bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Experience With Fenestration Modification of Castor Branched Stent-Graft for Aortic Arch Diseases
Authors: Zeng Zhaoxiang , Huo Weixue , Li Tao , Bao Xianhao , Lu Ye , Jing Zaiping , Feng Jiaxuan , Liang Chuan , Feng Rui 
Published: September 2024

Purpose: This study aimed to assess the safety and viability of combining branched stent graft with fenestrated thoracic endovascular aortic repair (TEVAR) in treating aortic arch lesions. Materials and Methods: The cohort included patients presenting with aortic arch lesions who underwent treatment with a combination of branched stent graft and fenestrated TEVAR between July 2020 and November 2022. Technical success was defined as the precise deployment of the stent graft, maintenance of branch vessel patency, and the absence of type I endoleak. The secondary outcomes examined were complications and all-cause mortality. Results: The study cohort comprised 21 patients (average age: 61.0±14.8 years) with aortic arch lesions from 3 tertiary care hospitals. The aortic arch lesions encompassed aortic dissection (N=8), aortic aneurysm (N=8), pseudoaneurysm (N=1), intramural hematoma (N=1), and penetrating aortic ulcer (N=3). The technical success rate achieved was 95.2% (20/21). Failure in one case was due to an intraoperative type I endoleak, which was rectified with an additional stent graft placement. The 30-day mortality rate was 4.8% (1/21). One patient suffered a stroke but responded well to medical intervention. The median hospital stay was 10.9±5.4 days. During the follow-up period, one death (4.8%) was associated with aortic complications. A type II endoleak was observed and managed with close monitoring. Two patients underwent re-interventions for retrograde type A dissection and stent migration, respectively. No occlusions were observed in the target branch arteries. Conclusions: The combination of branched stent graft with fenestrated TEVAR emerges as a viable strategy for addressing specific lesions in the aortic arch. Clinical Impact This study demonstrates the feasibility of using branched stent grafts with fenestrated TEVAR for treating aortic arch lesions, achieving a technical success rate of 95.2%. Compared to traditional open surgery, this innovative, minimally invasive approach reduces perioperative mortality and complications, such as stroke and spinal cord ischemia. For clinicians, it offers a viable alternative for patients unfit for open repair, particularly in complex aortic arch cases. While the initial outcomes are promising, further research is needed to assess long-term durability and risks, including stent graft migration and late endoleak, ensuring the technique’s safety and efficacy over time.
Conventional Therapy Combined With Quxie Capsule Modulating Gut Microbiome in Metastatic Colorectal Cancer Patients With the Third or Above Line Setting: Result From an Investigator-Initiated, Open-Label, Single-Arm, Phase II Study
Authors: Gu Zhien , Wang Lei , Zhai MA Jiawei , Zhang Tong , Yang Yufei 
Published: September 2024

Background: In patients with metastatic colorectal cancer (mCRC), Quxie Cap-sule (QX)—a combination of conventional therapy (including chemotherapy, targeted therapy or supportive care)—has shown a significant overall survival benefit compared with placebo and might have the property of dual effects of antitumor and immunity enhancement, both mediated by the microbiome. In preclinical models, QX has also shown activity against colorectal cancer. This study aimed to describe how the aforementioned effects of QX look after when focusing on the patients in third or above line setting. Methods: A Simon’s Minimax two-stage phase II design was used in this study, which enrolled mCRC patients who progressed after second-line treatment. Patients received conventional therapy plus QX until disease progression or unacceptable toxicity. Before and after 1-month intervention, we collected patients’ stool samples for microbiome analysis by 16s rRNA sequencing approaches. And the microbiome analysis before and after 1-month intervention was done through bioinformation analysis platform. Results: Fifteen patients were enrolled and gut microbiome were analyzed from 7 of 10 patients that with PFS over 3.7 months. Microbiome community analysis on genus level showed that the proportion of Lachnospiraceae_UCG-001 (0.04% vs 1.06%, P = .02249) significantly increased after conventional therapy plus QX while the proportion of Alistipes (2.96% vs 1.35%, P = .03461), Flavonifractor (0.04% vs 0.02%, P = .02249), Bifidobacterium (6.11% vs 1.14%, P = .02249) and Butyricimonas (0.24% vs 0.11%, P = .03603) significantly decreased after intervention . LEfSe analysis showed that after intervention, samples were highly related with unclassified-f-lachnospiraceae, Eubacterium and Lachnospiraceae_UCG-001. Conclusions: Decrease of gut bacteria with potential roles in carcinogenesis of colorectal cancer and increase in the abundance of gut anticancer bacteria such as Lachnospiraceae may partly explain how conventional therapy combined with QX can influence carcinogenesis and tumor progression in colon cancer. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100053874).
Comparison of neoadjuvant chemotherapy response and prognosis among pegylated liposomal doxorubicin, epirubicin and pirarubicin in HR ⩽ 10%/HER2-negative breast cancer: an exploratory real-world multicentre cohort study
Authors: Hong Yue , Peng Jing , Chen Qitong , Zhou Qin , Xu Feng , Yao Jia , Zou Qiongyan , Yuan Liqin , Li Lun , Long Qian , Liao Liqiu , Liu Mingwen , Liu Xuan , Zhang Danhua , Wang Shouman , Yi Wenjun 
Published: September 2024

