bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP): Study protocol and rationale
Authors: Yang Bin , Bai Xuesong , Yi Tingyu , Wang Haibo , Liu Yifeng , Ma Lin , Liu Sheng , Wu Shaoguang , Zhang Liyong , Peng Ya , Nogueira Raul G , Chen Wenhuo , Jiao Liqun 
Published: January 2025

Rationale: The Chemical Optimization of Cerebral Embolectomy (CHOICE) trial suggested that the administration of intra-arterial alteplase after successful endovascular thrombectomy (EVT) may improve neurological outcomes in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the anterior circulation. However, the use of adjunctive intra-arterial alteplase following successful EVT in acute posterior circulation stroke remains unexplored. Aims: This study aims to investigate the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation. Sample size: To detect an estimated 15% difference in the primary outcome between the two groups, a total of 376 patients will be enrolled. This sample size allows for 80% power and a 5% significance level, with an interim analysis planned after half of the sample (188 patients) has completed a 90-day follow-up. Methods and design: The Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) trial is a multicenter, prospective, randomized clinical trial using an open-label treatment design with blinded endpoint assessment (PROBE) conducted in China. Patients with acute basilar artery occlusion will be randomly assigned in a 1:1 ratio to receive either intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) or standard care following successful thrombectomy (defined as expanded thrombolysis in cerebral infarction [eTICI] ⩾ 2b50). Study outcomes: The primary outcome is the modified Rankin Scale (mRS) score of 0–2 at 90 days. Key secondary outcomes include changes in eTICI scores after intra-arterial thrombolysis (in the experimental group), mRS 0–3 at 90 days, ordinal shift analysis of mRS at 90 days, early neurological improvement at 48 h, and improvement in National Institutes of Health Stroke Scale (NIHSS) scores at 48 h and 7 days or discharge. Safety outcomes include symptomatic intracranial hemorrhage (sICH) rates at 48 h, 90-day mortality, non-intracranial hemorrhagic complications, and non-hemorrhagic serious adverse events. Discussion: The IAT-TOP trial will provide crucial evidence regarding the potential benefits of adjunctive intra-arterial alteplase in patients with AIS-LVO in the posterior circulation following successful thrombectomy. Trial registration: ClinicalTrials.gov NCT05897554
Impact of thrombocytopenia on failure of endoscopic variceal treatment in cirrhotic patients with acute variceal bleeding
Authors: He Yan , Romeiro Fernando Gomes , Sun Mingyu , Ji Fanpu , Zhu Qiang , He Yingli , Ma Dapeng , Yuan Shanshan , Liu Xiaofeng , Philips Cyriac Abby , Basaranoglu Metin , Méndez-Sánchez Nahum , Pinyopornpanish Kanokwan , Li Yiling , Wu Yunhai , Yang Ling , Shao Lichun , Mancuso Andrea , Chen Yu , Tacke Frank , Lin Su , Liu Lei , Li Bimin , Qi Xingshun 
Published: January 2025

Background: Acute variceal bleeding (AVB), a life-threatening complication of liver cirrhosis, can be effectively treated by endoscopy, but there is a risk of early rebleeding after endoscopic variceal treatment (EVT). Thrombocytopenia is the most common hemostatic abnormality in liver cirrhosis. However, it is still unclear about whether thrombocytopenia increases the failure of EVT in cirrhotic patients with AVB. Objectives: We investigated the association between thrombocytopenia and the failure of EVT in cirrhotic patients with AVB. Design: International multicenter, retrospective study. Methods: Overall, 2467 cirrhotic patients with acute gastrointestinal bleeding who were enrolled into an international multicenter study between September 30, 2020 and June 30, 2023 were retrospectively screened. Thrombocytopenia was defined as platelet count below 150 × 109/L and further classified as mild (100 × 109/L–150 × 109/L), moderate (50 × 109/L–100 × 109/L), and severe (<50 × 109/L). A 1:1 propensity score matching (PSM) analysis was performed. Five-day failure to control bleeding was evaluated. Results: Overall, 1079 patients were included, of whom 923 (85.5%) had thrombocytopenia, including mild ( n = 241), moderate ( n = 445), and severe ( n = 237) thrombocytopenia. PSM analysis demonstrated that the rate of 5-day failure to control bleeding was not significantly different between patients with and without thrombocytopenia (mild: (12/153) 7.8% vs (7/153) 4.6%, p = 0.236; moderate: (9/155) 5.8% vs (7/155) 4.5%, p = 0.608; or severe: (5/132) 3.8% vs (7/132) 5.3%, p = 0.555). Conclusion: Thrombocytopenia may not influence the efficacy of EVT in cirrhotic patients with AVB.
Cost-effectiveness of lazertinib as first-line treatment in patients with EGFR-mutated advanced lung cancer
Authors: Ku Li-Jung Elizabeth , Tsai Jui-Hung , Chen Li-Jun , Yang Szu-Chun 
Published: January 2025

