bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computed tomography perfusion as a predictor of gastric cancer grades
Authors: Khalaf Lamiaa M. R. , El-sharkawy Mostafa A. M. , Samy Marwa , Saad Emad , Khallaf Salah , Desoky Hagar H. M. , El-Barody Mohamed M. , Kamel Hosam M. 
Published: October 2024

Abstract
Background
Gastric cancer stands as one of the most prevalent malignancies globally, conventional endoscopic specimens have been the primary means of diagnosing preoperative gastric histopathology, however, their limitations in capturing intra-tumor heterogeneity compromise their efficacy in evaluating angiogenesis. Perfusion Computed Tomography (P-CT) emerges as a pivotal functional imaging modality, facilitating objective assessment of tissue perfusion, serving as a marker of angiogenesis. So, our research objective was to evaluate the efficacy of CT perfusion imaging in the prediction of histological grades of gastric tumors using quantitative perfusion parameters such as permeability surface (PS), blood flow (BF), mean transient time (MTT), and blood volume (BV), in addition to the qualitative scoring system then comparing the findings with the histopathological results.

Results
PS and BF were statistically significant predictors of the grade of differentiation, their odds ratio (OR) was (1.05, 95% CI 1.02–1.09, for each of them) (P = 0.004, P = 0.009, respectively). MTT also emerged as a significant predictor of the grade of differentiation with an OR of 0.76 (95% CI 0.57–0.93, P = 0.025). Using multivariate logistic regression model, PS was the most potent individual P-CT predictor of differentiation of the grade and the diagnosis of poorly differentiated tumors at ≥ 39 mL/100 g/min cut off point, followed by BF at ≥ 82.2 mL/100 g/min, and MTT at < 8.4 s. Regarding the qualitative scoring system P-CT, poorly differentiated tumors generally received higher scores of PS (P < 0.001), BF (P < 0.001), and BV (P = 0.017), than well and moderately differentiated tumors, however, MTT showed that poorly differentiated tumors were more frequently scored as low compared to well and moderately differentiated tumors (P < 0.001).

Conclusions
P-CT is an innovative, non-invasive biomarker for predicting gastric cancer grade by quantitative and qualitative assessment by P-CT parameters (PS, BF and MTT) with particular role of PS as the strongest individual P-CT predictor of differentiation grade followed by BF and MTT at specific cut off points.
Opioid system and related ligands: from the past to future perspectives
Authors: Rullo Laura , Morosini Camilla , Lacorte Antonio , Cristani Marco , Coluzzi Flaminia , Candeletti Sanzio , Romualdi Patrizia 
Published: October 2024

AbstractChronic pain is a pathological condition affecting about 30% of population. It represents a relevant social-health issue worldwide, and it is considered a significant source of human suffering and disability, strongly affecting patients’ quality of life. Despite several pharmacological strategies to guarantee an adequate pain management have been proposed over the years, opioids still represent one of the primary choices for treating moderate-to-severe pain in both cancer and non-cancer patients. However, chronic use of opioids often leads to numerous side effects, including respiratory depression, constipation, analgesic tolerance, and opioid-induced hyperalgesia (OIH), which can strongly limit their use. Given the fundamental role of opioid system in pain relief, this review provides a general overview about the main actors (endogenous opioid peptides and receptors) involved in its modulation. Furthermore, this review explores the action and the limitations of conventional clinically used opioids and describes the efficacy and safety profile of some promising analgesic compounds. A deeper understanding of the molecular mechanisms behind both analgesic effects and adverse events could advance knowledge in this field, thus improving chronic pain treatment.
‘I can feel sad about it and I can worry, but inside I know everything happens for a reason’: personal experiences in the aftermath of the March 15 Christchurch mosque attacks
Authors: Dean Shaystah , Eggleston Kate , Ali Fareeha , Thaufeeg Zimna , Wells Hayley , Zarifeh Julie , Sulaiman-Hill Ruqayyah , Bell Caroline , Crowe Marie 
Published: October 2024

Background
On 15 March 2019, a white supremacist gunman sequentially attacked two mosques in Christchurch, New Zealand, killing 51 people aged from 3 to 77 years and bullet-injuring 40 more. Approximately 250 people survived the atrocity, and many more family and community members have been directly or indirectly affected.

Aim
To develop an understanding of the personal experiences of some of those affected, including effects on daily life and well-being, in the 18–30 months following the attacks.

