bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical resection versus thermal ablation: comparison of sequential options after successful TACE downstaging therapy for unresectable hepatocellular carcinoma
Authors: An Chao , Wu Songsong , Zuo Mengxuan , Li Wang , Li Kai , Wu Peihong 
Published: January 2025

Background: Transarterial chemoembolization (TACE) is an effective and safe downstaging therapy for hepatocellular carcinoma (HCC). However, the selection of sequential therapeutic modalities is still controversial. Objectives: This study compared the effectiveness and safety of surgical resection (SR) and thermal ablation (TA) after patients with HCC underwent TACE downstaging therapy. Design: A retrospective, multi-institutional study. Methods: From June 2008 to October 2022, a total of 4782 consecutive patients with HCC beyond the initial Milan criteria underwent TACE at 12 hospitals. Among them, 609 patients who received successful downstaging therapy were retrospectively reviewed. Among them, 209 patients underwent an SR, and 390 patients received TA after TACE. The propensity score matching (PSM) method was applied to reduce selection bias between groups. Cumulative overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan–Meier method with the log-rank test. Results: After PSM 1:1 ( n = 185 in both groups), the cumulative 1-, 3-, 5-, and 10-year OS rates were 98.8%, 89.3%, 82.9%, and 64.4%, respectively, in the SR group and 99.5%, 88.4%, 75.3%, and 53.9%, respectively, in the TA group; these two groups were not significantly different (HR: 1.22; 95% CI: 0.78–1.89; p = 0.381). The cumulative 1-, 3-, 5-, and 10-year PFS rates were 88.5%, 69.2%, 58.8%, and 32.2%, respectively, in the SR group and 90.6%, 71.4%, 53.1%, and 32.0%, respectively, in the TA group, revealing no significant difference between the two groups (HR: 0.97; 95% CI: 0.71–1.32; p = 0.855). Conclusion: For HCC patients beyond the Milan criteria who received TACE downstaging therapy, TA might be acceptable as an alternative to SR in the first-line sequential treatment scheme.
Vestibular Implant Surgery: How to Deal With Obstructed Semicircular Canals—A Diagnostic and Surgical Guide
Authors: van de Berg Raymond , Stultiens Joost Johannes Antonius , van Hoof Marc , Van Rompaey Vincent , Hof Janke Roelofke , Vermorken Bernd Lode , Volpe Benjamin , Devocht Elke Maria Johanna , Pérez Fornos Angélica , Postma Alida Annechien , Lenoir Vincent , Becker Minerva , Guinand Nils 
Published: January 2025

Background A vestibular implant can partially restore vestibular function by providing motion information through implanted electrodes. During vestibular implantation, various obstructions of the semicircular canals, such as protein deposits, fibrosis, and ossification, can be encountered. The objective was to explore the relationship between preoperative imaging and intraoperative findings of semicircular canal obstruction and to develop surgical strategies for dealing with obstructions of the semicircular canal(s) in patients eligible for vestibular implantation. Methods Patients undergoing vestibulocochlear implantation (in an active clinical trial) were included in the current study when preoperative imaging indicated an obstruction in the semicircular canal. Preoperative imaging consisted of CT and MRI scans. During surgery, the bony semicircular canals were skeletonized (“bluelined”) to identify the course of the canals and create a fenestration to insert the electrodes. The aim was to place the electrodes in the semicircular canal ampullae. Surgical strategies were developed to deal with the soft tissue obstructions. These procedures were evaluated intraoperatively with microscopic visualization, postoperatively with CT imaging. Results The three included patients suffered from bilateral vestibulopathy and hearing loss due to autosomal dominant nonsyndromic sensorineural deafness 9 (DFNA9). A soft tissue obstruction was predicted in one semicircular canal (2 patients) or two semicircular canals (1 patient), based on preoperative imaging. Intraoperatively, bluelining the semicircular canals aided in identifying these locations, by revealing a “whiteline” instead of blueline. Depending on the nature and location of the obstruction, different surgical procedures were employed to facilitate proper electrode insertion. These were as follows: a dummy electrode was used to probe the soft tissue, the obstructive tissue was removed, and/or a bypass fenestration was created. In all patients, the electrodes could be implanted in the semicircular canal ampullae. Based on these first experiences, a diagnostic and surgical guide to deal with obstructions of the semicircular canals during vestibular implantation was developed. Conclusions Preoperative imaging can indicate locations of obstructions in the SCCs. Different surgical procedures can be applied to enable appropriate electrode positioning in the SCC ampulla. This article describes the first experiences with obstructions of the semicircular canals during intralabyrinthine vestibular implantation and presents a diagnostic and surgical guide. Trial registration ABR NL73492.068.20, METC20-087 (Maastricht University Medical Center) and NAC 11-080 (Geneva University Hospitals).
Promoting Environmental Citizenship Using Participatory School-Based Community Profiling on Water (Mis)uses
Authors: Prada da Silva Diogo Filipe , Silva Joel Bruno da , Barbosa Marta Oliveira , Ribeiro Norberto , Menezes Isabel 
Published: January 2025

