bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conversations About End-of-Life Decisions in Neonatology: Do Doctors and Parents Implement Shared Decision-Making?
Authors: Schouten Esther S. , Beyer Maria F. , Flemmer Andreas W. , de Vos Mirjam A. , Kuehlmeyer Katja 
Published: May 2022

Introduction:Advances in perinatal medicine have contributed to significantly improved survival of newborns. While some infants die despite extensive medical treatment, a larger proportion dies following medical decision-making (MDM). International guidelines about end-of-life (EOL) MDM for neonates unify in their recommendation for shared decision-making (SDM) between doctors and parents. Yet, we do not know to what extent SDM is realized in neonatal practice.ObjectiveWe aim at examining to which extent SDM is implemented in the NICU setting.MethodsBy means of Qualitative Content Analysis, audio-recorded conversations between neonatologists and parents were analyzed. We used a framework by de Vos that was used to analyze similar conversations on the PICU.ResultsIn total we analyzed 17 conversations with 23 parents of 12 NICU patients. SDM was adopted only to a small extent in neonatal EOL-MDM conversations. The extent of sharing decreased considerably over the stages of SDM. The neonatologists suggested finding a decision together with parents, while at the same time seeking parents' agreement for the intended decision to forgo life-sustaining treatment.ConclusionsSince SDM was only realized to a small extent in the NICU under study, we propose evaluating how parents in this unit experience the EOL-MDM process and whether they feel their involvement in the process acceptable and beneficial. If parents evaluate their involvement in the current approach beneficial, the need for implementation of SDM to the full extent, as suggested in the guidelines, may need to be critically re-assessed.
Further Evidence that Inhibition of Neuronal Voltage-Gated Calcium Channels Contributes to the Hypnotic Effect of Neurosteroid Analogue, 3β-OH
Authors: Timic Stamenic Tamara , Manzella Francesca M. , Maksimovic Stefan , Krishnan Kathiresan , Covey Douglas F. , Jevtovic-Todorovic Vesna , Todorovic Slobodan M. 
Published: May 2022

We recently reported that a neurosteroid analogue with T-channel-blocking properties (3β,5β,17β)-3-hydroxyandrostane-17-carbonitrile (3β-OH), induced hypnosis in rat pups without triggering neuronal apoptosis. Furthermore, we found that the inhibition of the CaV3.1 isoform of T-channels contributes to the hypnotic properties of 3β-OH in adult mice. However, the specific mechanisms underlying the role of other subtypes of voltage-gated calcium channels in thalamocortical excitability and oscillations in vivo during 3β-OH-induced hypnosis are largely unknown. Here, we used patch-clamp recordings from acute brain slices, in vivo electroencephalogram (EEG) recordings, and mouse genetics with wild-type (WT) and CaV2.3 knock-out (KO) mice to further investigate the molecular mechanisms of neurosteroid-induced hypnosis. Our voltage-clamp recordings showed that 3β-OH inhibited recombinant CaV2.3 currents. In subsequent current-clamp recordings in thalamic slices ex vivo, we found that selective CaV2.3 channel blocker (SNX-482) inhibited stimulated tonic firing and increased the threshold for rebound burst firing in WT animals. Additionally, in thalamic slices we found that 3β-OH inhibited spike-firing more profoundly in WT than in mutant mice. Furthermore, 3β-OH reduced bursting frequencies in WT but not mutant animals. In ensuing in vivo experiments, we found that intra-peritoneal injections of 3β-OH were less effective in inducing LORR in the mutant mice than in the WT mice, with expected sex differences. Furthermore, the reduction in total α, β, and low γ EEG power was more profound in WT than in CaV2.3 KO females over time, while at 60 min after injections of 3β-OH, the increase in relative β power was higher in mutant females. In addition, 3β-OH depressed EEG power more strongly in the male WT than in the mutant mice and significantly increased the relative δ power oscillations in WT male mice in comparison to the mutant male animals. Our results demonstrate for the first time the importance of the CaV2.3 subtype of voltage-gated calcium channels in thalamocortical excitability and the oscillations that underlie neurosteroid-induced hypnosis.
Application of Traditional Japanese Drug Jidabokuippo in a Modern Society
Authors: Nakae Hajime , Irie Yasuhito , Kitamura Toshiharu , Okuyama Manabu 
Published: May 2022

