bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opportunities and Challenges When Using the Electronic Health Record for Practice-Integrated Patient-Facing Interventions: The e-Assist Colon Health Randomized Trial
Authors: Elston Lafata Jennifer , Shires Deirdre A. , Shin Yongyun , Flocke Susan , Resnicow Kenneth , Johnson Morgan , Nixon Ellen , Sun Xinxin , Hawley Sarah 
Published: June 2022

Background Even after a physician recommendation, many people remain unscreened for colorectal cancer (CRC). The proliferation of electronic health records (EHRs) and tethered online portals may afford new opportunities to embed patient-facing interventions within clinic workflows and engage patients following a physician recommendation for care. We evaluated the effectiveness of a patient-facing intervention designed to complement physician office-based recommendations for CRC screening. Design Using a 2-arm pragmatic, randomized clinical trial, we evaluated the intervention’s effect on CRC screening use as documented in the EHR (primary outcome) and the extent to which the intervention reached the target population. Trial participants were insured, aged 50 to 75 y, with a physician recommendation for CRC screening. Typical EHR functionalities, including patient registries, health maintenance flags, best practice alerts, and secure messaging, were used to support research-related activities and deliver the intervention to enrolled patients. Results A total of 1,825 adults consented to trial participation, of whom 78% completed a baseline survey and were exposed to the intervention. Most trial participants (>80%) indicated an intent to be screened on the baseline survey, and 65% were screened at follow-up, with no significant differences by study arm. One-third of eligible patients were sent a secure message. Among those, more than three-quarters accessed study material. Conclusions By leveraging common EHR functionalities, we integrated a patient-facing intervention within clinic workflows. Despite practice integration, the intervention did not improve screening use, likely in part due to portal-based interventions not reaching those for whom the intervention may be most effective. Implications Embedding patient-facing interventions within the EHR enabled practice integration but may minimize program effectiveness by missing important segments of the patient population. Highlights Electronic health record tools can be used to facilitate practice-embedded pragmatic trial and patient-facing intervention processes, including patient identification, study arm allocation, and intervention delivery. The online portal-embedded intervention did not improve colorectal cancer (CRC) screening uptake following a physician recommendation, likely in part because portal users tend to be already highly engaged with healthcare. Relying on patient portals alone for CRC screening interventions may not alter screening use and could exacerbate well-known care disparities.
Changes in Anatomic Risk Factors for Patellar Instability During Skeletal Growth and Maturation
Authors: Pruneski James , O’Mara Lauren , Perrone Gabriel S. , Kiapour Ata M. 
Published: June 2022

Background: Several anatomic risk factors have been identified in the pathogenesis of patellofemoral instability. The literature is sparce regarding how these anatomic risk factors change during skeletal growth and development. Hypothesis: The anatomic risk factors associated with patellar instability change significantly during skeletal growth and maturation with different patterns in male versus female patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging data from 240 unique, asymptomatic knees (7-18 years of age; 50% female) were used to measure patellar height (Caton-Deschamps index), lateral patellar tilt angle, trochlear height, trochlear groove depth, trochlear sulcus angle, and tibial tubercle–trochlear groove (TT-TG) distance. Linear regression was used to test the associations between age and anatomic findings. Two-way analysis of variance with Holm-Šídák post hoc test was used to compare anatomic characteristics between sexes in 3 age groups: prepubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Results: Patellar height (female sex), lateral patellar tilt angle (male sex), and trochlear sulcus angle (both sexes) decreased with age ( P < .001). Trochlear height, depth, and TT-TG distance increased with age in both male and female participants ( P < .02). Male participants had a larger sulcus angle (by 5.3°± 1.6° at age 11-14 years) and greater trochlear height (by >5 mm across medial, central, and lateral regions at age 15-18 years) than age-matched female participants ( P < .01). We found no other sex-related differences in quantified anatomic features ( P > .1). Conclusion: The findings partially support our hypothesis indicating significant age-related changes in all quantified features, which were not different between male and female participants except for trochlear sulcus angle in early adolescence and trochlear height in late adolescence. In general, the majority of anatomic risk factors for patellar instability change with maturity in a direction that assists in reducing the risk of patellar instability and/or dislocation. The only outlier is the TT-TG distance, which increased by age, and in our oldest cohort of patients, the mean fell below the normal adult range. The current observations highlight the importance of age in the interpretation of risk for injury as well as the need for further studies to identify intrinsic and extrinsic factors that may result in abnormal development of these anatomic features during skeletal growth and maturation.
Effect of the Inverted V-Shaped Osteotomy on Patellofemoral Joint and Tibial Morphometry as Compared With the Medial Opening Wedge High Tibial Osteotomy
Authors: Kondo Eiji , Yabuuchi Koji , Joutoku Zenta , Matsubara Shinji , Iwasaki Koji , Matsuoka Masatake , Onodera Tomohiro , Momma Daisuke , Inoue Masayuki , Yagi Tomonori , Iwasaki Norimasa , Yasuda Kazunori 
Published: June 2022

