bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiangiogenic therapy combined with immune checkpoint blockade in urothelial cancer: Systematic review and meta-analysis
Authors: Moussa Mohammad Jad , Kovalenko Iuliia , Crupi Emanuele , Proskuriakova Ekaterina , Geng Yimin , Fallara Giuseppe , Benkhadra Raed , Raggi Daniele , Campbell Matthew T. , Msaouel Pavlos , Alhalabi Omar 
Published: December 2024

Background Antiangiogenic therapy had been tested in urothelial cancer (UC) without reaching the clinic. Objective We provide a systematic review and meta-analysis of trials to assess efficacy of immune checkpoint inhibitors (ICI) combined with antiangiogenic agents in UC. Methods Following PRISMA guidelines, we searched for trials with at least one arm of patients with UC treated with ICI plus antiangiogenics. Data were analyzed with the “meta” package from R using a one-staged frequentist meta-analysis. Results After screening 13,708 titles and abstracts, 9 studies were selected for analysis with 14 identified cohorts comprising 621 patients: 448 were ICI-naïve (ICI-N) and 173 were ICI-exposed (ICI-E). The estimated objective response rate (ORR) in all patients was 27% (21–35). In the ICI-N group, ORR was 34% (28–41). Conversely, the ICI-E group had a lower ORR of 16% (9–28). This difference was mainly driven by a higher partial response rate of 27% (23–31) in ICI-N group compared to 13% (8–20) in the ICI-E group. Disease control rate was 72% (66–77) ICI-N group vs. 71% (64–78) in ICI-E group. Median overall survival ranged from 6.4 to 24.9 months in the ICI-N group, and 8.2 to 10.4 months in ICI-E group. Median progression free survival ranged from 1.9 to 10.1 months and from 3 to 3.9 months in both groups, respectively. Conclusion ORR with ICI plus antiangiogenics was lower after prior ICI exposure, with substantial variability estimates among included trials, either due to differences among antiangiogenic agents used or trial-related factors. Future exploration of ICI combined with antiangiogenics in UC, especially in ICI-refractory setting, will benefit from better patient selection.
Husband's Contributions to Stimulate Wife's Confidence Experiencing Role Transition: Cross-Sectional Study
Authors: Wahyuni Sri , Arief Yuni Sufyanti , Triharini Mira , Nursalam Nursalam 
Published: December 2024

Introduction Pregnancy can cause various physical and physiological changes. It affects confidence, resulting in depression and disturbing health not only for a mother but also for her fetus. These will also determine the ability of the mother to take care of her baby after delivery. Objectives To analyze the husband's contributions to stimulate the wife's confidence in experiencing role transition. Methods This research used a quantitative method with a cross-sectional design. The research was conducted in Central Java. There were 150 respondents of pregnant mothers. The variables of this study were the husband's factors and the wife's self-confidence, which were collected by demographic questionnaire and spiritual well-being scale questionnaire (SWBS) with a total sampling technique. The data were analyzed using a multinominal regression Test. Results Husbands were 58% at the age of early adult (26–35 years old), 76% graduating from secondary school level, 61.3% working as private employees, and 70% well supporting their wives. Most respondents (48.7%) had good self-confidence shown by the relationship of all husband's characteristics covering age, education, occupation, and support with the wife's self-confidence in facing role transition and had a value of <0.05. Conclusion The husband's age in a productive period with a good husband's education and occupation level could make the husband have mature thoughts, and he can calm his wife based on correct knowledge so that the wife is not worried about facing them and feels confident. Nurses can motivate and educate husbands to always provide support to their wives in facing pregnancy.
Exploring the Feasibility of a Caregiver Burden-Mastery Hybrid Assessment Tool With Decision Matrix in a Memory Clinic: A Multimethod Study
Authors: Chan Ee Yuee , Ong Zhi Lei , Glass George Frederick , Ang Siew Ling , Lim Jun Pei , Ali Noorhazlina Binte , Lim Wee Shiong 
Published: December 2024