Background:Jidabokuippo (JDI) (治打撲一方) has been used in Japan to alleviate contusion-induced swelling and pain since medieval times.Method:This review investigated the effects of JDI on various symptoms in patients with trauma or static blood[TM1]. The PubMed and Igaku Chuo Zasshi databases were searched until 24 December 2021. We summarize the benefits of applying JDI to inflammatory conditions, including bruises.Results:JDI has been used to resolve blood[TM1]stasis, regulate qi in trauma patients, and treat inflammatory swelling and pain caused by rheumatoid arthritis and cellulitis. As the adverse event rate associated with JDI is low (1.3%), JDI is considered a safe drug.Conclusion:JDI can be used to resolve blood[TM1]stasis in trauma patients without adverse events associated with nonsteroidal anti-inflammatory drugs.
Characteristics and Predictors of Venous Thromboembolism Among Lymphoma Patients Undergoing Chemotherapy: A Cohort Study in China
Authors: Chen Yue , Lei Haike , Wang Wei , Zhu Jie , Zeng Chensi , Lu Zhuo , Li Luchun , Li Dairong , Long Bo , Liu Haixia 
Published: May 2022

Background: Venous thromboembolism (VTE) is a potential complication among lymphoma patients. We evaluated the incidence rate and predictors of VTE in lymphoma patients undergoing chemotherapy.Methods: The present study retrospectively studied 1,069 patients with lymphoma who were treated with chemotherapy from 2018 to 2020. We investigated clinical predictors of VTE among all patients. The follow-up results were obtained via telephone communication and from inpatient and outpatient records.Results: A total of 1,069 patients underwent chemotherapy for lymphoma. During a mean follow-up of 23.1 months, 52 (4.9%) patients developed VTE. According to a multivariate analysis, the five variables found to be independently associated with VTE were male sex (HR 2.273, 95% CI 1.197–4.316, p = 0.012), age &gt;64-years-old (HR 2.256, 95% CI 1.017–5.005, p = 0.045), the number of cycles of chemotherapy (HR 4.579, 95% CI 1.173–17.883, p = 0.029), platelet count ≥350 × 109/L (HR 2.533, 95% CI 1.187–5.406, p = 0.016), and D-dimer &gt;0.5 mg/L (HR 4.367, 95% CI 2.124–8.981, p &lt; 0.001).Conclusion: This population-based study confirms the risk factors for VTE among patients with lymphoma who underwent chemotherapy and confirms that targeted thromboprophylaxis may reduce the burden of VTE in this population.
Toward a Digital Future in Bipolar Disorder Assessment: A Systematic Review of Disruptions in the Rest-Activity Cycle as Measured by Actigraphy
Authors: Panchal Priyanka , de Queiroz Campos Gabriela , Goldman Danielle A. , Auerbach Randy P. , Merikangas Kathleen R. , Swartz Holly A. , Sankar Anjali , Blumberg Hilary P. 
Published: May 2022

BackgroundDisruptions in rest and activity patterns are core features of bipolar disorder (BD). However, previous methods have been limited in fully characterizing the patterns. There is still a need to capture dysfunction in daily activity as well as rest patterns in order to more holistically understand the nature of 24-h rhythms in BD. Recent developments in the standardization, processing, and analyses of wearable digital actigraphy devices are advancing longitudinal investigation of rest-activity patterns in real time. The current systematic review aimed to summarize the literature on actigraphy measures of rest-activity patterns in BD to inform the future use of this technology.MethodsA comprehensive systematic review using PRISMA guidelines was conducted through PubMed, MEDLINE, PsycINFO, and EMBASE databases, for papers published up to February 2021. Relevant articles utilizing actigraphy measures were extracted and summarized. These papers contributed to three research areas addressed, pertaining to the nature of rest-activity patterns in BD, and the effects of therapeutic interventions on these patterns.ResultsSeventy articles were included. BD was associated with longer sleep onset latency and duration, particularly during depressive episodes and with predictive value for worsening of future manic symptoms. Lower overall daily activity was also associated with BD, especially during depressive episodes, while more variable activity patterns within a day were seen in mania. A small number of studies linked these disruptions with differential patterns of brain functioning and cognitive impairments, as well as more adverse outcomes including increased suicide risk. The stabilizing effect of therapeutic options, including pharmacotherapies and chronotherapies, on activity patterns was supported.ConclusionThe use of actigraphy provides valuable information about rest-activity patterns in BD. Although results suggest that variability in rhythms over time may be a specific feature of BD, definitive conclusions are limited by the small number of studies assessing longitudinal changes over days. Thus, there is an urgent need to extend this work to examine patterns of rhythmicity and regularity in BD. Actigraphy research holds great promise to identify a much-needed specific phenotypic marker for BD that will aid in the development of improved detection, treatment, and prevention options.
Extension for Community Healthcare Outcomes Based Telementoring of Physicians for Dementia–Effectiveness in India
Authors: Nair Shruti , Sinha Preeti , Chand Prabhat , Sahu Prashant , Gorthi Naga VSS , Varghese Mathew , Sivakumar P. T. 
Published: May 2022

