bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study
Authors: Regnault Hélène , Chalaye Julia , Galetto-Pregliasco Athena , Perrin Clara , Derbel Haytham , Amaddeo Giuliana , Mulé Sébastien , Lequoy Marie , Kobeiter Hicham , Reizine Edouard , Itti Emmanuel , Duvoux Christophe , Laurent Alexis , Leroy Vincent , Sommacale Daniele , Rasolonirina Diana , Luciani Alain , Calderaro Julien , Tacher Vania , Brustia Raffaele 
Published: June 2024

Background:
Selective internal radiation therapy (SIRT) is recommended as a downstaging (DS) strategy for solitary unresectable HCC <8 cm. The aim of this study was to report the results of acquired experience in a tertiary center for all unresectable HCCs.

Methods:
We conducted a retrospective, observational study using data collected from consecutive patients undergoing SIRT between October 2013 and June 2020. DS was considered achieved when a curative treatment could be proposed 6 months after SIRT.

Results:
One hundred twenty-seven patients were included (male = 90%, 64 ± 11 y), of whom 112 (n = 88%) had cirrhosis. HCC was classified as BCLC stage C in 64 patients (50%), with a median diameter of 61 mm, an infiltrative pattern in 51 patients (40%), and portal vein invasion in 62 (49%) patients. Fifty patients (39%) achieved DS 6 months following SIRT, with 29 of them (23%) undergoing curative treatment in a median time of 4.3 months: 17 (13%) were transplanted, 11 (85%) had liver resection, and 1 patient had a radiofrequency ablation. The median overall survival of patients with or without DS was 51 versus 10 months, respectively (p < 0.001). In patients who achieved DS, progression-free survival was higher in patients who underwent surgery: 47 versus 11 months (p < 0.001). Four variables were independently associated with DS: age (OR: 0.96, 95% CI: [0.92, 0.99]; p = 0.032), baseline α-fetoprotein (OR: 1.00, 95% CI: [1.00, 1.00]; p = 0.034), HCC distribution (OR: 0.3, 95% CI: [0.11, 0.75]; p = 0.012), and ALBI grade (OR: 0.34. 95% CI: [0.14, 0.80]; p = 0.014).

Conclusions:
These results suggest that SIRT in patients with unresectable HCC could be an effective treatment: DS was achieved for around 39% of the patients and more than half of these then underwent curative treatment.
Screening patients in general practice for advanced chronic liver disease using an innovative IT solution: The Liver Toolkit
Authors: Prince David S. , Hoque Shakira , Kim Christy , Maher Salim , Miller Jane , Chomley Phoebe , Pritchard-Jones Janice , Spruce Sally , McGarry Nathan , Baker David , Elix Penelope , Liu Ken , Strasser Simone I. , Goodger Brendan , Zekry Amany , McCaughan Geoffrey W. 
Published: June 2024

Background:Identifying patients with undiagnosed advanced chronic liver disease (ACLD) is a public health challenge. Patients with advanced fibrosis or compensated cirrhosis have much better outcomes than those with decompensated disease and may be eligible for interventions to prevent disease progression.Methods:A cloud-based software solution (“the Liver Toolkit”) was developed to access primary care practice software to identify patients at risk of ACLD. Clinical history and laboratory results were extracted to calculate aspartate aminotransferase-to-platelet ratio index and fibrosis 4 scores. Patients identified were recalled for assessment, including Liver Stiffness Measurement (LSM) via transient elastography. Those with an existing diagnosis of cirrhosis were excluded.Results:Existing laboratory results of more than 32,000 adults across nine general practices were assessed to identify 703 patients at increased risk of ACLD (2.2% of the cohort). One hundred seventy-nine patients (26%) were successfully recalled, and 23/179 (13%) were identified to have ACLD (LSM ≥10.0 kPa) (10% found at indeterminate risk [LSM 8.0–9.9 kPa] and 77% low risk of fibrosis [LSM <8.0 kPa]). In most cases, the diagnosis of liver disease was new, with the most common etiology being metabolic dysfunction–associated steatotic liver disease (n=20, 83%). Aspartate aminotransferase-to-platelet ratio index ≥1.0 and fibrosis 4 ≥3.25 had a positive predictive value for detecting ACLD of 19% and 24%, respectively. Patients who did not attend recall had markers of more severe disease with a higher median aspartate aminotransferase-to-platelet ratio index score (0.57 vs. 0.46,p=0.041).Conclusions:This novel information technology system successfully screened a large primary care cohort using existing laboratory results to identify patients at increased risk ACLD. More than 1 in 5 patients recalled were found to have liver disease requiring specialist follow-up.
Arterial stiffness and cardiovascular risk in patients with nephrolithiasis: a 10-year prospective study
Authors: Comellato Gabriele , Caletti Chiara , Giani Anna , Macchi Federica , Mazzali Gloria , Faccioli Silvia , Zoico Elena , Andreola Stefano , Gambaro Giovanni , Zamboni Mauro , Fantin Francesco 
Published: June 2024

