bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy in the Management of upper Ureteric Stones Measuring from One to Two Centimeters: Randomized Prospective Study
Authors: Abou-Elfarag Badran Medhat Adel , El Shorbagy Amr Fekry , Tawfick Ahmed 
Published: July 2024

Abstract

Objective
This prospective study aims to compare the clinical efficacy and safety of flexible ureteroscopy versus laparoscopic ureterolithotomy in the management of upper ureteric stones measuring from one to two centimeters.

Methods
his randomized-prospective study was conducted on 64 patients admitted from Urology unit, Ain Shams University in the period from October 2020 till September 2022; only 56 patients were analyzed statistically and 8 patients were excluded due to shortage in post- operative data and follow up. Patients were divided into two groups Group A consists of 31 patients and Group B consists of 25 patients with matched age, gender and body mass index (BMI).

Results
In our study, The VAS score at 6 hours post-operative and day 1 post-operative was found to be 5.32 and 2.71 in FURS group and was found to be 7.28 and 3.28 in RPLU group respectively showing significant difference with (p- value &lt;0.001 and 0.016 respectively) between the two groups with more satisfaction in FURS group mostly due to the absence of trocars incisions. The complications were classified according to modified Clavien classification system. No major complications such as septic shock or death were reported in either treatment groups. As regards the recovery to work in postoperative and follow up periods in the present study, there was a significant difference between both groups with (P-value &lt;0.001), as we found that it takes about 4.56 ± 0.82 days in RPLU group and 3.06 ± 1.91 days in FURS group to return daily routine activities. As regards the stone free rate in follow up periods in the present study, there was a significant difference between both groups with (P-value 0,02), as we found that it was 100% and 80,6% in RPLU and FURS group respectively. Our success rate in RPLU group was found to be 100% in comparison to Irfan Nazir Mir et al which was 93.4% (28/30) with two patients (2/30) converted to open ureterolithotomy, either due to technical snag or due to difficulty in localizing the ureter laparoscopically.

Conclusion
Both F-URS and RTLU were safe and effective surgical procedures for treatment of large proximal ureteral stones. However, RTLU had a higher stone-free rate with comparable operating time and complication rate as compared to F-URS. Also as regards to postoperative pain, shorter hospital stay and faster return to daily activities, both have almost similar results.
Percutaneous Pharmacological Thrombolysis as an Effective Primary Mode of Management of Thrombosed Prosthetic Arterio-Venous Grafts
Authors: Hamada Nader Mohamed , Abdulrahman Salem Abdulrahman Mohamed Ahmed , Mohamed Elawady Karim Shalaby , AboElNeel Hamdy AbdelAzeem 
Published: July 2024

Abstract

Background
Thrombosis of prosthetic arterio-venous graft (PAVG) is the most common cause of failure of using this access for haemodialysis (HD) in end stage kidney disease (ESKD) patients. Many different open surgical and vascular techniques were described to restore the function of thrombosed PAVG.

Objectives
We wanted to assess the feasibility and patency rates following the continuous thrombolysis infusion using tissue Plasminogen Activator (tPA) followed by angiogram and angioplasty of stenotic segment(s) in thrombosed PAVG.

Methods
We performed retrospective analysis of prospectively collected data from patients who had a thrombosed AVG from January 2020 to January 2022. Thrombolysis took place maximum 7 days after thrombosis was diagnosed. We have excluded patients who were referred to us more than a week after thrombosis occurred and patients with relative or absolute contraindication for thrombolysis and/or anticoagulation.

Results
During the two years of the study, there were 58 patients referred to our centre with thrombosed PAVG. We have excluded 28 patients who didn’t fulfill inclusion criteria. We have performed PAVG continuous thrombolysis infusion using tPA till we have achieved reopening of the thrombosed PAVG followed by angiography and angioplasty. All patients had venous anastomosis stenosis while 17 patients had stenosis in the graft and only 5 had a stenosis at the arterial anastomosis. During the period of follow up primary patency was achieved in 80% of our patients while our primary assisted patency was 86.67%