Background: Recent studies have reported that medial opening wedge (OW) high tibial osteotomy (HTO) induces patella baja, resulting in degenerative changes in the patellofemoral joint. We have developed an inverted V-shaped (iV) HTO, which is classified as a neutral wedge osteotomy. Hypotheses: The study hypotheses were as follows: (1) patellar height, posterior tibial slope, and tibial length will not change between pre- and postoperative evaluations after iV-HTO; (2) the lateral shift ratio of the patella and the distance between the tibial tubercle and the trochlear groove may be significantly decreased after iV-HTO. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 191 patients (220 knees) who underwent HTO for medial osteoarthritis were enrolled retrospectively in this study: 107 knees underwent OW-HTO and 113 knees underwent iV-HTO. Clinical and radiological evaluations were performed before and at least 3 years after surgery. Results: Postoperatively, the mean Caton-Deschamps ratio was significantly decreased ( P < .0001) from 0.95 to 0.79 in the OW group, while there were no significant changes in the iV group. The mean posterior tibial slope was significantly increased ( P < .0001) from 8.5° to 10.5° in the OW group, while there were no significant differences in the iV group. Although the entire leg length was significantly increased ( P < .0003) in both groups after HTO, there were no significant differences in tibial length between the pre- and postoperative periods in the iV group. Regarding the congruity of the patellofemoral joint, the mean lateral shift ratio did not significantly change in the OW group, whereas it was significantly decreased ( P = .0012) from 11.5% to 8.8% in the iV group. The mean tibial tubercle–trochlear groove distance was significantly decreased ( P < .0001) from 12.8 to 9.7 mm in the iV group, while it was significantly increased in the OW group ( P < .0001). Concerning the clinical outcome, the Japanese Orthopaedic Association (JOA) and Lysholm knee scores at final follow-up (OW vs iV: JOA, 91.2 vs 90.1; Lysholm, 92.5 vs 89.0) were significantly increased ( P < .0001) as compared with the preoperative values (OW vs iV: JOA, 68.3 vs 66.8; Lysholm, 67.9 vs 61.0). Conclusion: Patellar height, posterior tibial slope, and tibial length did not change after the iV-HTO, while they were significantly changed after the OW-HTO. Although the preoperative degrees of varus knee and patellofemoral osteoarthritis were more severe in the iV group than the OW group, the iV-HTO led to altered patellofemoral joint congruity.
Simvastatin cardioprotection in cyclophosphamide-induced toxicity via the modulation of inflammasome/caspase1/interleukin1β pathway
Authors: Refaie Marwa MM , El-Hussieny Maram , Bayoumi Asmaa MA , Shehata Sayed , Welson Nermeen N , Abdelzaher Walaa Yehia 
Published: June 2022

Drug-induced cardiotoxicity is a serious adverse effect that occurs during the administration of chemotherapeutic agents such as cyclophosphamide (CYC). Therefore, there is a critical need to find cardioprotective agents to keep the heart healthy. The current study aimed to investigate the protective effect of simvastatin (SIM) against CYC-induced heart damage and evaluate different mechanisms involved in mediating this effect, including the inflammasome/caspase1/interleukin1β (IL1β) pathway and endothelial nitric oxide synthase (eNOS). 36 rats were randomly assigned to one of four groups: a control group that received only vehicles, a CYC group that received CYC (150 mg/kg/day) i.p. on the fourth and fifth days, a CYC+SIM group that received SIM (10 mg/kg/day) orally for 5 days and CYC (150 mg/kg/day) i.p. on the fourth and fifth days, and a CYC+SIM+ Nitro- ω-L-arginine (L-NNA) group that received L-NNA (25 mg/kg/day, SIM (10 mg/kg/day) orally for 5 days and CYC (150 mg/kg/day) i.p. on the 4th and 5th days. The CYC group revealed an obvious elevation in cardiac enzymes and heart weights with toxic histopathological changes. Moreover, there was an increase in malondialdehyde (MDA), tumor necrosis factor-alpha (TNFα) levels, and up-regulation of the NLRP3inflammasome/caspase1/IL1β pathway. In addition, total antioxidant capacity (TAC), eNOS, reduced glutathione (GSH), and superoxide dismutase (SOD) significantly decreased. CYC-induced cardiotoxicity was most properly reversed by SIM through its anti-oxidant, anti-inflammatory, and anti-apoptotic actions with the stimulation of eNOS. The co-administration of L-NNA diminished the protective effect of SIM, indicating the essential role of eNOS in mediating this effect. Therefore, SIM ameliorated CYC-induced cardiotoxicity.
Sleep Problems and Their Associations with Digital Screen Exposure Among 2 to 5 Years Old Children in Chandigarh, a North Indian Union Territory
Authors: Kaur Nimran , Gupta Madhu , Kiran Tanvi , Malhi Prahbhjot , Grover Sandeep 
Published: June 2022

