bluuebunny/crossref_metadata_2025_split huggingface dataset:
Network Meta-Analysis and Trial Sequential Analysis of Randomised Controlled Trials Comparing Robotic, Laparoscopic, and Open Pancreatoduodenectomy
Authors: Joseph Nejo , Varghese Chris , Lucocq James , McGuinness Matthew J. , Tingle Samuel , Marchegiani Giovanni , Soreide Kjetil , Abu-Hilal Mohammed , Samra Jas , Besselink Marc , White Steve , Pandanaboyana Sanjay 
Published: November 2024

Background:
The use of minimally invasive (laparoscopic and robotic) pancreatoduodenectomy (PD) is being increasingly adopted despite the lack of hard evidence to support its utilisation. With recent randomised controlled trials (RCTs) comparing open pancreatoduodenectomy (OPD) with robotic or laparoscopic pancreatoduodenectomy (RPD or LPD), we undertook a network meta-analysis (NMA) comparing all 3 approaches to evaluate comparative outcomes.

Methods:
A systematic search of MEDLINE, EMBASE, and Cochrane CENTRAL was conducted up to May 2024 and relevant RCTs were identified. A random-effects meta-analysis and trial sequential analysis (TSA) were conducted for primary outcomes, followed by a Bayesian NMA of length of stay (LOS), duration of surgery, intraoperative blood loss, and pancreas resection-related outcomes

Results:
Seven RCTs involving 1336 patients were included, 5 investigating LPD compared with OPD and 2 RPD to OPD. Pairwise meta-analysis indicated that LPD was associated with shorter hospital stay (mean difference [MD], −1.39; 95% confidence interval [CI], −2.33 to −0.45) and lower intraoperative blood loss compared with OPD (MD, −131; 95% CI, −146 to −117). However, LPD was associated with significantly longer operative duration (MD, 39.5; 95% CI, 34–45). TSA confirmed the robustness of the positive and negative findings on pairwise meta-analysis. In comparison, there were no significant differences between RPD and OPD in pairwise meta-analysis, which could not be confirmed by TSA. Network meta-analysis tended to favour LPD in most outcome parameters including LOS, duration of surgery, and pancreas resection-related outcomes.

Conclusions:
The current RCT evidence suggests potential better outcomes in LPD in comparison with RPD and OPD. However, few studies demonstrated robust statistical significance in outcome measures, suggesting an underpowered evidence base and possible selection bias. Hence, with current equivocal data, there is a need for ongoing RCTs to validate the role of minimally invasive approaches in PD.
Removal or Nonremoval of the Rib During a Direct Lateral Interbody Fusion Relative to Postoperative Pain
Authors: Littell Zane , Ablah Elizabeth , Okut Hayrettin , Dean Joey , Whitaker Camden 
Published: November 2024

Study Design:
Retrospective chart review.

Objective:
To determine whether there was a difference in postoperative pain among patients undergoing direct lateral interbody fusion (DLIF) who had rib removal compared with those who did not.

Background:
DLIF is a minimally invasive, lateral transpsoas surgical approach for spinal fusion that has a lower 2-year pain rating when compared with an open procedure. However, the DLIF surgical approach of the L1/L2 spinal level can be obstructed by the ribs. It is unknown whether patients undergoing a DLIF with rib removal experience more pain than their counterparts without rib removal.

Methods:
Patients who underwent a DLIF from an individual spine surgeon at Wesley Medical Center between January 1, 2014 and December 31, 2018 were grouped by rib status: with removal versus without. Postoperative pain, measured by a 0 (no pain) to 10 (worst pain) Visual Analog Scale (VAS), was recorded on the day of discharge.

Results:
The analysis included data from 136 patients, 75 with removal and 61 without. Patient demographics did not differ significantly by age, sex, insurance, estimated blood loss, or length of stay. However, number of spinal levels fused was greater when rib removal occurred, 4.5 versus 3.5 (P = 0.008). The mean baseline VAS with rib removal was 6.6 (1.7) and at discharge it was 7.6 (2.1). The mean baseline VAS without removal was 6.7 (2.0) compared with 7.8 (1.8) at discharge. The multivariate model predicting discharge VAS indicated there was no difference in pain by rib removal status (P = 0.180). VAS at discharge was associated with positive morphine milligram equivalents; as the VAS pain score increased so did the morphine dose (P = 0.028).