Method
Qualitative thematic analysis of semi-structured interviews with 21 men and women from September 2020 to August 2021 was performed. Participants were drawn from a larger quantitative study and included injured, bereaved, witnesses, family members and those from the wider Muslim community in Christchurch.

Results
Four superordinate themes were identified: being overwhelmed in the midst of chaos; experiencing silent and enduring impact; living similarly, but differently; and gaining meaning and growth. These themes captured ongoing distress inclusive of physical symptoms, family and community relationship dynamics and connectedness, secondary stressors, and diversity in coping and growth. For most, the centrality of Islam as a faith tradition was woven throughout.

Conclusion
Consistent with previous literature, post-trauma reactions were pervasive and varied. This appeared to be compounded by secondary stressors in this cohort, such as sociopolitical circumstances, demographic diversity, the COVID-19 pandemic and justice processes. Findings also revealed a strong spiritual thread in the experiences of this minority faith community, shedding light on a complex interaction between recovery and post-traumatic growth.
Association between dietary fat intake and the risk of Alzheimer's disease: Mendelian randomisation study
Authors: Zhu Yunqing , Lan Yongbing , Lv Jun , Sun Dianjianyi , Li Liming , Zhang Dai , Yu Canqing , Yue Weihua 
Published: October 2024

BackgroundObservational studies have shown a controversial relationship between dietary fat intake and Alzheimer's disease, and the causal effects are unclear.AimsTo assess the causal effects of total fat, saturated fat and polyunsaturated fat (PUF) intakes on the risk of Alzheimer's disease.MethodA two-sample Mendelian randomisation analysis was performed using genome-wide association study summary statistics on different types of fat intake from UK Biobank (n = 51 413) and on late-onset Alzheimer's disease (LOAD; 4282 cases, n = 307 112) and all forms of Alzheimer's disease (6281 cases, n = 309 154) from the FinnGen consortium. In addition, a multivariable Mendelian randomisation (MVMR) analysis was conducted to estimate the effects independent of carbohydrate and protein intakes.ResultsGenetically predicted per standard deviation increase in the total fat and saturated fat intakes were associated with 44 and 38% higher risks of LOAD (total fat: odds ratio = 1.44, 95% CI 1.03–2.02; saturated fat: odds ratio = 1.38, 95% CI 1.002–1.90; P = 0.049). The associations remained significant in the MVMR analysis (total fat: odds ratio = 3.31, 95% CI 1.74–6.29; saturated fat: odds ratio = 2.04, 95% CI 1.16–3.59). Total fat and saturated fat intakes were associated with a higher risk of all forms of Alzheimer's disease in the MVMR analysis (total fat: odds ratio = 2.09, 95% CI 1.22–3.57; saturated fat: odds ratio = 1.60, 95% CI 1.01–2.52). The PUF intake was not associated with LOAD or all forms of Alzheimer's disease.ConclusionsThis study indicated that total dietary fat intake, especially saturated fat, contributed to the risk of Alzheimer's disease, and the effects were independent of other nutrients. These findings informed prevention strategies and management for Alzheimer's disease directly towards reducing dietary saturated fat intake.
Dose-Specific Effects of Denosumab on Serum Calcium Levels in Patients With Osteoporosis and Various Renal Functions
Authors: Sun Xiaoxu , Bolster Marcy B , Leder Benjamin Z , Fan WuQiang 
Published: October 2024

Abstract

Context
Patients with osteoporosis and advanced chronic kidney disease (CKD) are at increased risk for hypocalcemia when initiating denosumab. It remains unclear if subsequent doses of denosumab pose a similar hypocalcemia risk as the initial dose.

Objectives
To study dose-specific hypocalcemia risks of denosumab.

Design, Setting, Patients, and Exposure
An observational study of 10 398 consecutive patients with varying renal function who received denosumab within the Mass General Brigham healthcare system between January 1, 2016, and February 29, 2024.

Main Outcomes and Measures
Dose-specific effects of denosumab on serum calcium levels and incidence of hypocalcemia (albumin-corrected serum calcium level &lt; 8.5 mg/dL).

Results
In 159 patients with sufficient data for 3 consecutive doses of denosumab, the initial dose of denosumab reduced serum calcium levels by an average of 0.34, 0.52, and 1.12 mg/dL in patients with glomerular filtration rate (GFR) of ≥60 (n = 89), 30 to 59 (n = 46), and &lt; 30 (n = 24) mL/min/1.73m2, respectively (P &lt; .001). Among patients with GFR of &lt; 30 mL/min/1.73m2, the initial, second, and third dose of denosumab reduced serum calcium levels by an average of 1.12, 0.72, and 0.60 mg/dL, respectively (P = .014). In a cohort of 325 patients with sufficient data for 2 doses of denosumab, a Kaplan–Meier analysis revealed a trend of higher incidence of hypocalcemia following the initial dose compared to the second dose in patients with GFR of &lt; 30 mL/min/1.73m2.

