bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immunohistochemical study of mismatch repair and programmed death ligand-1 protein expression in prostatic acinar adenocarcinoma in correlation with patient clinicopathological parameters
Authors: El-Din Somaia A.S. , Halim Mariam I. , Radwan Nehal A. , Sayed Shaymaa G. , Al Hashmi Khalid , Al Sinawi Shadia , Al-Badi Suaad , Al Rashdi Afrah , Al Husaini Samya , Albadi Hajer , Shalaby Asem A. 
Published: August 2024

Background
Castrate-resistant prostate cancer (CRPC) is the main challenge among prostate cancer patients; most are metastatic and eventually resist any treatment. No cure yet exists for them.

Aim
Investigate the immunohistochemical expression of mismatch repair genes (MMR) protein products for loss of expression and programmed death ligand-1 (PDL-1) overexpression in prostatic acinar adenocarcinoma cases as a trial to find benefit from using immune checkpoint inhibitor drugs as a new therapeutic modality, especially in CRPC.

Patients and methods
This study included 166 cases of prostatic acinar adenocarcinoma of different grades and stages along with different responses to therapy including 57% being classified as CRPC. Tissue microarray was applied using mostly three cores from each donor case, resulting in the formation of six new recipient blocks. Immunohistochemical staining for MSH2, MSH6, MLH1, PMS2, and PDL-1 was done. Interpretation of the results, their correlation with all collected clinical and pathological parameters, and statistical analysis of the results were done.

Results
Most of the studied cases showed retained nuclear stain for all MMR genes (MSH2, MSH6, MLH1, PMS2), with total loss of the nuclear stain found in few cases ranging from one (0.7%) case in MLH1 to six (4.2%) cases in MSH2. PDL-1 was expressed in about seven (4.8%) cases. No significant correlation was found between MMR protein loss or PDL-1 expression and the different clinicopathological parameters including CRPC.

Conclusion
The limited cases that showed MMR protein loss or PDL-1 expression may suggest that the immune checkpoint inhibitors are of limited value in CRPC but can be used as the last option after investigations of these markers as still few cases can show these changes. Patchy loss of MMR proteins is suggested to be further investigated by molecular studies.
The Correlation between Tumour Location, Clinicopathological Characteristics and Mismatch Repair Protein (MMR) Status of Colorectal Cancer In Egyptian Patients
Authors: Elgohary Shimaa A , Abdelsalam Shaimaa Mohamed , Khaled Randa Said Taha 
Published: August 2024

Background:
Colorectal cancer (CRC) is considered one of the most common cancers worldwide. By the year of 2035, it is predicted that there will be a dramatic rise of colonic and rectal cancers of 60% and 71.5% respectively. It has been reported that microsatellite instability (MSI) is a genetic target in hereditary nonpolyposis colorectal cancer cases however recent studies have shown that it is also implicated in the development of sporadic cases. MSI/MMR mutations can stimulate tumourigenesis by inactivating tumour suppressor genes and cases with high or deficient MMR (dMMR) have shown a better clinical outcome and response to programmed cell death 1 (PD-1) inhibitors in many studies. Furthermore, right and left sided colon cancers have different clinicopathological features and may display a different MMR status.

Aim of the work:
This work aimed to examine immunohistochemical expression of MMR proteins in colorectal tumours of Egyptian patients and their correlation with the age, sex, tumour grade, histological type and TNM stage to implicate possible therapeutic and prognostic potential.

Material and Methods:
This retrospective study was conducted on 409 cases of archived, formalin fixed paraffin embedded tissue blocks and immunohistochemical staining was performed using monoclonal antibodies against (MLH1, PMS2, MSH2 and MSH6).