Conclusion:
Patients undergoing a DLIF with rib removal expressed no difference in postoperative pain compared with patients without rib removal.
Effect and mechanism of endoclip papilloplasty in reducing the incidence of cholelithiasis
Authors: Li Yao , Lu Xiaofang , Wang Yingchun , Chang Hong , Zhang Yaopeng , Liu Wenzheng , Zheng Wei , Yan Xiue , Huang Yonghui 
Published: November 2024

Abstract

Background:
Endoscopic sphincterotomy (EST) is widely used to treat common bile duct stones (CBDS); however, long-term studies have revealed the increasing incidence of recurrent CBDS after EST. Loss of sphincter of Oddi function after EST was the main cause of recurrent CBDS. Reparation of the sphincter of Oddi is therefore crucial. This study aims to investigate the effectiveness and safety of endoclip papilloplasty (ECPP) for repairing the sphincter of Oddi and elucidate its mechanism.

Methods:
Eight healthy Bama minipigs were randomly divided into the EST group and the ECPP group at a 1:1 ratio, and bile samples were collected before endoscopy and 6 months later. All minipigs underwent transabdominal biliary ultrasonography for the diagnosis of cholelithiasis 6 months after endoscopy. The biliary microbiota composition and alpha and beta diversity were analyzed by 16S rRNA gene sequencing. Differential metabolites were analyzed by bile acid metabolomics to explore the predictive indicators of cholelithiasis.

Results:
Three minipigs were diagnosed with cholelithiasis in the EST group, while none in the ECPP group showed cholelithiasis. The biliary Firmicutes/Bacteroidota (F/B) ratio was increased after EST and decreased after ECPP. The Chao1 and observed species index significantly decreased 6 months after EST (P = 0.017 and 0.018, respectively); however, the biliary α-diversity was similar before and 6 months after ECPP. The β-diversity significantly differed in the EST group before and 6 months after EST, as well as in the ECPP group before and 6 months after ECPP (analysis of similarities [ANOSIM]: R = 0.917, P = 0.040; R = 0.740, P = 0.035; respectively). Glycolithocholic acid (GLCA) and taurolithocholic acid (TLCA) accumulated in bile 6 months after EST.

Conclusions:
ECPP has less impact on the biliary microenvironment than EST and prevents duodenobiliary reflux by repairing the sphincter of Oddi. The bile levels of GLCA and TLCA may be used to predict the risk of cholelithiasis.
Humoral immunity in HIV-1 post-treatment controllers
Authors: Mouquet Hugo 
Published: November 2024

Purpose of review
Decoding the HIV-1 immune response, including its humoral arm, in post-treatment controllers (PTCs) is paramount to unveil immune correlates of viral control, which could help developing novel strategies towards HIV-1 remission. Here, we review novel findings on the humoral response to HIV-1 in PTCs.

Recent findings
New data reveal the heterogeneity of humoral immune profiles in PTCs, principally influenced by viral exposure and dynamics. Stably aviremic PTCs, akin early ART-treated individuals, show minimal antibody B-cell response. Conversely, virally exposed PTCs develop functionally coordinated and effective humoral responses to HIV-1. They can produce antibodies cross-neutralizing heterologous HIV-1 viruses, including broadly neutralizing antibodies (bNAbs) exerting selective immune pressure. PTCs also elicit neutralizing antibodies against contemporaneous autologous viruses presumed to play a major role in sustaining viral suppression.

Summary
The immune mechanisms underlying virologic control in PTCs likely involve various immune effectors. Notably, functional HIV-1 humoral responses can generate bNAbs and autologous neutralizing antibodies; however, their exact contribution to maintaining long-term control of plasma viremia and the precise mechanisms driving their induction require further investigation.
Long-acting preexposure prophylaxis: early data on roll-out in the United States
Authors: Koss Catherine A. , Parikh Urvi M. 
Published: November 2024

Purpose of review
Long-acting preexposure prophylaxis (LA-PrEP), including cabotegravir (CAB-LA) and lenacapavir, could expand biomedical prevention coverage and reduce HIV incidence. This review describes LA-PrEP rollout in the United States, early clinical innovations in delivery, as well as opportunities and challenges for future delivery.

