bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a staging system for hepatoid adenocarcinoma of the stomach based on multicenter data: a retrospective cohort study
Authors: Huang Ying-Qi , Huang Ze-Ning , Hong Qing-Qi , Zhang Peng , Zhang Zi-Zhen , He Liang , Shang Liang , Wang Lin-Jun , Sun Ya-Feng , Li Zhi-Xiong , Liu Jun-Jie , Ding Fang-Hui , Lin En-De , Fu Yong-An , Lin Shuang-Ming , Chen Qi-Yue , Zheng Chao-Hui , Huang Chang-Ming , Li Ping 
Published: September 2024

Background:
Hepatoid adenocarcinoma of the stomach (HAS) is a rare subtype of gastric cancer (GC) with a poor prognosis. Furthermore, the current pathological staging system for HAS does not distinguish it from that for common gastric cancer (CGC).

Methods:
The clinicopathological data of 251 patients with primary HAS who underwent radical surgery at 14 centers in China from April 2004 to December 2019 and 5082 patients with primary CGC who underwent radical surgery at two centers during the same period were retrospectively analyzed. A modified staging system was established based on the differences in survival.

Results:
After 1:4 propensity score matching (PSM), 228 patients with HAS and 828 patients with CGC were analyzed. Kaplan–Meier (K–M) analysis showed patients with HAS had a poorer prognosis compared with CGC. Multivariate analysis identified pN stage, CEA level, and perineural invasion (PNI) as independent prognostic factors in patients with HAS. A modified pT (mpT) staging was derived using recursive partitioning analysis (RPA) incorporating PNI and pT staging. The modified pathological staging system (mpTNM) integrated the mpT and the eighth American Joint Committee on Cancer (AJCC) pN definitions. Multivariate analysis showed that the mpTNM stage outperformed other pathological variables as independent predictors of OS and RFS in patients with HAS. The mpTNM staging system exhibited significantly higher predictive accuracy for 3-year OS in patients with HAS (0.707, 95% CI: 0.650–0.763) compared to that of the eighth AJCC staging system (0.667, 95% CI: 0.610–0.723, P<0.05). Analysis using the Akaike information criterion favored the mpTNM staging system over the eighth AJCC staging system (824.69 vs. 835.94) regarding the goodness of fit. The mpTNM stages showed improved homogeneity in survival prediction (likelihood ratio: 41.51 vs. 27.10). Comparatively, the mpTNM staging system outperformed the eighth AJCC staging system in survival prediction, supported by improvements in the net reclassification index (NRI: 47.7%) and integrated discrimination improvement (IDI: 0.083, P<0.05). The time-dependent ROC curve showed that the mpTNM staging system consistently outperformed the eighth AJCC staging system with increasing observation time.

Conclusion:
The mpTNM staging system exhibited superior postoperative prognostic accuracy for patients with HAS compared to the eighth AJCC staging system.
Resuscitative endovascular balloon occlusion of the aorta for trauma patients with uncontrolled hemorrhage: a retrospective target trial emulation (the AT-REBOA target trial)
Authors: Hallmann Barbara , Honnef Gabriel , Eibinger Nicolas , Eichlseder Michael , Posch Martin , Puchwein Paul , Zoidl Philipp , Zajic Paul 
Published: September 2024

Background
Noncompressible truncal hemorrhage is a major contributor to preventable deaths in trauma patients and, despite advances in emergency care, still poses a big challenge.

Objectives
This study aimed to assess the clinical efficacy of trauma resuscitation care incorporating Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) compared to standard care for managing uncontrolled torso or lower body hemorrhage.

Methods
This study utilized a target trial design with a matched case–control methodology, emulating randomized 1 : 1 allocation for patients receiving trauma resuscitation care with or without the use of REBOA. The study was conducted at a high-volume trauma center in Southern Austria, including trauma patients treated between January 2019 and October 2023, aged 16 and above, with suspected severe non-compressible torso hemorrhage. The primary outcome was 30-day in-hospital mortality. Secondary outcomes were in-hospital mortality rates at 3, 6, 24 h, and 90 days, need for damage control procedures, time to these procedures, computed tomography (CT) scan rates during resuscitation, complications, length of intensive care and in-hospital stay, and causes of death.