ObjectiveThe study aimed to evaluate the effectiveness of a program based on the telementoring model [Extension for Community Healthcare Outcomes (ECHO)] for primary care physicians in diagnosing and treating patients with dementia.MethodThe ECHO model was adapted through 12 live sessions of 2 h every 2 weeks consisting of a didactic presentation by the expert, peer-led new case discussions, and follow-up discussions. In addition, there were 10 h of self-paced e-learning and interim assignments. The impact was examined by noting participation, session ratings, monthly clinical reports, and comparing knowledge and competency scores before and after the course.ResultsAmong the 63 participants, 39.7% attended at least 80% of the sessions; completing the program successfully. The ratings for all sessions ranged from “good” to “excellent.” The paired samplet-test revealed a statistically significant improvement (p&lt; 0.001) in self-rated skills and confidence in diagnosing and treating dementia with an effect size of 1.25 and 1.37, respectively. No change in the knowledge score was observed throughout the course. A considerable increase in dementia-related clinical practice was observed during four monthly summary of clinical cases. Due to the limited data of monthly reports during the COVID pandemic, no statistical analysis was attempted.ConclusionThe ECHO model appears to have a positive immediate impact on the clinical ability of primary care physicians to diagnose and treat dementia. Its direct impact on patient health and at the community level should be aimed at in future studies.
Healthcare Professionals' Views on the Management of Medication Complexities in the Elderly With Mental Health Disorders: A Cross-Sectional Study
Authors: Aguiar João Pedro , Gama Marques João , Leufkens Hubert G. M. , Alves da Costa Filipa 
Published: May 2022

BackgroundMany challenges in elderly pharmacotherapy are identified, including the use of Potentially Inappropriate Medications (PIMs) which may increase the odds of adverse events, especially in elderly patients with mental health disorders (e. g., behavioral, and psychological symptoms of dementia–BPSD, schizophrenia, bipolar disorder). However, information on the knowledge and practice of healthcare professionals (HCPs) about this topic is still scarce.MethodsA cross-sectional study was undertaken from July-October 2019. An online questionnaire was specifically designed and validated for this study. We sought HCPs (physicians, pharmacists, and nurses) worldwide, using (a) social media, via Facebook, Twitter, and LinkedIn; and (b) email contacts of the research team (convenience sample). Either way participants were asked to share on their social media or via e-mail the questionnaires with other HCPs (snowballing sample). The survey assessed two main domains: knowledge and practice. Knowledge was evaluated by self-report (perceived knowledge by a 5-item Likert confidence scale) and using three clinical cases, scored between 0 and 30 points (each one rated from 0 to 10 points; real knowledge). Barriers in clinical practice were evaluated using a 5-item Likert scale judging practitioners' opinion.ResultsA total of 165 questionnaires were collected. HCPs were mainly female (n = 114; 69.1%), with a mean age of 35.3 ± 11.3 years old. Seventy-two percent (n = 118) were pharmacists, 21.1% (n = 35) were physicians, and 7.3% (n = 12) nurses. There was a weak correlation, albeit significant, between perceived and real knowledge (r = 0.199; p = 0.001). The mean score of the clinical vignettes regarding elderly patients with dementia and bipolar disorder were 4.59 ± 4.08 and 4.86 ± 2.97 points, respectively. Most HCPs were classified as having an intermediate knowledge (n = 100; 60.6%) about medication complexities in the elderly with mental disorders. Most HCPs agreed that lack of time (81.6%; n = 138), lack of education and training on elderly pharmacotherapy (72.2%; n = 122), and lack of tools adapted to daily practice (61.8%; n = 105) were the main barriers.ConclusionsMost of the HCPs felt confident to manage medication complexities in elder patients with mental disorders, but only a minority obtained a good score in the knowledge assessment test. The main barriers identified included structural barriers (tools unfit for practice) and process barriers (time).
Development and Validation of a Risk Stratification Model of Pulmonary Ground-Glass Nodules Based on Complementary Lung-RADS 1.1 and Deep Learning Scores
Authors: Meng Qingcheng , Li Bing , Gao Pengrui , Liu Wentao , Zhou Peijin , Ding Jia , Zhang Jiaqi , Ge Hong 
Published: May 2022