Conclusions
Endovascular tPA thrombolysis for early thrombosis of prosthetic AVAs is feasible, safe, and is associated with an excellent technical success and very good 12 months patency rate.
Social defeat stress impairs systemic iron metabolism by activating the hepcidin–ferroportin axis
Authors: Kasahara Emiko , Nakamura Ayumi , Morimoto Kenki , Ito Shiho , Hori Mika , Sekiyama Atsuo 
Published: July 2024

AbstractChronic psychological stress has been reported to decrease circulating iron concentrations and impair hematopoiesis. However, the underlying mechanisms remain unclear. This study aimed to investigate the effects of psychological stress on biological iron metabolism by using the social defeat stress (SDS) model, a widely used model of depression. Compared with control mice, mice subjected to SDS (SDS mice) had lower social interaction (SI) behavior. The SDS mice also showed impaired hematopoiesis, as evidenced by reduced circulating red blood cell counts, elevated reticulocyte counts, and decreased plasma iron levels. In the SDS mice, the iron contents in the bone marrow decreased, whereas those in the spleen increased, suggesting dysregulation in systemic iron metabolism. The concentrations of plasma hepcidin, an important regulator of systemic iron homeostasis, increased in the SDS mice. Meanwhile, the concentrations of ferroportin, an iron transport protein negatively regulated by hepcidin, were lower in the spleen and duodenum of the SDS mice than in those of the control mice. Treatment with dalteparin, a hepcidin inhibitor, prevented the decrease in plasma iron levels in the SDS mice. The gene expression and enzyme activity of furin, which converts the precursor hepcidin to active hepcidin, were high and positively correlated with plasma hepcidin concentration. Thus, furin activation might be responsible for the increased plasma hepcidin concentration. This study is the first to show that psychological stress disrupts systemic iron homeostasis by activating the hepcidin–ferroportin axis. Consideration of psychological stressors might be beneficial in the treatment of diseases with iron‐refractory anemia.
The correlation between TRIM28 expression and immune checkpoints in CRPC
Authors: Xue Dun , Zuo Qian , Chang Jie , Wu Xinghui 
Published: July 2024

AbstractThis study delves into the unexplored realm of castration‐resistant prostate cancer (CRPC) by investigating the role of TRIM28 and its intricate molecular mechanisms using high‐throughput single‐cell transcriptome sequencing and advanced bioinformatics analysis. Our comprehensive examination unveiled dynamic TRIM28 expression changes, particularly in immune cells such as macrophages and CD8+ T cells within CRPC. Correlation analyses with TCGA data highlighted the connection between TRIM28 and immune checkpoint expression and emphasized its pivotal influence on the quantity and functionality of immune cells. Using TRIM28 knockout mouse models, we identified differentially expressed genes and enriched pathways, unraveling the potential regulatory involvement of TRIM28 in the cGAS‐STING pathway. In vitro, experiments further illuminated that TRIM28 knockout in prostate cancer cells induced a notable anti‐tumor immune effect by inhibiting M2 macrophage polarization and enhancing CD8+ T cell activity. This impactful discovery was validated in an in situ transplant tumor model, where TRIM28 knockout exhibited a deceleration in tumor growth, reduced proportions of M2 macrophages, and enhanced infiltration of CD8+ T cells. In summary, this study elucidates the hitherto unknown anti‐tumor immune role of TRIM28 in CRPC and unravels its potential regulatory mechanism via the cGAS‐STING signaling pathway. These findings provide novel insights into the immune landscape of CRPC, offering promising directions for developing innovative therapeutic strategies.
Exploration of the miR‐187‐3p/CNR2 pathway in modulating osteoblast differentiation and treating postmenopausal osteoporosis through mechanical stress
Authors: Zhang Lei , Zeng Canjun , Huang Juanyu , Yan Haohang , Jiang Yutao , Li Runguang 
Published: July 2024