Results
Median age was 55 [interquartile range (IQR) 42–64] years. Median total injury severity, assessed by Injury Severity Score, was 46.5 (IQR: 43–57). There was no significant difference in 30-day in-hospital mortality between groups [9/11 (41%) vs. 9/11 (41%), odds ratio: 1.00, 95% confidence interval (CI): 0.3–3.36, P > 0.999]. Lower mortality rates within 3, 6, and 24 h were observed in the REBOA group; in a Cox proportional hazards model, hazard ratio (95% CI) for mortality in the REBOA group was 0.87 (0.35–2.15). Timing to damage control procedures did not significantly differ between groups, although patients in the REBOA group underwent significantly more CT scans. Bleeding was cited as the main cause of death less frequently in the REBOA group.

Conclusion
In severely injured patients presenting with possible major non-compressible torso hemorrhage, a systematically implemented resuscitation strategy including REBOA during the initial hospital phase, is not associated with significant changes in mortality.
Acceptability of Doxycycline Prophylaxis, Prior Antibiotic Use, and Knowledge of Antimicrobial Resistance Among Australian Gay and Bisexual Men and Nonbinary People
Authors: Holt Martin , Bavinton Benjamin R. , Calabrese Sarah K. , Broady Timothy R. , Clackett Shawn , Cornelisse Vincent J. , Yu Simin , Gordon Tina , Heath-Paynter Dash , de Wit John B. F. , MacGibbon James 
Published: September 2024

Background
There is growing interest in novel sexually transmissible infection (STI) prevention strategies, including doxycycline postexposure prophylaxis (doxy-PEP). We assessed interest in doxy-PEP and other STI prevention strategies among gay and bisexual men and nonbinary people in Australia, as well as prior antibiotic use for STI prevention, and knowledge of antimicrobial resistance (AMR).

Methods
We conducted a national, online survey in June to July 2023. Multivariable logistic regression was used to identify factors associated with the acceptability of doxy-PEP.

Results
Of 2046 participants, 26.9% had been diagnosed with an STI in the previous year. Condoms were rated as an acceptable STI prevention strategy by 45.1% of the sample, STI preexposure prophylaxis by 54.0%, and doxy-PEP by 75.8%. Previous antibiotic use for STI prevention was reported by 7.5% of the sample, and 2.6% were currently using antibiotics for STI prevention. Over half the sample (62.1%) had some knowledge of AMR. Of those who knew something about AMR, 76.2% were concerned about it. Interest in using doxy-PEP was independently associated with previous use of antibiotics for STI prevention (adjusted odds ratio, 3.09; 95% confidence interval, 1.78–5.35; P < 0.001), whereas those who were concerned about AMR were less interested in it (adjusted odds ratio, 0.51; 95% confidence interval, 0.36–0.72; P < 0.001).

Conclusions
Doxycycline postexposure prophylaxis was highly acceptable to gay and bisexual men and nonbinary people in Australia, and few factors distinguished between interest in using it or not. We recommend community and professional discussion and education about the effective use of doxy-PEP, AMR, and who would most benefit from doxy-PEP.
Anal Cancer Screening Practices Among Higher-Risk Populations in an Academic Medical System
Authors: Gore Daniel , O'Donoghue Ashley , Dechen Tenzin , Zerillo Jessica , Multani Ami , Krakower Douglas 
Published: September 2024

Background
Although some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus–associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy.

Methods
We extracted outpatient clinical data for the aforementioned populations from January 1, 2015, to August 1, 2022, at 3 sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and human papillomavirus testing results. We used χ
2 tests and logistic regression to assess for associations between patient characteristics and anal cancer screening.

Results
Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than White patients (95% confidence interval [CI], 0.40–0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% confidence interval, 0.20–0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings.