Introduction Family members caring for a person living with dementia (PWD) can experience caregiver burden, leading to psychological distress if unmanaged. It's essential for healthcare professionals, especially nurses to identify caregivers at risk of stress and depression, triggering prompt management during their contact with caregivers of PWD. The study team developed an evidence-based caregiver burden-mastery hybrid assessment and intervention decision matrix (CHAT-MI) for caregivers of PWD and examined its feasibility of use. Objective To determine the feasibility and usability of implementing the CHAT-MI assessment-decision matrix tool in an outpatient setting in Singapore. Methods CHAT-MI was developed through earlier research, research evidence, clinical guidelines, and expert opinion. A multimethod study was conducted in a Singapore outpatient memory clinic from November 2020 to January 2021. Caregivers of PWD who attended the clinic self-administered the assessment tool to determine their burden and personal mastery levels. Clinicians used a decision matrix to guide interventions based on the assessments. Feedback was gathered from both caregivers and clinicians through surveys and semistructured interviews. Results Thirty-four caregivers and six clinicians participated in the study. Caregivers found the burden-mastery assessment tool relatively easy to use and understand and helpful. Clinicians found the assessment-decision matrix tool acceptable, feasible, and useful, enhancing standard care by providing insights into caregivers’ current coping capabilities. Clinicians shared that junior clinicians could benefit from CHAT-MI to better detect caregiving stress and deliver interventions. Nevertheless, more can be done to train clinicians in the understanding of the concept of mastery (i.e., perceived control over life events) to help clinicians better engage and support caregivers. Conclusion CHAT-MI was found to be relatively brief and can aid the outpatient clinic setting. This suggests that such an evidence-based assessment cum intervention can be considered for use in a real-world clinical setting to aid both caregivers and clinicians.
A Literature Review Exploring Time to Re-Rupture after Functional Rehabilitation Treatment of Achilles Tendon Rupture
Authors: Bosse Jordan , Homere Andrew , Belle Parker Emily , Smith Jeremy T. , Bluman Eric M. , Martin Elizabeth A. , Chiodo Christopher P. 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Achilles tendon rupture is a common ankle injury. Patients who suffer a rupture may be treated operatively or nonoperatively. Nonoperative treatment with functional rehabilitation has grown in popularity over the last decade. However, re-rupture remains a known complication with this treatment. The current literature review explored time to re-rupture (TTR) in patients treated with functional rehabilitation for an Achilles tendon rupture. So that orthopaedists can optimally counsel patients with regard to return to activity, our primary goal was to investigate the time from initial injury to re-rupture. Secondary endpoints included the mechanism of re-rupture as well as the age, athletic status, and sex of patients who re-ruptured. Methods: A literature search was performed using PubMed. Articles examining functional rehabilitation published in English after 2010 with data on TTR were included. Mechanism of re-rupture, athletic status, and treatment method were collected. Studies where patients were immobilized for longer than four weeks were excluded. When TTR was reported as a range, authors were contacted, and data were used only if specific TTR was available. Results: Eleven articles were included. Of the 1,653 patients, 78 sustained a re-rupture (4.7%). The average TTR was 9 weeks (range, 2 to 28 weeks). Seventy-seven of the patients (98.7%) re-ruptured at or prior to 20 weeks (4.6 months), with a single re-rupture at 28 weeks. Most patients were male (77.5%). There was no significant difference in TTR by re-rupture mechanism (high energy vs low energy, p=0.09), age (≥40 vs < 40, p=0.35), sex (male vs female, p=0.53), and athlete status (non-athlete/unknown vs athlete, p=0.42). Re-rupture was more often treated operatively than nonoperatively (72.5% vs 27.5%). Conclusion: This data adds to our understanding of re-rupture following functional rehabilitation for Achilles tendon rupture. Orthopaedists can counsel patients that the vast majority of re-ruptures occur within 20 weeks of injury and are rarely seen after 6 months. Summary of Included Patients Experiencing Re-Rupture After Functional Rehabilitation
A Radiographic Comparison between Successful and Failed Total Contact Casted Patients with Charcot Neuroarthropathy
Authors: Chopra Avani , Koroneos Zachary A. , Benedict Christian , Pitcher Michaela D. , Pitcher Michaela D. , Aynardi Michael 
Published: December 2024