Background: Watching television and other electronic devices can adversely affect children’s sleep. This study aims to ascertain the association of sleep problems with digital screen exposure (DSE) among 2- to 5-year-old children in Chandigarh, India. Methods: A cross-sectional study was conducted among 400 randomly selected families having 2- to 5-year-old children, using a validated DSE questionnaire and the standard child’s sleep habits questionnaire abbreviated, from October 2017 to March 2018. The American and Indian Academy of Pediatrics guidelines were used to define higher DSE as more than 1 h per day. The multivariate binary logistic regression analysis was performed using IBM SPSS Statistics for Macintosh, Version 26.0 (IBM Corp., New York, USA), to identify significant predictors of sleep problems. Results: Boys (51.5%) and girls (48.5%) were equally represented. On average, children (3.5 ± 0.9 years) slept for 10 ± 1.6 h per day. Bedtime sleep resistance (15.1% vs 11%) and sleep behavior problems (11.8% vs 5.6%) were significantly ( P < .05) higher among children with higher DSE than children having DSE of less than 1 h per day. The significant predictors of sleep problems were children living in a nuclear family (adjOR = 2.4, CI [1.1, 5.3]), watching non-educational digital media content (adjOR = 2.6, 2.36, CI [1.1, 6.2]), and absence of digital media rules at home (adjOR = 3.9, CI [1.3, 12]). In the subgroup analysis, children having higher DSE (adjOR = 2.4, CI [1.1, 4.9]) had a significantly greater probability of bedtime resistance, and those living in a nuclear family (adjOR = 1.7, CI [1.1, 2.7]) had a significantly greater probability of morning waking-up problems. Conclusion: Sleep problems were significantly associated with higher DSE among young children in Chandigarh, India.
Psychometric Properties of the Malay Version of Peer Pressure Scale Questionnaire-Revised
Authors: Zulkifly Muhamad Afiq , Wahab Suzaily , Azmi Amirul Danial , Awang Siti Rahmah , Mustaffa Normah , Ibrahim Norhayati , Kadir Nor Ba’yah Abdul 
Published: June 2022

Background: Adolescence is a critical period of transition from childhood to adulthood and involves changes in a child’s biological, emotional, and social aspects. An adolescent’s behavior and actions are largely impacted by peer pressure. The Peer Pressure Scale Questionnaire-Revised (PPSQ-r) is a tool for assessing the susceptibility of adolescents to peer pressure. Aims: This study aimed to translate and validate PPSQ-r for examining the impact of peer pressure among Malaysian adolescents. Methods: A forward-backward translation was executed in accordance with the established guidelines. The face validity of the questionnaire was assessed by a panel of experts from the relevant fields. 25 items of the questionnaire were tested for principal component analysis (PCA), and internal consistency was appraised via Cronbach’s α. Results: A total of 143 respondents among selected secondary school students were used in this study. The age range of the respondents was 13 to 18 years, with a mean age of 15 (SD = 1.316). One component was extracted via PCA, and one item was removed because of poor factor loading. 24 retained items exhibited excellent reliability with Cronbach’s α value of 0.932. The mean score for the PPSQ-r Malay version was 42.88 (SD = 16.57). Conclusion: PPSQ-r Malay version is reliable and valid as a peer pressure assessment tool among adolescents in Malaysia. However, the development of the norms based on the Malaysian adolescent population is recommended for risk classifications.
Sedation quality of alfaxalone associated with butorphanol, methadone or pethidine in cats injected into the supraspinatus or the quadriceps muscle
Authors: Giannettoni Giacomo , Moretti Giulia , Menchetti Laura , Pepe Arianna , Bellocchi Federica , Bufalari Antonello , Nannarone Sara 
Published: June 2022