Conclusion
Only one-fifth of PWH received anal cancer screening, and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.
Efficacy of Doxycycline as Preexposure and/or Postexposure Prophylaxis to Prevent Sexually Transmitted Diseases: A Systematic Review and Meta-Analysis
Authors: Boschiero Matheus Negri , Sansone Nathália Mariana Santos , Matos Laura Ribeiro , Marson Fernando Augusto Lima 
Published: September 2024

Introduction
Bacterial sexually transmitted infections (STIs), specifically infection by Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum, have an important burden worldwide. The use of doxycycline as preexposure prophylaxis (PREP or doxy-PREP) or postexposure prophylaxis (PEP or doxy-PEP) might be effective as prophylaxis because it is effective against C. trachomatis and T. pallidum.

Aims
Our objective was to evaluate the efficacy of doxycycline as PREP or PEP against bacterial STIs (C. trachomatis, N. gonorrhoeae, and T. pallidum).

Methods
A systematic review and meta-analysis of randomized clinical trials of a high-risk group of individuals was conducted to evaluate whether doxycycline is as effective as PREP or PEP in preventing bacterial STIs. The PubMed-MEDLINE (MEDlars online), Cohrane, Scientific Electronic Library Online (SciELO), and Latin America and the Caribbean Literature on Health Sciences (Literatura Latino-Americana e do Caribe em Ciências da Saúde -LILACS) databases were searched for randomized clinical trials published up to March 2024. Data were extracted from published reports. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence interval (CI) were pooled across trials.

Main Outcome Measure
The primary end points were any incidence of bacterial STIs and individual STI infections.

Results
A total of 4 studies were included in the analysis, 3 of which evaluated doxy-PEP and 1 evaluated doxy-PREP. In the doxy-PEP group, a total of 1182 participants were evaluated. In the pooled analysis of doxy-PEP studies, the incidence of the first STI was lower in the doxy-PEP group (HR, 0.538 [95% CI, 0.337–0.859]; I
2 = 77%; P < 0.05). Regarding individual infections, only 2 studies were included. In the doxy-PEP group, the incidence of individual infection of C. trachomatis was lower compared with controls (RR, 0.291 [95% CI, 0.093–0.911]) (I
2 = 89%; P < 0.05). Because only one study evaluated doxy-PREP, it was not possible to calculate a meta-analysis index; however, the use of doxycycline as PREP was associated with a decrease in the rate of any STI.

Conclusions
The use of doxy-PEP might reduce the first STI, mainly C. trachomatis, if used within 72 hours after condomless sex. The use of doxy-PREP might also decrease the chance of any STI; however, only 1 study was evaluated.
Assessing Attitudes and Knowledge of Mpox Vaccine Among Unvaccinated Men Who Have Sex With Men
Authors: Green Caitlin J. , (Chela) Hall Grace , Kachur Rachel , Finley Elizabeth , Furness Bruce W. , Merritt Matthew , Lewis Felicia M. T. 
Published: September 2024

Background
The 2022 mpox outbreak disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Mpox cases continue to be reported nationally. Vaccination is a tool to prevent the spread of and serious disease from mpox. To understand mpox vaccine uptake and hesitancy, a virtual focus group with unvaccinated GBMSM was conducted.

Methods
In November 2022, a 60-minute, virtual focus group was conducted within an artificial intelligence (AI) platform that engages participants in chat-based conversation. The AI system uses machine learning and natural language processing to analyze and provide results immediately to the moderator. Descriptive frequencies, cross-tabulations, and qualitative themes were analyzed.

Results
Fifty-one GBMSM aged 18 to 55 years participated, of whom 12 had attempted to get the mpox vaccine. The top barriers in accessing the vaccine included challenges in scheduling appointments (4 of 12), available vaccine locations (3 of 12), and transportation (2 of 12). Nine participants reported not wanting the vaccine, and 22 were undecided; of these, 15 (4 of 9 and 11 of 22, respectively) said they did not think they needed the vaccine due to low perceived risk or monogamy. Among the undecided, after receiving health messaging about mpox, 12 of 22 said the messaging made them reconsider getting the vaccine.