Purpose This study analyzes the contributions of the Healthy Waters educational program to the awareness and understanding of environmental issues related to water to generate changes in attitudes in the community. Design/Approach/Methods A community school intervention was conducted in a public school in Paredes, Porto, Portugal. Using a participatory research approach, 35 participants were recruited from the seventh and eighth grades. A retrospective pretest/posttest questionnaire was used to assess the influence of the intervention. A thematic analysis of the tutors’ logbooks was performed to ascertain the relevant domains of change for students during the intervention. Findings Results showed statistically significant changes in proenvironmental attitudes and behaviors at the end of the intervention. The effect sizes of the statistical analyses showed that the intervention generally had a positive influence on the environmental awareness of the participants. The tutors’ evaluations of the intervention indicated a diversified gain in students’ environmental learning. Originality/Value The results of this study demonstrate that this type of intervention increases students’ knowledge of and involvement in environmental issues while reinforcing their environmental citizenship.
Comparative Analysis of Injury and Illness Rates Among Team USA Athletes at the Tokyo 2020 Summer Olympic and Paralympic Games
Authors: Post Eric G. , Cali Malia G. , Clark Stephanie C. , Noble-Taylor Kayle E. , Robinson David M. , Hasley Ike B. , Larson Emily G. , McPherson April L. , Anderson Travis , Finnoff Jonathan T. , Adams William M. 
Published: January 2025

Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games. Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games. Study Design: Descriptive epidemiology study. Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes. Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90). Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.
Rescue stenting after failed mechanical thrombectomy: The RES-CAT study
Authors: Collet-Vidiella Roger , Camps-Renom Pol , Núñez-Guillén Ana , Quesada Helena , Rizzo Federica , Rodriguez-Villatoro Noelia , Amaro Sergio , Llull Laura , Santana Daniel , Estrada Edgardo , Flores Alan , Terceño Mikel , Bashir Saima , Hernández-Pérez María , Remollo Sebastià , Barrachina-Esteve Oriol , Cánovas David , Vivas Elio , Rodríguez-Campello Ana , Mauri Gerard , Purroy Francisco , Ramos-Pachón Anna , Guasch-Jiménez Marina , Guisado-Alonso Daniel , Prats-Sánchez Luis , Martínez-Domeño Alejandro , Lambea-Gil Álvaro , Ezcurra-Díaz Garbiñe , Branera-Pujol Jordi , Martínez-González José Pablo , Dinia Lavinia , Salvat-Plana Mercè , Pérez de la Ossa Natalia , Molina Carlos A. , Cardona Pere , Martí-Fàbregas Joan 
Published: January 2025

