bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Scenario and Future Perspectives of Porcine Corneal Xenotransplantation
Authors: Nascimento Heloisa , Martins Thaís M. M. , Moreira Rodrigo , Barbieri Gabriel , Pires Pedro , Carvalho Lucimeire N. , Rosa Larissa R. , Almeida Augusto , Araujo Michelle Silva , Pessuti Carmen Luz , Ferrer Henrique , Pereira Gomes José Álvaro , Belfort Rubens , Raia Silvano 
Published: October 2024

Abstract:
Corneal diseases represent a significant cause of blindness worldwide, with corneal transplantation being an effective treatment to prevent vision loss. Despite substantial advances in transplantation techniques, the demand for donor corneas exceeds the available supply, particularly in developing countries. Cornea xenotransplantation has emerged as a promising strategy to address the worldwide scarcity, notably using porcine corneas. In addition to the inherent immune privilege of the cornea, the low cost of porcine breeding and the anatomical and physiological similarities between humans and pigs have made porcine corneas a viable alternative. Nonetheless, ethical concerns, specifically the risk of xenozoonotic transmission and the necessity for stringent biosafety measures, remain significant obstacles. Moreover, the success of xenotransplantation is compromised by innate and adaptive immune responses, which requires meticulous consideration and further studies. Despite these challenges, recent breakthroughs have further contributed to reducing immunogenicity while preserving the corneal architecture. Advances in genetic engineering, such as the use of CRISPR-Cas9 to eliminate critical porcine antigens, have shown promise for mitigating immune reactions. Additionally, new immunosuppressive protocols, such as have techniques like decellularization and the use of porcine-derived acellular matrices, have greatly increased graft survival in preclinical models. Future research must focus on refining immunomodulatory strategies and improving graft preparation techniques to ensure the long-term survival and safety of porcine corneal xenotransplantation in clinical trials in humans.
An immune signature of postoperative cognitive decline: a prospective cohort study
Authors: Verdonk Franck , Cambriel Amélie , Hedou Julien , Ganio Ed , Bellan Grégoire , Gaudilliere Dyani , Einhaus Jakob , Sabayev Maximilian , Stelzer Ina A. , Feyaerts Dorien , Bonham Adam T. , Ando Kazuo , Choisy Benjamin , Drover David , Heifets Boris , Chretien Fabrice , Aghaeepour Nima , Angst Martin S. , Molliex Serge , Sharshar Tarek , Gaillard Raphael , Gaudilliere Brice 
Published: October 2024

Background:
Postoperative cognitive decline (POCD) is the predominant complication affecting patients over 60 years old following major surgery, yet its prediction and prevention remain challenging. Understanding the biological processes underlying the pathogenesis of POCD is essential for identifying mechanistic biomarkers to advance diagnostics and therapeutics. This study aimed to provide a comprehensive analysis of immune cell trajectories differentiating patients with and without POCD and to derive a predictive score enabling the identification of high-risk patients during the preoperative period.

Material and methods:
Twenty-six patients aged 60 years old and older undergoing elective major orthopedic surgery were enrolled in a prospective longitudinal study, and the occurrence of POCD was assessed 7 days after surgery. Serial samples collected before surgery, and 1, 7, and 90 days after surgery were analyzed using a combined single-cell mass cytometry and plasma proteomic approach. Unsupervised clustering of the high-dimensional mass cytometry data was employed to characterize time-dependent trajectories of all major innate and adaptive immune cell frequencies and signaling responses. Sparse machine learning coupled with data-driven feature selection was applied to the presurgery immunological dataset to classify patients at risk for POCD.

Results:
The analysis identified cell-type and signaling-specific immune trajectories differentiating patients with and without POCD. The most prominent trajectory features revealed early exacerbation of JAK/STAT and dampening of inhibitory κB and nuclear factor-κB immune signaling responses in patients with POCD. Further analyses integrating immunological and clinical data collected before surgery identified a preoperative predictive model comprising one plasma protein and 10 immune cell features that classified patients at risk for POCD with excellent accuracy (AUC=0.80, P=2.21e-02 U-test).

