bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individualised Lifestyle Intervention in Polycystic Ovarian Syndrome Women Who Desire Fertility: A Feasibility Study
Authors: Koduri Parisuddharao , Parimala Chinta , Kunjummen Aleyamma Thayparmbil , Yadav Bijesh Kumar , Kapoor Nitin , Sandhiya P. , Vimala  , Kamath Mohan Shashikant 
Published: September 2024

Background:
Polycystic ovarian syndrome (PCOS) is one of the common causes of anovulatory infertility among women in the reproductive age group. Women with PCOS and obesity often have difficulty in conceiving, and they are more prone for developing metabolic syndrome. Lifestyle modification plays a key role in women with PCOS, who are overweight or obese and is recommended as a first line management option. The earlier trials evaluating the role of lifestyle intervention in infertile PCOS women had methodological issues, smaller sample size and high dropout rates and none of these trials reported live birth as their outcome.

Aim:
The current study was planned to explore the feasibility of conducting large adequately powered multicentric trial in future in South Asian women with PCOS who desire fertility. Setting and Design: The study was done in the Department of Reproductive Medicine and Surgery & the Department of Endocrinology and Metabolism at a university level tertiary care hospital. The study is an open label, single center, randomized controlled trial.

Materials and Methods:
A total of 60 PCOS women aged between 18-40 years with body mass index of > 23 kg/m2 who desire fertility, were randomized to individualized lifestyle intervention and usual care. The primary outcome was the dropout rate, and the secondary outcomes were change in body weight, anthropometric parameters, clinical pregnancy rates and the quality of life specific to PCOS after the trial period. All the participants were followed up for 6 months and the outcomes were assessed.

Statistical Analysis:
Comparison between the intervention and control groups was done using statistical tests using the SPSS and R software.

Results:
The dropout rates were significantly higher in the individualized lifestyle intervention arm compared to usual care control arm (19/30, 63% vs 9/30, 30%, P=0.019). We did not find any statistically significant difference in anthropometric measurements, pregnancy rates (P=0.57) and clinical pregnancy rates (P=0.21) and quality of life specific to PCOS compared with sixth month visit from baseline visit.

Conclusion:
The current feasibility study showed significantly higher dropout rates in individualized lifestyle intervention arm compared to usual care control arm. The knowledge gained from the feasibility study has been used to design an adequately powered trial to evaluate effectiveness of individualized lifestyle intervention in women with PCOS who wish to conceive.
Topical Medroxyprogesterone Acetate and Corneal Epithelium Healing after Photorefractive Keratectomy: A Randomized, Double-masked Contralateral Eye Study
Authors: Peyman Alireza , Pourazizi Mohsen , Irajpour Matin , Noorshargh Pegah , Aslani Asieh 
Published: September 2024

ABSTRACT

Objective:
The objective of the study was to evaluate the efficacy and safety of topical 1% medroxyprogesterone in corneal epithelial healing after photorefractive keratectomy (PRK).

Methods:
In this placebo-controlled double-masked randomized contralateral eye study, 66 eyes of 33 patients with myopia and myopia-astigmatism were assigned into two groups to receive either 1% topical medroxyprogesterone (intervention) or artificial tear (placebo) at the end of PRK surgery. The patients were followed up daily for 5 days until epithelial healing was achieved. The time taken for epithelial healing was the main outcome measure.

Findings:
The mean age of the subjects was 32.97 ± 7.6 years and 46 individuals were female (69.7%). All baseline refractive characteristics were comparable between the groups. There was no significant difference between the two groups in terms of epithelial defect size on Day 1 (P: 0.67). Both groups exhibited a consistent pattern of decreasing epithelial defect size from Day 1 to Day 5, with the control group having slightly worse initial values. There were no significant differences between the groups in the following days. Both groups showed substantial reductions in the epithelial defect size, but the intervention group showed a more prominent decrease on Day 2. The intervention did not show a significant statistical difference compared to the control group, and both groups ended up with a similar outcome.

Conclusion:
These findings suggest that the topical 1% medroxyprogesterone does not significantly affect the healing of corneal epithelium after PRK.
Visual parameter status as a predictive factor for the outcomes of occlusion therapy in anisometropic amblyopia
Authors: Palani Subashree , Rangasami Sathiskumar , Baskaran Antony A. 
Published: September 2024

PURPOSE:
The purpose is to compare visual parameters between normal and amblyopic eyes in anisometropic amblyopia and to find predictive factors for occlusion therapy.

