bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ocular and Systemic Abnormalities in Punctal Agenesis
Authors: Marshall Rayna F. , Landau-Prat Daphna , Strong Alanna , Katowitz James A. , Katowitz William R. 
Published: October 2024

Background:
Punctal agenesis (PA) is a rare congenital anomaly that can occur in isolation or as part of an underlying syndrome. The benefit of genetic assessment in individuals with PA and clinical features that should prompt molecular workup has not been systematically studied. The aim of this study was to identify ocular and extraocular features associated with PA and determine its association with an underlying syndrome.

Methods:
A retrospective medical records review of ocular and extraocular medical histories in all patients diagnosed with PA at the Children’s Hospital of Philadelphia between 2009 and 2023 was conducted.

Results:
Forty-four patients were included, ages 3.3 ± 3.3 years. Our cohort was 31 males (70%). Twenty patients had isolated PA (45.5%), while 24 patients (54.5%) had other associated ocular or extraocular abnormalities. The most common ocular comorbidities were refractive disorders (n = 8, 33%), ptosis (n = 8, 33%), strabismus (n = 7, 29%), other eyelid disorders (n = 9, 38%), and amblyopia (n = 6, 25%). Nineteen (43%) individuals had systemic disorders and 18 (41%) underwent genetic testing. An associated genetic diagnosis was found in 17 (39%) individuals. The most common associated syndrome was ectodermal dysplasia. Systemic disorders were more prevalent in individuals with syndromic PA (4, 20% isolated PA vs. 15, 63%, PA-plus, p = 0.005).

Conclusions:
The presence of additional ocular abnormalities was associated with an increased rate of systemic disorders (63%). In individuals with PA who also exhibit additional ocular disorders, systemic evaluation and genetic workup should be considered.
China ARCHES: A Phase 3 Trial of Enzalutamide vs Placebo in Metastatic Hormone-Sensitive Prostate Cancer
Authors: Chang Yuan , Li Yonghong , Zeng Gongqian , Guo Hongqian , Hu Zhiquan , Zhang Xiaoping , He Dalin , He Zhisong , Zhang Dahong , Kadeerbai Haishan , Liu Yuning , Zhou Fangjian , Ye Dingwei 
Published: October 2024

Purpose:
This study evaluated the efficacy and safety of enzalutamide vs placebo, both combined with androgen deprivation therapy, in Chinese men with metastatic hormone-sensitive prostate cancer.

Materials and Methods:
Patients were randomized 2:1 to enzalutamide 160 mg/day or placebo, both in combination with androgen deprivation therapy. The primary trial end point was the time to prostate-specific antigen progression. Selected secondary end points included radiographic progression-free survival, time to castration resistance, time to initiation of new antineoplastic therapy, undetectable prostate-specific antigen (<0.2 ng/mL) rate among patients with detectable levels at baseline, and safety.

Results:
From September 11, 2019, to November 18, 2022, 180 patients were randomized to treatment (enzalutamide: n = 120; placebo: n = 60). Baseline characteristics were balanced between the treatment arms. Median treatment duration in the enzalutamide vs the placebo arm was 25.66 vs 15.11 months. After 63 prostate-specific antigen progression events (enzalutamide: n = 23; placebo: n = 40), enzalutamide significantly reduced the hazard for prostate-specific antigen progression by 87% (hazard ratio: 0.130; 95% confidence interval: 0.076, 0.222; P < .0001) vs placebo. Radiographic progression-free survival, time to castration resistance, and achievement of undetectable prostate-specific antigen levels were increased with enzalutamide vs placebo, while treatment-emergent adverse event rates were similar. Serious and grade 3 to 4 treatment-emergent adverse events occurred in 35.3% and 52.1%, respectively, of enzalutamide recipients vs 20.3% and 39.0%, respectively, of placebo recipients.

Conclusions:
In Chinese men with metastatic hormone-sensitive prostate cancer, enzalutamide significantly reduced the hazard for prostate-specific antigen progression vs placebo when combined with androgen deprivation therapy. The China ARCHES (NCT04076059) results were consistent with those of the global ARCHES study (NCT02677896).
Urologist-Administered MRI-Guided Transurethral Ultrasound Ablation of the Prostate Using a Mobile Treatment Center: A Case Series
Authors: Childs Alexandria , Donkor Emmanuel , Wootton Cole , Chopra Rajiv , Cookson Michael , Stratton Kelly 
Published: October 2024

Introduction:
Transurethral ultrasound ablation (TULSA) relies on real-time MRI to precisely control the treatment of prostate cancer and avoid side effects. To overcome limited urologist access to MRI, we present a case series on the first use of a mobile TULSA treatment center.