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: This study aims to evaluate the influence of foot deformity severity, as assessed by radiographic measurements, on the efficacy of total contact casting (TCC) in patients with Charcot neuroarthropathy. TCC is a common treatment in this patient population that aims to immobilize the foot and ankle to mitigate trauma, preventing additional damage, and safeguard the foot structure. There is limited data on the optimal radiographic measurement in predicting which patients will be successfully treated with TCC (Griffiths et al., 2021). By comparing radiographic outcomes between patients who were successfully treated with TCC and those who required surgical intervention following TCC failure, we seek to clarify the role of anatomical deformity in treatment prognosis. Methods: We retrospectively analyzed a cohort of Charcot neuroarthropathy patients treated within a single healthcare system. Patients with radiographs of the affected foot within 2 years prior to or 1 year after the initiation of TCC. Patients were divided into two groups: those successfully managed with TCC (n=10) and those necessitating surgery due to TCC failure (n=16). Ten measurements of standard radiographic parameters used for quantifying the level of deformity in Charcot (Wukich et al., 2014) were included in this study. These measurements were Meary’s angle, Calcaneal pitch, medial and lateral column height, calcaneal 5th metatarsal angle, talar declination, tibiotalar angle, Kite’s angle, hindfoot-forefoot angle, and talonavicular coverage angle. All measurements were collected using Phillips PACS Software (Release 4.7) by three trained evaluators with two evaluators assigned per scan. Differences in the average [value] between groups were assessed using an unpaired t-test. Results: The cohort was comprised of 26 patients (16 males, 10 females). Our analysis revealed that lateral column height was the only parameter with a statistically significant difference in the height measurement (p< 0.05) between the groups. There were no other significant differences detected amongst any of the 9 other measurements. Conclusion: This study revealed that there is a lack of significant differences in most radiographic measurements between patients successfully treated with TCC and those requiring surgical intervention. This may suggest that standard radiographic measurements used for characterizing foot deformity does not help to predict the outcomes of TCC for CN. These findings emphasize the need for a more comprehensive understanding of treatment success predictors beyond anatomical considerations.
A Retrospective, Comparative Study on Infinity Ankle Replacements vs Ankle Fusions
Authors: Steyn John , Penner Murray J. , Younger Alastair S.E. , Wing Kevin , Veljkovic Andrea , Sadr Hooman , Gagne Oliver 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: End-stage ankle arthritis (EAA) can diminish quality of life and handicap one’s daily activities. Ankle fusion or Total ankle arthroplasty (TAA) are two surgeries used to treat EAA. While ankle fusion has traditionally been the treatment of choice, it often impairs ankle functionality, and can increase the development of painful hindfoot arthritis. TAA typically has shorter recovery time and wider range of motion. Historically, TAA prostheses were inadequate due to frequent failures. Modern design and techniques have improved outcomes, decreased failure rates, allowed more normalized gait, and reduced adjacent joint arthritis development, but long-term performance remains ill-defined. The INFINITY® Total Ankle System (Stryker Inc.) is a 2-component fixed-bearing, bone-sparing design that this study aims to compare to ankle fusion through patient reported outcomes. Methods: Patients at least 19 years old at the time of index procedure were selected. We compared 100 patients who had the INFINITY® TAA between 2013- August 1st, 2021, with 200 ankle fusion patients from 2008 -August 1st, 2021, all with minimum 1 year of follow up. The primary outcome was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes were the MODEMS, and SF-36 scores. Revision fusion and revision INFINITY® patients were excluded. Results: At 1 year follow up, Ankle Fusion AOS scores improved from a preoperative average of 55.25±19.31, to 26.01±21.64, vs 52.37±19.09 to 22.33±21.41 for INFINITY® TAA. At the last follow up after surgery (LFU), mean AOS scores in the Infinity cohort were significantly lower after linear regression for baseline variables with a mean difference of -6.76 (-12.52, -0.99 95% CI) p-value 0.02. The difference remained significant after removing 1-year follow up, and 9-14 year follow up, at -6.58 (-12.89, -0.27 95% CI), p-value 0.041. The revision rate for ankle fusion was 3.5%, while revision rate for INFINITY® TAA was 2%. Conclusion: Patients undergoing INFINITY® TAA had significantly lower mean AOS scores than patients undergoing ankle fusion at their last follow up after surgery, both before and after linear regression for baseline variables. This remained significant after excluding earlier (1-year) follow up, and later (9-14 year) follow up that only had fusion cohort data.
A Smaller Tibiotalar Sector is a Risk Factor for Recurrent Anterolateral Ankle Instability after Modified Broström-Gould Procedure
Authors: Zendeli Flamur , Pflueger Patrick , Viehoefer Arnd , Hodel Sandro , Farshad Mazda , Wirth Stephan H. , Weigelt Lizzy 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: Several demographical and clinical risk factors for recurrent ankle instability have been described. The main objective of this study was to investigate the potential influence of morphological characteristics of the ankle joint on the occurrence of recurrent instability and the functional outcomes following a modified Broström-Gould procedure for chronic lateral ankle instability. Methods: Fifty-eight ankles from 58 patients (28 males and 30 females) undergoing a modified Broström-Gould procedure for chronic lateral ankle instability between January 2014 and July 2021 were available for clinical and radiological evaluation. Based on the preoperative radiographs the following radiographic parameters were measured: talar width (TW), tibial anterior surface angle (TAS), talar height (TH), talar radius (TR), tibiotalar sector (TTS), ankle mortise angle (AMA). The history of recurrent ankle instability and the functional outcome using the Karlsson Score were assessed after a minimum follow-up of 2 years. Results: Recurrent ankle instability was reported in 14 patients (24%). The TTS was significantly lower in patients with recurrent ankle instability (69.8 degrees vs 79.3 degrees) (P < .00001). The multivariate logistic regression model confirmed the TTS as an independent risk factor for recurrent ankle instability (OR = 1.64) (P = .003). The receiver operating characteristic curve analysis revealed that patients with a TTS lower than 72 degrees (= low-TTS group) had an 82-fold increased risk for recurrent ankle instability (P = .001). The low-TTS group showed a significantly higher rate of recurrent instability (58% vs 8%; P = .0001) and a significantly lower Karlsson score (65 points vs 85 points; P < .00001). Conclusion: A smaller TTS was found to be an independent risk factor for recurrent ankle instability and led to poorer functional outcomes after a modified Broström-Gould procedure.
Ankle Fractures in the Complex Diabetic Patient. Minimally Invasive Surgery and Augmentation with Ring Fixation
Authors: Cuchacovich Natalio , Mena Javier , Diaz Nicolas , Bergeret Juan , Rivera Maximiliano , Fuentes Patricio , Bastias Gonzalo F. 
Published: December 2024