METHODS:
Sixty patients with anisometropic amblyopia between the ages of 5 and 25 years were enrolled in the prospective, longitudinal, and interventional study. Patients were selected based on no improvement with spectacle correction alone after 1 month of follow-up. Baseline parameters such as LogMAR visual acuity, LEA contrast sensitivity, TNO stereopsis test, online Farnsworth D-15 test for color vision, accommodation with RAF ruler, +2.00/-2.00 flipper test, and dynamic retinoscopy were recorded. All patients were treated with occlusion therapy depending on their grades of amblyopia. After 6 months of follow-up, improvement in visual acuity was recorded with a LogMAR chart and correlated with initial visual parameters. Paired “t” test, Chi-square test, independent “t” test, analysis of variance test were used as statistical analysis.

RESULTS:
Visual functions such as contrast sensitivity, accommodative facility, near point of accommodation, and accommodative amplitude showed a statistically significant difference between normal and amblyopic eyes of anisometropic amblyopia patients, whereas color vision did not differ significantly between normal and amblyopic eyes. Sixty-seven percentage of patients had poor stereopsis. Eighty percentage of patients who were younger had improvement in final best-corrected visual acuity and these patients had better stereopsis, contrast sensitivity, and mild-to-moderate amblyopia on initial testing.

CONCLUSION:
The age of the patient, degree of anisometropia, spherical equivalent in amblyopic eyes, stereopsis, contrast sensitivity values at initial presentation, and compliance to occlusion therapy were found to be positive predictive factors of occlusion therapy.
Evaluation of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume levels in pediatric keratoconus patients
Authors: Toprak Müge , Altıntaş Özgül , Sezer Özge Y. , Yılmaz Tuğan Büşra 
Published: September 2024

PURPOSE:
To examine the level of neutrophil–lymphocyte ratio and platelet-lymphocyte ratio in the pediatric patient group with keratoconus.

METHODS:
Patients aged 5–18 years with a diagnosis of keratoconus followed by the corneal department and children in the similar age group who were determined as controls were included in the study. Their topographies were evaluated. In both groups, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and mean platelet volume (MPV) were measured.

RESULTS:
The study group consisted of children aged 15 ± 1.4 years and the control group 13 ± 1.3 years of age. The mean central corneal thickness of the patients in the patient group was 445.64 μm, and in the control group was 532.25 μm. The NLR was 3.37 ± 1.04 in the patient group and 2.31 ± 0.82 in the control group. The PLR was significantly increased in the KC group (147.54 ± 41.36) than in the control group (118.71 ± 27.11) (P = 0.042). MPV in the patient group was 12.18 ± 2.76 and 7.00 ± 1.37 in the control group. This value was found to be statistically significant (P = 0.047) when the control group and the patient group were compared.

CONCLUSION:
Platelet/lymphocyte ratio and mean platelet volume, which are thought to be new markers of systemic inflammation, may be new indices in keratoconus in pediatric patients.
Ocular findings in the evaluation of abusive head trauma in children
Authors: Alswayed Sarah K. , Aldharman Sarah S. , Alraddadi Jumanah S. , Almuneef Maha , Aldibasi Omar , Alfreihi Shatha 
Published: September 2024

PURPOSE:
Abusive head trauma (AHT) is a form of child physical abuse that can result in major ocular injuries. This study describes the clinical presentation and ocular manifestations of infants diagnosed with AHT in a tertiary care center in Saudi Arabia.

METHODS:
This is an observational, retrospective, cross-sectional study from 2015 to 2022 conducted at King Abdullah Specialized Children’s Hospital (KASCH) in Riyadh, Saudi Arabia. Inclusion criteria include infants <2 years of age, diagnosed with AHT that had an eye examination as part of the evaluation.

RESULTS:
A total of 25 (50 eyes) cases of AHT had an eye examination documented in the electronic patients’ records. The majority were males 19 (76%), and <6 months of age 10 (40%). About half of the children were healthy 13 (52%), and 12 (48%) had underlying physical illness. All patients had computed tomography scans. Subdural bleeding was noted in 22 (88%), 1 (4%) had epidural, and 4 (16%) had subarachnoid bleed. External ocular signs were noted in 8 (32%) patients only, including raccoon eyes, periorbital bruises, subconjunctival hemorrhage, and nonfixating eyes. Fundus findings were bilateral in 18 (72%), unilateral in 2 (8%), and normal in 5 (20%). In those with findings, the majority of 34 (68%) eyes had multiple retinal hemorrhages, 4 (8%) had vitreous hemorrhages, 2 (4%) retinal detachments, and 1 (2%) retinoschisis.

