different when harvested anteriorly versus posteriorly. The posterior harvest group had a mean incision length that was significantly smaller than that of the anterior harvest group. No iatrogenic nerve injuries or neurovascular complications were observed in either group. Conclusion: A posterior incision for hamstring autograft harvest provided an alternative approach in adolescents, which resulted in a 20% smaller incision than an anterior approach. For procedures such as MPFL reconstruction that do not require concomitant anteromedial work, posterior hamstring harvest may be used to improve cosmesis while producing viable hamstring autograft tissue for surgical reconstruction.
Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic
Authors: Bourke M , Williams N , Dowdall J , Barry MC 
Published: March 2022

Background The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes Aim The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. Results Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year. Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. Conclusion Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.
Eptifibatide bridging therapy for staged carotid artery stenting and cardiac surgery: Safety and feasibility
Authors: Caton M Travis , Narsinh Kazim H , Baker Amanda , Amans Matthew R , Hetts Steven W , Rapp Joseph H , Ianuzzi James C , Tseng Elaine , Gasper Warren J , Cooke Daniel L 
Published: March 2022

Background Prophylactic carotid artery stenting (CAS) is an effective strategy to reduce perioperative stroke in patients with severe carotid stenosis who require cardiothoracic surgery (CTS). Staging both procedures (CAS-CTS) during a single hospitalization presents conflicting demands for antiplatelet therapy and the optimal pharmacologic strategy between procedures is not established. The purpose of this study is to present our initial experience with a “bridging” protocol for staged CAS-CTS. Methods A retrospective review of staged CAS-CTS procedures at a single referral center was performed. All patients had multivessel coronary and/or valvular disease and severe carotid stenosis (>70%). Patients not previously on aspirin were also started on aspirin prior to surgery, followed by eptifibatide during CAS (intraprocedural bolus followed by post-procedural infusion which was continued until the morning of surgery). Pre- and perioperative (30 days) neurologic morbidity and mortality was the primary endpoint. Results 11 CAS procedures were performed in 10 patients using the protocol. The median duration of eptifibatide bridge therapy was 36 h (range 24–288 h). There was one minor bleeding complication (1/11, 9.1%) and no major bleeding complications during the bridging and post-operative period. There was one post-operative, non-neurologic death and zero perioperative ischemic strokes. Conclusions For patients undergoing staged CAS-CTS, Eptifibatide bridging therapy is a viable temporary antiplatelet strategy with a favorable safety profile. This strategy enables a flexible range of time-intervals between procedures.
Predictors of clinically significant prostate cancer in biopsy-naïve and prior negative biopsy men with a negative prostate MRI: improving MRI-based screening with a novel risk calculator
Authors: van Riel Luigi A.M.J.G. , Jager Auke , Meijer Dennie , Postema Arnoud W. , Smit Ruth S. , Vis André N. , de Reijke Theo M. , Beerlage Harrie P. , Oddens Jorg R. 
Published: March 2022