Background:
Nephrolithiasis is frequently associated with cardiovascular diseases. These conditions present common risk factors: systemic inflammation that promotes oxidative stress leading to arterial wall stiffening may also play a role in plaque formation predisposing to nephrolithiasis.

Objectives:
The aim of this study was to evaluate arterial stiffness indices at baseline and after a 10-year follow-up, in patients with nephrolithiasis compared with patients without.

Methods:
A total of 82 patients (37 men; mean age 45 ± 13 years) were enrolled at the Geriatrics and Nephrology Outpatient Clinic: 66 were diagnosed with nephrolithiasis, whereas the control group consisted of 16 individuals. At baseline and after 10 years, they underwent clinical evaluation and arterial stiffness measurement, such as carotid-femoral pulse wave velocity (CF-PWV), by arterial applanation tonometry.

Results:
At baseline, when compared with the control group, patients with nephrolithiasis showed higher SBP and CF-PWV. After 10 years, patients with nephrolithiasis, but not those without, showed a significant raise in CF-PWV, even after adjustment for age and sex. In a stepwise regression model, with CF-PWV changes during the follow-up as the dependent variable, and age, sex, follow-up years, Δ mean arterial pressure, BMI, hypertension and nephrolithiasis as independent variables, nephrolithiasis was proved to be the only significant predictor of ΔCF-PWV, accounting for 6% of the variance.

Conclusion:
Our study shows higher baseline CF-PWV and greater increase in ΔCF-PWV within 10 years in individuals with nephrolithiasis than in those without, demonstrating an increased cardiovascular risk for nephrolithiasis patients.
Anterior Chamber Angle and Intraocular Pressure Control After Phacoemulsification in Primary Angle Closure With Different Mechanisms
Authors: Song Woo Keun , Sung Kyung Rim , Kim Ko Eun 
Published: June 2024

Précis:
Different mechanisms of angle closure represented distinct aspects of intraocular pressure (IOP) control after phacoemulsification. Classification of angle closure mechanisms is necessary for postoperative IOP management and glaucoma progression in primary angle closure eyes.

Purpose:
To investigate the relationship between the anterior chamber angle (ACA) characteristics, measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in eyes with primary angle closure disease (PACD) with different angle closure mechanisms.

Methods:
PACD eyes were classified into 3 groups according to angle closure mechanisms using preoperative SS AS-OCT images; pupillary block (PB), plateau iris configuration (PIC), exaggerated lens vault (ELV). This retrospective, clinical cohort study included eighty-five eyes of 85 PACD patients: 34 with PB, 23 with PIC, and 28 with ELV. ACA parameters were measured preoperatively and 1 month postoperatively using SS AS-OCT. IOP measurements were performed preoperatively and during 6 months postoperatively. Postoperative IOP reduction and fluctuation were calculated, and their correlations with SS AS-OCT parameters were analyzed.

Results:
PIC group showed the lowest postoperative IOP reduction compared with the other groups (P=0.023). Preoperative ACA measurements were significantly associated with postoperative IOP reduction in ELV and PB groups, while postoperative measurements were in PIC group. Preoperative and postoperative change of iridotrabecular contact (ITC) index and area were correlated with postoperative IOP reduction in PB and ELV groups but not in PIC group. Postoperative ITC index (P=0.031) and area (P=0.003) showed significant correlations with postoperative IOP fluctuation only in PIC group.