Category: Diabetes; Trauma Introduction/Purpose: Ankle fractures in complex diabetic patients (target organ damage, obesity, and HBA1C > 8 mg/dl) are associated with serious complications. Good results have been reported with MIS techniques in patients at risk of soft tissue complications and with the use of early containment frames in patients with diabetic neuroarthropathy. Our objective was to evaluate a novel, minimally invasive management protocol with augmentation using ring external fixation. Methods: Retrospective IRB approved study including 18 complicated diabetic patients with bi- or trimalleolar ankle fractures with a minimum follow-up of one year. Fibular intramedullary fixation was performedand percutaneous screws were used for the medial and posterior malleolar fractures. The stability of the construct was increased by using a ring external fixator. Demographic data, AOFAS scores, and Lower Extremity Functional Score (LEFS) functional scales were obtained, as well as a record of complications during the complete follow-up and visual analog scale (VAS). Results: The mean age and HBA1C were 56 years (R:37-73) and 9.8 ± 2.5 mg/dl. The external fixator time was 12.3 weeks (6-28) with complete healing in of 16/18 patients (89%) at 12.6 weeks (R:8-24). The average AOFAS was 79 (R:67-97), LEFS was 61.8% (R37.5-90). The mean postoperative VAS score was 4.4/10. The most frequent complication was superficial pin infections (38.8%) and there was one case of secondary Charcot Neuroarthropathy. No deep infections or wound dehiscence was observed. Conclusion: This minimally invasive fixation technique with augmentation is a safe alternative for complex diabetic patients with poor metabolic control and high HBA1C values. In our patients, we achieved high union rates according to what is reported in the literature, with a low incidence of major complications and acceptable functional results. Percutaneous fixation and ring augmentation
Are Intramedullary Implants Used for Midfoot Charcot Fit for Female Metatarsals?
Authors: Yammine Kaissar , Sayegh George E. , ElAlam Anthony , Jamaleddine Youssef , Mouawad Joseph , Assi Chahine 
Published: December 2024