Methods:
Clinical outcomes were retrospectively reviewed from our institutional database. A mobile MRI scanner was installed next to a surgical hospital, equipped with the ablation system and MRI-compatible anesthesia. Manufacturer testing confirmed that mobile TULSA continued to meet the requirements of fixed installations. Patients underwent preoperative assessment of candidacy for anesthesia and treatment in a mobile MRI setting. Positioning, anesthesia induction, and device placement were performed in the MRI scanner room. The intended ablation zone was delineated by the urologist using magnetic resonance images acquired with treatment devices in place. Ablation was controlled by the treatment software and monitored by the urologist using real-time MRI. A Foley catheter was placed for postoperative drainage; the patients awoke in the mobile MRI before transfer to postanesthesia care unit.

Results:
Six patients underwent TULSA in the mobile treatment unit, with no intraoperative complications. The median procedure time was 3.2 hours, with workflow improvements during equipment setup, patient positioning, and treatment planning. Contrast-enhanced images confirmed devascularization of the index lesion and successful nerve sparing. Six-month follow-up demonstrated promising PSA and MRI findings, and improvements in lower urinary tract symptoms.

Conclusions:
TULSA can be safely administered by urologists using a mobile MRI treatment center. Mobile MRI units could be used to expand patient access to TULSA.
Durability of Laser Endoureterotomy for the Treatment of Benign Ureteral Strictures: A Systematic Review and Meta-Analysis
Authors: Bhojani Naeem , Miller Larry E. , Bhattacharyya Samir , Emiliani Esteban , Krambeck Amy , Kamphuis Guido M. , Chew Ben H. 
Published: October 2024

Purpose:
Laser endoureterotomy is a common minimally invasive treatment of ureteral strictures. However, data evaluating the durability of this technique are limited. This systematic review and meta-analysis assessed treatment success rates after laser endoureterotomy for managing benign ureteral strictures.

Materials and Methods:
A systematic literature search identified studies published from January 2000 to December 2023 reporting outcomes of laser endoureterotomy for benign ureteral strictures. Random-effects meta-analysis models calculated treatment success rates at 3 months, 6 months, and annually thereafter until estimates became unreliable (standard error > 10%).

Results:
Nine studies comprising 308 patients (310 strictures) met eligibility criteria. The methodological quality of the studies was rated as good in 8 studies and fair in 1 study. Strictures were most commonly attributable to stone disease or previous surgery, predominantly located in the proximal (38%) or distal (35%) ureter, with a median length of 10 mm. Holmium laser was used in 98% of cases. Intraoperative complication rates were low (0.9%). The treatment success rate was 84% at 3 months, 74% at 1 year, 70% at 2 years, and 68% at 3 years. Sensitivity analysis indicated that the results were not overly influenced by any single study, and modest heterogeneity was observed among studies.

Conclusions:
Minimally invasive laser endoureterotomy is an effective and durable treatment for short benign ureteral strictures, making it a viable alternative to reconstructive surgery.
Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019–2020
Authors: Yang Alina W. , Blosnich John R. 
Published: October 2024

Objectives:
To estimate the prevalence of adverse childhood experiences (ACEs) among a population-based sample of adults in the United States by their primary source of health care.

Background:
Debate continues around the effectiveness and implementation of health care–based screening of ACEs. However, it is unclear how the burden of ACEs would be distributed across different sources of health care (ie, what a health system might expect should it implement ACEs screening).

Methods:
Data are from 8 U.S. states that include optional modules for ACEs and health care utilization in their 2019 or 2020 Behavioral Risk Factor Surveillance System survey. The analytic sample includes respondents with completed interviews (n = 45,820). ACEs were categorized into ordinal categories of 0, 1, 2, 3, or ≥4; and the prevalence of ACEs was summarized across 5 sources of health care: (1) employer-based or purchased plan; (2) Medicare, Medicaid, or other state programs; (3) TRICARE, Veterans Affairs, or military (ie, military-related health care); (4) Indian Health Service; or (5) some other source. All estimates were weighted to account for the complex sampling design.

Results:
Across all health insurance types, at least 60% of individuals reported at least one ACE. The greatest prevalence of patients reporting ≥4 ACEs occurred for military-related health care (21.6%, 95% CI = 18.2–25.5) and Indian Health Service (45.4%, 95% CI = 22.6–70.3).