Conclusion:
Immune system-wide monitoring of patients over 60 years old undergoing surgery unveiled a peripheral immune signature of POCD. A predictive model built on immunological data collected before surgery demonstrated greater accuracy in predicting POCD compared to known clinical preoperative risk factors, offering a concise list of biomarker candidates to personalize perioperative management.
Preservation of the MMPH and Status of the Notch Configurations Are Important Factors for Successful Revision ACL Reconstruction
Authors: Park Seong Yun , Park Sung Bae , Lee Yong Seuk 
Published: October 2024

Objective:
The aim of this study was to identify the differences in anatomical factors between the patients who underwent revision and primary anterior cruciate ligament reconstructions (ACLR) and compare the outcomes between the 2 surgeries.

Design:
Retrospective cohort study.

Setting:
Single institution tertiary academic center between 2014 and 2020.

Patients:
A total of 84 matched patients who underwent revision (group I) or primary ACLR (group II).

Interventions:
Radiological evaluations were performed using side-to-side differences (SS-D), femorotibial angle, and posterior tibial slope. The medial meniscus posterior horn status as width (MMPHW), medial tibial plateau width (MTPW), notch configurations, tunnel positions, and sagittal graft angle were measured using 3D-CT and magnetic resonance imaging (MRI).

Main Outcome Measures:
Graft signals were assessed using MRI. The clinical outcomes were assessed.

Results:
Group I showed larger SS-D and higher mean Howell grade of anterior cruciate ligament (ACL) graft than group II (P = 0.002 and P = 0.004, respectively). Multivariate regression analyses showed that the decreased MMPHW/MTPW ratio (P = 0.010) and notch width index (P < 0.007) were significantly independent factors associated with the higher Howell grade of ACL grafts. The decreased MMPHW/MTPW ratio (P < 0.001) was a significantly independent factor associated with larger SS-D. In the subgroup analysis, all patients in the notchplasty group showed wider notches postoperatively (P < 0.001).

Conclusions:
Revision ACLRs resulted in worse ACL signal intensity and stability outcome. The results of this study suggest that it may be important to preserve the MMPHW as much as possible and check notch configurations, especially during a revision ACLR.
Combination of FDG PET/CT radiomics and clinical parameters for outcome prediction in patients with non-Hodgkin’s lymphoma
Authors: Ortega Claudia , Anconina Reut , Joshi Sayali , Metser Ur , Prica Anca , Johnson Sarah , Liu Zhihui Amy , Keshavarzi Sareh , Veit-Haibach Patrick 
Published: October 2024

Purpose
The purposes was to build model incorporating PET +  computed tomography (CT) radiomics features from baseline PET/CT + clinical parameters to predict outcomes in patients with non-Hodgkin lymphomas.

Methods
Cohort of 138 patients with complete clinical parameters and follow up times of 25.3 months recorded. Textural analysis of PET and manual correlating contouring in CT images analyzed using LIFE X software. Defined outcomes were overall survival (OS), disease free-survival, radiotherapy, and unfavorable response (defined as disease progression) assessed by end of therapy PET/CT or contrast CT. Univariable and multivariable analysis performed to assess association between PET, CT, and clinical.

Results
Male (P = 0.030), abnormal lymphocytes (P = 0.030), lower value of PET entropy (P = 0.030), higher value of SHAPE sphericity (P = 0.002) were significantly associated with worse OS. Advanced stage (III or IV, P = 0.013), abnormal lymphocytes (P = 0.032), higher value of CT gray-level run length matrix (GLRLM) LRLGE mean (P = 0.010), higher value of PET gray-level co-occurrence matrix energy angular second moment (P < 0.001), and neighborhood gray-level different matrix (NGLDM) busyness mean (P < 0.001) were significant predictors of shorter DFS. Abnormal lymphocyte (P = 0.033), lower value of CT NGLDM coarseness (P = 0.082), and higher value of PET GLRLM gray-level nonuniformity zone mean (P = 0.040) were significant predictors of unfavorable response to chemotherapy. Area under the curve for the three models (clinical alone, clinical + PET parameters, and clinical + PET + CT parameters) were 0.626, 0.716, and 0.759, respectively.
Radiation exposure in vesicoureteral reflux diagnostics: a comparative study of direct radionuclide cystography and voiding cystourethrogram
Authors: Viljamaa Hanna-Reeta , Ripatti Liisi L.M. , Larjava Heli R.S. , Noponen Tommi E.J. , Saikkonen Aleksi , Rautava Päivi T.K. , Koivisto Mari A. , Pakkasjärvi Niklas A. 
Published: October 2024

Introduction
Voiding cystourethrography (VCUG) is the standard method for diagnosing vesicoureteral reflux (VUR) but has been criticized for radiation exposure. Direct radionuclide cystography (DRC) was developed to reduce this risk. We aimed to assess DRC’s efficacy as a screening tool and compare its radiation burden to VCUG.