Background: Pegylated liposomal doxorubicin (PLD), epirubicin and pirarubicin are the main anthracyclines widely used in China. PLD demonstrates therapeutic response comparable to epirubicin and pirarubicin in neoadjuvant chemotherapy (NAC) of breast cancer. Objectives: The objectives of our study were to retrospectively assess the real-world effectiveness and prognostic characteristics of PLD as NAC for HR ⩽ 10%/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. Design: This was a retrospective study. Methods: Our study enrolled patients with HR ⩽ 10%/HER2-negative breast cancer who received PLD-, epirubicin- or pirarubicin-based NAC from three centres in Hunan Province, China, between 2015 and 2022. We employed inverse probability of treatment weighting to balance the differences in patients’ characteristics among the PLD, epirubicin, and pirarubicin groups. The endpoints were pathological complete response (pCR), event-free survival (EFS), and overall survival (OS). Results: A total of 267 patients were included. After NAC, the pCR rates in PLD group were superior to epirubicin group (PLD, 34.1%; epirubicin, 20.8%, p = 0.038). The differences in EFS (log-rank p = 0.99) and OS (log-rank p = 0.33) among the three groups were not statistically significant. Among the three groups, non-pCR patients had worse EFS than pCR patients (log-rank p = 0.014). For patients with pCR, the differences in EFS (log-rank p = 0.47) and OS (log-rank p = 0.38) were not statistically significant among the three groups, and the EFS (log-rank p = 0.59) and OS (log-rank p = 0.14) of non-pCR patients in the PLD group were similar to those in the epirubicin and pirarubicin groups. Conclusion: PLD had a similar therapeutic response and prognosis compared to epirubicin or pirarubicin in NAC for patients with HR ⩽ 10%/HER2 negative breast cancer, which means that PLD represents a potential NAC option.
Pulmonary Embolism Post-Femoral Neck Fracture Surgery: A Critical Predictor of Five-Year Mortality
Authors: Atzmon Ran , Dubin Jeremy , Shemesh Shai , Tamir Eran , Yaacobi Eyal , Palmanovich Ezequiel , Drexler Michael , Ohana Nissim 
Published: September 2024

Objectives This study examines the impact of pulmonary embolism (PE) on mortality among patients with femoral neck fractures, exploring the predictive value of preoperative PE for postoperative occurrences and associated mortality over a 5-year follow-up period. Methods We analyzed 2256 patients over 60 years old admitted with femoral neck fractures, focusing on those who developed DVT or PE postoperatively. Surgical intervention aimed within 48 hours without pharmacological thromboprophylaxis, utilizing mechanical prophylaxis instead. Postoperative management included Enoxaparin administration. Data analysis employed SPSS 21, with chi-squared tests, T-tests, and multivariate logistic regression to explore mortality and PE incidence. Results PE was diagnosed in 1.4% of patients, with a notable mortality contrast between patients with PE (87%) and those without (59.7%) over 5 years. A history of preoperative PE emerged as a significant risk factor for postoperative PE. Despite surgical variations, no significant correlation was found between surgery type and PE incidence. Early postoperative weight-bearing and institutional rehabilitation did not significantly alter PE incidence rates. Conclusions The study underscores the significant mortality risk associated with preoperative PE in femoral neck fracture patients. It highlights the necessity for vigilant PE risk assessment and management, challenging assumptions about the protective role of early mobility and rehabilitation in PE incidence. Further research is essential to refine patient care strategies and improve outcomes.
Actuarial Evaluation of the Financial Backing Risk on Chinese Public Pension
Authors: Yang Zaigui , Chen Xiaohua 
Published: September 2024