Background: Lazertinib demonstrates efficacy similar to that of osimertinib in the first-line treatment of epidermal growth factor receptor ( EGFR)-mutated advanced lung cancer. However, its cost-effectiveness has not yet been evaluated. Objective: To study the cost-effectiveness of lazertinib as a first-line treatment for patients with EGFR-mutated advanced lung cancer. Design: A partitioned survival model-based cost-effectiveness analysis. Methods: We conducted the economic analysis from the perspective of the healthcare sector with a lifetime horizon. Simulated patients were entered into the models upon the diagnosis of EGFR-mutated advanced lung cancer. Lazertinib was compared with gefitinib. The model inputs were derived from the trials (survival outcomes, incidence of adverse events (AEs), and subsequent therapies), National Health Insurance payments (costs of drugs and AEs), and hospital cohorts (utility values). Deterministic and probabilistic analyses were also conducted. Results: Applying the same daily price of osimertinib (US$110) to that of lazertinib, the incremental cost-effectiveness ratio of lazertinib versus gefitinib was US$93,792 per quality-adjusted life year (QALY). The cost of lazertinib was a major determinant. If the daily price of lazertinib could be reduced to US$75, lazertinib would become cost-effective at a willingness-to-pay (WTP) threshold of US$70,000 per QALY. Given the WTP threshold, the probability that lazertinib would be cost-effective was 0.7%. Conclusion: Lazertinib is not a cost-effective first-line treatment for EGFR-mutated advanced lung cancer. Lowering prices enables cost-effectiveness.
Differential Effects of the Type of Physical Exercise on Blood Pressure in Independent Older Adults
Authors: Cancela-Carral Jose M. , Bezerra Pedro , Lopez-Rodriguez Adriana , Silva Bruno 
Published: January 2025

Background: Exercise and its effect on cardiovascular diseases have been extensively studied in the elderly population. The difference in blood pressure (BP) between fit and unfit subjects can be >5 mmHg. It is not well established whether the positive effects of exercising on BP are associated with exercise type, be it aerobic or anaerobic (maximal muscle strength). Hypothesis: Anaerobic training (maximal muscle strength) causes greater improvements than aerobic training on BP in active older adults. Study Design: Clinical trial. Level of Evidence: Level 4. Methods: This clinical trial was carried out with 202 participants (n = 116 aerobic program [ABPG], n = 86 strength program [SBPG]; 58.05% female; age 67.61 ± 5.01 years). The training program was carried out between 2018 and 2021. Periodic evaluations of BP (systolic BP [SBP] and diastolic BP [DBP]) were conducted with a frequency of twice per year. BP comparisons were made by using 2 × 2 analysis of variance with repeated measurements over the course of the 4 years of the project. Results: Throughout the training program, SBPG showed significant and consistent improvements in both SBP and DBP ( P < 0.01). On the other hand, the ABPG reported a significant initial improvement ( P < 0.01), which was not repeated in subsequent years. BP monitoring carried out over the 4 years showed a decrease in DBP and SBP, with this decrease being more pronounced in SBPG. However, the differences between the groups were not significant (2021; DBP, F = 1.227; P = 0.27; SBP, F = 0.826, P = 0.36). Conclusion: Among persons aged ≥65 years, muscle strength training programs appear to be more effective in inducing exercise-related positive changes in BP and cardiovascular risk factors compared with aerobic exercise programs. Clinical Relevance: Muscle strength training programs result in favorable changes in BP and cardiovascular risk factors.
Providers’ Beliefs and Values: Understanding Their Approach to Gender-Affirming Care
Authors: Shirin Ahona , Daniello Maya , Stamm Laura 
Published: January 2025