Purpose: A pre-biopsy decision aid is needed to counsel men with a clinical suspicion for clinically significant prostate cancer (csPCa), despite normal prostate magnetic resonance imaging (MRI). Methods: A risk calculator (RC) for csPCa (International Society of Urological Pathology grade group (ISUP) ⩾ 2) presence in men with a negative-MRI (Prostate Imaging–Reporting and Data System (PI-RADS) ⩽ 2) was developed, and its performance was compared with RCs of the European Randomized Study of Screening for Prostate Cancer (ERSPC), Prostate Biopsy Collaborative Group (PBCG), and Prospective Loyola University mpMRI (PLUM). All biopsy-naïve and prior negative biopsy men with a negative-MRI followed by systematic prostate biopsy were included from October 2015 to September 2021. The RC was developed using multivariable logistic regression with the following parameters: age (years), family history of PCa (first- or second-degree family member), ancestry (African Caribbean/other), digital rectal exam (benign/malignant), MRI field strength (1.5/3.0 Tesla), prior negative biopsy status, and prostate-specific antigen (PSA) density (ng/ml/cc). Performance of RCs was compared using receiver operating characteristic (ROC) curve analysis. Results: A total of 232 men were included for analysis, of which 18.1% had csPCa. Parameters associated with csPCa were family history of PCa ( p < 0.0001), African Caribbean ancestry ( p = 0.005), PSA density ( p = 0.002), prior negative biopsy ( p = 0.06), and age at biopsy ( p = 0.157). The area under the curve (AUC) of the developed RC was 0.76 (95% CI 0.68–0.85). This was significantly better than the RCs of the ERSPC (AUC: 0.59; p = 0.001) and PBCG (AUC: 0.60; p = 0.002), yet similar to PLUM (AUC: 0.69; p = 0.09). Conclusion: The developed RC (Prostate Biopsy Cohort Amsterdam (‘PROBA’ RC), integrated predictors for csPCa at prostate biopsy in negative-MRI men and outperformed other widely used RCs. These findings require external validation before introduction in daily practice.
Long-term Continuous Glucose Monitor Use in Very Young Children With Type 1 Diabetes: One-Year Results From the SENCE Study
Authors: Van Name Michelle A. , Kanapka Lauren G. , DiMeglio Linda A. , Miller Kellee M. , Albanese-O’Neill Anastasia , Commissariat Persis , Corathers Sarah D. , Harrington Kara R. , Hilliard Marisa E. , Anderson Barbara J. , Kelley Jennifer C. , Laffel Lori M. , MacLeish Sarah A. , Nathan Brandon M. , Tamborlane William V. , Wadwa R. Paul , Willi Steven M. , Williams Kristen M. , Wintergerst Kupper A. , Woerner Stephanie , Wong Jenise C. , DeSalvo Daniel J. 
Published: March 2022

Objectives: Achieving optimal glycemic outcomes in young children with type 1 diabetes (T1D) is challenging. This study examined the durability of continuous glucose monitoring (CGM) coupled with a family behavioral intervention (FBI) to improve glycemia. Study Design: This one-year study included an initial 26-week randomized controlled trial of CGM with FBI ( CGM+FBI) and CGM alone ( Standard-CGM) compared with blood glucose monitoring (BGM), followed by a 26-week extension phase wherein the BGM Group received the CGM+FBI ( BGM-Crossover) and both original CGM groups continued this technology. Results: Time in range (70-180 mg/dL) did not improve with CGM use (CGM+FBI: baseline 37%, 52 weeks 41%; Standard-CGM: baseline 41%, 52 weeks 44%; BGM-Crossover: 26 weeks 38%, 52 weeks 40%). All three groups sustained decreases in hypoglycemia (<70 mg/dL) with CGM use (CGM+FBI: baseline 3.4%, 52 weeks 2.0%; Standard-CGM: baseline 4.1%, 52 weeks 2.1%; BGM-Crossover: 26 weeks 4.5%, 52 weeks 1.7%, P-values <.001). Hemoglobin A1c was unchanged with CGM use (CGM+FBI: baseline 8.3%, 52 weeks 8.2%; Standard-CGM: baseline 8.2%, 52 weeks 8.0%; BGM-Crossover: 26 weeks 8.1%, 52 weeks 8.3%). Sensor use remained high (52-week study visit: CGM+FBI 91%, Standard-CGM 92%, BGM-Crossover 88%). Conclusion: Over 12 months young children with T1D using newer CGM technology sustained reductions in hypoglycemia and, in contrast to prior studies, persistently wore CGM. However, pervasive hyperglycemia remained unmitigated. This indicates an urgent need for further advances in diabetes technology, behavioral support, and diabetes management educational approaches to optimize glycemia in young children.
Determining Losses in Jet Injection Subcutaneous Insulin Delivery: A Model-Based Approach
Authors: McHugh Alexander D. , Chase J. Geoffrey , Knopp Jennifer L. , Zhou Tony , Holder-Pearson Lui 
Published: March 2022