Conclusion
The magnitude of serum calcium decrease following subsequent dose(s) was smaller than that following the initial dose of denosumab among patients with osteoporosis and advanced CKD.
Spine Stereotactic Radiosurgery Provides Long-Term Local Control and Overall Survival for Benign Intradural Tumors
Authors: Taori Suchet , Adida Samuel , Kann Michael R. , Bhatia Shovan , Sefcik Roberta K. , Burton Steven A. , Flickinger John C. , Zinn Pascal O. , Gerszten Peter C. 
Published: October 2024

BACKGROUND AND OBJECTIVES:
The role of radiosurgery in the treatment of benign intracranial tumors is well established. However, there are limited long-term follow-up studies on outcomes after stereotactic radiosurgery (SRS) for benign intradural spinal tumors. In this article, we report a large single-institution experience in using SRS to treat patients with benign intradural tumors of the spine.

METHODS:
Overall, 184 patients (55% female) and 207 benign intradural tumors were treated. The median patient age was 52 years (range: 19-93). Tumor histology included schwannoma (38%), meningioma (15%), neurofibroma (21%), hemangioma (9%), hemangioblastoma (8%), hemangiopericytoma (5%), and paraganglioma (4%). Thirty-four (16%) lesions underwent resection before radiosurgery. Twenty-three (11%) lesions were NF1-mutated. The median single-fraction margin dose was 14 Gy (range: 11-20), and the median multifraction margin dose was 21 Gy (range: 15-30).

RESULTS:
The median follow-up was 63 months (range: 1-258). At last follow-up, tumors volumetrically regressed (15%), remained stable (77%), or locally progressed (8%, median: 20 months [range: 3-161]) after SRS. The 1-, 5-, and 10-year local control rates were 97%, 92%, and 90%, respectively. On multivariable analysis, the absence of the NF1 mutation (P = .004, hazard ratio: 0.23, 95% CI: 0.08-0.63) and single-fraction SRS (P = .007, hazard ratio: 0.24, 95% CI: 0.08-0.68) correlated with improved local control. The median overall survival was 251 months (range: 1-258), and 1-, 5-, and 10-year overall survival rates were 95%, 85%, and 70%, respectively. For patients with pre-existing symptoms, tumor-associated pain and neurological deficits were noted to improve or remain stable in 85% and 87% of cases, respectively. Adverse radiation effects included delayed myelopathy (1%), acute pain flare (9%), dermatitis (0.5%), dysphagia (0.5%), and dysphonia (0.5%).

CONCLUSION:
With long-term follow-up, spine radiosurgery is a safe and effective treatment for benign intradural tumors. In carefully selected patients, even with an NF1 mutation, SRS is associated with a high likelihood of local tumor control.
Corporate Social Responsibility and Consumer Choice: Lessons from the Milk Boycott
Authors: Kim In Kyung , Kim Kyoo il 
Published: October 2024

We study the impact of a boycott on one of the largest Korean dairy producers, triggered by the exposure of the firm’s unethical management practices, on sales of its own and others. We find empirical evidence that the boycott had substantial and long-lasting consequences. First, consumer utility from the boycotted products decreased significantly, reflecting consumers’ strong willingness to take part in collective action. Second, our discrete choice demand model, which addresses both price endogeneity and product substitution, estimates that sales of the boycotted firm decreased by almost 8% or, equivalently, by 8.1 million liters during the 12-month postboycott period. Third, the boycotted firm’s sales and revenue decreases would have been more severe had the firm not cut prices after the boycott outbreak. Our findings emphasize top-level managers’ role in fostering an ethical organizational culture within the firm and taking proper and timely countermeasures to curb losses incurred by a boycott. This paper was accepted by Eric Anderson, marketing. Funding: This work was supported by the Asian Studies Center of Michigan State University [Dr. Delia Koo Faculty Endowment Award] and Sogang University [New Faculty Research Funding Grant 202310031.01]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.01062 .
PREDICTORS OF ROTATIONAL FAILURE IN PAEDIATRIC SUPRACONDYLAR HUMERAL FRACTURES
Authors: Gardner W. T. , Davies P. , Campbell D. , Reidy M. 
Published: October 2024