AbstractThis study aimed to explore how mechanical stress affects osteogenic differentiation via the miR‐187‐3p/CNR2 pathway. To conduct this study, 24 female C57BL/6 mice, aged 8 weeks, were used and divided into four groups. The Sham and OVX groups did not undergo treadmill exercise, while the Sham + EX and OVX + EX groups received a 8‐week treadmill exercise. Post‐training, bone marrow and fresh femur samples were collected for further analysis. Molecular biology analysis, histomorphology analysis, and micro‐CT analysis were conducted on these samples. Moreover, primary osteoblasts were cultured under osteogenic conditions and divided into GM group and CTS group. The cells in the CTS group underwent a sinusoidal stretching regimen for either 3 or 7 days. The expression of early osteoblast markers (Runx2, OPN, and ALP) was measured to assess differentiation. The study findings revealed that mechanical stress has a regulatory impact on osteoblast differentiation. The expression of miR‐187‐3p was observed to decrease, facilitating osteogenic differentiation, while the expression of CNR2 increased significantly. These observations suggest that mechanical stress, miR‐187‐3p, and CNR2 play crucial roles in regulating osteogenic differentiation. Both in vivo and in vitro experiments have confirmed that mechanical stress downregulates miR‐187‐3p and upregulates CNR2, which leads to the restoration of distal femoral bone mass and enhancement of osteoblast differentiation. Therefore, mechanical stress promotes osteoblasts, resulting in improved osteoporosis through the miR‐187‐3p/CNR2 signaling pathway. These findings have broad prospect and provide molecular biology guidance for the basic research and clinical application of exercise in the prevention and treatment of PMOP.
Insights into the role of glycerophospholipids on the iron export function of SLC40A1 and the molecular mechanisms of ferroportin disease
Authors: Debbiche Rim , Elbahnsi Ahmad , Uguen Kévin , Ka Chandran , Callebaut Isabelle , Le Gac Gérald 
Published: July 2024

AbstractSLC40A1 is the sole iron export protein reported in mammals. In humans, its dysfunction is responsible for ferroportin disease, an inborn error of iron metabolism transmitted as an autosomal dominant trait and observed in different ethnic groups. As a member of the major facilitator superfamily, SLC40A1 requires a series of conformational changes to enable iron translocation across the plasma membrane. The influence of lipids on protein stability and its conformational changes has been little investigated to date. Here, we combine molecular dynamics simulations of SLC40A1 embedded in membrane bilayers with experimental alanine scanning mutagenesis to analyze the specific role of glycerophospholipids. We identify four basic residues (Lys90, Arg365, Lys366, and Arg371) that are located at the membrane‐cytosol interface and consistently interact with 1‐palmitoyl‐2‐oleoyl‐sn‐glycero‐3‐phosphocholine (POPC) and 1‐palmitoyl‐2‐oleoyl‐sn‐glycero‐3‐phosphoethanolamine (POPE) molecules. These residues surround a network of salt bridges and hydrogens bonds that play a critical role in stabilizing SLC40A1 in its basal outward‐facing conformation. More deeply embedded in the plasma membrane, we identify Arg179 as a charged amino acid residue also tightly interacting with lipid polar heads. This results in a local deformation of the lipid bilayer. Interestingly, Arg179 is adjacent to Arg178, which forms a functionally important salt‐bridge with Asp473 and is a recurrently associated with ferroportin disease when mutated to glutamine. We demonstrate that the two p.Arg178Gln and p.Arg179Thr missense variants have similar functional behaviors. These observations provide insights into the role of phospholipids in the formation/disruption of the SLC40A1 inner gate, and give a better understanding of the diversity of molecular mechanisms of ferroportin disease.
Do low skeletal muscle bulk and disturbed body fat mass impact tumor recurrence in stage I/II hepatocellular carcinoma undergoing surgery? An observational cohort study
Authors: Lee Chao-Wei , Tsai Hsin-I , Hsu Hsiao-Mei , Yu Ming-Chin , Lee Wei-Chen , Wang Chih-Chi , Hsieh Yi-Chung , Lin Cheng-Yu , Cheng Mei-Ling , Lo Chi-Jen , Wang Ching-Ting , Lin Yu-Ching 
Published: July 2024

Introduction:
The influence of deranged body composition on stage I/II hepatocellular carcinoma (HCC) after surgery remains undetermined. The current study aimed to investigate the impact of low skeletal muscle bulk and disturbed body fat mass on the recurrence outcome of stage I/II HCC patients undergoing liver resection. The associated metabolomic alterations were also assessed.

Methods:
From 2012 to 2021, stage I and II HCC patients who underwent liver resection at our institute were retrospectively reviewed. Their preoperative body composition including skeletal muscle mass and body fat volume was measured by computed tomography (CT). The recurrence outcome was recorded and analyzed. The preoperative serum was collected and subjected to metabolomic analysis.