Conclusions:
ACEs are extremely common across sources of health care, but some health systems have greater proportions of patients with high ACE exposures. The unique strengths and challenges of specific health care systems need to be integrated into the debate about clinical ACEs screening.
Platelet-derived extracellular vesicles in cardiovascular disease and treatment – from maintaining homeostasis to targeted drug delivery
Authors: Weiss Luisa , Macleod Hayley , Maguire Patricia B. 
Published: October 2024

Purpose of review
Cardiovascular disease (CVD) remains a major global health burden. Rising incidences necessitate improved understanding of the pathophysiological processes underlying disease progression to foster the development of novel therapeutic strategies. Besides their well recognized role in CVD, platelet-derived extracellular vesicles (PEVs) mediate inter-organ cross talk and contribute to various inflammatory diseases.

Recent findings
PEVs are readily accessible diagnostic biomarkers that mirror pathophysiological disease progression but also may confer cardioprotective properties. Monitoring the effects of modulation of PEV signatures through pharmacotherapies has also provided novel insights into treatment efficacy. Furthermore, exploiting their inherent ability to infiltrate thrombi, atherosclerotic plaques and solid tumours, PEVs as well as platelet-membrane coated nanoparticles are emerging as novel effective and targeted treatment options for CVD and cancer.

Summary
Collectively, in-depth characterization of PEVs in various diseases ultimately enhances their use as diagnostic or prognostic biomarkers and potential therapeutic targets, making them clinically relevant candidates to positively impact patient outcomes.
Novel intravesical therapies and delivery systems for the management of bladder cancer
Authors: Grobet-Jeandin Elisabeth , Rouprêt Morgan , Seisen Thomas 
Published: October 2024

Purpose of review
Bladder cancer is a substantial burden for public health worldwide. A risk-adapted treatment strategy is required for non muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). To date, treatment includes surgery with or without peri-operative local or systemic treatment. The aim of this review was to explore novel intravesical therapies and delivery systems emerging in NMIBC and MIBC.

Recent findings
Several novel intravesical therapies and delivery systems for NMIBC and MIBC treatment recently emerged. Hyperthermic intravesical chemotherapy (HIVEC) allows a reasonable cancer control in selected high-risk NMIBC. Novel intravesical drugs such as nadofaragene firadenovec, Oncofid-P-B or Nogapendekin alfa-inbakicept seem to be safe and well tolerated. However, their efficacy in high-risk NMIBC should be further investigated. Hydrogels appear to be safe, well tolerated and potentially efficient in primary chemoablation in selected cases of low-grade intermediate-risk NMIBC tumors. Drug-releasing intravesical systems (drug-RIS) such as TAR-200 are safe and well tolerated, providing high partial and complete response rate in both NMIBC and MIBC patients.

Summary
The armamentarium for the treatment of bladder cancer patients is expanding, notably with HIVEC, hydrogels, drug-RIS and novel therapies. However, accurate patients’ selection is key to prevent disease progression in any bladder-sparing strategy, and radical cystectomy remains the gold-standard to date.
Adverse perinatal outcomes associated with different classes of antiretroviral drugs in pregnant women with HIV
Authors: Hey Molly , Thompson Lucy , Portwood Clara , Sexton Harriet , Kumarendran Mary , Brandon Zoe , Kirtley Shona , Hemelaar Joris 
Published: October 2024

Objective:
Women with HIV (WHIV) are at an increased risk of adverse perinatal outcomes compared to women without HIV, despite antiretroviral therapy (ART). There is evidence that the risk of adverse perinatal outcomes may differ according to ART regimen. We aimed to assess the risk of adverse perinatal outcomes among WHIV receiving different classes of ART, compared to women without HIV.

Design:
A systematic review and meta-analysis

Methods:
We searched Medline, CINAHL, Global Health, and EMBASE for studies published between January 1, 1980, and July 14, 2023. We included studies which assessed the risk of 11 predefined adverse perinatal outcomes among WHIV receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based ART, protease inhibitor based ART or integrase strand transfer inhibitor (INSTI)-based ART, compared to women without HIV. The perinatal outcomes assessed were preterm birth (PTB), very PTB (VPTB), spontaneous PTB (sPTB), low birthweight (LBW), very LBW (VLBW), term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth and neonatal death (NND). Random effects meta-analyses examined the risk of each adverse outcome in WHIV receiving NNRTI-based, protease inhibitor based, or INSTI-based ART, compared with women without HIV. Subgroup and sensitivity analyses were conducted based on country income status, study quality, and timing of ART initiation. The protocol is registered with PROSPERO, CRD42021248987.