Recent findings
Although CAB-LA is approved in numerous countries, availability is limited outside of implementation studies. Data on CAB-LA rollout in routine care are mainly limited to the U.S at present. Early data indicate that oral PrEP far exceeds CAB-LA use and gaps exist between prescription and receipt of CAB-LA, with barriers including insurance coverage. Successful early clinic models include multidisciplinary staffing for benefits navigation, medication procurement, and injection provision, scheduling, and monitoring. Innovative models are being explored for community health worker delivery, low-barrier care for persons with psychosocial barriers, and telehealth and community-based models. Given persistent disparities in HIV diagnoses and oral PrEP use, there is a critical need for equitable implementation of CAB-LA and forthcoming products, including long-acting lenacapavir.

Summary
Gaps exist between the promise of LA-PrEP and actual use in US settings. To achieve population-level impact with LA-PrEP, there is an urgent need for greatly expanded access, clinical systems prepared for delivery, and a focus on LA-PrEP equity.
Transforming HIV prevention: the promise of long-acting preexposure prophylaxis in high HIV burden settings
Authors: Joseph Davey Dvora , Dadan Sumaya , Wara Nafisa 
Published: November 2024

Purpose of review
Recent research on efficacy and safety of long-acting preexposure prophylaxis (PrEP) holds the promise to transform HIV prevention in high HIV burden settings. We review emerging findings regarding early end-user acceptability of long-acting PrEP modalities, feasibility of integrating long-acting PrEP into health systems, and considerations regarding drug resistance and cost.

Recent findings
Long-acting PrEP, particularly injectables, was found to be highly acceptable among individuals across key populations in high HIV burden settings. Concerns around use of long-acting PrEP highlight the importance of choice and ability to switch methods. Existing provider-level barriers to oral PrEP implementation (e.g., overburdened staff, training gaps) may impact long-acting PrEP rollout – however, utilization of PrEP implementation strategies such as task-shifting, timely PrEP training for all providers, differentiated service delivery, and integration with sexual health services, may mitigate barriers. Studies modeling injectable PrEP scale-up demonstrate substantial benefits in HIV mortality reduction, outweighing risks of increased integrase inhibitor resistance, but also highlight the urgency of pricing long-acting PrEP to ensure access and affordability.

Summary
Long-acting PrEP could be a game changer in HIV prevention in high burden settings. There is an urgent need for rapid scale production and price reductions to ensure access in high HIV burden settings. Implementation strategies are needed to address individual and provider-level barriers.
Future options for long-acting HIV treatment and prevention
Authors: Arens Yotam , Gulick Roy M. 
Published: November 2024

Purpose of review
The aim of this review was to describe future options for long-acting HIV treatment and preexposure prophylaxis (PrEP) regimens featuring both innovations with currently approved antiretrovirals and a profile of investigational agents in the pipeline.

Recent findings
Newer formulations and modes of delivery for existing antiretroviral drugs and a number of investigational agents are under study for long-acting HIV treatment and PrEP. Regimens with weekly oral dosing for HIV treatment, monthly oral dosing for HIV PrEP, and injectable agents with longer dosing intervals (every 3 months or longer) for treatment and PrEP are in clinical development. Newer agents with novel mechanisms of action and newer modes of administration including vaginal rings, implants, patches, and rectal douches also are under investigation.

Summary
Despite the success of current antiretroviral therapy and PrEP with one-pill, once-daily regimens, there is a continuing need for new formulations, investigational agents, and novel modes of delivery to overcome barriers to implementation and ensure real-world effectiveness. Newer long-acting antiretroviral regimens for HIV treatment and PrEP using novel preparations and strategies will offer choice, enhance adherence, decrease toxicity, and improve patient and provider satisfaction.
Implementation of Volumetric Finger-Prick Self-Sampling for Therapeutic Drug Monitoring of Immunosuppressants After Kidney Transplantation: Lessons Learned From the Practice
Authors: Vethe Nils Tore , Åsberg Anders , Bergan Stein , Robertsen Ida , Midtvedt Karsten 
Published: November 2024

Background:
Home-based hospital services are becoming increasingly popular, and the addition of remote outpatient appointments after kidney transplantation facilitates more practical and closer follow-up. In this context, finger-prick self-sampling is an important aspect of monitoring of immunosuppressants and biomarkers. Nevertheless, several issues must be addressed to ensure the feasibility and quality when implementing microsampling in clinical practice. We summarize our experiences and opinions in this field.