Conclusions:
SS AS-OCT parameters including ITC index and area showed different associations with postoperative IOP control, which should be considered in determination of lens extraction and treatment of PACD eyes.
Arginine-Proline Metabolism as a Mediator in the Association Between Coal Dust Exposure and Lung Function
Authors: Su Xuesen , Sun Yuanyuan , Shi Yiwei , Kong Xiaomei , Liu Ting , Dong Hantian , Yu Xiao , Xue Ting , Zhang Chenwei , Zhang Xinri 
Published: June 2024

Objectives
To investigate the mediating role of the activation degree of arginine-proline metabolism in the association of coal dust and decreased lung function.

Methods
Cumulative dust exposure (CDE) represented coal dust exposure, whereas the hydroxyproline-to-arginine concentration ratio (Hyp/Arg) in bronchoalveolar lavage fluid gauged arginine-proline metabolism activation. Pulmonary function indicators, including predicted value of forced vital capacity (FVC%pred), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC%), and the ratio of actual to predicted value of FEV1 (FEV1%pred), diffusing capacity of the lungs for carbon monoxide (DLCO%pred), difference value between alveolar air and arterial partial oxygen pressure (P(A−a) O2), and 6-minute walking distance test (6MWT), were assessed.

Results
Findings revealed a significant association between elevated CDE and increased Hyp/Arg, increased P(A−a) O2, decreased 6MWT, DLCO%pred, and decreased FVC%pred. However, no statistically significant association was found between CDE and FEV1%pred or FEV1/FVC%. The mediating effect of Hyp/Arg was significant for CDE’s impact on P(A−a) O2 and DLCO%pred but not on 6MWT and FVC%pred.

Conclusions
These results highlight the role of Hyp/Arg in mediating the association between CDE and lung function parameters, shedding light on potential therapeutic avenues for mitigating coal dust–induced lung function impairment.
The New Semisynthetic TORP: A Prosthesis for Ossicular Reconstruction Both With the Absence and the Presence of the Stapes Superstructure
Authors: Malafronte Giuseppe , Fetoni Anna Rita , Motta Gaetano , Presutti Livio 
Published: June 2024

Objectives
To describe the new semisynthetic total ossicular replacement prosthesis (New-SSTORP) and to evaluate the New-SSTORP ossiculoplasty results both with the presence and absence of the stapes superstructure.

Study Design
Prospective study.

Setting
Tertiary referral center.

Methods
From April 2023 to May 2023, 18 New-SSTORP ossiculoplasties were performed by the first author. In all patients, the New-SSTORP was interposed between the footplate and the eardrum. The study group was divided into two groups (group A and group B). Group A included 13 patients with the absence of stapes superstructure. Group B included five patients with the presence of stapes superstructure. A successful reconstruction was defined as a postoperative air-bone gap ABG ≤20 dB. For all patients of groups A and B, the last audiometric control considered was performed in January 2024. The mean follow-up was 8½ months. The χ
2 test was used to compare results. p < 0.05 was considered significant.

Main Outcome Measures
Mean postoperative ABG ≤20 dB

Results
At the end of follow-up, the overall success rate (ABG ≤20 dB) of New-SSTORP ossiculoplasty was obtained in 88.8% (n = 16 of 18) of cases. In group A, the success rate of New-SSTORP ossiculoplasty occurred in 84.6% (n = 11 of 13) of cases, and in group B, the success rate of New-SSTORP ossiculoplasty occurred in 100% (n = 5 of 5) of cases. There was no audiological statistically significant difference between groups A and B (Fisher value is 1; p < 0.05). In all cases, the time for positioning of New-SSTORP was about 5 minutes

Conclusion
The New-SSTORP has a minimal technical challenge for building and placement. The New-SSTORP ossiculoplasty results are very good both with the presence and absence of SS.
Vasopressin, protein metabolism, and water conservation
Authors: Carty Joshua S. , Watts Jason A. , Arroyo Juan Pablo 
Published: June 2024

Purpose of review
Highlight the mechanisms through which vasopressin and hypertonic stress regulate protein metabolism

Recent findings
Mammals have an ‘aestivation-like’ response in which hypertonic stress increases muscle catabolism and urea production
Vasopressin can directly regulate ureagenesis in the liver and the kidney
In humans chronic hypertonic stress is associated with premature aging, diabetes, cardiovascular disease, and premature mortality

Summary
There is an evolutionarily conserved ‘aestivation-like’ response in humans in which hypertonic stress results in activation of the vasopressin system, muscle catabolism, and ureagenesis in order to promote water conservation.
Bidirectional relationship between acute pancreatitis and pancreatic cancer
Authors: Jeon Christie Y. , Arain Mustafa A. , Korc Murray , Kozarek Richard A. , Phillips Anna E. 
Published: June 2024

Purpose of review
The burdens of pancreatic ductal adenocarcinoma (PDAC) and acute pancreatitis are increasing globally. We reviewed current literature on whether acute pancreatitis is a causal factor for PDAC and examined clinical manifestations of PDAC-associated acute pancreatitis.