Results:
Of 108 720 identified citations, 22 cohort studies including 191 857 women were eligible for analysis. We found that WHIV receiving NNRTI-based ART (mainly efavirenz or nevirapine) are at an increased risk of PTB (risk ratio 1.40, 95% confidence interval 1.27–1.56), VPTB (1.94, 1.25–3.01), LBW (1.63, 1.30–2.04), SGA (1.53, 1.17–1.99), and VSGA (1.48, 1.16–1.87), compared with women without HIV. WHIV receiving protease inhibitor based ART (mainly lopinavir/ritonavir or unspecified) are at an increased risk of PTB (1.88, 1.55–2.28), VPTB (2.06, 1.01–4.18), sPTB (16.96, 1.01–284.08), LBW (2.90, 2.41–3.50), VLBW (4.35, 2.67–7.09), and VSGA (2.37, 1.84–3.05), compared with women without HIV. WHIV receiving INSTI-based ART (mainly dolutegravir) are at an increased risk of PTB (1.17, 1.06–1.30) and SGA (1.20, 1.08–1.33), compared with women without HIV.

Conclusion:
The risks of adverse perinatal outcomes are higher among WHIV receiving ART compared with women without HIV, irrespective of the class of ART drugs. This underlines the need to further optimize ART in pregnancy and improve perinatal outcomes of WHIV.
Optimizing Catheter Verification
Authors: Stroeder Jonas , Multusch Malte , Berkel Lennart , Hansen Lasse , Saalbach Axel , Schulz Heinrich , Heinrich Mattias P. , Elser Yannic , Barkhausen Jörg , Sieren Malte Maria 
Published: October 2024

Purpose
Accurate detection of central venous catheter (CVC) misplacement is crucial for patient safety and effective treatment. Existing artificial intelligence (AI) often grapple with the limitations of label inaccuracies and output interpretations that lack clinician-friendly comprehensibility. This study aims to introduce an approach that employs segmentation of support material and anatomy to enhance the precision and comprehensibility of CVC misplacement detection.

Materials and Methods
The study utilized 2 datasets: the publicly accessible RANZCR CLiP dataset and a bespoke in-house dataset of 1006 annotated supine chest x-rays. Three deep learning models were trained: a classification network, a segmentation network, and a combination of both. These models were evaluated using receiver operating characteristic analysis, area under the curve, DICE similarity coefficient, and Hausdorff distance.

Results
The combined model demonstrated superior performance with an area under the curve of 0.99 for correctly positioned CVCs and 0.95 for misplacements. The model maintained high efficacy even with reduced training data from the local dataset. Sensitivity and specificity rates were high, and the model effectively managed the segmentation and classification tasks, even in images with multiple CVCs and other support materials.

Conclusions
This study illustrates the potential of AI-based models in accurately and reliably determining CVC placement in chest x-rays. The proposed method shows high accuracy and offers improved interpretability, important for clinical decision-making. The findings also highlight the importance of dataset quality and diversity in training AI models for medical image analysis.
DIABEZE: Diabetes self-management among the elderly in a Belgian home for the aged: a best practice implementation project
Authors: Corremans Marleen , Ohenewaa Comfort , Van Steenberghe Isaura , Bekkering Trudy , Jespers Hilke 
Published: October 2024

ABSTRACT

Objectives:
The aim of this project was to improve the self-management of diabetes among elderly residents in a Belgian home for the aged.

Introduction:
Diabetes is a common chronic condition with significant comorbidity. Incidence is increasing, but a third of patients with diabetes are unaware that they have the disease. The treatment of diabetes requires a multifactorial approach. Treatment guidelines on diabetes recommend involving patients in monitoring their condition because supported self-management improves daily glycemic control.

Methods:
This evidence implementation project used the JBI Evidence Implementation Framework, which follows three phases. In the first phase, the area of change, stakeholders’ role, and practice context and readiness for change are investigated. In the second phase, a baseline audit is conducted to compare current practice with best practice. Strategies are then implemented to address any areas of non-compliance with best practice. In the third phase, a follow-up audit is conducted to evaluate changes in practice.

Results:
At baseline, six criteria had 0% compliance, two criteria had compliance lower than 50%, and only 49% of health care workers were familiar with the procedure for hypoglycemia treatment. Improvement strategies included creating awareness among health workers. In the follow-up audit, one criterion improved from 0% to 100%, three criteria improved from 0% to 85%, two criteria reached the threshold of 50% compliance, and one criterion reached 19%. Further audits are needed to ensure sustainability.