Objectives: This qualitative study explored the beliefs and values influencing healthcare providers’ delivery of gender-affirming care (GAC) to transgender and gender-diverse (TGD) youth amidst current social and political dynamics. Methods: The study PI conducted 43 semi-structured interviews with providers across states with varying GAC legislation. Responses from 41 providers were analyzed in this paper. A thematic approach to data analysis was employed using qualitative coding. Results: Key themes emerged: criteria for treatment, ethical and moral considerations, and professional and personal responsibility. Providers widely endorsed GAC as evidence-based and essential for alleviating distress and promoting autonomy. They emphasized the importance of respecting patients’ gender identities and viewing GAC as life-saving. Conclusion: Despite legislative challenges, the study highlights a strong consensus among providers on the medical necessity of GAC for TGD youth.
Cervical Cancer and Cervical Cancer Screening in Women with HIV in Guangxi, China: A Model Simulation Study
Authors: Zhao Ran , Kulasingam Shalini 
Published: January 2025

Background. Cervical cancer screening can effectively reduce the disease burden. In China, the current cervical cancer screening guidelines do not provide separate screening recommendations for women living with HIV (WLWH) to account for their increased risk. Methods. We developed a comprehensive individual-based simulation model to provide evidence to support tailored cervical cancer screening programs for WLWH in Guangxi, a region with a high prevalence of HIV in China. Compared with the current screening coverage (i.e., the status quo), we evaluated the benefits and the harms associated with 9 cytology-based cervical cancer screenings tailored to WLWH in Guangxi. The 9 strategies vary in terms of screening interval (every 1, 3, or 5 y) and the age to exit screening (at age 65 y, 85 y, or no exit). Results. All screening strategies evaluated were effective in reducing cervical cancers and cancer deaths among WLWH. Compared with the status quo, the percentage reduction in total cancers ranged from 18% to 60%, and the percentage reduction in cancer deaths ranged from 20% to 62%. Strategies with a 3- or 5-y screening interval had lower numbers of colposcopies per cancer and cancer deaths prevented. Conclusion. Implementing cytology-based cervical cancer screening among WLWH in Guangxi, China, can effectively prevent cervical cancer cases and cancer deaths. Our results suggest that adopting an older end age and a shorter screening interval might be more effective in preventing cancer cases and deaths but may also be associated with more screenings and potential harms and costs, while adopting a 3- or 5-y screening interval may provide a more reasonable balance of benefits and harms to prevent future cancer cases and deaths among WLWH in Guangxi, China. Highlights Our comprehensive model can be used to evaluate various health interventions that aim to reduce the disease burden caused by HPV and cervical cancer. Cytology-based cervical cancer screening tailored to WLWH in Guangxi, China can effectively prevent cervical cancer cases and cancer deaths. Adopting a 3- or 5-y screening interval may provide a more reasonable balance of benefits and harms to prevent future cancer cases and deaths.
Rescue therapy after failed thrombectomy in medium/distal vessel occlusions: A retrospective analysis of an international, multi-center registry
Authors: Anastasiou Aikaterini , Brehm Alex , Dobrocky Tomas , Mujanovic Adnan , de Dios Lascuevas Marta , Carmona Fuentes Tomas , López-Frías López-Jurado Alfonso , Hidalgo Valverde Blanca , Berlis Ansgar , Maurer Christoph J. , Nguyen Thanh N , Abdalkader Mohamad , Klein Piers , Thevoz Guillaume , Michel Patrik , Kaschner Marius , Weiss Daniel , Alexandre Andrea M. , Pedicelli Alessandro , Machi Paolo , Bernava Gianmarco , Kuwahara Shuntaro , Uchida Kazutaka , Wenderoth Jason , Joshi Anirudh , Karwacki Grzegorz , Lakatos Lehel-Barna , Tessitore Agostino , Vinci Sergio Lucio , Cervo Amedeo , Rollo Claudia , Hui Ferdinand , Mozumder Aaisha Siddiqua , Romano Daniele Giuseppe , Flora Gianmarco , Goyal Nitin , Batra Vivek , Inoa Violiza , Cognard Christophe , Hoferica Matúš , Rautio Riitta , Kaiser Daniel , Alph Hanna , Clarke Julian , Hug Nick , Koch Alma , Schulze-Zachau Victor , Rommers Nikki , Katan Mira , Psychogios Marios-Nikos 
Published: January 2025