Objectives The aim of this study was to compare the quality of sedation with three different anaesthetic protocols (alfaxalone combined with butorphanol, methadone or pethidine) administered intramuscularly in cats, and to evaluate the influence of the injection site (between supraspinatus and quadriceps muscles) on the onset and quality of sedation. Methods A total of 151 cats were selected for this study. Cats were sedated with alfaxalone (3 mg/kg) combined with either butorphanol (0.3 mg/kg; n = 50), methadone (0.3 mg/kg; n = 53) or pethidine (5 mg/kg; n = 48). The combination was injected intramuscularly into the supraspinatus (n = 79) or quadriceps muscle (n = 72). The data included a scoring system for the quality of sedation and physiological parameters, such as heart rate (HR), respiratory rate, body temperature and occurrence of mydriasis, monitored during the first 30 mins of anaesthesia. Results The opioid associated with alfaxalone influenced the overall sedation score, the degree of myorelaxation, the occurrence of mydriasis and HR. The overall sedation score was poorer with butorphanol than with methadone ( P = 0.008), and butorphanol induced a lower degree of myorelaxation than methadone ( P = 0.013). The injection into the supraspinatus showed better qualitative results for sedation and a faster onset time (in about 3 mins) than that into the quadriceps ( P <0.001). HR decreased from baseline ( P <0.001) and over time ( P <0.001), mainly in cats of the butorphanol–supraspinatus and pethidine–quadriceps groups ( P = 0.004). The occurrence of mydriasis was lower after butorphanol than after methadone and pethidine ( P = 0.025), while the incidence of side effects did not differ among groups. Conclusions and relevance All three protocols provided a good quality of sedation and allowed performing the scheduled procedure. Moreover, the injection into the supraspinatus muscle showed superior results in all the qualitative scores of sedation and quicker onset time than that into the quadriceps muscle.
Vedolizumab blocks α4β7 integrin-mediated T cell adhesion to MAdCAM-1 in microscopic colitis
Authors: Besendorf Laura , Müller Tanja M. , Geppert Carol-Immanuel , Schneider Ines , Mühl Laura , Atreya Imke , Vitali Francesco , Atreya Raja , Neurath Markus F. , Zundler Sebastian 
Published: June 2022

Background: In Crohn’s disease and ulcerative colitis, the anti-α4β7 integrin antibody vedolizumab has demonstrated efficacy in phase III trials and has been successfully used under real-world conditions. Occasionally, it has also been used in other forms of inflammatory bowel disease (IBD) such as microscopic colitis (MC). However, the mechanisms of vedolizumab in MC have not been studied to date. Therefore, we aimed to investigate the expression and functional role of gut-homing integrins and in particular α4β7 integrin in a cohort study in MC. Methods: We studied the expression of gut homing integrins on T cells from patients with MC and healthy controls by flow cytometry. To investigate the function of α4β7 integrin in MC and the potential of vedolizumab to block it, we used dynamic adhesion assays and transmigrations assays. Moreover, we describe two clinical cases of MC patients treated with vedolizumab. Results: A specific profile of gut homing markers can be found on T cells from patients with MC. α4β7 integrin functionally leads to firm adhesion to MAdCAM-1 and supports transmigration. Vedolizumab is able to block both processes. In two cases of MC, we observed reduced clinical symptoms and histologic improvement upon therapy with vedolizumab. Conclusion: Our data suggest that α4β7 mediates gut homing of T cells also in MC and that, on single cell level, vedolizumab blocks the function of α4β7 in MC. Thus, we provide mechanistic evidence supporting vedolizumab as promising therapeutic option for MC.
A phase Ib/II study of regorafenib and paclitaxel in patients with beyond first-line advanced esophagogastric carcinoma (REPEAT)
Authors: Stroes Charlotte I , Schokker Sandor , Khurshed Mohammed , van der Woude Stephanie O , Mathôt Ron AA , Slingerland Marije , de Vos-Geelen Judith , Zucchetti Massimo , Matteo Cristina , van Dijk Erik , Ylstra Bauke , Thijssen Victor , Derks Sarah , Godefa Tesfay , Dijksterhuis Willemieke , Breimer Gerben E , van Delden Otto M , Verhoeven Rob HA , Meijer Sybren L , Bijlsma Maarten F , van Laarhoven Hanneke WM 
Published: June 2022