Recent findings
Recent findings detail the timing of acute pancreatitis before and after PDAC occurrence, further solidifying the evidence for PDAC-associated acute pancreatitis and for acute pancreatitis as a causal risk factor for PDAC. The risk of PDAC remains elevated above the general population in patients with distant history of acute pancreatitis. PDAC risk also increases with recurrent acute pancreatitis episodes, independent of smoking and alcohol. Mechanisms linking acute pancreatitis to PDAC include inflammation and neutrophil infiltration, which can be attenuated by suppressing inflammation and/or epigenetic modulation, thus slowing the progression of acinar-to-ductal metaplasia. Clinical presentation and management of acute pancreatitis in the context of PDAC are discussed, including challenges acute pancreatitis poses in the diagnosis and treatment of PDAC, and novel interventions for PDAC-associated acute pancreatitis.

Summary
PDAC risk may be reduced with improved acute pancreatitis prevention and treatment, such as antiinflammatories or epigenetic modulators. Increased acute pancreatitis and PDAC burden warrant more research on better diagnosis and management of PDAC-associated acute pancreatitis.
Urologic oncology considerations in transgender and gender diverse patients
Authors: Tinajero Juan , Rashid Tina 
Published: June 2024

Purpose of review
This review delves into the pressing issue of urologic oncology considerations within the transgender and gender-diverse (TGD) community. With estimates suggesting that TGD individuals constitute 0.3 to 0.5% of adults worldwide, and this number steadily rising, our review examines the barriers that impede the delivery of excellent quality care, particularly in the context of cancer diagnosis and treatment.

Recent findings
Recent findings highlight disparities in cancer screening, diagnosis, and treatment access for TGD individuals. These challenges are compounded by a dearth of research and the failure of healthcare systems to account for gender identity and its nuances in data collection. Main themes in the literature include the impact of gender-affirming hormone therapy and surgery on cancer risk, challenges in prostate cancer screening and management, and considerations pertinent to testicular and other urological cancers in TGD patients.

Summary
The implications for clinical practice and research are profound and emphasize the need for multidisciplinary approaches that cater to the unique healthcare needs of TGD individuals. This includes comprehensive strategies for inclusive and accurate data collection, alongside the development of evidence-based guidelines for cancer screening and management tailored specifically to this population.
Atypical Presentations of Pediatric-Acquired Thrombotic Thrombocytopenic Purpura
Authors: Ziv Amit , Dardik Rima , Yacobovich Joanne , Uziel Yosef , Haviv Ruby , Avishai Einat , Kenet Gili , Toren Amos , Barel Ortal , Barg Assaf Arie 
Published: June 2024

Background:
Immune thrombotic thrombocytopenic purpura (iTTP) in children is a rare, severe thrombotic microangiopathy. This condition is characterized by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia due to reduced activity of the von Willebrand factor-cleaving protease ADAMTS13.

Methods:
A retrospective case series evaluating data collected from the medical files of 4 children diagnosed with iTTP.

Results:
The presented case series depicts a variety of iTTP presentations: 1 case of primary iTTP, 1 case induced by Shiga toxin, 1 associated with RAS-associated autoimmune leukoproliferative disease (RALD), and 1 initial manifestation of systemic lupus erythematosus (SLE). Notably, 2 patients recovered without undergoing plasma exchange.