Lateral-entry wiring (LEW) for displaced supracondylar humeral fractures (SHFs) has been popularised internationally. BOAST guidance suggests either LEW or crossed wires; the latter has reported lower risk of loss of fracture reduction –we explore technical reasons why.We reviewed 8 years of displaced SHFs in two regional centres. Injuries were grouped using the Gartland Classification, with posterolateral or posteromedial displacement assessment for Gartland 3 injuries. We identified any loss of fracture reduction, and reviewed intra-operative imaging to identify learning points that may contribute to early rotational displacement (ERD).345 SHFs were included, between 2012 and 2020. Gartland 2 (n=117) injuries had a 3.42% risk. ERD. Gartland 3 crossed wirings (n=114) had a 6.14% risk of ERD, with those moving all being posterolaterally displaced. Gartland 3, posterolaterally displaced LEW (n=56) had a 35.7% risk of ERD. Gartland 3, posteromedially displaced LEW (n=58) had a 22.4% risk of ERD. All injuries with ERD except 3 had identifiable learning points, the commonest being non-divergence of wires, or wires not passing through both fracture fragments.LEW requires divergent spread and bicolumnar fixation. Achieving a solid construct through this method appears more challenging than crossed wiring, with rates of ERD 3–5× higher. Low-volume surgeons should adhere to BOAST guidelines and choose a wiring construct that works best in their hands. They can also be reassured that should a loss of position occur, the risk of requirement for revision surgery is extremely low in our study (0.3%), and it is unlikely to affect long term outcomes.
DOES CHANGE IN CORONAL PLANE ALIGNMENT OF THE KNEE CLASSIFICATION FOLLOWING TOTAL KNEE ARTHROPLASTY INFLUENCE PATIENT-REPORTED OUTCOMES AND SURVIVORSHIP? A REVIEW OF 1,062 CASES WITH TEN YEARS’ FOLLOW-UP
Authors: Al-Abbasi G. , Wallace D.T. , Mahmood F. , Ohly N. , Clarke J. 
Published: October 2024

Restoration of native Coronal Plane Alignment of the Knee (CPAK) phenotype is a strategy suggested to achieve better satisfaction. The aim of this study was to investigate the influence of changes in CPAK classification on patient-reported outcome measures (PROMs) and survivorship in a large cohort of manual mechanically aligned (MA) cemented TKAs.A retrospective analysis of 1062 consecutive cemented TKAs using MA philosophy at a single institution. Pre- and post-operative hip-knee-ankle radiographs were classified using the CPAK classification. Oxford Knee Score (OKS) and patient satisfaction (4-point-Likert scale) were collected prospectively. Implant survival data was obtained from our national arthroplasty database. We compared the outcomes of patients who maintained or changed their CPAK classification following TKA. Satisfaction was analysed using chi-square test, and OKS was analysed using Mann-Whitney test.Pre-operatively, most patients were CPAK type-I (38.8%). 85.5% of patients changed their CPAK type post-operatively, with CPAK type-V observed in 41.2% of these. Significantly better satisfaction (p=0.033) and OKS (p=0.021) were observed at one-year follow-up in patients who changed CPAK type, although the difference was below OKS minimally important clinical difference. There was no difference in satisfaction (p=0.73) and OKS (p=0.26) at one year between CPAK-V and non-V classifications. Post-operative CPAK type had no correlation with satisfaction and OKS. 12 TKAs (1.1%) were revised within 10 years (3 septic).In this large cohort of MA-TKA, excellent survivorship was observed at 10 years, with no demonstrable difference in outcome related to the final CPAK phenotype or change in phenotype.
A SCOTTISH CENTRE'S EXPERIENCE OF RAPIDLY DESTRUCTIVE OSTEOARTHRITIS OF THE HIP IN THE SETTING OF A RESTRICTED ARTHROPLASTY SERVICE: DO DELAYS AFFECT OUTCOMES? WHAT CAN WE LEARN?
Authors: Sattar M. , Lennox L. , Lim J. W. , Medlock G. , Mitchell M. 
Published: October 2024