Conclusion
During an outbreak, many unvaccinated GBMSM who may be at increased risk for mpox either wanted the vaccine or, with appropriate health messaging, may be open to getting the vaccine. Messaging about mpox vaccine efficacy, potential side effects, and how to access the vaccine may improve vaccine uptake especially as cases continue to occur.
Engagement and Factors Associated With Annual Anal Human Papillomavirus Screening Among Sexual and Gender Minority Individuals
Authors: Nitkowski Jenna , Ridolfi Timothy J. , Lundeen Sarah J. , Giuliano Anna R. , Chiao Elizabeth , Fernandez Maria E. , Schick Vanessa , Smith Jennifer S. , Bruggink Paige , Brzezinski Bridgett , Nyitray Alan G. 
Published: September 2024

Background
Although self-sampling could help address anal cancer screening barriers, no studies have investigated annual engagement with this method or compared it with annual screening with a provider. Building on our baseline article, we compared annual anal screening engagement between home-based self-sampling and clinic-based clinician sampling.

Methods
The Prevent Anal Cancer Self-Swab Study recruited and randomized sexual and gender minority individuals 25 years and older who have sex with men to a home or clinic arm. Home-based participants were mailed an anal human papillomavirus self-sampling kit at baseline and 12 months, whereas clinic-based participants were asked to schedule and attend 1 of 5 participating clinics at baseline and 12 months. Using Poisson regression, we conducted an intention-to-treat analysis of 240 randomized participants who were invited to screen at both timepoints.

Results
More than half (58.8%) of participants completed annual (median = 370 days) anal screening. In the home arm, 65.0% of participants engaged in annual screening compared with 52.5% of clinic-based participants (P = 0.049). When stratified by HIV status, persons living with HIV had a higher proportion of home (71.1%) versus clinic (22.2%) annual screening (P < 0.001). Non-Hispanic Black participants participated more in home-based annual anal screening (73.1%) than annual clinic screening (31.6%; P = 0.01). Overall, annual screening engagement was significantly higher among participants who had heard of anal cancer from an LGBTQ organization, reported “some” prior anal cancer knowledge, preferred an insertive anal sex position, and reported any prior cancer diagnosis.

Conclusions
Annual screening engagement among those at disproportionate anal cancer risk was higher in the home arm.
Long-Term Outcomes of 1989 Immediate Implant-Based Breast Reconstructions: An Analysis of Risk Factors for Failure and Revision Surgery
Authors: Kooijman Merel M. L. , van Bommel Annelotte C. M. , van Duijnhoven Frederieke H. , Scholten Astrid N. , Smorenburg Carolien H. , Woerdeman Leonie A. E. , Breugem Corstiaan C. 
Published: September 2024

Background:
Nipple- or skin-sparing mastectomy and immediate implant-based breast reconstruction (IBR) is potentially associated with long-term unfavorable outcomes, such as revision surgery and reconstruction failure. This large patient cohort study aimed to provide long-term data on the incidence of these outcomes and to identify predictive risk factors.

Methods:
Between 2012 and 2019, 1989 mastectomies with IBR were performed in 1512 women in the authors’ institute. A direct-to-implant method was used in 93% and a 2-staged method with tissue expander in 7%. Logistic regression analysis was used to identify patient- and treatment-related risk factors associated with revision surgery or reconstructive failure.

Results:
The mean follow-up was 62.2 months. IBR failed in 6.7% of all breasts; thus, a breast was present in 93.3%. Age older than 44 years yielded a 2.6-fold, and radiotherapy, a 1.7-fold increased risk for reconstruction failure. Revision surgery was performed in 60% of all breasts. The mean number of revisions of all IBRs was 1.2 (range, 0 to 8; SD, 1.37). Factors associated with significantly higher rates of revision surgery were age older than 44 years (OR, 1.23), smoking (OR, 1.53), specimen weight greater than 492 g (OR, 1.39), implant volume greater than 422 g (OR, 1.95), and radiotherapy (OR, 1.51). Nipple preservation was protective for both outcomes (OR, 0.71 and 0.42, respectively). Direct-to-implant procedures did not require any surgical revision in 43% of these patients.