Background: There are limited therapeutic options in cases of failed reperfusion (modified thrombolysis in cerebral infarction [mTICI] score < 2b) after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue therapy (balloon angioplasty and/or stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after rescue therapy in medium/distal vessel occlusions (MDVOs) have not been reported. This study aims to report the outcomes of rescue therapy in MDVO stroke patients. Methods: We performed an analysis of the “Blood pressure and Antiplatelet medication management after reScue angioplasty after failed Endovascular treatment in Large and distal vessel occlusions with probable IntraCranial Atherosclerotic Disease” (BASEL ICAD) retrospective registry. All MDVO stroke patients were included in the analysis. Results: Out of the 718 registry patients, 87 (12.1%) presented with an MDVO. Fifty-six patients (64.4%) showed an occlusion of the M2 segment of the middle cerebral artery. Rescue stenting was performed in 78 patients (89.7%) while balloon angioplasty alone was performed in 9 patients (10.3%). Successful reperfusion (mTICI score ⩾ 2b) was achieved in 73 (83.9%) patients after rescue therapy. Symptomatic intracranial hemorrhage (sICH) occurred in 8 patients (9.2%) and post-treatment stent occlusion in 12 patients (13.8%). Ninety days mortality was 20.7%. Twenty-eight patients (32.2%) achieved functional independence at 90 days (modified Rankin Scale 0–2). Conclusion: Rescue therapy with stenting and/or balloon angioplasty in patients undergoing EVT for isolated MDVO with suspected underlying intracranial atherosclerotic disease is an effective reperfusion strategy but is associated with complications and poor functional outcomes.
Economic impact of prolonged tracheal extubation times on operating room time overall and for subgroups of surgeons: a historical cohort study
Authors: Dexter Franklin , Marian Anil A. , Epstein Richard H. 
Published: January 2025

Abstract
Background
Prolonged tracheal extubation time is defined as an interval ≥ 15 min from the end of surgery to extubation. An earlier study showed that prolonged extubations had a mean 12.4 min longer time from the end of surgery to operating room (OR) exit. Prolonged extubations usually (57%) were observed during OR days with > 8 h of cases and turnovers, such that longer OR times from prolonged extubation can be treated as a variable cost (i.e., each added minute incurs an expense). The current study addressed limitations of the generalizability of these earlier investigations.

Methods
The retrospective cohort study included cases performed at a university hospital October 2011 through June 2023 with general anesthesia, tracheal intubation and extubation in the OR where the anesthetic was performed, and non-prone positioning. The primary endpoint was the interval from end of surgery to OR exit. Mean OR time differences with/without prolonged extubation were analyzed pairwise by surgeon. The variance among surgeons was estimated using the DerSimonian-Laird method with Knapp-Hartung adjustment for the sample sizes of surgeons. Proportions were analyzed after arcsine transformation, and the inverse taken to report results.

Results
There were prolonged extubations for 23% (41,768/182,374) of cases. Prolonged extubations had a mean 13.3 min longer time from the end of surgery to OR exit (95% confidence interval 12.8–13.7 min, P < 0.0001). That result was among the 71 surgeons each with ≥ 9 cases having prolonged extubation times and ≥ 9 cases with typical extubation times. Results were similar using a threshold of ≥ 3 cases, comprising 257 surgeons (13.2 min, P < 0.0001). Among the 71 surgeons with at least nine prolonged extubations, on most days with a prolonged extubation during at least one of their cases, there were > 8 h of cases and turnover times in the OR (77%, 73%-81%, P < 0.0001). Results were similar when analyzed for the 249 surgeons each with ≥ 3 cases with prolonged extubation (76%, P < 0.0001).