The Comprehensive Scheme on Reducing Social Insurance Contribution Rates (RSICR scheme) issued in 2019 had an important impact on the financial backing risk of the Chinese Public Pension for Enterprise Employees. We developed actuarial models for contribution revenues, benefit expenditures, and the balance of the public pension to analyze the impact of the RSICR scheme on the financial status of the Chinese Public Pension and the financial backing risk early warning after its implementation. This was done according to the State Council Documents and considering the interruption of participants’ contributions and the contribution salary being lower than the statistical salary. We found that (1) the RSICR scheme will worsen financial status in earlier years; however, it effectively slows down the trend of financial deterioration in most years of the forecasted period. (2) After implementing the RSICR scheme, four early warning indicators were selected and calculated. Since 2022, the financial backing risk of the Chinese Public Pension has increased rapidly, and four warning levels–blue, yellow, orange, and red–and their corresponding warning-year intervals were obtained. (3) According to sensitivity analyses, the key reverse early warning indicators’ influencing factors ranged from strong to weak: retirement age, firm contribution rate, and total fertility rate. In the same direction, from strong to weak, are the benefit growth rate, the bookkeeping interest rate, and the transitional coefficient. Finally, we propose policy suggestions to alleviate the financial backing risk. JEL Classification: G22, G23, H83, P34.
Evaluating Feedback Comments in Entrustable Professional Activities: A Cross-Sectional Study
Authors: Andreou Vasiliki , Peters Sanne , Eggermont Jan , Schoenmakers Birgitte 
Published: September 2024

INTRODUCTION Competency-based medical education (CBME) has transformed postgraduate medical training, prioritizing competency acquisition over traditional time-based curricula. Integral to CBME are Entrustable Professional Activities (EPAs), that aim to provide high-quality feedback for trainee development. Despite its importance, the quality of feedback within EPAs remains underexplored. METHODS We employed a cross-sectional study to explore feedback quality within EPAs, and to examine factors influencing length of written comments and their relationship to quality. We collected and analyzed 1163 written feedback comments using the Quality of Assessment for Learning (QuAL) score. The QuAL aims to evaluate written feedback from low-stakes workplace assessments, based on 3 quality criteria (evidence, suggestion, connection). Afterwards, we performed correlation and regression analyses to examine factors influencing feedback length and quality. RESULTS EPAs facilitated high-quality written feedback, with a significant proportion of comments meeting quality criteria. Task-oriented and actionable feedback was prevalent, enhancing value of low-stakes workplace assessments. From the statistical analyses, the type of assessment tool significantly influenced feedback length and quality, implicating that direct and video observations can yield superior feedback in comparison to case-based discussions. However, no correlation between entrustment scores and feedback quality was found, suggesting potential discrepancies between the feedback and the score on the entrustability scale. CONCLUSION This study indicates the role of the EPAs to foster high-quality feedback within CBME. It also highlights the multifaceted feedback dynamics, suggesting the influence of factors such as feedback length and assessment tool on feedback quality. Future research should further explore contextual factors for enhancing medical education practices.
Outcomes of Michigan Medicine's integrated patient safety and communication and resolution program, 2013–2022
Authors: Burney Richard E , Mckeown Ellen S , Zhang Yan , Anderson Susan G , Blackwell Amy C , Hebert Dale L 
Published: September 2024

Background Whether to manage malpractice claims by a proactive communication and resolution program or by the traditional adversarial legal process remains an important but unsettled question in health care risk management and the long-term durability of a communication and resolution program is unknown. We report here on the current outcomes of the Michigan Medicine communication and resolution program after 20 years in operation. Methods Deidentified data from the Michigan Medicine claims database for fiscal years 2013 through 2022 were analyzed to delineate the processes and outcomes of the Michigan Medicine communication and resolution program. Results During the period of study, patient safety event reports increased by 37.5% while the proportion of events associated with harm fell from 10.5% to 6.7%. The Clinical Care Review Committee, a multidisciplinary medical staff quality and safety oversight panel, deemed care reasonable in 638 of 989 claims (65%), guiding communication and resolution program discussions. 564 (88%) of these were closed or dismissed without payment. 288 (83%) of the 349 cases in which care was deemed unreasonable were settled. The rate of liability claims remained stable at 3.8/100,000 exposures per month. The median time to resolve claims was 11 months. Conclusions Analysis of the most recent 10 years of Michigan Medicine's communication and resolution program activity confirms that the program is well-integrated into its system-wide patient safety program and that its early success has proven durable. It also illustrates the benefits of integrating multidisciplinary quality review and improvement into a communication and resolution program. It may serve as a model for other health care systems.
Arthroscopic Mumford Procedure for AC Joint Arthritis
Authors: Gil Noriega Gustavo Antonio , Polanco Rosario Roberto , Herrera Huependo Gilberto Antonio , Llinás Hernández Paulo José 
Published: September 2024