Results:
A total of 450 stage I and II HCC patients were included in the current study. Among them, 76% were male and around 60% had HBV infection. After stratified by normal cut-off values obtained from a healthy cohort, 6.4% of stage I/II HCC patients were found to have a low psoas muscle index (PMI), 17.8% a high subcutaneous adipose tissue (SAT) index, and 27.8% a high visceral adipose tissue (VAT) index. Cox regression multivariate analysis further demonstrated that low PMI and high SAT index were independent prognostic factors for time-to-recurrence (TTR) after surgery. Metabolomic analysis discovered that free fatty acid β-oxidation was enhanced in patients with low PMI or high SAT index.

Conclusion:
The current study demonstrated that reduced psoas muscle mass may impair while elevated SAT may prolong the TTR of stage I/II HCC patients undergoing liver resections. VAT, on the other hand, was not associated with recurrence outcomes after surgery. Further studies are warranted to validate our findings.
Clinical efficacy of different therapeutic strategies in patients with spontaneous rupture of the esophagus: a multicenter retrospective cohort study
Authors: Luan Siyuan , Xiao Xin , Zeng Xiaoxi , Ren Jie , Liu Wen , Luo Jiwen , Mei Xinyu , Zhou Xinpeng , Li Rulin , Deng Yufeng , Fu Maoyong , Shi Guidong , Du Shijian , Wu Yunhua , Li Chong , Wang Yuncang , Li Gang , Yang Changjie , Zhou Jianfeng , Mao Chengyi , Hu Weipeng , Chen Longqi , Yang Yushang , Yuan Yong 
Published: July 2024

Background:
The therapeutic strategy for patients with spontaneous rupture of the esophagus includes surgical repair, endoscopic therapy, supportive care, and others. However, no evidence exists to direct clinical decision-making regarding the choice of operative and nonoperative management. This study aimed to determine the clinical efficacy of different therapeutic strategies in both general and stratified patients.

Methods:
This study retrospectively analyzed a consecutive cohort of 101 patients at nine tertiary referral hospital centers in China. Patients were divided into operative and nonoperative groups based on the initial treatment. Short-term outcomes, including 90-day mortality, length of hospital stay, and postoperative leakage, were compared. Subgroup analysis was performed based on treatment timing and Pittsburgh perforation severity score.

Results:
Of 101 patients, 60 (58.4%) underwent operative management. A significant difference in 90-day mortality between operative and nonoperative groups was observed (15.0 vs. 34.1%; P=0.031). Operative management tends to yield similar therapeutic benefits in timely [odds ratio (OR), 0.250; 95% confidence interval (CI), 0.05–1.14; P=0.073) and delayed (OR, 0.42; 95% CI, 0.12–1.47; P=0.175) treatment groups. Based on perforation severity score stratification, operative management significantly decreased the risk of 90-day mortality (OR, 0.211; 95% CI, 0.064–0.701; P=0.011) for patients in low-risk and moderate-risk groups but may be detrimental for patients in high-risk group (OR, 1.333; 95% CI, 0.233–7.626; P=0.746).

Conclusions:
Operative management might be superior to nonoperative management for low-risk and moderate-risk patients with spontaneous rupture of the esophagus. However, for patients at high risk, operative management might not provide additional benefits compared with nonoperative management. Further research involving larger sample sizes is required for accurate patient stratification and conclusive evidence-based guidelines.
Pulmonary rehabilitation in idiopathic pulmonary fibrosis
Authors: Dowman Leona M. , Holland Anne E. 
Published: July 2024

Purpose of review
This review synthesizes the expanding evidence for pulmonary rehabilitation that has led to its recommended inclusion in the holistic care of people with idiopathic pulmonary fibrosis (IPF), as well as discussing strategies that may maximize and sustain benefits.

Recent findings
Pulmonary rehabilitation is an effective intervention leading to significant improvements in exercise tolerance, symptoms, and quality of life for people with IPF. Improvements in symptoms and quality of life can persist longer term, whereas functional capacity does not; therefore, strategies to preserve functional capacity are an important area of research. Referral early in the disease course is encouraged to promote longer lasting effects. Evidence that high-intensity interval training may optimize benefits of exercise training is emerging. Supplemental oxygen is frequently used to manage exercise-induced desaturation, although its use as an adjunct therapy requires more evidence.