Methods:
This article is based on the authors' experience regarding the laboratory and clinical implementation of finger-prick self-sampling in kidney transplant recipients. The referenced literature is related to the authors' knowledge in this field.

Results:
We present considerations for the selection of relevant analytes, key characteristics of selected volumetric sampling tools (Mitra and Capitainer), and the associated sampling pitfalls. In addition, we address the requirements for patients performing finger-prick sampling, appropriate design of methods and workflow, critical points for validation, and aspects related to logistics and digital solutions.

Conclusions:
Volumetric finger-prick self-sampling is suitable for monitoring immunosuppressants and certain biomarkers that are relevant to outpatient follow-up after kidney transplantation. We believe that a carefully designed system for the entire workflow, including patient training, will be beneficial in enabling a safe experience for transplant recipients, as well as ensuring overall efficiency and adequate quality. In the future, a combination of immunosuppressants with a wide range of biomarkers has significant potential for use in at-home self-sampling after kidney transplantation.
Tight junction regulation, intestinal permeability, and mucosal immunity in gastrointestinal health and disease
Authors: Saha Kushal , Zhou Yin , Turner Jerrold R. 
Published: November 2024

Purpose of review
The contributions of intestinal barrier loss, that is, increased permeability, to multiple disorders, including inflammatory bowel disease (IBD), have been a topic of speculation for many years, and the literature is replete with conclusions based on correlation and speculation. The goal of this article is to critically review recent advances in mechanistic understanding of barrier regulation and the evidence for and against contributions of intestinal barrier loss to disease pathogenesis.

Recent findings
It is now recognized that intestinal permeability reflects the combined effects of two distinct routes across tight junctions, which form selectively permeable seals between adjacent epithelial cells, and mucosal damage that leads to nonselective barrier loss. These are referred to as pore and leak pathways across the tight junction and an unrestricted pathway at sites of damage. Despite advances in phenotypic and mechanistic characterization of three distinct permeability pathways, development of experimental agents that specifically target these pathways, and remarkable efficacy in preclinical models, pathway-targeted therapies have not been tested in human subjects.

Summary
After decades of speculation, therapeutic interventions that target the intestinal barrier are nearly within reach. More widespread use of available tools and development of new tools that discriminate between pore, leak, and unrestricted pathway permeabilities and underlying regulatory mechanisms will be essential to understanding the local and systemic consequences of intestinal barrier loss.
Olfactory outcomes in skull base surgery
Authors: Venkatesh Sanjena , Douglas Jennifer E. 
Published: November 2024

Purpose of review
This review examines the impact of skull base surgery on olfactory function, a critical yet often overlooked aspect of postoperative quality of life. As surgical techniques continue to evolve, understanding their impact on olfaction is key to optimizing patient outcomes.

Recent findings
The relationship between skull base surgery and olfactory function continues to be debated in the literature. With the adoption of transnasal surgical approaches, a significant concern has been its impact on olfaction. Prior studies have shown evidence of olfactory dysfunction following transnasal skull base surgery, though these findings are not universal. A particular area of discussion involves the use of the pedicled nasoseptal flap, which has demonstrated potentially negative short-term olfactory impacts. Additional concerns surround flap design (olfactory strip preservation) and technique of flap harvest (cold knife versus electrocautery). Evidence suggests that olfactory strip preservation may effectively maintain postoperative olfactory performance, while cold knife techniques offer no clear advantage over electrocautery.

Summary
The inconsistencies in the literature underscore the need for standardized, large-scale studies that directly compare surgical techniques to better understand the impact of transnasal skull base surgery on olfaction. This is essential to optimizing surgical outcomes and improving patient quality of life postoperatively.
Career and lifestyle among female surgeons in Jordan
Authors: Abu-Jeyyab Mohammad , Mse’adeen Mohammad Al , Tafesh Ru’a , Zein Eddin Sadeen , Zuaiter Saja , Al-Mse’adeen Namareq , Masoud Bayan , Jariri Hala , AlKatib Malak , Alabbasi Marah , Sarhan Mohammed Y. , Akel Alaa 
Published: November 2024

Background:
Female surgeons face various challenges that may affect their career and lifestyle satisfaction, such as gender bias, work-family conflict, and lack of mentorship. However, little is known about the situation of female surgeons in Jordan, a developing country with limited resources and a high demand for surgical services.

