bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful management of severe scalp avulsion injury: a case report and review of surgical interventions
Authors: Paudel Sujan , Luitel Prajjwol , Thapaliya Ishwor , Thapa Anup , Sharma Samit 
Published: September 2024

Abstract
Scalp avulsion injuries caused by machinery present substantial challenges necessitating urgent medical intervention. A 30-year-old female suffered near-complete scalp avulsion from entanglement in agricultural machinery and underwent surgical repair with a latissimus dorsi free flap and split-thickness skin graft. Free flap techniques offer reliable wound closure but may lead to cosmetic concerns. Safety measures in high-risk environments are crucial to prevent such incidents.
Nodal melanosis in malignant melanoma: a rare case from the Middle East with comprehensive surgical and histopathological findings
Authors: Suliman Alsadig , Mohamed Osman Reem , SeedAhmed Lina 
Published: September 2024

Abstract
Malignant melanoma, a highly aggressive skin cancer, accounts for 75% of skin cancer-related deaths. This case report details a 59-year-old Sudanese male with a malignant melanoma of the left foot, presenting with nodal melanosis, a rare condition involving benign pigmented deposits in the lymph nodes. The patient underwent below-knee amputation and inguinal lymph node dissection. Significant black discoloration was observed in the lymph nodes, indicating nodal melanosis. Histopathological examination of excised lymph nodes confirmed the presence of both malignant melanoma and benign melanosis. Despite surgical intervention, the patient eventually developed distant metastases, including lung nodules and a liver lesion. This case underscores the importance of recognizing nodal melanosis in metastatic malignant melanoma and highlights the challenges of managing advanced cases in resource-limited settings. Surgical management remains critical, particularly wide resection and lymph node dissection, even as systemic therapies advance.
A phase II study of FOLFOX combined with nab-paclitaxel in the treatment of metastatic or advanced unresectable gastric, gastroesophageal junction adenocarcinoma: a Big Ten Cancer Research Consortium trial
Authors: Dreyer Marie S , Mulcahy Mary , Kocherginsky Masha , Chen Yolande , Hochster Howard S , Kasi Pashtoon M , Kircher Sheetal , Lou Emil , Ma Yangruijue , Uboha Nataliya V , Benson Al B 
Published: September 2024

Abstract

Background
Doublet platinum or taxane-based therapies are the current standard backbone of treatment for advanced gastric/gastroesophageal junction (GEJ) adenocarcinoma. Previously used anthracycline-based triplet regimens are no longer used routinely due to toxicity and lack of superior efficacy. We hypothesized that the addition of nab-paclitaxel to FOLFOX (FOLFOX-A) would induce higher efficacy and better tolerability.

Patients and Methods
Eligible patients with chemotherapy-naïve advanced unresectable HER2-negative gastric or GEJ adenocarcinoma were enrolled in this phase II single-arm trial of FOLFOX (oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, 5-FU 2400 mg/m2 over 46-48 hours) + nab-paclitaxel (150 mg/m2) every 14 days of a 28-day cycle. Evaluable disease according to RECIST v1.1 for solid tumors was required. The primary endpoint was the objective response rate. Simon’s optimal 2-stage design was used to test 5% versus 20% response rate with 90% power and 10% one-sided type I error rate.

Results
The study enrolled 39 patients. Median age was 63 (range 20-80) years, 30 (77%) were male, 34 (94%) were White, and 21 (57%) had gastric tumors. The median number of cycles completed was 4.5 (range: 0-36), and 25 patients required dose reductions or discontinuation of at least one component due to toxicity. Of the 38 patients evaluable for response, 15 (42.9%) had complete/partial response (CR/PR) as the best response, and 13 (37.1%) had stable disease. progression-free survival (PFS) and OS data were available for 38 patients, with a median follow-up duration of 27 months (range: 18.2-51.9 months for censored patients). Median PFS was 6.6 months (95% CI: 5.6-12.9), with 31.0% (95% CI: 18.4%-52.4%) 12-month PFS rate. The median OS was 10.5 months (95% CI: 8.8-20.7), 12-month OS rate was 44.7% (95% CI: 31.4%-63.7%). Treatment-related grade 3-4 toxicities included peripheral sensory neuropathy and anemia (18.4% each), neutropenia (15.8%), and diarrhea and lymphopenia (7.9% each).