Conclusions:
Despite the necessity of revision surgery in the majority of IBRs, nearly half of the breasts did not require any revision surgery, and long-term reconstruction failure rates are extremely low. Therefore, IBR should be offered to all eligible women undergoing mastectomy, while understanding the risks.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Brief Report: Internalized Poverty-Related Stigma and Interpersonal Violence Among Women Living With HIV in the United States
Authors: Maya Sigal , Sheira Lila A. , Frongillo Edward A. , Pala Andrea Norcini , Kempf Mirjam-Colette , Konkle-Parker Deborah , Wilson Tracey E. , Tien Phyllis C. , Wingood Gina , Topper Elizabeth F. , Neilands Torsten B. , Johnson Mallory O. , Logie Carmen H. , Weiser Sheri D. , Turan Janet M. , Turan Bulent 
Published: September 2024

Background:
Interpersonal violence (IPV) affects half of women living with HIV (WLHIV) in the United States and has important consequences for mental health and HIV outcomes. Although different types of stigmas (eg, HIV- or sexual identity-related) are associated with increased risk of IPV, the relationship between poverty-related stigma and IPV is unclear, even though poverty frequently co-occurs with IPV.

Methods:
Data from up to 4 annual visits (2016–2020) were collected from 374 WLHIV enrolled in a substudy of the Women's Interagency HIV Study (now known as Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study) at 4 sites across the United States. A validated measure of the perceived stigma of poverty was used, along with questions on recent experiences of IPV. We used a mixed-effects model to assess the association between internalized poverty stigma and IPV.

Results:
The unadjusted model with internalized poverty stigma and recent IPV as independent and dependent variables, respectively, suggested that the 2 were associated (prevalence ratio 1.29 [95% CI: 1.02 to 1.62, P = 0.033]). After adjusting for income and education, we found an independent association between internalized poverty-related stigma and recent IPV, with a prevalence ratio of 1.35 (95% CI: 1.07 to 1.71, P = 0.011).

Conclusion:
Our findings suggest that reducing the psychologic consequences of poverty may better situate WLHIV to escape or avoid IPV. The usefulness of screening WLHIV who may be experiencing poverty-related stigma for IPV should be investigated. Interventions that address internalized poverty-related stigma may provide an avenue for reducing the harms caused by IPV in addition to interventions aiming to reduce violence itself.
Assessing and Managing Medical Adhesive-Related Skin Injury in Patients with a Peripherally Inserted Central Catheter
Authors: Ratliff Catherine , Barton Andrew , Hitchcock Jan , Gray Mikel 
Published: September 2024

BACKGROUND:
Medical adhesive-related skin injuries (MARSIs) are prevalent adverse effects associated with use of medical devices and increasingly recognized as potentially avoidable. Despite advances in preventive measures, MARSI events still occur, and individualized care must be designed to meet patient needs.

CASES:
This article describes three cases where skin injuries occurred because of application, removal, and ongoing use of a medical adhesive device; all three cases occurred underneath dressings used to secure and protect the skin adjacent to a peripherally inserted central catheter (PICC). The first case describes evaluation and management of a skin tear in an elderly female with multiple comorbid conditions, and Case 2 describes assessment and care of contact irritant dermatitis occurring under a PICC dressing. In both cases, specialist nurses with knowledge of MARSI assessed and managed the skin underneath the medical adhesive device in a manner that allowed maintenance of the PICC and continuation of therapy. In contrast, Case 3 describes a female with irritant contact dermatitis underneath a PICC dressing that was responding to care by the nurse specialists of a vascular access team. In this case, the patient presented to their facility’s emergency department with severe itching. The vascular access team initially was not consulted, and the PICC line was removed, although inspection revealed dry skin without signs of infection.

CONCLUSIONS:
Medical adhesive-related skin injury is a clinically relevant and useful construct that identifies a variety of prevalent conditions associated with the use of medical adhesive device such as tapes and PICC dressings. These cases, in particular Cases 1 and 2, illustrate that the MARSI construct provides a framework for assessing and managing medical skin injuries with the possibility of preserving the PICC and the ongoing therapy these patients were receiving.