Objective: Accurate, safe glycemic management requires reliable delivery of insulin doses. Insulin can be delivered subcutaneously for action over a longer period of time. Needle-free jet injectors provide subcutaneous (SC) delivery without requiring needle use, but the volume of insulin absorbed varies due to losses associated with the delivery method. This study employs model-based methods to determine the expected proportion of active insulin present from a needle-free SC dose. Methods: Insulin, C-peptide, and glucose assay data from a frequently sampled insulin-modified oral glucose tolerance test trial with 2U SC insulin delivery, paired with a well-validated metabolic model, predict metabolic outcomes for N = 7 healthy adults. Subject-specific nonlinear hepatic clearance profiles are modeled over time using third-order basis splines with knots located at assay times. Hepatic clearance profiles are constrained within a physiological rate of change, and relative to plasma glucose profiles. Insulin loss proportions yielding optimal insulin predictions are then identified, quantifying delivery losses. Results: Optimal parameter identification suggests losses of up to 22% of the nominal 2U SC dose. The degree of loss varies between subjects and between trials on the same subject. Insulin fit accuracy improves where loss greater than 5% is identified, relative to where delivery loss is not modeled. Conclusions: Modeling shows needle-free SC jet injection of a nominal dose of insulin does not necessarily provide metabolic action equivalent to total dose, and this availability significantly varies between trials. By quantifying and accounting for variability of jet injection insulin doses, better glycemic management outcomes using SC jet injection may be achieved.
Treatment of Persistent Post-traumatic Diplopia – An Algorithmic Approach to Patient Stratification and Operative Management
Authors: Reddy Sashank K. , Colakoglu Salih , Yoon Joshua S. , Bhoopalam Myan , Merbs Shannath L. , Manson Paul N. , Grant Michael P. 
Published: March 2022

Study Design Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma. Objective Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes. Methods A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005–2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified. Results Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair. Conclusions Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.
Utilization of youth-friendly reproductive health service and associated factors among youth in Aleta Wondo town, southern Ethiopia, 2020
Authors: Amaje Elias , Daniel Eyasu , Tefera Kebede , Sirage Nurye 
Published: March 2022

Background: Youth faces various sexual and reproductive health problems in developing countries like Ethiopia. Major health problems like unintended pregnancy, unsafe abortion, and sexually transmitted infections are common among youth in Ethiopia. This study aimed to determine the level of utilization of youth-friendly reproductive health services and associated factors among youth in Aleta Wondo town, southern Ethiopia, from 20 to 30 June 2020. Methods: A community-based cross-sectional study was conducted among youths of Aleta Wondo town from 20 to 30 June 2020. A total of 421 study participants were selected from households of selected kebeles in the town by using a systematic random sampling method. Data were collected using structured pretested face-to-face interviewer-administered questionnaires. The data were entered using Epi-data version 4.4.2 and exported to SPSS version 25 for analysis. Bivariate and multivariate logistic regression models were used to determine factors significantly associated with the utilization of youth-friendly reproductive health services. Adjusted odds ratio and 95% confidence interval with p value of <0.05 were considered to declare statistical significance. Results: The level of utilization of youth-friendly reproductive health services was 32.8% (95% confidence interval = 28.0%–37.0%). Youth-friendly service utilization was significantly associated with being female gender (adjusted odds ratio = 2.20, 95% confidence interval = 1.34–3.62), living alone (adjusted odds ratio = 2.99, 95% confidence interval = 1.48–5.77), who had not ever discussed with their parents (adjusted odds ratio = 0.46, 95% confidence interval = 0.27–0.81), have visited service required and missed service (adjusted odds ratio = 1.96, 95% confidence interval = 1.19–3.24), and have sexual partner (adjusted odds ratio = 4.52, 95% confidence interval = 2.75–7.44). Conclusion: Youth-friendly reproductive health service utilization among youth Aleta Wondo town was low. Factors like gender, current living place, have ever discussed in reproductive health issues with their parents, have visited health facility and missed service, and having sexual partner were predictors of youth-friendly service utilization. It is better to work in collaboration with youth clubs and schoolteachers to scale up youth-friendly service.
The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case Report
Authors: Shahzad Muhammad Asim , Baxi Pravir V. , Rodby Roger A. 
Published: March 2022