Summary
Current evidence strongly supports the inclusion of pulmonary rehabilitation in the standard holistic care of IPF, with early participation encouraged. Further research is needed to establish the optimal exercise strategies, modalities and adjunct therapies that enhance outcomes of pulmonary rehabilitation and promote longer lasting effects.
Do Medicare Inpatient Rehabilitation Facility Patients’ Self-care and Mobility Outcomes Vary by Dual Eligibility Status, Race and Ethnicity, Rural Residence, Socioeconomic Status, and Living Alone?
Authors: Deutsch Anne , Palmer Lauren , McMullen Tara , Luke Jordi , Kwon Sophia , Ingber Melvin J. 
Published: July 2024

Objective
The aim of the study is to examine whether inpatient rehabilitation facility patients’ risk-adjusted functional outcomes varied with the following five social drivers of health: Medicare-Medicaid dual eligibility status, race and ethnicity, rural residence, socioeconomic status, and living alone.

Design
This cohort study examined unadjusted and adjusted mobility and self-care change scores during inpatient rehabilitation facility stays for 428,710 Medicare patients with and without social drivers of health. Regression models isolated the mean marginal effect of each of the five social factors on mobility and self-care change scores after adjusting for covariates.

Results
Patients with full dual status had slightly lower risk-adjusted mobility and self-care improvement (−4.5% and −3.3%, respectively) compared with patients without dual status. Patients who identified as Black, Asian, and Native Hawaiian had self-care marginal effects that were slightly lower (−4.8%, −4.1%, and −3.7%, respectively) than patients who were White. Patients living in lower socioeconomic status neighborhoods and patients who lived alone had slightly higher mobility and self-care improvement scores. Risk-adjusted marginal differences in improvement scores for patients with and without these social factors were small and did not meet the meaningfully different criteria.

Conclusion(s)
Overall, inpatient rehabilitation facility patients’ risk-adjusted functional outcomes did not vary meaningfully by dual eligibility status, race or ethnicity, rural residence, socioeconomic status. or living alone.
Characterizing Sentinel Lymph Node Status in Breast Cancer Patients Using a Deep-Learning Model Compared With Radiologists' Analysis of Grayscale Ultrasound and Lymphosonography
Authors: Machado Priscilla , Tahmasebi Aylin , Fallon Samuel , Liu Ji-Bin , Dogan Basak E. , Needleman Laurence , Lazar Melissa , Willis Alliric I. , Brill Kristin , Nazarian Susanna , Berger Adam , Forsberg Flemming 
Published: July 2024

Abstract
The objective of the study was to use a deep learning model to differentiate between benign and malignant sentinel lymph nodes (SLNs) in patients with breast cancer compared to radiologists' assessments.
Seventy-nine women with breast cancer were enrolled and underwent lymphosonography and contrast-enhanced ultrasound (CEUS) examination after subcutaneous injection of ultrasound contrast agent around their tumor to identify SLNs. Google AutoML was used to develop image classification model. Grayscale and CEUS images acquired during the ultrasound examination were uploaded with a data distribution of 80% for training/20% for testing. The performance metric used was area under precision/recall curve (AuPRC). In addition, 3 radiologists assessed SLNs as normal or abnormal based on a clinical established classification. Two-hundred seventeen SLNs were divided in 2 for model development; model 1 included all SLNs and model 2 had an equal number of benign and malignant SLNs. Validation results model 1 AuPRC 0.84 (grayscale)/0.91 (CEUS) and model 2 AuPRC 0.91 (grayscale)/0.87 (CEUS). The comparison between artificial intelligence (AI) and readers' showed statistical significant differences between all models and ultrasound modes; model 1 grayscale AI versus readers, P = 0.047, and model 1 CEUS AI versus readers, P < 0.001. Model 2 r grayscale AI versus readers, P = 0.032, and model 2 CEUS AI versus readers, P = 0.041.
The interreader agreement overall result showed κ values of 0.20 for grayscale and 0.17 for CEUS.
In conclusion, AutoML showed improved diagnostic performance in balance volume datasets. Radiologist performance was not influenced by the dataset’s distribution.