Conclusions:
This project improved diabetes self-management in elderly people living in a Belgian home for the aged. An in-depth planning phase with internal facilitation and interdisciplinary collaboration between all co-workers addressed barriers related to quality systems, structure, communication, and education.

Spanish abstract:

http://links.lww.com/IJEBH/A258
Spatiotemporal control of a multilayered co-axial flow in a 3D printed microchannel with cascaded nozzles
Authors: Werner Helen , TaiediNejad Ebrahim , Sahin Mehmet Akif , Leuthner Moritz , Erfle Peer , Hayden Oliver , Dietzel Andreas , Destgeer Ghulam 
Published: October 2024

AbstractSculpting and stopping multilayered co-flowing streams is challenging due to inhomogeneous pressure distribution within a fluidic circuit composed of multiple interconnected microchannels having variable flow resistances. Here, we have investigated three different flow control methods to effectively stop a multilayered flow inside a 3D-printed microfluidic channel by bringing the average flow velocity from >100 mm s-1to below a critical velocity of 200 µm s-1within a certain delay timetDof ∼2s. Firstly, we 3D printed a sequence of three concentric nozzles (∼75 µm) embedded serially inside the microchannel (∼200 µm) using a two-photon polymerization (2PP) method. Secondly, we used the 2PP-based 3D printed device to produce a structured coaxial flow of four streams with individual layer thicknesses ofO(10 µm) within the outlet section of the microchannel. Thirdly, we removed the pressure gradient across the fluidic circuit, from > 2 bar to ∼0 bar, to stop the multilayered flow and measuredtDto assess the performance of the three stop flow methods. During the stop-flow phase, an inhomogeneous pressure gradient across different inlets resulted in a backflow to inlet channels with lower pressures. In the three stop-flow methods investigated, we systemically managed the fluidic capacitance to minimize a dimensionless backflow index (BFI) value from ∼0.3 (worst case) to ∼0.03 (best case) for a total flow rate ranging from 16.8 µl min-1to 168 µl min-1. Finally, we have recommended the best stop-flow conditions, which resulted in a minimal delay time oftD∼ 2s and a BFI < 0.05.
Spike mRNA Vaccine Encapsulated in a Lipid Nanoparticle Composed of Phospholipid 1,2-Dioleoyl-sn-Glycero-3-Phosphoethanolamine Induced Potent B- and T-cell Responses Associated with Protection against COVID-19 in Hamsters
Authors: Quadiri Afshana , Prakash Swayam , Zayou Latifa , Dhanushkodi Nisha Rajeswari , Chilukuri Amruth , Ryan Gemma , Wang Kelly , Vahed Hawa , BenMohamed Lbachir 
Published: October 2024

ABSTRACTLipid nanoparticles (LNPs) have recently emerged as one of the most advanced vehicle platforms for efficient in vivo delivery of nucleoside-modified mRNA vaccine, particularly for COVID-19. LNPs comprise four different lipids: ionizable lipids, helper or neutral lipids, cholesterol, and lipids attached to polyethylene glycol (PEG). Studies on using the mRNA-LNP platform for vaccines have largely focused on the nucleic acid cargo with less attention to the LNP vehicle. While the LNPs protect mRNA from degradation and efficiently deliver the mRNA to antigen-presenting cells the effect of lipid composition and biophysical properties on the immunogenic and protective mRNA vaccine remain to be fully elucidated. In the present study, we used SARS-CoV-2 Spike-mRNA as a prototype vaccine, to study the effect of 4 different of LNPs with various lipid compositions. We demonstrate that when the same Spike-mRNA was delivered in the LNP4 formulation based on phospholipid 1,2-dioleoyl-sn-glycero-3- Phosphoethanolamine it outperformed the immunogenicity and protective efficacy of three LNPs (LNP1, LNP2, and LNP3) that are based on different lipids. Compared to other three LNPs, the LNP4: (i) enhanced phenotypic and functional maturation of dendritic cells; (ii) induced strong T-cell responses, (iii) increased secretion of proinflammatory, pro-follicular T helper (Tfh) cell cytokines; (iv) induced higher neutralization IgG titers; and (v) and provided better protection against SARS-CoV-2 infection and COVID-19 in the hamster model. We discussed the potential mechanisms by which LNP which include the phospholipid 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine may activate protective B- and T-cell responses.