Results:
MMR protein expression revealed intact expression (MMR-proficient status) in (84.4%) of the cases while (15.6%) of the cases showed lost protein expression. MMR protein loss was seen more frequently in patients with right side colon cancer compared to left side counterparts and this was statistically highly significant (p=0.001*). MLH1/PMS2 loss was the most frequent pattern while MSH2/MSH6 loss was less frequent. Moreover, a statistically significant correlation was demonstrated between loss of MLH1 and PMS2 among right-side tumours, while left-side CRC tumours revealed obvious loss MSH2 and MSH6. In regards to age and gender, a statistically significant correlation was seen regarding loss of MSH2 (p=0.008*) and MSH6 (p=0.002*). In thirty-eight cases, PMS2 was lost and showed a positive correlation regarding grade (p=0.045*). These results have shown the difference in MMR status of right and left sided colorectal cancers and the potential prognostic and therapeutic impact.

Conclusion:
The frequency of mismatch repair deficiency (dMMR) status in this cohort study carried on Egyptians’ CRC cases was 15.6%. It showed varying expression in right sided CRC in comparison to Left sided ones. The different biological factors regarding right and left sided colonic cancers may be used to identify cases who needs screening and further management.
Role of androgen receptor expression in the metastatic potential of colorectal carcinoma
Authors: Foda Abd AlRahman Mohammad , Sakr Hader I. , Sabry Rania M. , Eldehna Wesal M. , Elaziz Ahmed Elnaghi Khaled Abd , Enan Eman T. 
Published: August 2024

Background
The prevalence of colorectal cancer (CRC) is widespread and associated with significant morbidity and deaths. In CRC, hormone receptors, such as androgen receptors (AR), are pathologically modified. Additional research is required to understand better its function and predictive and therapeutic value in CRC metastatic potential.

Objective
To assess the AR status in CRC primary tumors and metastatic lymph nodes.

Methods
Tissue microarray and immunohistochemical techniques were applied to 75 CRC cases with lymph node (LN) metastases. We correlate the results with all relevant clinicopathological indicators of prognostic relevance.

Results and conclusion
Out of the 75 cases that were analyzed, 16% of CRC primaries and 12% of LN metastases had nuclear AR that was focally positive. AR expression was significantly correlated with advanced age, conventional non-mucinous histology, lower grade, and arousal on top of adenoma. A deeper invasion was likewise linked to AR expression; however, this association was not statistically significant. AR expression has a positive prognostic influence since the median overall and disease-free survival of cases with positive AR expression in either primary carcinomas or LN metastases were significantly higher than that of cases with negative expression in both primary and LN metastases. We assume that AR expression in CRC has a positive prognostic influence.
Evaluation of the effect of vitamin D on the placenta, kidney, and growth of developing fetuses in preeclamptic mice
Authors: Abd El Rahman Sarah H. , El Shabaka Hamza , El Ansary Mervat , Mohammed Hend A. 
Published: August 2024

Background
Preeclampsia (PE) is a complicated syndrome that leads to maternal and fetal morbidity and mortality. PE is defined by the elevation of the mother’s blood pressure (hypertension) and the presence of proteinuria.

Objective
This study aimed to evaluate the effect of vitamin D on 18-day-old mice fetuses in which the PE syndrome was induced in the mother by L-NG-nitro arginine methyl ester (L-NAME).

Materials and methods
The mice grouping was divided as: (a) the control group (group I), (b) the female pregnant mice of the second group intraperitoneally injected with 50 mg/kg/day of L-NAME (group II), (c) the female pregnant mice of the third group were administered orally with 50 IU/kg/day of vitamin D (group III), and (d) the female pregnant mice of the fourth group were intraperitoneally injected with 50 mg/kg/day L-NAME and then orally, with 50 IU/kg/day vitamin D (group IV). All groups were treated daily from 7 to 14 days of gestation.