Background: Acromioclavicular (AC) joint arthritis is a common cause of shoulder pain in young patients. Management has been focused on relieving pain mainly with conservative nonsurgical procedures such as corticoid injections, physical therapy and even, recently, orthobiological interventions with platelet-rich plasma and hyaluronic acid injections. However, failed conservative management opens the door to surgical interventions such as the arthroscopic distal third of the clavicle resection. Indications: Patients submitted to this surgery must have a confirmed diagnosis of an arthritic, painful AC joint that has not been properly responding to nonoperative management. Technique Description: The surgical procedure is done in the beach chair position with standard arthroscopic portals. After a proper intraarticular evaluation of the structures and ruling out any other causes of pain, the surgeon passes to the subacromial space. Identification of the AC joint is made by following the coracoacromial ligament medial and with manipulation of the clavicle from the patient's skin. Debridement should start by releasing the anterior and posterior ligaments to allow for proper visualization of the articulation. A bur or a 5.5-mm shaver is used to start resection of the distal third of the clavicle under visualization and with care to not create a vault. The procedure is considered done when a smooth articular surface is visualized and with at least 5 mm of space between the clavicle and the acromion. Results: The proposed technique, which is a variant of the classic distal clavicle excision, has shown improved functional outcomes with reproducible postoperative scores and low complications rates in the setting of patients with isolated AC joint arthritis. Conclusion: Surgical management of the painful, arthritic AC joint has been evolving alongside with the history of shoulder arthroscopy; the proposed arthroscopic approach is an easy and effective way of freeing the patient of pain and discomfort with quick return to activities and sports. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Drone-delivered automated external defibrillators for out-of-hospital cardiac arrest: A simulation-based feasibility study
Authors: Smith Christopher M , Phillips Joe , Rees Nigel , Powell Carl , Sheehan Anthony , O’ Sullivan Mary 
Published: September 2024

Background Cardiopulmonary resuscitation (CPR) and defibrillation markedly increases survival following out-of-hospital cardiac arrest (OHCA). Members of the public can perform both before the ambulance service arrives. However, bystanders use a public-access Automated External Defibrillator (AED) in around 5% of cases. Using Unmanned Aerial Vehicles (‘drones’) to deliver AEDs may overcome many of the barriers preventing public-access AED use. The study team investigated how quickly and easily bystanders performing CPR could use drone-delivered AEDs. Methods The study team developed an AED-capable drone between May and November 2020 and conducted 18 OHCA simulations in July and September 2021. A single participant found a simulated patient inside a building and made a 999-call to a Welsh Ambulance Services NHS Trust call-handler. Once cardiac arrest was confirmed during the 999-call a nearby drone launched, reached hovering altitude and delivered the AED immediately outside the building. The participant retrieved the AED when instructed to do so, attached it to the patient and delivered a single shock. The primary outcome was hands-off CPR time. Secondary outcomes included ease of AED retrieval, by using a questionnaire adapted from the System Usability Scale and exploring participant behaviours via post-simulation interviews and reviews of audio and video recordings of the simulation. Results Hands-off CPR time was (median) 109 s (interquartile range 87–130 s). Participants spent 19 s (16–22 s) away from the patient's side when retrieving the AED. Participants found it easy to use the AED but often sought the call-handler's reassurance that it was appropriate to retrieve it. Conclusion Participants found it easy to retrieve and use an AED delivered by drone in simulated OHCAs. Hands-off CPR time was potentially clinically relevant in this lone bystander simulation, but there was only a small increase in hands-off time caused by retrieval of the drone-delivered AED.
Turbocharging protein binding site prediction with geometric attention, inter-resolution transfer learning, and homology-based augmentation
Authors: Lee Daeseok , Hwang Wonjun , Byun Jeunghyun , Shin Bonggun 
Published: September 2024

Abstract
Background
Locating small molecule binding sites in target proteins, in the resolution of either pocket or residue, is critical in many drug-discovery scenarios. Since it is not always easy to find such binding sites using conventional methods, different deep learning methods to predict binding sites out of protein structures have been developed in recent years. The existing deep learning based methods have several limitations, including (1) the inefficiency of the CNN-only architecture, (2) loss of information due to excessive post-processing, and (3) the under-utilization of available data sources.

Methods
We present a new model architecture and training method that resolves the aforementioned problems. First, by layering geometric self-attention units on top of residue-level 3D CNN outputs, our model overcomes the problems of CNN-only architectures. Second, by configuring the fundamental units of computation as residues and pockets instead of voxels, our method reduced the information loss from post-processing. Lastly, by employing inter-resolution transfer learning and homology-based augmentation, our method maximizes the utilization of available data sources to a significant extent.

Results
The proposed method significantly outperformed all state-of-the-art baselines regarding both resolutions—pocket and residue. An ablation study demonstrated the indispensability of our proposed architecture, as well as transfer learning and homology-based augmentation, for achieving optimal performance. We further scrutinized our model’s performance through a case study involving human serum albumin, which demonstrated our model’s superior capability in identifying multiple binding sites of the protein, outperforming the existing methods.

Conclusions
We believe that our contribution to the literature is twofold. Firstly, we introduce a novel computational method for binding site prediction with practical applications, substantiated by its strong performance across diverse benchmarks and case studies. Secondly, the innovative aspects in our method— specifically, the design of the model architecture, inter-resolution transfer learning, and homology-based augmentation—would serve as useful components for future work.