Rationale: Nondilated obstructive uropathy (NDOU) is a rare cause of acute renal failure reported in less than 5% of cases of obstructive uropathy. It is typically associated with intrapelvic malignancies and diseases causing retroperitoneal lymphadenopathy and retroperitoneal fibrosis. As these conditions may prevent radiographic dilation of the collecting system, the diagnosis of NDOU may be missed by usual diagnostic testing. Presenting concerns of the patient: We present a case of acute anuric renal failure in a middle-aged woman with metastatic breast cancer associated with abdominal and retroperitoneal lymphadenopathy. Acute kidney injury was initially deemed secondary to drug-induced acute tubular necrosis (ATN) from bisphosphonate; however, there remained a high clinical suspicion of NDOU due to the presence of enlarged retroperitoneal lymph nodes on CT abdomen and pelvis with concerns for encasement of bilateral renal pelvic regions and ureters. Diagnoses: The patient underwent a retrograde pyelogram which demonstrated questionable narrowing bilaterally at the level of the renal pelvices. This led to an even stronger clinical suspicion of NDOU and urology service was consulted for evaluation. Intervention: Bilateral ureteral stents were placed by urology which led to robust urine output and rapid reversal of renal failure over the next 24 to 48 hours. Outcomes: Despite 2 weeks of anuria and hemodialysis, this patient’s creatinine came back to her baseline. She was able to discontinue hemodialysis and her creatinine stabilized at 88.4 μmol/L (1 mg/dL). Teaching points: Nondilated obstructive uropathy is rare but important diagnosis that requires a high clinical suspicion in the appropriate clinical scenario. The lack of dilatation is believed to be related to encasement of the collecting system by tumor, fibrosis, or as in our case metastatic retroperitoneal lymphadenopathy. As this diagnosis cannot be overlooked, aggressive direct visualization or even intervention with internal or external stenting may be required to both diagnose and treat this condition.
Construction of a Tool to Predict Overall Survival of Patients With Primary Spinal Tumors After Surgical Resection: A Real-World Analysis Based on the Surveillance, Epidemiology, and End Results Database
Authors: Huang Zhangheng , Tong Yuexin , Kong Qingquan 
Published: March 2022

Background We aim to construct a practical clinical prediction model to accurately evaluate the overall survival (OS) of patients with primary spinal tumors after primary tumor resection, thereby aiding clinical decision-making. Methods A total of 695 patients diagnosed with a primary spinal tumor, selected from the Surveillance, Epidemiology, and End Results (SEER) database, were included in this study. The Cox regression algorithm was applied to the training cohort to build the prognostic nomogram model. The nomogram’s performance in terms of discrimination, calibration, and clinical usefulness was also assessed in the internal SEER validation cohort. The fitted prognostic nomogram was then used to create a web-based calculator. Results Four independent prognostic factors were identified to establish a nomogram model for patients with primary spinal tumors who had undergone surgical resection. The C-index (.757 for the training cohort and .681 for the validation cohort) and the area under the curve values over time (both >.68) showed that the model exhibited satisfactory discrimination in both the SEER cohort. The calibration curve revealed that the projected and actual survival rates are very similar. The decision curve analysis also revealed that the model is clinically valuable and capable of identifying high-risk patients. Conclusions After developing a nomogram and a web-based calculator, we were able to reliably forecast the postoperative OS of patients with primary spinal tumors. These tools are expected to play an important role in clinical practice, informing clinicians in making decisions about patient care after surgery.