Results and conclusion
The placenta of mice injected with L-NAME showed different phases of histopathological changes in the basal and labyrinth zone. Meanwhile, the kidney in 18-day-old fetuses maternally injected with L-NAME showed an apparent enlargement in the glomerular area and the presence of hemorrhages among the tubules. However, the 18-day-old fetuses maternally treated with L-NAME and vitamin D (group IV) showed mild injury. This study concluded that induced PE-like symptoms in pregnant mice by L-NAME caused increased fetal growth restriction, impairment of placental histology, and histopathology of the kidneys of fetuses. On the other hand, vitamin D ameliorated the effect of L-NAME and reduced the risk of PE.
Myopic shift in pediatric cataract surgery associated with age and surgical complications
Authors: Menezes Filho Celso , Messias Andre , Silva Paulo Henrique F , Antunes-Foschini Rosalia 
Published: August 2024

Abstract

Purpose:
To investigate predictors for myopic shift after pediatric cataract surgery after at least 3 years follow-up.

Study Design:
Cross-sectional and retrospective study.

Methods:
This study included patients treated for congenital or infantile cataract operated up to 5 years of age between 2010 and 2017. Patients were recruited for ophthalmologic evaluation. Surgical and medical data were acquired in medical charts.

Statistical Analysis:
Univariate and multivariate regressions were performed to look for potential risk factors for myopic shift.

Results:
This study evaluated 81 eyes of 50 patients, with 62 (77%) being bilateral cases, 48 (59%) with intraocular lens implantation, and 37 (74%) patients being strabismic. Age at surgery was 7.7 (3.7–30.5) months and at evaluation was 93.5 (55.1–113.0) months. Total myopic shift was Symbol ‐4.32 ± 3.25 D, significantly greater in patients operated on up to 6 months of life (-5.73 ± 3.14 D). The distant best-corrected visual acuity (BCVA) was 0.6 (0.3–1.0) log of minimum angle of resolution (logMAR). Regarding myopic shift, in univariate analysis, older age at surgery is a protective factor (+0.08 D for each month older, P = 0.001). The presence of strabismus (-2.52 D, P = 0.014), aphakia (-2.45 D, P = 0.006), distant BCVA (-0.15 D per 0.1 logMAR, P = 0.024), and surgical complications (-3.02 D, P = 0.001) are risk factors. In multivariate analysis, older age at surgery (+0.06 D, P = 0.012) and surgical complications (-2.52 D, P = 0.001) remain significant.

Conclusion:
In pediatric cataract surgery, myopic shift is greater when surgery is performed in a younger age and if associated with surgical complications.
Efficacy, safety, and tolerability of lifitegrast 5% eye drops: A randomized, double-blind, active-controlled trial in Indian patients with dry eye disease
Authors: Sharma Namrata , Basu Sayan , Shetty Rohit , Kumar Pramod , Mondal Anindita , Babu P Seshu , Srivastava Richa , Pande Ranjana A , Karat Shubashree , Desai Hemaxi P , Manjula S , Kumar M Krishna 
Published: August 2024

Purpose:
To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED).

Methods:
A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed.

Results:
At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group.

Conclusion:
To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%.
To identify risk factors for central visual field progression in moderate to advanced glaucoma
Authors: Patil Trupti S , Natarajan Viswanathan , George Ronnie 
Published: August 2024

Purpose:
To identify the risk factors for central visual field progression in moderate to advanced glaucoma.

Methods:
We included patients with moderate to advanced primary glaucoma who had undergone at least five reliable Humphrey visual field (HVF) 10-2 tests with follow-up of at least 2 years. Regression slopes for each threshold location on the 10-2 plot were calculated. A test location with a regression slope worsening more than -1 dB/year with P < 0.01 was labeled as a progressing point on point-wise linear regression (PLR) analysis. We compared point-wise progression with progression on the 10-2 mean deviation (defined as a negative MD slope P < 0.05).