Conclusions
FOLFOX-A has a significant response rate, expected toxicities, and should be considered for future investigation in combination with immunotherapy given the recent approvals.
Supercharged Phosphotriesterase for improved Paraoxon activity
Authors: Kronenberg Jacob , Britton Dustin , Halvorsen Leif , Chu Stanley , Kulapurathazhe Maria Jinu , Chen Jason , Lakshmi Ashwitha , Renfrew P Douglas , Bonneau Richard , Montclare Jin Kim 
Published: September 2024

Abstract
Phosphotriesterases (PTEs) represent a class of enzymes capable of efficient neutralization of organophosphates (OPs), a dangerous class of neurotoxic chemicals. PTEs suffer from low catalytic activity, particularly at higher temperatures, due to low thermostability and low solubility. Supercharging, a protein engineering approach via selective mutation of surface residues to charged residues, has been successfully employed to generate proteins with increased solubility and thermostability by promoting charge–charge repulsion between proteins. We set out to overcome the challenges in improving PTE activity against OPs by employing a computational protein supercharging algorithm in Rosetta. Here, we discover two supercharged PTE variants, one negatively supercharged (with −14 net charge) and one positively supercharged (with +12 net charge) and characterize them for their thermodynamic stability and catalytic activity. We find that positively supercharged PTE possesses slight but significant losses in thermostability, which correlates to losses in catalytic efficiency at all temperatures, whereas negatively supercharged PTE possesses increased catalytic activity across 25°C–55°C while offering similar thermostability characteristic to the parent PTE. The impact of supercharging on catalytic efficiency will inform the design of shelf-stable PTE and criteria for enzyme engineering.
Suture Pull-Through Technique for EndoArt Insertion in a Complex Case Scenario
Authors: Vishwakarma Pratima , Wiedemann Johanna , Kobayashi Akira , Hayashi Takahiko , Schlereth Simona , Cursiefen Claus , Bachmann Björn 
Published: September 2024

Purpose:
The purpose of this study was to describe a novel suture pull-through technique of EndoArt implant insertion.

Method:
EndoArt insertion was performed using a novel suture pull-through technique after several failed Descemet membrane endothelial keratoplasty surgeries for a 59-year-old woman who had undergone multiple surgeries after open globe injury and had artificial iris implant with scleral-fixated intraocular lens.

Result:
With this technique, EndoArt insertion into the anterior chamber was possible without implant dislocation. Postoperatively, anterior segment optical coherence tomography was recorded and peripheral detachment of the implant was noted. Rebubbling was required thrice with augmentation of the anchoring sutures. At 45 days of follow-up, EndoArt was principally attached.

Conclusions:
A novel suture pull-through technique of EndoArt implant insertion can be used for ensuring higher safety in complex cases like aphakia, aniridia, and vitrectomized eyes to prevent implant dislocation into the vitreous cavity.
TREM2 macrophages mediate the beneficial effects of bariatric surgery against MASH
Authors: Fredrickson Gavin , Florczak Kira , Barrow Fanta , Mahmud Shamsed , Dietsche Katrina , Wang Haiguang , Parthiban Preethy , Hakeem Andrew , Almutlaq Rawan , Adeyi Oyedele , Herman Adam , Bartolomucci Alessandro , Staley Christopher , Dong Xiao , Jahansouz Cyrus , Williams Jesse W. , Mashek Douglas G. , Ikramuddin Sayeed , Revelo Xavier S. 
Published: September 2024

Background and Aims:
For patients with obesity and metabolic syndrome, bariatric procedures such as vertical sleeve gastrectomy (VSG) have a clear benefit in ameliorating metabolic dysfunction-associated steatohepatitis (MASH). While the effects of bariatric surgeries have been mainly attributed to nutrient restriction and malabsorption, whether immuno-modulatory mechanisms are involved remains unclear.

Approach and Result:
Using murine models, we report that VSG ameliorates MASH progression in a weight loss-independent manner. Single-cell RNA sequencing revealed that hepatic lipid-associated macrophages (LAMs) expressing the triggering receptor expressed on myeloid cells 2 (TREM2) repress inflammation and increase their lysosomal activity in response to VSG. Remarkably, TREM2 deficiency in mice ablates the reparative effects of VSG, suggesting that TREM2 is required for MASH resolution. Mechanistically, TREM2 prevents the inflammatory activation of macrophages and is required for their efferocytic function.