Introduction The efficacy of intracranial rescue stenting (RS) following failed mechanical thrombectomy (MT) in large-vessel occlusion (LVO) stroke remains uncertain. We aimed to evaluate clinical outcomes of RS in patients with anterior circulation LVO stroke following unsuccessful MT. Patients and methods We conducted a retrospective analysis using the Stroke Code Registry of Catalonia (January 2016–March 2022), a prospective, population-based registry including patients treated at 10 comprehensive stroke centers. We compared outcomes between patients who received RS and those who did not after failed MT. The primary outcome was the shift in 90-day functional status, assessed by the modified Rankin Scale (mRS), adjusted for confounders using inverse probability of treatment weighting (IPTW). Secondary outcomes included good (mRS ⩽ 2 or 3 if baseline mRS was 3) and excellent (mRS ⩽ 1) outcomes, ischemic recurrences, hemorrhagic transformation, and 90-day mortality. Results Of 601 patients, 69 underwent RS. RS did not significantly impact the 90-day mRS shift (adjusted common odds ratio [acOR] 1.06, [95% CI 0.85–1.32]; p = 0.613). However, RS was associated with higher rates of good (18.8% vs 11.7%; aOR 1.41, [95% CI 1.00–1.99]; p = 0.048) and excellent outcomes (17.4% vs 5.7%; aOR 2.90, [95% CI 1.89–4.43]; p < 0.001). Symptomatic intracranial hemorrhage (9.4% vs 7.4%; p = 0.507) and 90-day mortality (30.4% vs 39.8%; p = 0.135) were similar between groups. Stroke recurrence (4.2% vs 1.7%; p = 0.247) showed no significant difference at 33-month follow-up. Discussion and conclusion RS may increase the likelihood of good and excellent outcomes in anterior LVO stroke after failed MT, without increasing long-term risks. Further randomized trials are warranted for comprehensive validation.
Percutaneous nephroscopy versus flexible ureteroscopy in the treatment of calyceal diverticulum calculi: a meta-analysis
Authors: Hu Conglei , Ma Rui , Shao Yongxiang , Liang Zilong , Cheng Meng , Pang Haofeng , Yao Liping , Liu Fei 
Published: January 2025

Abstract
Background
There is still controversy about the best minimally invasive surgical method for the treatment of calyceal diverticulum calculi. We conducted meta-analysis to evaluate the effectiveness and safety of PCNL and FURL in the treatment of calyceal diverticulum calculi.

Methods
We searched Pubmed, Cochrane Library, Web of Science, Embase, Clinical trial platform, CNKI, VIP until April 2024. We utilized the Newcastle–Ottawa Scale (NOS, 0 to 9 stars) to assess the quality of the included literature.

Results
Totally 15 high-quality studies with 755 patients were included in the meta-analysis. Meta-analysis showed that FURL group was better than PCNL group in blood loss [SMD = 1.713, 95%CI:(0.858, 2.568), Z = 3.928, P = 0.000] and hospital stay [SMD = 2.611, 95%CI: (1.726, 3.496), Z = 5.784, P = 0.000], there was no significant difference in operating time [SMD = 0.079, 95%CI:(-0.43, 0.589), Z = 0.306, P = 0.760], complication rate [OR = 1.793,95%CI: (0.952,2.602), Z = 1.586, P = 0.113], stone-free rate [OR = 1.339, 95%CI: (0.576, 3.112), Z = 0.678, P = 0.497] and symptom-free rate [OR = 3.826,95%CI: (0.561,10.238), Z = 0.966, P = 0.334] as well.

Conclusion
Whether FURL is indeed superior to PCNL in safety, whether FURL's efficacy is really close to PCNL, and whether FURL can surpass PCNL as the first choice for the treatment of renal diverticulum stones in the future need to be further verified by multi-center, large-sample and high-quality studies.
Ecological drivers shaping mainstem and tributary fish communities in the upper Jinsha River, southeastern Qinghai-Tibet Plateau
Authors: Lin Pengcheng , Fujiwara Masami , Ma Baoshan , Xia Zhijun , Wu Xinghua , Wang Chunling , Chang Tao , Gao Xin 
Published: January 2025

Abstract
Background
Elucidating spatial variation in ecological communities and the mechanisms of community assembly is crucial for biodiversity conservation in river ecosystems. The upper Jinsha River located in the eastern part of the Qinghai-Tibet Plateau, is experiencing intensified human activities, such as hydropower development. In this study, fish surveys were conducted at 38 sites, including 15 mainstem sites and 23 tributary sites of the upper Jinsha River, China, to analyze the spatial patterns and ecological drivers of fish communities.