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Radiological assessments of metatarsal biometrics have been documented in few studies and often lack direct clinical significance. The narrower diameter of female metatarsals could be an impediment for intramedullary implant suitability. This investigation examines the radiological morphometry of female metatarsals to assess the diameter fitness of intramedullary implants used for midfoot Charcot fusion. Methods: Foot roentgenograms of 143 female patients in the standing position were collected for radiological assessment. Initially, basic biometric parameters were determined at the level of the metatarsal neck. Cortical thickness was derived by subtracting the inner width from the outer width measurements. Following a hypothetical reaming, mean values of inner width, outer width, and cortical thickness were assessed for fitness estimation. Implant fitness was considered satisfactory if either a) the inner width was below the threshold of 6mm, and/or b) the cortical thickness was below the threshold of 2mm (1 mm on each side of the cortex). Additional examination was performed using the lower quartile values for further analysis. Results: The findings revealed that: a) the mean inner width of M5 was significantly greater compared to M2, M3 and M4 (p ˂ 0.00001), while no significant difference was observed among the median metatarsals, and b) M2 exhibited a significantly higher outer width than M3 and M4 (p ˂ 0.00001), with no difference observed with M5. According to the predefined threshold values, the estimated width fitness values (after hypothetical reaming) for accepting implant diameter were deemed inadequate for M2, M3 and M4, and the estimated cortical thickness values deemed inadequate for M3, M4 and M5. Conclusion: Our study indicates, for the first time, a discrepancy in the inner width of the lateral metatarsals at the neck level concerning commercially available Charcot-specific intramedullary implants for female patients. This mismatch suggests an increased vulnerability to cortex fractures at the metatarsal neck and potential implant migration. If a critical width is identified, utilizing smaller implant diameters or opting for a proximal insertion at the base of the metatarsals might present more suitable alternatives.
Deletion of lymphotoxin-β receptor (LTβR) protects against acute kidney injury by PPARα pathway
Authors: Wang Zufeng , Cheng Yichun , Fan Jiahe , Luo Ran , Xu Gang , Ge Shuwang 
Published: December 2024

Abstract
Background
Recent data has shown a considerable advancement in understanding the role of lymphotoxin-β receptor (LTβR) in inflammation. However, the functions and underlying mechanisms of LTβR in acute kidney injury (AKI) remain largely unknown.

Methods
AKI was induced in mice by renal ischemia-reperfusion (I/R). HK-2 cells and primary renal tubular epithelial cells (RTECs) were subjected to hypoxia/reoxygenation (H/R) injury. The effects of LTβR depletion were examined in mice, as well as primary RTECs. Bone marrow chimeric mice was generated to determine whether the involvement of LTβR expression by parenchymal cells or bone marrow derived cells contributes to renal injury during AKI. RNA sequencing techniques were employed to investigate the mechanism via which LTβR signaling provides protection against I/R-induced AKI

Results
LTβR expression was downregulated both in vivo and in vitro models of AKI. Moreover, depletion of LTβR decreased renal damage and inflammation in I/R-induced AKI. We also found that LTβR deficient mice engrafted with wild type bone marrow had significantly less tubular damage, implying that LTβR in renal parenchymal cells may play dominant role in I/R-induced AKI. RNA sequencing indicated that the protective effect of LTβR deletion was associated with activation of PPARα signaling. Furthermore, upregulation of PPARα was observed upon depletion of LTβR. PPARα inhibitor, GW6471, aggravated the tubular damage and inflammation in LTβR−/− mice following I/R injury. Then we further demonstrated that LTβR depletion down-regulated non-canonical NF-κB and Bax/Bcl-2 apoptosis pathway through PPARα.

Conclusions
Our results suggested that the LTβR/PPARα axis may be a potential therapeutic target for the treatment of AKI.