Conclusions:
Overall, our findings indicate that bariatric surgery improves MASH through a reparative process driven by TREM2+ macrophages, providing insights into the mechanisms of disease reversal that may result in new therapies and improved surgical interventions.
Seizure Risk Associated With the Use of Transcranial Magnetic Stimulation for Coma Recovery in Individuals With Disordered Consciousness After Severe Traumatic Brain Injury
Authors: Ripley David , Krese Kelly , Rosenow Joshua M. , Patil Vijaya , Schuele Stephan , Pacheco Marilyn S. , Roth Eliot , Kletzel Sandra , Livengood Sherri , Aaronson Alexandra , Herrold Amy , Blabas Brett , Bhaumik Runa , Guernon Ann , Burress Kestner Catherine , Walsh Elyse , Bhaumik Dulal , Bender Pape Theresa L. 
Published: September 2024

Objective:
Repetitive Transcranial Magnetic Stimulation (rTMS) is emerging as a promising treatment for persons with disorder of consciousness (DoC) following traumatic brain injury (TBI). Clinically, however, there are concerns about rTMS exacerbating baseline seizure risk. To advance understanding of risks, this article reports evidence of DoC-TBI rTMS-related seizure risk.

Setting:
Acute and sub-acute hospitals.

Participants:
Persons in states of DoC 6.5 months to 15 years after TBI (n = 20) who received active rTMS (n = 17) or placebo rTMS (n = 3). After completing placebo procedures, placebo participants completed active rTMS procedures. These 3 participants are included in the active group.

Design:
Meta-analysis of data from 3 clinical trials; 2 within-subject, 1 double blind randomized placebo-controlled. Each trial used the same rTMS protocol, provided at least 30 rTMS sessions, and delivered rTMS to the dorsolateral prefrontal cortex.

Main Measures:
During each study’s rTMS treatment phase, seizure occurrences were compared between active and placebo groups using logistic regression. After stratifying active group by presence/absence of seizure occurrences, sub-groups were compared using contingency chi-square tests of independence and relative risk (RR) ratios.

Results:
Two unique participants experienced seizures (1 active, 1 placebo). Post seizure, both participants returned to baseline neurobehavioral function. Both participants received antiepileptics during remaining rTMS sessions, which were completed without further seizures. rTMS-related seizure incidence rate is 59 per 1000 persons. Logistic regression revealed no difference in seizure occurrence by treatment condition (active vs placebo) or when examined with seizure risk factors (P > .1). Presence of ventriculoperitoneal shunt elevated seizure risk (RR = 2.0).

Conclusion:
Collectively, findings indicate a low-likelihood that the specified rTMS protocol exacerbates baseline seizure rates in persons with DoC after TBI. In presence of VP shunts, however, rTMS likely elevates baseline seizure risk and mitigation of this increased risk with pharmacological seizure prophylaxis should be considered.
Beyond T-Trials, T4DM and TRAVERSE: the next large testosterone randomized controlled trial
Authors: Yeap Bu B. , Tran Cammie , Douglass Catherine M. , McNeil John J. 
Published: September 2024

Purpose of review
Lower testosterone concentrations have been associated with poorer health outcomes in ageing men, but proving causality and demonstrating potential for therapeutic benefit requires randomized clinical trials (RCTs). This review discusses recent observational findings and results of major testosterone RCTs, to explore the need for another, larger trial.

Recent findings
Evidence of Leydig cell impairment emerges in men above the age of 70 years. Lower testosterone is associated with diabetes risk, and also risk of incident dementia. An individual participant data meta-analysis found that below thresholds of testosterone of 7.4 nmol/L and 5.3 nmol/l respectively, risks of all-cause mortality and cardiovascular deaths in men increased. Testosterone for the Prevention of Type 2 Diabetes Mellitus (T4DM), a multicentre RCT, showed that testosterone treatment prevented or reverted type 2 diabetes in men at high risk. Testosterone Replacement Therapy for Assessment of Long-term Vascular Events and Efficacy Response in Hypogonadal Men (TRAVERSE), a cardiovascular safety trial, demonstrated cardiovascular and prostate safety of testosterone treatment in men with or at risk of cardiovascular disease. T4DM confirmed findings from the Testosterone Trials (T-Trials) that testosterone improved sexual function, and bone microarchitecture and density. However, in TRAVERSE, testosterone-treated men had a higher risk of clinical bone fractures, but not major osteoporotic fractures.

Summary
Men with disorders of the hypothalamic–pituitary–testicular (HPT) axis causing androgen deficiency warrant consideration for testosterone therapy. In men with an intact HPT axis, testosterone treatment is a pharmacological intervention which requires justification from high quality RCT data. Currently, there is insufficient evidence to justify wider use of testosterone for prevention of cardiometabolic disease. However, there is scope for another large testosterone RCT to investigate whether testosterone treatment might, in older men, extend disability-free survival.
Investigating the prevalence burden of peptic ulcer disease in older adults aged 70+ from 1990 to 2019: an analysis of Global Disease Burden Studies
Authors: Zhuo Mingxing , Fang Meiling , Yin Ying , Wang Jin , Wei Zhaoxia , Lu Jiaming , Jia Yegui 
Published: September 2024

Background
Peptic ulcer disease (PUD) affects individuals aged ≥70 years globally, exerting a significant impact on their health and well-being. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management.