PurposeTo assess the value of novel deep learning (DL) scores combined with complementary lung imaging reporting and data system 1.1 (cLung-RADS 1.1) in managing the risk stratification of ground-glass nodules (GGNs) and therefore improving the efficiency of lung cancer (LC) screening in China.Materials and MethodsOverall, 506 patients with 561 GGNs on routine computed tomography images, obtained between January 2017 and March 2021, were enrolled in this single-center, retrospective Chinese study. Moreover, the cLung-RADS 1.1 was previously validated, and the DL algorithms were based on a multi-stage, three-dimensional DL-based convolutional neural network. Therefore, the DL-based cLung-RADS 1.1 model was created using a combination of the risk scores of DL and category of cLung-RADS 1.1. The recall rate, precision, accuracy, per-class F1 score, weighted average F1 score (F1weighted), Matthews correlation coefficient (MCC), and area under the curve (AUC) were used to evaluate the performance of DL-based cLung-RADS 1.1.ResultsThe percentage of neoplastic lesions appeared as GGNs in our study was 95.72% (537/561) after long-period follow-up.Compared to cLung-RADS 1.1 model or DL model, The DL-based cLung-RADS 1.1 model achieved the excellent performance with F1 scores of 95.96% and 95.58%, F1weighted values of 97.49 and 96.62%, accuracies of 92.38 and 91.77%, and MCCs of 32.43 and 37.15% in the training and validation tests, respectively. The combined model achieved the best AUCs of 0.753 (0.526–0.980) and 0.734 (0.585–0.884) for the training and validation tests, respectively.ConclusionThe DL-based cLung-RADS 1.1 model shows the best performance in risk stratification management of GGNs, which demonstrates substantial promise for developing a more effective personalized lung neoplasm management paradigm for LC screening in China.
Subarcsecond Imaging of a Solar Active Region Filament With ALMA and IRIS
Authors: da Silva Santos J. M. , White S. M. , Reardon K. , Cauzzi G. , Gunár S. , Heinzel P. , Leenaarts J. 
Published: May 2022

Quiescent filaments appear as absorption features on the solar disk when observed in chromospheric lines and at continuum wavelengths in the millimeter (mm) range. Active region (AR) filaments are their small-scale, low-altitude analogues, but they could not be resolved in previous mm observations. This spectral diagnostic can provide insight into the details of the formation and physical properties of their fine threads, which are still not fully understood. Here, we shed light on the thermal structure of an AR filament using high-resolution brightness temperature (Tb) maps taken with ALMA Band 6 complemented by simultaneous IRIS near-UV spectra, Hinode/SOT photospheric magnetograms, and SDO/AIA extreme-UV images. Some of the dark threads visible in the AIA 304 Å passband and in the core of Mg ii resonance lines have dark (Tb < 5,000 K) counterparts in the 1.25 mm maps, but their visibility significantly varies across the filament spine and in time. These opacity changes are possibly related to variations in temperature and electron density in filament fine structures. The coolest Tb values (< 5,000 K) coincide with regions of low integrated intensity in the Mg ii h and k lines. ALMA Band 3 maps taken after the Band 6 ones do not clearly show the filament structure, contrary to the expectation that the contrast should increase at longer wavelengths based on previous observations of quiescent filaments. The ALMA maps are not consistent with isothermal conditions, but the temporal evolution of the filament may partly account for this.
Efficacy and Safety of Simultaneous Integrated Boost Intensity-Modulation Radiation Therapy Combined with Systematic and Standardized Management for Esophageal Cancer
Authors: Deng Wenzhao , Zhang Xueyuan , Su Jingwei , Song Chunyang , Xu Jinrui , Zhao Xiaohan , Shen Wenbin 
Published: May 2022