Results
NMDS and PERMANOVA analysis revealed significant disparities in the fish communities between the mainstem and tributaries. Schizothorax dolichonema and Schizopygopsis malacanthus dominated the mainstem, whereas Schizopygopsis malacanthus, Schizothorax wangchiachii, and Triplophysa stenura dominated the tributaries. Fish beta diversity exhibited substantial turnover across the mainstem, tributaries, and entire river basin. Both environmental factors (e.g., altitude and the proportion of cobble substrate) and spatial variables were significantly correlated with fish beta diversity, but their relative importance differed between the mainstem and tributaries. Specifically, in the mainstem, environmental variables emerged as the primary drivers. In contrast, spatial factors assumed a predominant role in the tributary communities.

Conclusions
The results suggested that environmental filtering predominantly drove fish community assembly in the mainstem, whereas dispersal limitation exerted had a greater influence on the fish communities in the tributaries. These results contribute to our understanding of the spatial patterns and formation mechanisms of fish assemblages between mainstem and tributaries in high-altitude rivers, such as the upper Jinsha River. In the context of hydropower development in the upper Jinsha River, our findings offer insights into the management and conservation of fish diversity.
Safety and efficacy of CD33-targeted CAR-NK cell therapy for relapsed/refractory AML: preclinical evaluation and phase I trial
Authors: Huang Ruihao , Wang Xiaoqi , Yan Hongju , Tan Xu , Ma Yingying , Wang Maihong , Han Xiao , Liu Jia , Gao Li , Gao Lei , Jing Guangjun , Zhang Cheng , Wen Qin , Zhang Xi 
Published: January 2025

Abstract
Background
Due to the lack of effective treatment options, the prognosis of patients with relapsed/refractory acute myeloid leukemia (R/R AML) remains poor. Although chimeric antigen receptor (CAR)-T-cell therapy has shown promising effects in acute lymphoblastic leukemia (ALL) and lymphoma, its application in R/R AML is limited by “off-target” effects, which lead to severe bone marrow suppression and limit its clinical application. CAR-natural killer (NK) cells not only exhibit antitumor effects but also demonstrate increased safety and universality. We have developed a new CAR construct that targets CD33 and modified NK cells, specifically eliminating AML cells while reducing severe side effects on stem cells.

Methods
The CD33-targeting domain was selected by CAR-T cells, and this optimized CAR construct was subsequently transduced into umbilical cord-derived NK cells via a retroviral vector. Preclinical efficacy and safety studies were conducted both in vitro and in vivo. Ten eligible patients with R/R AML aged 18–65 years who received one or more infusions of anti-CD33 CAR-NK cells following the preconditioning regimen were enrolled. We assessed the response rates and treatment-related side effects post-infusion, while also documenting the long-term efficacy of the therapy.

Results
The CD33 sequence was selected on the basis of its antitumor efficacy and safety in CAR-T-cell studies conducted both in vitro and in vivo. CD33 CAR-NK cells demonstrated efficacy comparable to that of CD33 CAR-T cells but showed limited toxicity to hematopoietic stem cells (HSCs). Ten patients, with a median of five prior lines of treatment, completed the efficacy evaluation (range, 3–8). No grade 3–4 adverse events were observed, except bone marrow suppression, which was relieved within one month. No cases of immune effector cell–associated neurotoxicity syndrome (ICANS) or graft-versus-host disease (GVHD) were reported following CAR-NK cell infusion. Only one patient experienced grade 2 cytokine release syndrome (CRS) and presented with persistent fever. By day 28, six of ten patients had achieved minimal residual disease (MRD)-negative complete remission.