Methods
This study utilized Global Burden of Disease Study data to examine the prevalence and temporal changes of PUD in individuals aged 70 years and older between 1990 and 2019. The analysis included assessing estimated annual percentage changes (EAPCs) to investigate temporal trends and regional variations.

Results
Over the past 30 years, the number of individuals aged 70 years and above suffering from PUD globally has increased from 1 065 730 cases in 1990 to 1 608 463 cases in 2019. Despite an increasing number of cases, the prevalence of PUD among the elderly has exhibited a steady decline, with an EAPC of −1.47 (95% confidence interval: −1.57 to −1.37) over this timeframe. In 2019, the prevalence rates of PUD among individuals aged 70–74, 75–79, 80–84, and 85 years and older were 313.36, 365.77, 388.45, and 352.51 per 100 000 population, respectively. South Asia, high-income North America, and Central Sub-Saharan Africa were the regions with the highest prevalence rates of PUD in 2019, with rates of 624.90, 575.48, and 474.80 per 100 000 population, respectively. At the national level, Ireland, Australia, Brazil, Brunei Darussalam, and Bangladesh have effectively managed the burden of PUD among the elderly, achieving the greatest reduction. Additionally, regions with higher levels of socioeconomic development tended to have relatively lower burdens of PUD among the elderly, and prevalence rates varied across different regions and age groups.

Conclusion
Our study highlights the enduring burden of PUD among the global elderly population, emphasizing the significance of tailored interventions to address this pressing issue. This research underscores the critical need for targeted public health strategies aimed at improving outcomes specifically for older adults affected by PUD.
Inflammatory bowel disease and pulmonary embolism: a nationwide perspective
Authors: Aldiabat Mohammad , Alhuneafat Laith , Al Ta’ani Omar , Altarawneh Saba , Aleyadeh Wesam , Almuzamil Taimur , Butt Ali , Alahmad Majd , Madi Mahmoud Y , Alsabbagh Khaled , Ayoub Malek , Kilani Yassine , Alsakarneh Saqr , Jaber Fouad , Alhamdani Adee 
Published: September 2024

Objective
To examine the characteristics and outcomes of patients with inflammatory bowel disease (IBD) hospitalized with pulmonary embolism (PE).

Methods
This cross-sectional observational study analyzed data from the 2016 to 2019 National Inpatient Sample to investigate hospitalizations for PE in the USA, stratified by the presence or absence of IBD. Adult patients were selected using the International Classification of Diseases, Tenth Revision codes for PE, Crohn’s disease, and ulcerative colitis. Data on patient demographics, comorbidities, and hospital characteristics were collected. Statistical analysis included univariable and multivariable logistic regression using Stata/BE 17.0, focusing on in-hospital mortality and complications in PE patients with and without IBD. Adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI) were calculated when appropriate.

Results
PE/IBD group was younger (mean age 58.3 vs. 62.7 years; P < 0.001), had a higher proportion of white patients (81.2% vs. 70.9%; P < 0.001), and had a greater prevalence of chronic liver disease (7.54% vs. 6.02%; P = 0.002) when compared to PE/non-IBD patients. The PE/IBD group had lower prevalence rates of coronary artery disease, congestive heart failure, obesity, chronic obstructive pulmonary disease, hypertension, and diabetes. Regarding primary outcomes, there was no significant difference in in-hospital mortality between the two groups (aOR, 0.92; 95% CI, 0.77–1.09; P = 0.355). However, the IBD/PE group had a higher risk of acute kidney injury, sepsis, septic shock, cardiac arrhythmias, and deep vein thrombosis. As for secondary outcomes, PE/IBD patients had more extended hospital stays and higher healthcare costs compared with PE/non-IBD patients.

Conclusion
Hospitalized PE patients with IBD differ demographically and have a different comorbidity profile compared to those without IBD. PE/IBD patients demonstrate greater use of healthcare resources and elevated risk of hospitalization adverse events than PE/non-IBD patients, highlighting the necessity for individualized management approaches in this population.
Adolescents and Young Adults With Respiratory Failure in U.S. PICUs: A Pediatric Health Information System Database Study, 2011–2022
Authors: Gochenour Kevin S. , Ross Melissa H. , Flori Heidi R. , Kohne Joseph G. 
Published: September 2024

Objectives:
To examine the clinical characteristics, outcomes, and resource use of adolescents and young adults (AYAs) admitted to PICUs in the United States with respiratory failure.