Materials and methods
We retrospectively analyzed patient records encompassing children who underwent VCUG or DRC to diagnose VUR from 2011 to 2020 at our hospital.

Results
A total of 156 children were included (median age: 0.75 years, 53.8% females). Indications included urinary tract infection in 71.2% of patients and antenatal hydronephrosis in 26.9%. DRC was performed on 122 patients (78.2%) and VCUG on 96 patients (61.5%), with solitary use in 38.5 and 21.8% of cases, respectively, and combined application in 39.7%. DRC detected VUR in 35.3% (43/122) and VCUG in 61.5% (59/96) of patients. Bladder-filling rates differed significantly between DRC (37%) and VCUG (67%) (P < 0.0001). Median radiation doses were lower in VCUG (0.023 mSv) than in DRC (0.073 mSv). For patients requiring complementary VCUG after DRC, the median radiation dose for DRC was 0.063 mSv (P < 0.0001), resulting in a total median dose of 0.098 mSv. Cost analysis revealed VCUG as more cost-effective, with an additional expenditure of approximately 345 euros per patient undergoing DRC in our cohort.

Conclusion
DRC imposed a higher radiation burden on patients than VCUG and often necessitated follow-up VCUG for positive cases. This challenges the utility of DRC as a low-radiation alternative in VUR screening.

Level of evidence
Level 4: cohort study without a control group.
An associate of suspicious axillary node and sentinel node in breast cancer to minimizing axillary surgery, prospective cohort study
Authors: Chirappapha Prakasit , Lertsithichai Panuwat , Adireklarpwong Lakkana , Kaeosuwan Supanat , Wiratkapun Cholatip , Lapkittichot Sarunthorn , Taerakul Navalee , Trimankha Muntana , Nimitkul Kanitha , Pipatsakulroj Wiriya , Sukarayothin Thongchai , Leesombatpaiboon Monchai , Suvikapakornkul Ronnarat , Wasuthit Yodying 
Published: October 2024

Background:
Arm morbidity and postoperative complications following sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) are common problems in patients with breast cancer. The de-escalating axillary surgery is increasing; however, there is a lack of patients with suspicious nodes. This study aimed to reduce the need for SLNB in suspicious lymph node cases.

Methods:
A prospective cohort study of women with invasive breast cancer who underwent surgery between January 2021 and December 2022. The study included two cohorts: Cohort A comprised patients with stage cT1-2N0-1M0 cancer who planned upfront surgery, while Cohort B included patients with stages cT1-4N2M0, cT3-4N1M0, or cT1-2N0-1M0 who received neoadjuvant systemic treatment. During the study, a clip was inserted into the suspicious lymph node on imaging to determine whether it could serve as a sentinel node and potentially replace SLNB or reduce the need for axillary surgery.

Result:
In cohort A, 22 surgeries were performed, while in cohort B, seven surgeries were performed. The median follow-up time was 15 months. In cohort A, 71% of the patients had cN0 disease, while 28% had cN1 disease. A suspicious node correlated to a sentinel node was noted in 66.67% of cohort A. The false-negative rate (FNR) was 14.28%. However, when the clip node removal procedure was performed instead of the sentinel node procedure, the FNR was 10%.

Conclusion:
In early breast cancer, suspicious nodes in imaging studies could not currently represent sentinel lymph nodes, and the FNR was still high. Nevertheless, more studies with larger populations will provide a better understanding due to the limited number of patients.
Gastric glomus tumor with a rare presentation: a case report and review of the literature
Authors: Thalji Mariam Mohammed , Alnajjar Yousef A. , Mohammad Maen , Khadra Hala , Bannoura Sami , Al-Ashhab Hazem 
Published: October 2024

Introduction and importance:
Gastric glomus tumors (GGT) are rare soft tissue tumors of the gastrointestinal tracts (GIT). It is somewhat challenging to establish the diagnosis of GGT and differentiate it from the more common submucosal neoplasms.