Conclusions
Our preclinical and clinical data demonstrated the primary efficacy and safety of CD33 CAR-NK cells for patients with R/R AML. Expanded samples and longer follow-up periods are needed to provide further efficacy data.

Trial registration
NCT05008575 (https://clinicaltrials.gov/study/NCT05008575).
Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management
Authors: Sato Ryota , Hasegawa Daisuke , Guo Stephanie , Nuqali Abdulelah E. , Moreno Jesus E. Pino 
Published: January 2025

AbstractSepsis often leads to vasoplegia and a hyperdynamic cardiac state, with treatment focused on restoring vascular tone. However, sepsis can also cause reversible myocardial dysfunction, particularly in the elderly with pre-existing heart conditions. The Surviving Sepsis Campaign Guidelines recommend using dobutamine with norepinephrine or epinephrine alone for patients with septic shock with cardiac dysfunction and persistent hypoperfusion despite adequate fluid resuscitation and stable blood pressure. However, the definition of cardiac dysfunction and hypoperfusion in these guidelines remains controversial, leading to varied clinical interpretations. Cardiac dysfunction with persistent hypoperfusion despite restoring adequate preload and afterload is often considered a cardiogenic shock. Therefore, sepsis complicated by new-onset myocardial dysfunction or worsening of underlying myocardial dysfunction due to sepsis-induced cardiomyopathy, resulting in cardiogenic shock, can be defined as “Sepsis-induced cardiogenic shock (SICS)”. SICS is known to be associated with significantly higher mortality. A history of cardiac dysfunction is a strong predictor of SICS, highlighting the need for precise diagnosis and management given the aging population and rising cardiovascular disease prevalence. Therefore, SICS might benefit from early invasive hemodynamic monitoring with a pulmonary artery catheter (PAC), unlike those with septic shock alone. While routine PAC monitoring for all septic patients is impractical, echocardiography could be a useful screening tool for high-risk individuals. If echocardiography indicates cardiogenic shock, PAC might be warranted for continuous monitoring. The role of inotropes in SICS remains uncertain. Mechanical circulatory support (MCS) might be considered for severe cases, as high-dose vasopressors and inotropes are associated with worse outcomes. Correct patient selection is the key to improving outcomes with MCS. Engaging a cardiogenic shock team for a multidisciplinary approach can be beneficial. In summary, addressing the evidence gaps in SICS diagnosis and management is crucial. Echocardiography for screening, advanced monitoring with PAC, and careful patient selection for MCS are important for optimal patient care.
Trends and cost structure of drug-based secondary prevention of ischemic strokes
Authors: Kohlhase Konstantin , Bohmann Ferdinand O. , Grefkes Christian , Strzelczyk Adam , Willems Laurent M. 
Published: January 2025

Abstract
Background
Advances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes.

Methods
Annual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal–Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis.

Results
The study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1–Q3:1157–1157], p < 0.006), 20.0% to AHTs (€127.8 [76.7–189.8]), 15.7% to ODs (€525.6 [76.7–641.5]), and 8.7% to LLDs (€43.8 [43.8–43.8]). Cardioembolic strokes had the highest annual costs per patient (€1328.6 [1169.0–1403.4]) with higher expenditure for DOACs (p < 0.001) and AHTs (p < 0.026). DAPT costs were highest for large-vessel strokes (p < 0.001) and accounted for 2.5% of total costs. There was a significant trend change in DDDs for clopidogrel in 2010 (p < 0.001), for prasugrel in 2017 (p < 0.001), for ASA in 2015 (p < 0.001) and for DOACs in 2012 (p = 0.017).

Conclusions
DOACs for cardioembolic strokes were the primary cost driver in drug-based secondary stroke prevention, whereas permanent ASA and DAPT only accounted for a minor cost proportion. LLDs were associated with lower costs than AHTs and ODs. There were significant changes in DDDs for the respective substances, whereas the costs for DOACs as the most expensive pharmaceuticals remained widely stable across the last decade.