Conclusions
Matching earlier findings, prolonged tracheal extubation times are important economically, increasing OR time by 13 min and usually performed in ORs with lists of cases of sufficient duration to treat the extra time as a variable cost.
Development of a standardized patient-reported clinical questionnaire for children with spinal pain
Authors: Overgaard Freja Gomez , Lauridsen Henrik Hein , Damkjær Mads , Ebbesen Anne Reffsøe , Hestbæk Lise , Konner Mikkel Brunsgaard , O’Neill Søren Francis Dyhrberg , Pape Stine Haugaard , Rathleff Michael Skovdal , Straszek Christian Lund , Nim Casper 
Published: January 2025

Abstract
Background
Spinal pain affects up to 30% of school-age children and can interfere with various aspects of daily life, such as school attendance, physical function, and social life. Current assessment tools often rely on parental reporting which limits our understanding of how each child is affected by their pain. This study aimed to address this gap by developing MySpineData-Kids (“MiRD-Kids”), a tailored patient-reported questionnaire focusing on children with spinal pain in secondary care (Danish hospital setting).

Methods
The process and development of MiRD-Kids followed a structured, multi-phase approach targeted children in outpatient care. The first phase involved evidence-synthesis, expert consultations, and item formulation, resulting in the first version. The second phase involved pilot testing among pediatric spinal pain patients, leading to modifications for improved clarity and relevance. The third phase involved implementation at the Pediatric outpatient track at The Spine Centre of Southern Denmark, University Hospital of Southern Denmark.

Results
MiRD-Kids was based on selected items from seven questionnaires, encompassing 20 items across six domains. Pilot testing with 13 pediatric patients facilitated modifications and finalized the questionnaire. The questionnaire includes sections for parents/legal guardians and six domains for children covering pain, sleep, activities, trauma, concerns, and treatment, following the International Classification of Functioning, Disability, and Health (ICF). Implementation challenges were overcome within a 2-month period, resulting in the clinical questionnaire MiRD-Kids a comprehensive tool for assessing pediatric spinal pain in hospital outpatient settings.

Conclusion
MiRD-Kids is the first comprehensive questionnaire for children with spinal pain seen in outpatient caresetting and follows the ICF approach. It can support age-specific high-quality research and comprehensive clinical assessment of children aged 12 to 17 years, potentially, contributing to efforts aimed at mitigating the long-term consequences of spinal pain.
Effects of culturally-appropriate group education for migrants with type 2 diabetes in primary healthcare: pre-test-post-test design
Authors: Hjelm Katarina , Hadziabdic Emina 
Published: January 2025

Abstract
Background
The global incidence of type 2 diabetes is rapidly rising, particularly among migrants in developed countries. Migrants bear a significant burden of diabetes. However, this study is the only to evaluate the effects of a culturally appropriate diabetes intervention for these migrants on diabetes knowledge and health outcomes, adding a novel perspective to the existing literature.
The aim of the study was to evaluate the effects on diabetes knowledge, HbA1c, and self-rated health of a previously developed, culturally appropriate diabetes education model, based on individual beliefs about health and illness, underpinned by knowledge, and conducted through focus group discussions.

Methods
Observational study evaluating the intervention using a pre-test-post-test design. It involved structured interviews and HbA1c measurements before, immediately after, and three months post-participation in the group-based intervention. The study included 22 migrants from the Middle East and Africa, divided into eight focus groups. The group education was conducted by a multi-professional team, led by a diabetes specialist nurse, in primary healthcare settings. Descriptive and analytical statistics applied in analysing data.

Results
The findings showed that participation in the diabetes education significantly improved the knowledge levels, led to an initial change and possible short-term improvement in HbA1c (better immediate post-intervention), albeit statistically insignificant, but no change in glycaemic control over time and in self-rated health (SRH).

Conclusions
The findings supported the hypothesis of improved knowledge. Moreover, the findings showed a possible initial change in glycaemic control, but no overall effect. The study showed no change in self-rated (perceived) health. Further studies involving other populations and long-term follow-ups are needed. This study highlights the importance of culturally tailored diabetes educational programmes in our multicultural society. By recognising individual beliefs about health and illness, this education programme can significantly increase knowledge and thereby contribute to improved self-care and thus, overall health. Furthermore, it is recommended for daily practice in primary healthcare, supporting healthcare professionals with a proven strategy to increase knowledge.