Case presentation:
A 34-year-old female patient presented with upper gastrointestinal bleeding. Extensive workup including endoscopic ultrasonography (EUS) revealed a well-circumscribed isoechoic mass arising from the muscularis propria. Based on fine needle biopsy (FNB) findings, with H&E stains performed only initially, the mass was considered a neuroendocrine tumor (NET). Antrectomy with Billroth II anastomosis was performed. A microscopic and immunohistochemical studies of the resected specimen showed the cells to be positive for smooth muscle actin (SMA) making GGT the final diagnosis.

Clinical discussion:
Of the 116 patients included in our analysis, 56.9% (n=66) were females and age group was between 41 and 64 years old in 63.8% (n=74) of the patients. About 55 cases (47.4%) had abdominal or epigastric pain or discomfort, which was the most frequent clinical symptom. In immunohistochemistry, SMA staining is present in 68.1% of the cases, underscoring its diagnostic significance. Laparotomy with wedge or partial gastrectomy was employed in 46.1% of the recorded cases. Due to malignant potential, long-term follow-up and monitoring are usually recommended.

Conclusion:
Despite the rarity of GGT, they should be included in the differential diagnosis of gastric submucosal tumors, with immunohistochemistry studies playing a major role in the diagnosis. Furthermore, a comprehensive evaluation of the literature in the past 8 years was presented in a table.
Involving Patients and/or Their Next of Kin in Serious Adverse Event Investigations: A Qualitative Study on Hospital Perspectives
Authors: Knap Linda J. , Dijkstra-Eijkemans Rachel I. , Friele Roland D. , Legemaate Johan 
Published: October 2024

Background
The involvement of patients or next of kin (P/N) after a serious adverse event (SAE) is evolving. Beyond providing mandatory information, there is growing recognition of the need to incorporate their interests. This study explores practical manifestations of P/N involvement and identifies significant considerations for hospitals.

Methods
The data collection involved various qualitative research methods: 7 focus groups with 56 professionals from 37 hospitals, an interview with 2 representatives from the Dutch Association of Hospitals, and an interactive reflection seminar with over 60 participants from 34 hospitals. Before the focus groups, a brief questionnaire was sent out to survey participants’ practices regarding into SAE investigations. After the study, another questionnaire was distributed to gather suggestions for future improvements and to identify their lessons learned. Thematic analysis was applied to the gathered data to identify key themes.

Results
Hospitals are increasingly acknowledging the interests and perspectives of P/N, recognizing their potential contributions to organizational learning and improvement. P/N involvement following SAEs includes active participation in different stages of the investigation process, not just passive information dissemination. Important factors influencing involvement are the provision of (emotional) support, identification of needs, and transparency of the SAE investigation.

Conclusions
This study enhances understanding of evolving practices surrounding P/N involvement in the context of SAEs in Dutch hospitals. The findings highlight the importance of promoting meaningful involvement, recognizing the significance of P/N experiences, and fostering a culture of transparency and collaboration. By examining the dynamics of involvement, this research aims to inform policy development and facilitate the implementation of patient-centered approaches to post-SAE care.
Enhancing Sepsis Care at an Academic Emergency Department in a Resource-Constrained Setting: A Quality Improvement Initiative
Authors: Noureldeen Haytham , Bakhsh Abdullah , Alshabasy Adel , Alawi Maha , Bakhribah Ahmad , Nasrallah Nihad , Aljuhani Ohoud , Margushi Rahaf , Bantan Rafal , Bokhari Raneem , Idris Sarah , Alshamrani Lamis , Samman Abeer , Alharthi Elaf , Alothman Ali 
Published: October 2024

Objectives
The early recognition of sepsis and septic shock is crucial for improved patient outcomes. Quality improvement programs have ameliorated processes and outcomes in the care of patients with sepsis and septic shock. This study aimed to improve the proportion of patients receiving antibiotics within 1 hour of triage and compliance with sepsis bundles.

Methods
A multidisciplinary sepsis task force was created to monitor and improve sepsis care. The program lasted 24 months from January 1, 2018, to December 31, 2019. A unique screening criterion was created by combining items from the systemic inflammatory response syndrome, quick sequential organ failure assessment, and National Early Warning Score systems. Thereafter, a sepsis flowsheet was implemented in the emergency department for monitoring. The measures between the first 12 months and the last 12 months were compared.