Aim:
The aim of this study was to assess the career and lifestyle satisfaction among female surgeons in Jordan, and to explore the relationship between income level, family stability, job security, and job satisfaction. The study also aimed to identify the variation of the challenges that surround female surgeons in different regions of Jordan.

Methods:
This was a cross-sectional study that used a self-administered questionnaire to collect data from 244 female surgeons working in Jordan. The questionnaire was adapted from the National Lifestyles in Surgery Today Survey, which was previously used to assess career and lifestyle satisfaction among surgeons in the United States. The questionnaire consisted of four sections: demographic and practice characteristics, career satisfaction, work-life balance, and perceived challenges and improvement areas. The data were analyzed using descriptive and inferential statistics.

Results:
The study polled 340 surgeons, the majority of whom were female, young, and general surgeons, to investigate the variables influencing their job satisfaction. Working hours were shown to be related to residence (P=0.000, X2=163.749) and to have an influence on health (4.40%), pay (64.12%), hobbies (46.76%), and family (55%). Female surgeons suffered increased sex bias (68.85%), disrespect (31.56%), inadequate mentorship (35.25%), and harassment (16.00%), according to the research. Quite similarly, 30.21% of male corespondents agreed to the presence of sex discrimination, with 10.42% and 21.88% conjoining on the evidence of lack of respect and incompetent mentoring, respectively. According to the survey, professional happiness varies by speciality, with ENTs being the most satisfied (97.10%) and OBGYNs being the least satisfied (25%). The survey also discovered that male students (36.76%) were more likely to be recommended to pursue a career in surgery than female students (31.18%). According to the survey, salary, leave, and sector are also variables impacting job happiness, with the majority of satisfied surgeons earning 1000 JOD or less, having 30 days of leave, and working in the MOH or the private sector.

Conclusions:
Female surgeons in Jordan are generally satisfied with their careers but face several challenges that affect their work-life balance and professional development. There is a need for more advocacy and support for female surgeons in Jordan to address these challenges and improve their career and lifestyle satisfaction.
Why might fears and worries persist after a pain education–grounded multimodal intervention for chronic back pain? A qualitative study
Authors: Rizzo Rodrigo R. N. , Wand Benedict M. , Leake Hayley B. , O'Hagan Edel T. , Traeger Adrian C. , Gustin Sylvia M. , Moseley G. Lorimer , Sharma Saurab , Cashin Aidan G. , Bagg Matthew K. , McAuley James H. , Bunzli Samantha 
Published: November 2024

Abstract

Introduction:
The effect of pain education (PE) on pain intensity and function diminishes after a few months in people with chronic low back pain (CLBP). One possible explanation is the return of underlying fears and worries related to the condition.

Objective:
To explore topics related to participants' beliefs and feelings that might explain why fears and worries persist after a PE-grounded intervention for CLBP.

Methods:
We conducted a qualitative study involving semistructured interviews with participants from the active arm of a randomised controlled trial who received an individualised PE-grounded intervention for adults with CLBP. We used reflexive thematic analysis with an inductive approach.

Results:
Twenty participants were interviewed (9 women and 11 men, median age = 54 years, median pain duration = 4 years, 13 reporting at least 30% pain reduction on the trial primary outcome). Three themes were identified: 1) “Are you implying my pain is not real?”: a few participants believed the validity of their pain was being questioned. 2) “You don't understand, my pain is different”: most participants considered the influence of an altered nervous system but did not exclude the possibility of having structural and biomechanical influences for the persistence of their back pain. 3) “I am unsure how to fit it into my daily life”: fear and worries persisted when participants could not figure out how to apply an alternative way of making sense of pain in their daily lives.

Conclusion:
Patients' perceptions about PE should be monitored and might be addressed with communication strategies, educational content that matches patients' characteristics, and reinforcements over time.