ObjectiveTo analyze and compare the efficacy and safety of simultaneous integrated boost intensity-modulation radiation therapy (SIB-IMRT) combined with systematic and standardized management for esophageal cancer.MethodsFrom January 2012 to January 2019, 200 patients with esophageal cancer who received radical chemoradiotherapy in our hospital were treated with lymphatic drainage area radiation prevention combined with systematic and standardized management. According to difference in radiotherapy methods, the patients were divided into local lesion 92 patients treated with simultaneous integrated boost intensity-modulation radiation therapy (SIB-IMRT) combined with systematic standardized management (SIB-IMRT group), and late course boost intensity-modulation radiation therapy (LCB-IMRT) combined with systematic standardized management 108 patients (LCB-IMRT group). The short-term eficacy of the two groups were compared. The dose volume parameters of the organ in danger are evaluated based on the dose volume histogram. The related adverse reactions during chemoradiotherapy were compared between two groups. The local control rate and survival rate were compared between the two groups.ResultsThe recent total effective rates of rats in the SIB-IMRT group and LCB-IMRT group were 95.65% and 90.74%, respectively, and there was no significant difference between the two groups (p &gt; 0.05). The mean doses to left and right lung, heart and spinal cord in the SIB-IMRT group were significantly lower than that in the LCB-IMRT group (p &lt; 0.05). There was no significant difference in the incidence of adverse reactions such as radiation esophagitis, radiation pneumonitis, radiation tracheitis, gastrointestinal reaction and bone marrow suppression between the SIB-IMRT group and LCB-IMRT groups (p &gt; 0.05). The one-year and three-year overall survival rates in the SIB-IMRT group and LCB-IMRT groups were 82.61%, 42.39% and 77.78%, 34.26%, respectively, and the median survival times were 38 and 29 months, respectively. The local control rates in the SIB-IMRT group and LCB-IMRT group in one and three years were 84.78%, 56.52% and 75.93%, 41.67%, respectively. The 3-year local control rate in the SIB-IMRT group was higher than that in the LCB-IMRT group (p &lt; 0.05), but there was no significant difference in the 1-and 3-year overall survival rates between the two groups (p &gt; 0.05).ConclusionSIB-IMRT combined with systematic and standardized management in the treatment of esophageal cancer can reduce the amount of some organs at risk and improve the local control rate of the lesion.
Diagnoses after newly recorded abdominal pain in primary care: observational cohort study
Authors: Price Sarah J , Gibson Niamh , Hamilton William T , Bostock Jennifer , Shephard Elizabeth A 
Published: May 2022

BackgroundNon-acute abdominal pain in primary care is diagnostically challenging.AimTo quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and nine cancers in adults after newly recorded abdominal pain in primary care.Design and settingObservational cohort study of 125 793 Clinical Practice Research Datalink GOLD records.MethodParticipants, aged ≥40 years, had newly recorded abdominal pain between 1 January 2009 and 31 December 2013. Age- and sex-stratified 1-year cumulative incidence by diagnosis is reported.ResultsMost (>70%) participants had no pre-specified diagnoses after newly recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in males and urinary tract infection in females. The incidence of upper gastrointestinal problems plateaued at age ≥60 years (aged 40–59 years: males 4.9%, 95% confidence interval [CI] = 4.6 to 5.1, females 4.0%, 95% CI = 3.8 to 4.2; aged 60–69 years: males 5.8%, 95% CI = 5.4 to 6.2, females 5.4%, 95% CI = 5.1 to 5.8). Urinary tract infection incidence increased with age (aged 40–59 years: females 5.1%, 95% CI = 4.8 to 5.3, males 1.1%, 95% CI = 1.0 to 1.2; aged ≥70 years: females 8.0%, 95% CI = 7.6 to 8.4, males 3.3%, 95% CI = 3.0 to 3.6%). Diverticular disease incidence rose with age, plateauing at 4.2% (95% CI = 3.9 to 4.6) in males aged ≥60 years, increasing to 6.1% (95% CI = 5.8 to 6.4) in females aged ≥70 years. Irritable bowel syndrome incidence was higher in females (aged 40–59 years: 2.9%, 95% CI = 2.7 to 3.1) than males (aged 40–59 years: 2.1%, 95% CI = 1.9 to 2.3), decreasing with age to 1.3% (95% CI = 1.2 to 1.5) in females and 0.6% (95% CI = 0.5 to 0.8) in males aged ≥70 years.ConclusionAlthough abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.