Results
The proportion of patients receiving antibiotics within 1 hour of triage improved from 44% to 84%, intravenous crystalloid administration within 3 hours improved from 62% to 94%, serum lactic acid measurement within 3 hours improved from 62% to 94%, and vasopressor initiation within 6 hours improved from 76% to 94%. The mortality rates decreased from 32% to 21% between the 2 study periods.

Conclusions
This program emphasizes the impact of a structured quality improvement program on the process and outcomes of care.
The potential impact of new tuberculosis vaccines on the burden of tuberculosis in people with HIV in South Africa
Authors: Sumner Tom , Clark Rebecca A. , Prys-Jones Tomos O. , Bakker Roel , Churchyard Gavin , White Richard G. 
Published: October 2024

Background:
People with HIV (PWH) are at an increased risk of tuberculosis (TB). New TB vaccines may help reduce this burden. New TB vaccine candidates are well tolerated and immunogenic in PWH. There are currently limited data on vaccine efficacy in this population.

Methods:
Using mathematical modeling, we explored the potential impact of a novel TB vaccine on TB burden in PWH in South Africa between 2030 and 2050. We compared the impact of a vaccine delivered irrespective of HIV status to vaccination of either PWH or people without HIV. We explored the impact of reduced vaccine efficacy and duration of protection in PWH relative to people without HIV on our model predictions.

Results:
Vaccination irrespective of HIV status, with a vaccine with equal efficacy and duration in PWH, could avert up to 1.01 (95% range: 0.96–1.22) million TB cases in PWH. Restricting vaccination to PWH or people without HIV would achieve 65% (60–70) and 48% (46–53) of the total impact, respectively. These results are strongly dependent on the assumed efficacy and duration of protection in PWH. Further information on these characteristics is important to identify the most efficient use of new vaccines to reduce TB burden in PWH.

Conclusion:
Our results suggest that new vaccines could play an important role in reducing the TB burden in PWH. Vaccines targeted at people without HIV could provide significant indirect benefit to PWH, but vaccines which are well tolerated and effective in PWH will be critical to maximizing the impact in this population.
Anticoagulant Treatment May Decrease the Relapse Rate of Pulmonary Arterial Involvement in Behçet’s Disease
Authors: Abacar Kerem Yiğit , Boncukcuoglu Ayşe Elif , Aksoy Aysun , Kocakaya Derya , Cimsit Cagatay , Direskeneli Haner , Alibaz-Oner Fatma 
Published: October 2024

Objectives
Pulmonary arterial involvement (PAI) is one of the most common causes of mortality in Behçet’s disease (BD). In this study, we aimed to evaluate the clinical features, course, and recurrence risk factors of BD-associated PAI.

Methods
BD patients who were followed up in Marmara University BD outpatient clinic between 1990 and 2023 were included. All data were acquired from the patients' medical records. PAIs were classified according to the type of the vascular involvement as thrombosis or aneurysm. Factors affecting the risk of relapses were determined using multivariate Cox regression analysis.

Results
Among 1350 BD patients, 110 (8.1%) had PAI. The mean age (SD) of patients with PAI was 42.4 (11.6) years, and the male/female ratio was 2.2 (76/34). Thirty-two (29.1%) of 110 patients were asymptomatic. Asymptomatic patients with PAI were significantly younger (p = 0.031) than the symptomatic group. Also, a greater prevalence of females (p = 0.001) and higher recurrence rates (p = 0.019) were observed in the symptomatic group. Pulmonary arterial thrombosis was seen in 104 (94.5%) and aneurysms in 9 patients (6.6%). At least one PAI relapse was observed in 31 patients (28.2%). In multivariate analysis, the Cox regression model was significant (p = 0.013), and not starting anticoagulants independently increased the PAI relapse risk (hazards ratio, 4.36; 95% confidence interval, 1.14–24.1; p = 0.042).

Conclusions
Pulmonary arterial thrombosis is the main presentation type of PAI in BD, whereas aneurysmatic formation is rare. Despite immunosuppressive treatment, relapses occur during follow-up in one third of patients with PAI. When anticoagulant therapy is added to immunosuppressive therapy, the relapse rate in BD patients with PAI is significantly reduced.