CONCLUSION:
Fundus examination is an important part of the comprehensive examination of children with suspected AHT; the majority of patients had an abnormal fundus examination with the tendency of bilateral findings.
Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation
Authors: Zhao Zong-Xian , Hu Zong-Ju , Yao Run-Dong , Su Xin-Yu , Zhu Shu , Sun Jie , Yao Yuan 
Published: September 2024

BACKGROUND
Prior studies have shown that preserving the left colic artery (LCA) during laparoscopic radical resection for rectal cancer (RC) can reduce the occurrence of anastomotic leakage (AL), without compromising oncological outcomes. However, anatomical variations in the branches of the inferior mesenteric artery (IMA) and LCA present significant surgical challenges. In this study, we present our novel three dimensional (3D) printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.
AIM
To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.
METHODS
We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital. Patients were divided into the 3D printing and control groups for statistical analysis of perioperative characteristics.
RESULTS
The 3D printing observation group comprised of 72 patients, while the control group comprised 68 patients. The operation time (174.5 ± 38.2 minutes vs 198.5 ± 49.6 minutes, P = 0.002), intraoperative blood loss (43.9 ± 31.3 mL vs 58.2 ± 30.8 mL, P = 0.005), duration of hospitalization (13.1 ± 3.1 days vs 15.9 ± 5.6 days, P < 0.001), postoperative recovery time (8.6 ± 2.6 days vs 10.5 ± 4.9 days, P = 0.007), and the postoperative complication rate (P < 0.05) were all significantly lower in the observation group.
CONCLUSION
Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively, thereby reducing intraoperative bleeding and shortening operating time, demonstrating better clinical application potential.
Development of a novel difficulty scoring system for laparoscopic liver resection procedure in patients with intrahepatic duct stones
Authors: Luo Bo , Wu Si-Kai , Zhang Ke , Wang Pei-Hong , Chen Wei-Wei , Fu Ning , Yang Zhi-Ming , Hao Jing-Cheng 
Published: September 2024

BACKGROUND
For intrahepatic duct (IHD) stones, laparoscopic liver resection (LLR) is currently a reliable treatment. However, the current LLR difficulty scoring system (DSS) is only available for patients with hepatocellular carcinoma.
AIM
To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.
METHODS
We used clinical data from 80 patients who received LLR for IHD stones. Forty-six of these patients were used in multiple linear regression to construct a scoring system. Another 34 patients from different centers were used as external validation. The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.
RESULTS
The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort: Location of stones, number of stones ≥ 3, stones located in the bile ducts of several grades, previous biliary surgery less than twice, distal bile duct atrophy. Subsequently, the data set was validated using a DSS developed from the variables. The following variables were identified as statistically significant in external validation: Operative time, blood loss, intraoperative transfusion, postoperative alanine aminotransferase, and Clavien-Dindo grading ≥ 3. These variables demonstrated statistically significant differences in patients with three or more grades.
CONCLUSION
Patients with IHD stones have varying degrees of surgical difficulty, and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.
Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery
Authors: Wang Xiao-Hong , Chen Fang-Fang , Pan Jia , Jiang Yun-Fei , Yao Min-Yue , Mao Jia-Li , Xu Ya-Feng 
Published: September 2024

BACKGROUND
Fast-track surgery (FTS) is a modern nursing approach that has gained popularity in the perioperative phase of surgery.
AIM
To investigate the impact of FTS on perioperative care for hepatobiliary surgery.
METHODS
A retrospective analysis was performed on 98 patients who underwent hepatobiliary surgery and were admitted to our hospital from August 2021 to October 2023. They were divided into an observation group and a control group with 49 patients in each group according to different nursing directions. The control group was treated with standard nursing and the observation group was treated with FTS concept nursing. The length of hospital stay, visual analog scale (VAS) score, wound complications, nursing satisfaction, self-rating scale (SAS) score, and SF-36 quality of life (QoL) score were compared between the two groups before and after care.
RESULTS
The duration of hospitalization, hospitalization cost, operation time, first implantation time, exhaust time, and first defecation time were shorter than the observation group (P < 0.05). Additionally, the observation group showed a significant difference between the VAS and SAS scores on days 1, 3, and 7 (P < 0.05). The complication rate in the observation group was 4.05% was significantly lower than the 18.36% in the control group, and the comparison groups were statistically significant (χ 2 = 5.018, P = 0.025). The observation group had a significantly higher level of nurse satisfaction (94.92%) than the control group (79.59%; χ 2 = 6.078, P = 0.014). Both groups showed higher QoL scores after nursing care, with higher scores in the observation group than in the control group (P = 0.032).
CONCLUSION
FTS in patients undergoing hepatobiliary surgery can effectively improve negative mood, QoL, and nursing satisfaction; reduce wound complications; and accelerate patient rehabilitation.
Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study
Authors: Cho Sung Hoon , Kim Gun Woo , Hwang Suyeong , Lim Kyoung Hoon 
Published: September 2024