Purpose: Regorafenib monotherapy, a multikinase inhibitor of angiogenesis, tumor microenvironment, and tumorigenesis, showed promising results in gastric cancer. We aimed to assess the tolerability of regorafenib and paclitaxel in patients with advanced esophagogastric cancer (EGC) refractory to first-line treatment, and explore potential biomarkers. Methods: Patients received paclitaxel (80 mg/m2) on days 1, 8, and 15 of a 28-day cycle and regorafenib (80/120/160 mg) on days 1–21 in the dose-escalation cohort, and the maximum-tolerated dose (MTD) in the dose-expansion cohort. Exploratory, overall survival (OS) and progression-free survival (PFS) were compared to a propensity-score matched cohort receiving standard second-/third-line systemic treatment. Paclitaxel pharmacokinetics were assessed using samples from day 1 (D1) and day 15 (D15). We performed enzyme-linked immunosorbent assay measurements of galectin-1, RNA sequencing, and shallow whole-genome sequencing of metastatic tumor biopsies for biomarker analyses. Results: In the dose-escalation cohort ( n = 14), the MTD of regorafenib was 120 mg. In all, 34 patients were enrolled in the dose-expansion cohort. Most common toxicities (all grades; grade ⩾ 3) were fatigue (79%; 4%) and sensory neuropathy (63%; 4%). Best responses achieved were partial response (28%) and stable disease (54%). Median OS and PFS were 7.8 and 4.2 months, respectively (median follow-up: 7.8 months). OS ( p = 0.08) and PFS ( p = 0.81) were not significantly improved compared to the matched cohort. Paclitaxel concentrations were significantly increased with regorafenib (D15) compared with paclitaxel only (D1; p < 0.05); no associations were observed with toxicity or efficacy. An increase in circulating galectin-1 compared to baseline was associated with shorter OS ( p < 0.01). Enrichment of angiogenesis-related gene expression was observed in short survivors measured by RNA sequencing. Chromosome 19q13.12-q13.2 amplification was associated with shorter OS ( p = 0.02) and PFS ( p = 0.02). Conclusion: Treatment with regorafenib and paclitaxel is tolerable and shows promising efficacy in advanced EGC refractory to first-line treatment. Galectin-1 and chromosome 19q13.12-q13.2 amplification could serve as negative predictive biomarkers for treatment response. Registration: Clinicaltrials.gov, NCT02406170, https://clinicaltrials.gov/ct2/show/NCT02406170
Resection of Giant Cemento-Ossifying Fibroma of Jaws by Intraoral Approach—A Case Report and Review
Authors: VE Kanna Shanthosh , Hariram  , Sharma Shivani , Agrawal Amiya , Gupta Richa , Chourasia Nirmal 
Published: June 2022

Introduction: The World Health Organization in 1971 first classified fibro-osseous lesions (FOLs) as cementum forming tumors of jaws as ossifying fibroma (OF), cement-osseous dysplasia, and fibrous dysplasia. Various theories have been put forward regarding the origin of cemento-ossifying fibroma (COF) but current interests are oriented toward traumatic and developmental etiologies. The COFs are a slow-growing osteoexpansile tumor which grows to a considerable size. The tumor usually arises from tooth bearing and periodontal ligament region basically of odontogenic origin. Background: An inordinate, bony hard swelling, present united in both the jaws showing radiopaque-radiolucent mass, corticated margins, with expansion of buccal as well as lingual cortex gives a delusional image for the provisional diagnosis for surgeon, particularly to decide the surgical approach. These traits showing similarity with FOLs, more particularly cemento-OF, owing to its odontogenic or periodontal origin. Case Report: In this case, a 42-year-old female presented with abovementioned features was first taken for biopsy and then planned for simultaneous surgical resection of pathology for both jaws, from an intraoral approach giving a scar-free result. Preclusion of immediate complications was dealt with reconstruction of mandible with 2.5-mm titanium reconstruction plate. Conclusion: The diagnosis of cement-OF is based on clinical-radiographic-histopathologic evaluation. If remain untreated, these tumor can grow up to an average size of 80 mm, therefore, demanding an early surgical intervention. In our case, intraoral approach leads to almost no residual fibrosed tissue. The patient is further being planned for rehabilitation with either free fibula graft or 3-dimensional mandibular prosthesis.