Conclusion:
Early ADAMTS13 testing in children with unexplained hemolysis or thrombocytopenia is crucial. The diverse underlying causes, including infections and autoimmune disorders, underscore the complexity of iTTP in the pediatric population. These cases highlight the necessity for personalized treatment approaches that consider each patient's unique clinical situation and potential alternatives or modifications to conventional therapeutic regimens.
Association Among Individual Race, Hospital Racial Composition, and Access to Minimally Invasive Hysterectomy for Patients With Uterine Leiomyomas
Authors: Yoh Katherine , Prest Matthew , Huang Yongmei , Hou June Y. , Clair Caryn M. St. , Pua Tarah , Buckley Alexander , Khoury-Collado Fady , Accordino Melissa , Hershman Dawn L. , Wright Jason D. 
Published: June 2024

OBJECTIVE:
To assess the relative associations of individual race and hospital racial composition on the likelihood of undergoing minimally invasive hysterectomy for the treatment of uterine leiomyomas in New York State.

METHODS:
We performed a retrospective cohort study that used the New York SPARCS (Statewide Planning and Research Cooperative System) database to identify women with uterine leiomyomas who underwent hysterectomy from 2000 to 2018. Hospitals were grouped by racial composition into quartiles based on the proportion of non-Hispanic Black (Black) patients, with quartile 1 corresponding to the lowest proportion of Black patients and quartile 4 corresponding to the greatest proportion of Black patients. Surgical route was characterized as minimally invasive (laparoscopic, vaginal, or robot-assisted) or abdominal hysterectomy. The contributions of individual race and hospital racial composition on route of hysterectomy were assessed with a series of logistic regression models accounting for patient and hospital characteristics.

RESULTS:
A total of 259,161 women with leiomyomas who underwent hysterectomies at 215 hospitals were identified. The rate of minimally invasive hysterectomy increased from 20.2% in 2000 to 65.7% in 2018. From 2000 to 2009, 29.6% of White patients underwent minimally invasive hysterectomy compared with 12.3% of Black women (P<.001). Minimally invasive hysterectomy was performed in 34.4% of patients in hospitals that served the lowest percentage of Black patients, compared with 15.9% in centers serving the highest percentage of Black patients (P<.001). Similar trends were noted for the 2010–2018 time period. In a series of models, both individual race (odds ratio [OR] 0.52; 95% CI, 0.48–0.56) and hospital racial quartile (OR 0.43; 95% CI, 0.32–0.58) remained associated with performance of minimally invasive hysterectomy.

CONCLUSION:
Black women and women who receive care at hospitals that serve a greater proportion of Black patients are less likely to receive minimally invasive surgery when undergoing definitive surgical management for uterine leiomyomas. These disparities are worsening.
Induced Abortion and Out-of-State Travel Among Insured Women Before and After the Dobbs v. Jackson Women's Health Organization Decision
Authors: Odouard Ilina C. , Guadamuz Jenny S. , Chakraborty Apurba , Alexander G. Caleb , Qato Dima M. 
Published: June 2024

OBJECTIVE:
To quantify changes in abortion rates and out-of-state travel for abortion among insured women before and after the Dobbs v. Jackson decision.

METHODS:
This was a cross-sectional analysis of IQVIA's anonymized, patient-level preadjudicated medical claims on induced medication or procedural abortions among 43.1 million insured women of reproductive age (15–49 years) in the United States. We used information from the Guttmacher Institute to stratify states based on post-Dobbs abortion access policy: 1) legal with protections, 2) legal with restrictions, 3) partial ban, and 4) full ban. The main outcomes were 1) total number and rate of abortions per 100,000 women of reproductive age and 2) proportion of women with out-of-state abortions before (July–December 2021) and after (July–December 2022) Dobbs.

RESULTS:
Between January 2021 and December 2022, a total of 212,875 women of reproductive age (mean±SD age 28.1±6.5 years) had at least one induced abortion. In a comparison of the pre-Dobbs period with the post-Dobbs periods, there were increases in both the total number of women with at least one abortion (from 54,634 to 57,017) and the rate of abortions (from 121.7 to 137.7/100,000). Increases in abortion rates were driven primarily by states where abortion is legal with protections (from 278.5 to 328.5/100,000), whereas abortion rates declined slightly in states with partial (from 16.1 to 15.0/100,000) and full (from 7.2 to 6.8/100,000) abortion bans. Increases in the percentage of women traveling out of state to obtain an abortion were observed only in restrictive states and were greatest in states with full abortion bans (27.4% before Dobbs to 53.4% after Dobbs) (P<.001).

CONCLUSION:
There was a modest increase in abortion rates among insured women nationally after Dobbs, with modest increases in abortions among residents of states with protective abortion policies and increases in out-of-state abortions among residents of full- and partial-ban states.