Design:
Retrospective cohort study.

Setting:
De-identified data from 48 U.S. children’s hospitals contributing to the Pediatric Health Information System (PHIS) database.

Patients:
All patients older than 30 days old with respiratory failure, defined as encounters with clinical transaction codes for noninvasive or invasive mechanical ventilation, admitted to PHIS database PICUs from January 2011 to December 2022. Patients were categorized into five cohorts (< 15, 15–18, 19–21, 22–25, and > 25 yr old).

Interventions:
None.

Measurements and Main Results:
A total of 430,238 patients were identified. AYA (≥ 15 yr old) accounted for 15% (65,740) of all PICU admissions with respiratory failure. Forty-nine percent (32,232/65,740) of AYA older than 25 years had medical technology dependence compared with 39% in those younger than 15 years (p < 0.001). Sixty-one percent of AYA older than 25 years had a cardiovascular comorbidity compared with 35% of those younger than 15 years (p < 0.001). Forty percent of AYA older than 25 years had a neurologic comorbidity, and 27% a gastrointestinal comorbidity, compared with 27% and 31%, respectively, in those younger than 15 years (all p < 0.001). Compared with those younger than 15 years, AYA median hospital crude mortality rate was higher at 7.7% compared with 5.2%, as were median hospital charges per encounter at $163K (interquartile range [IQR], $77K–$350K) vs. $121K (IQR, $53K–$278K; all p < 0.001). Median ventilator days and hospital length of stay in survivors were similar for all age cohorts.

Conclusions:
AYA represent a substantial proportion of patients admitted to the PICU with respiratory failure. These individuals have unique comorbidities and are at risk for increased mortality and resource utilization compared with younger patients during hospitalization. Medical complexity and sequelae of pediatric illness may delay the transition of AYA to adult care, necessitating collaboration between adult and pediatric critical care physicians to increase research across the age spectrum and develop and implement appropriate evidence-based guidelines.
Total versus Partial Pancreatectomy in Patients with Pancreatic Cancer Arising from Multifocal or Diffuse Intraductal Papillary Mucinous Neoplasia – A Multicenter Observational Study
Authors: Rompen Ingmar F. , Habib Joseph R. , Kinny-Köster Benedict , Campbell Brady A. , Stoop Thomas F. , Kümmerli Christoph , Andel Paul C.M. , Leseman Charlotte A. , Lesch Carolin , Daamen Lois A. , Javed Ammar A. , Lafaro Kelly J. , Nienhüser Henrik , Billeter Adrian T. , Molenaar I. Quintus , Müller-Stich Beat P. , Besselink Marc G. , He Jin , Loos Martin , Büchler Markus W. , Wolfgang Christopher L. 
Published: September 2024

Aim:
To investigate the impact of total pancreatectomy (TP) on oncological outcomes for patients at high-risk of local recurrence or secondary progression in the remnant gland after partial pancreatectomy (PP) for IPMN-associated cancer.

Summary Background Data:
Major risk factors for invasive progression in the remnant gland include multifocality, diffuse main duct dilation, and the presence of invasive cancer. In these high-risk patients, a TP may be oncologically beneficial. However, current guidelines discourage TP, especially in elderly patients.

Methods:
This international multicenter study compares TP versus PP in patients with adenocarcinoma arising from multifocal or diffuse IPMN (2002-2022). Log-rank test and multivariable Cox-analysis with interaction analysis was performed to assess overall survival (OS), disease-free survival (DFS), and local-DFS.

Results:
Of 359 included patients, 162 (45%) were treated with TP, whereas 197 (55%) underwent PP. Despite TP and PP having similar R0-rates (59% vs. 58%, P=0.866), patients undergoing a TP had significantly longer local-DFS compared to PP (P=0.039). However, no difference in OS was observed between the two surgical approaches (P=0.487). In a multivariable analysis, young age (optimal cut-off ≤63.6 yrs) was associated with an OS benefit derived from TP (HR:0.44, 95%CI:0.22-0.89), whereas no significant difference was observed in elderly patients (HR:1.24, 95%CI:0.92-1.67, Pinteraction=0.007).

Conclusion:
Since overall, patients with diffuse or multifocal IPMN with an invasive component do not benefit from TP in terms of OS, the indication for TP may be individualized to young patients who have sufficient life expectancy to benefit from the prevention of secondary progression or local recurrence.