Results:
Ninety-six eyes of 74 patients with a median follow-up of 4 years (±1.97) were included. The median mean deviation 10-2 (MD) at inclusion was -19.01 dB (interquartile range [IQR] -13.2 to -24.14). Eighteen eyes (18.75%) had moderate glaucoma and 78 eyes (81.25%) had advanced glaucoma. The baseline median 24-2 MD in moderate glaucoma was -10.35 dB (IQR -11.35 to -9.25) and in advanced glaucoma was -24.96 dB (IQR -28.48 to -18.26). Based on 10-2 PLR, 27 eyes (28%) showed progression. On multivariate logistics regression analysis, the rate of change for 10-2 MD was a risk factor for progression based on 10-2 PLR analysis: odds ratio (OR) 0.04 (95% confidence interval [CI]: 0.006–0.323), P = 0.002, and for progression based on 10-2 MD analysis: OR 0.03 (95% CI: 0.002–0.602), P = 0.02. In addition, average MD 24-2 (OR 1.343 [95% CI: 1.006–1.793], P = 0.04) and visual field index (OR 0.787 [95% CI: 0.649–0.954], P = 0.01) were found to be risk factors based on 10-2 PLR.

Conclusion:
Rate of change for 10-2 mean deviation and baseline damage were predictors of point-wise progression.
Atypical mycobacterial keratitis: Clinical outcome in nonrefractive surgery cases
Authors: Priyadarshini Kshyanaprava , Priyadarshini Smruti Rekha , Sahu Srikant Kumar , Behera Himansu Sekhar , Das Sujata 
Published: August 2024

Purpose:
To identify the predisposing factors, clinico-microbiological profiles, and treatment responses in patients with atypical mycobacterial keratitis.

Methods:
The study retrospectively analyzed patients who presented at a tertiary eyecare center in eastern India with atypical mycobacterial keratitis between 2008 and 2021. The diagnostic criteria included cases positive for acid-fast bacilli on Ziehl–Nielsen stain or culture. The antibiotic susceptibility pattern was observed, and treatment was initiated accordingly.

Results:
Out of the 29 cases, ocular predisposing factors were present in 62.1% with an antecedent history of trauma, and vegetative matter was the most common risk factor. There was no predisposing association with systemic conditions in any case. A long lag time was observed between the onset of corneal infection and presentation in 79.3% of cases, with the average time being 43.7 days. Clinical signs mimicked fungal keratitis in most cases. Typical cracked windshield appearance was only observed in two cases. Two patients presented with clinical pictures like peripheral ulcerative keratitis. Topical amikacin was used as treatment in 28 cases. Based on disk diffusion assay, 28 (96.5%) isolates were sensitive to amikacin. Twelve (41.3%) were sensitive to vancomycin, six (20.6%) to gatifloxacin, six (20.6%) to ciprofloxacin, and four (13.7%) to moxifloxacin. Twelve participants showed good final visual acuity posttreatment, which improved to over two lines of Snellen’s visual acuity chart (44.5%).

Conclusion:
Atypical mycobacteria keratitis may not present with classically described clinical features. The duration of presentation, clinical presentation, special microbiological stains, targeted therapy, and antibiotic susceptibility patterns are the key to successfully managing these intractable infections and obtaining favorable outcomes.
Sugar-Sweetened Beverages and Diet Related Chronic Non-Communicable Diseases in Sub-Saharan Africa
Authors: Amu Hubert , Dotse Priscilla A. N. , Atimbisa Jennifer , Ohipeni Doris K. , Kamal Sarat , Charles-Unadike Veronica O. , Addo Phyllis , Baiden Frank E. 
Published: August 2024