BACKGROUND
The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. On the other hand, delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. Furthermore, there is a lack of consensus regarding the most appropriate strategies for monitoring and managing splenic injuries, especially lower-grade (I-III).
AIM
To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.
METHODS
We retrospectively analyzed patients who visited the Level I Trauma Center between January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.
RESULTS
Using the American Association for the Surgery of Trauma spleen injury scale, the splenic injuries were categorized into the following order based on severity: Grade I (n = 57, 17.6%), grade II (n = 114, 35.3%), grade III (n = 89, 27.6%), grade IV (n = 50, 15.5%), and grade V (n = 13, 4.0%). Of a total of 323 patients, 35 underwent splenectomy and 126 underwent angioembolization. 19 underwent delayed angioembolization, and 5 under-went both initial and delayed angioembolization. In 14 patients who had undergone delayed angioembolization, no extravasation or pseudoaneurysm was observed on the initial computed tomography scan. There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm, which can occur even in a grade I spleen injury or even 21 days after the injury. The mean detection time for a delayed pseudoaneurysm was 6.26 ± 5.4 (1-21, median: 6, interquartile range: 2-9) days.
CONCLUSION
We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.
Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer
Authors: Li Xing-Fei , Ma Tan-Tu , Li Tao 
Published: September 2024

BACKGROUND
Gallbladder cancer (GBC) is the most common malignant tumor of the biliary system, and is often undetected until advanced stages, making curative surgery unfeasible for many patients. Curative surgery remains the only option for long-term survival. Accurate postsurgical prognosis is crucial for effective treatment planning. tumor-node-metastasis staging, which focuses on tumor infiltration, lymph node metastasis, and distant metastasis, limits the accuracy of prognosis. Nomograms offer a more comprehensive and personalized approach by visually analyzing a broader range of prognostic factors, enhancing the precision of treatment planning for patients with GBC.
AIM
To identify risk factors and develop a predictive model for GBC prognosis.
METHODS
A retrospective study analyzed the clinical and pathological data of 93 patients who underwent radical surgery for GBC at Peking University People's Hospital from January 2015 to December 2020. Kaplan-Meier analysis was used to calculate the 1-, 2- and 3-year survival rates. The log-rank test was used to evaluate factors impacting prognosis, with survival curves plotted for significant variables. Single-factor analysis revealed statistically significant differences, and multivariate Cox regression identified independent prognostic factors. A nomogram was developed and validated with receiver operating characteristic curves and calibration curves.
RESULTS
Among 93 patients who underwent radical surgery for GBC, 30 patients survived, accounting for 32.26% of the sample, with a median survival time of 38 months. The 1-year, 2-year, and 3-year survival rates were 83.87%, 68.82%, and 53.57%, respectively. Univariate analysis revealed that carbohydrate antigen 19-9 expression, T stage, lymph node metastasis, histological differentiation, surgical margins, and invasion of the liver, extrahepatic bile duct, nerves, and vessels (P ≤ 0.001) significantly impacted patient prognosis after curative surgery. Multivariate Cox regression identified lymph node metastasis (P = 0.03), histological differentiation (P < 0.05), nerve invasion (P = 0.036), and extrahepatic bile duct invasion (P = 0.014) as independent risk factors. A nomogram model with a concordance index of 0.838 was developed. Internal validation confirmed the model's consistency in predicting the 1-year, 2-year, and 3-year survival rates.
CONCLUSION
Lymph node metastasis, tumor differentiation, extrahepatic bile duct invasion, and perineural invasion are independent risk factors. A nomogram based on these factors can be used to personalize and improve treatment strategies.
Surgical and non-surgical risk factors affecting the insufficiency of ileocolic anastomosis after first-time surgery in Crohn’s disease patients
Authors: Cwaliński Jaroslaw , Lorek Filip , Mazurkiewicz Łukasz , Mazurkiewicz Michał , Lizurej Wojciech , Paszkowski Jacek , Cholerzyńska Hanna , Zasada Wiktoria 
Published: September 2024

BACKGROUND
Crohn's disease (CD) often necessitates surgical intervention, particularly when it manifests in the terminal ileum and ileocecal valve. Despite undergoing radical surgery, a subset of patients experiences recurrent inflammation at the anastomotic site, necessitating further medical attention.
AIM
To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients.
METHODS
This study enrolled 77 patients who underwent open ileocolic resection with primary stapled anastomosis. Patients were stratified into two groups: Group I comprised individuals without anastomotic insufficiency, while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period. Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts.
RESULTS
Anastomotic insufficiency was detected in 12 patients (15.6%), with a mean time interval of 30 months between the initial surgery and recurrence. The predominant reasons for re-intervention included stenosis and excessive perianastomotic lesions. Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction, anastomotic bleeding, and clinically confirmed micro-leakage. Additionally, patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD.
CONCLUSION
Successful surgical outcomes hinge on the attainment of a fully functional anastomosis, optimal metabolic status, and clinical remission of the underlying disease. Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure, thereby enabling noninvasive interventions.