The Covid-19 pandemic restricted access to elective arthroplasty theatres. Consequently, there was a staggering rise in waiting times for patients awaiting total hip arthroplasty (THA). Concomitantly, rapidly destructive osteoarthritis (RDOA) incidence also increased.Two cohorts of patients were reviewed: patients undergoing primary THA, pre-pandemic (December 2017-December 2018) and patients with RDOA (ascertained by dual consultant review of pre-operative radiographs) undergoing THA after the pandemic started (March 2020 – March 2022). There were 236 primary THA cases in the pre-pandemic cohort. Out of the 632 primary THA cases post-pandemic, 186 cases (29%) had RDOA. Within this RDOA cohort, the pre-operative mean OHS, EQ5D3L and EQVAS (12.7, 10.5 and 57.6 respectively) were all poorer than in the pre-pandemic population (18.3, 9.4 and 66.7 respectively) (p<0.05). There was no significant difference between the RDOA and pre-pandemic cohort in Patient Reported Outcome Measures (PROMS) at 12 months, perhaps due to their ceiling effect.Within the RDOA cohort, 7 cases required acetabular augments, 1 of which also required femoral shortening. The rate of intra-operative fracture, dislocation, infection, return to theatre, and revision were 2.2%, 2.7%, 4.3%, 3.8% and 2.2% respectively, greater than those reported in the literature. No fractures nor dislocations occurred in robot assisted arthroplasties.With ever increasing waiting lists, RDOA prevalence will continue to rise. Increased surgical challenges and potential use of additional implants generated by its presence excludes these patients from waiting list initiative pathways, potentiating the complexity of the operative procedure. Going forwards, the economic burden and training implications must be considered.
THE NUMBER OF DISTAL RADIAL FRACTURES IN THE ELDERLY WILL INCREASE BY MORE THAN HALF BY 2040: PREDICTION MODELLING USING NATIONAL DATA
Authors: Bell K.R. , Yapp L.Z. , White T.O. , Molyneux S.G. , Clement N.D. , Duckworth A.D. 
Published: October 2024

The aim was to predict the number and incidence of distal radius fractures in Scotland over the next two decades according to age group, categorised into under 65yrs(65) and 65yrs and older (65), and estimate the potential increased operative burden.The number of distal radius fractures in Scotland was isolated from the Global Burden of Disease database and this was used, in addition to historic population data and published population estimates, to create a multivariable model allowing incorporation of age group, sex and time. A Negative Binomial distribution was used to predict incidence in 2030 and 2040 and calculate projected number of fractures. A 20.4% operative intervention rate was assumed (local data).In terms of number of fractures, there was a projected 61% rise in the 65 group with an overall increase of 2099 fractures per year from 3417 in 2020 (95% confidence interval (CI) 2960 – 3463) to 5516 in 2040 (95% CI 4155 – 5675). This was associated with 428 additional operative interventions per year for those 65yrs. The projected increase between 2020 and 2040 was similar in both sexes (60% in females, 63% in males), however the absolute increase in fracture number was higher in females. There was a 4% projected fall in the number of fractures in those 65.Incidence of distal radius fractures is expected to considerably increase over the next two decades due to a projected increase in the number of fractures in the elderly. This has implications for associated morbidity and healthcare resource use.
THE X-RAY CALIBRATION PROJECT
Authors: Zace P. , Maas Z. , McIntyre R. , Khan Z. , Bailey O. 
Published: October 2024

Increasing the accuracy of information provided through X-Rays maximises pre-operative planning. Aim of this project is to determine the necessity of calibration probes that would improve the accuracy of pre-operative templating. This is a retrospective study involving leg length and pelvis X-Rays performed across the NHS Lanarkshire from 01/03/2023 until 31/04/2024.A total of 87 leg length X-Rays were identified, 18 had a calibration probe present. Leg length was measured on each and the X-Rays were calibrated against the existing probe. In 66.7% of cases there was a major leg length discrepancy of over 2cm between the pre-calibrated and post-calibrated X-Rays. Pelvic X-Rays of 80 patients that underwent total hip replacement were reviewed. Preoperative templating was compared to the implants inserted. An average of 1.94 discrepancy in the size of the acetabular implant was identified whilst in 30 cases the size of the femoral stem was incorrect by at least 1 size. Magnification of 119.7% on X-Rays was found to provide the most accurate templating. Seventy seven cases of pelvic X-Rays before and after hip hemiarthroplasty were also reviewed. The implant head was templated incorrectly in 74% of cases and the stem in 51%. It was identified that pelvic X-Ray magnification of 121.7% would provide the most accurate results.X-Rays with no calibration probes provide inaccurate measurements leading to faulty preoperative planning. Standardised use of a calibration sphere is strongly suggested and whenever that is not available, we suggest magnification of 121%.