abstract
In Sub-Saharan Africa (SSA), diet-related chronic non-communicable diseases (DR-CNCDs) pose a growing public health threat, jeopardising progress towards achieving Sustainable Development Goal 3.4. One contributing factor to this rising threat is the recent surge in consumption of sugar-sweetened beverages (SSBs), across SSA in recent years. Using the socio-ecological model, this commentary explores the nexus between DR-NCDs and SSBs and offers interventions to address this public health challenge at the individual, interpersonal, community, organisational and policy levels. At the individual level, health education campaigns should target individuals and ensure an increase in awareness creation. The life-course approach underscores the importance of promoting healthier dietary choices from childhood to prevent diet-related non-communicable diseases in later life. Schools and workplaces enforcing local policies that discourage SSB consumption patterns will make a huge difference at the community and organisational levels. At the societal/policy level, comprehensive strategies such as sugar taxes, front-of-pack labelling, advertising restrictions and health education programmes are crucial.
A Targeted Clinical Reasoning Remediation Program for Residents and Fellows in Need
Authors: Parsons Andrew S. , Dreicer Jessica J. , Martindale James R. , Young Gregory , Warburton Karen M. 
Published: August 2024

ABSTRACT
Background There is no standardized, widely accepted process for individualized clinical reasoning remediation.
Objective We describe a novel, targeted assessment and coaching process that allows for individualized intervention for residents and fellows struggling with clinical reasoning.
Methods Residents and fellows at the University of Virginia with performance concerns are referred to COACH (Committee on Achieving Competence Through Help) and assessed by a remediation expert. A subset is referred to a clinical reasoning remediation coach who performs an additional assessment and cocreates an individualized remediation plan. Following remediation, residents and fellows are reassessed by their respective programs. We report the frequency of struggle, remediation time invested, and academic outcomes.
Results From 2017 to 2022, 114 residents and fellows referred to COACH met inclusion criteria, of which 38 (33%) had a deficiency in clinical reasoning. Targeted assessment revealed the following microskill deficits: hypothesis generation (16 of 38, 42%); data gathering (6 of 38, 16%); problem representation (7 of 38, 18%); hypothesis refinement (3 of 38, 8%); and management (6 of 38, 16%). Remediation required a mean of nearly 23 hours per trainee. Of the 38 trainees, 33 (87%) are in good standing at the time of writing.
Conclusions Our unique program offers a feasible, targeted approach to clinical reasoning remediation based on our current understanding of the clinical reasoning process. Early hypothesis generation was the most common microskill deficit identified.
Streamlining Communication: “Resident Huddle” on General Medicine Wards at a Veterans Affairs Hospital
Authors: Litwin Liat , McGarry Brian , McGhee Bryn , Kent Kyle , Warner Scott , Hunsaker Shona , Smeraglio Andrea 
Published: August 2024

ABSTRACT
Background Orienting medical trainees to new practice environments is essential. Huddles have been shown to improve communication and safety outcomes. However, their use in orienting trainees to systems processes and changes on inpatient general medicine (GM) wards remains unexplored.
Objective Implement a weekly inpatient huddle between residents and hospital leaders to improve dissemination of information around health system operations.
Methods In 2019, we established “Resident Huddle,” a weekly 20-minute huddle for senior internal medicine residents rotating on GM wards at a US Department of Veterans Affairs Hospital led by the site leads. Resident Huddle content included system updates, rotation updates, process reminders, performance feedback, and systems and patient safety concerns raised by trainees. Reactions to the huddle were assessed via survey. Behavioral change was assessed by rates of complete trainee admission medication reconciliation documentation before and after huddle implementation.
Results Resident Huddle started in October 2019 and continues to this day. Between October 2019 and June 2022, 136 of 205 participants completed surveys (66% response rate). Respondents agreed or strongly agreed that the huddle provided useful information for care delivery (94%, 128 of 136), improved work engagement (73%, 99 of 136), provided feedback on practice patterns (90%, 121 of 135), and that issues they experienced were acknowledged and acted upon (86%, 114 of 133). Retrospective medical record analysis demonstrated improvement in admission medication reconciliation completion rate by trainees from pre-intervention (32%, 19 of 60) to post-intervention (73%, 44 of 60).
Conclusions A weekly huddle between hospital leaders and residents strengthened communication and equipped trainees with operational health systems knowledge to enhance patient care outcomes while fostering a greater sense of engagement with their work environment.