bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detective flow imaging versus contrast-enhanced EUS in solid pancreatic lesions
Authors: Mulqui Maria Victoria , Caillol Fabrice , Ratone Jean Philippe , Hoibian Solène , Dahel Yanis , Meunier Élise , Archimbaud Clément , Giovannini Marc 
Published: August 2024

Abstract

Background and objectives
Detective flow imaging EUS (DFI-EUS) is a new technology that detects fine vessels and low-flow velocity without contrast agents, used in real time during EUS, with a better resolution compared to usual technologies such as color Doppler and eFLOW. The aim of this study was to compare DFI-EUS with contrast-enhanced EUS (CE-EUS) for the evaluation of vascularization in solid pancreatic lesions.

Methods
We included patients who had a pancreatic mass visualized by EUS, with recorded images of their assessment in DFI-EUS and CE-EUS techniques and a histological diagnosis confirmed malignant tumors or a minimum of 1-year follow-up for benign lesions.

Results
Of the 107 patients included in this retrospective single-center study, the histological diagnosis revealed 69 cases (64.5%) of pancreatic adenocarcinoma, 18 cases (16.8%) of neuroendocrine tumors (NETs), and 10 cases (9.3%) of metastases from nonpancreatic cancers. A smaller proportion (9.4%) exhibited other lesions. As a result, the incidence of intralesional microvascularization was 43.9% with DFI-EUS and 48.6% with CE-EUS, indicating a positive correlation between the 2 techniques (P = 0.0001). Compared to CE-EUS, DFI-EUS exhibited sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88.5%, 98.2%, 97.9%, and 90%, respectively, for the detection of intralesional vessels.

Conclusions
The novel technique DFI-EUS demonstrates a remarkable correlation with CE-EUS, exhibiting high sensitivity and specificity for the assessment of microvascularization in solid pancreatic lesions. This method eliminates the need for a contrast agent, thus carrying no risk of adverse effects.
Current Concepts in Brachial Plexus Birth Injuries: A Comprehensive Narrative Review
Authors: Khabyeh-Hasbani Nathan , O’Brien Devon M. , Meisel Erin M. , Koehler Steven M. 
Published: August 2024

Background:
Brachial plexus birth injury (BPBI) encompasses a spectrum of upper extremity paralysis cases following childbirth. The etiology of BPBI is multifactorial, involving maternal, obstetric, and neonatal associative factors. Despite opportunities for spontaneous recovery, recent literature demonstrates that a significant proportion of infants experience residual deficits and functional limitations as they age. Understanding the complex anatomy of the brachial plexus, clinical presentations of the pathology, diagnostic workup, current treatment options, and common secondary sequelae is instrumental for appropriate management of BPBI.

Methods:
Following a comprehensive search strategy used by the authors to identify relevant literature relating to the progression, patho-anatomy, clinical presentation, management, and treatment of BPBI, this comprehensive narrative review outlines current approaches to assess, manage, and advance BPBI care.

Results:
We advocate for prompt referral to specialized multicenter brachial plexus clinics for accurate diagnosis, timely intervention, and individualized patient-centered assessment. Further research is needed to elucidate mechanisms of injury, refine diagnostic protocols, and optimize long-term outcomes.

Conclusions:
Collaboration between healthcare providers and families is paramount in providing comprehensive care for infants with BPBI. This review offers insights into the current understanding and management of BPBI, highlighting the importance of tailored approaches and intraoperative decision-making algorithms to optimize functional outcomes.
Use of HEMHealing, an Oxygenating Dressing in the Treatment of a Full-thickness Burn on the Fingertips
Authors: Awan Tamer O. , Lhuaire Martin , Lantieri Laurent 
Published: August 2024

Summary:
The optimal treatment for full-thickness burn injuries involves surgical intervention, which may include skin grafting or reconstruction by flap. The complexity of treatment arises from the need for both effective temporary wound coverage and permanent skin restoration while also considering the potential risk of finger amputation in the case of hand burn. A 22-year-old woman sustained a thermal burn of three fingers while participating in an art activity involving wax hand molding. Initial treatment with a standard oily dressing did not yield satisfactory results, and the option to try HEMHealing was offered, a new oxygenating biological gel dressing, resulting in progressive debridement, granulation, and epithelialization of the wound. Complete healing was achieved within 10 and 15 days for the second and fourth fingers, respectively, and within 8 weeks for the third finger. The use of HEMHealing, in this case, most likely contributed to accelerating wound healing, promoting the growth of new tissues, improving local tissue oxygenation, and avoiding a disabling distal amputation.
Extracorporeal Membrane Oxygenation Pathway for Management of Refractory Cardiac Arrest: a Retrospective Study From a National Center of Extracorporeal Cardiopulmonary Resuscitation
Authors: Shehatta Ahmed Labib , Kaddoura Rasha , Orabi Bassant , Mohamed Ibrahim Mohamed Izham , El-Menyar Ayman , Alyafei Sumaya Alsaadi , Alkhulaifi Abdulaziz , Ibrahim Abdulsalam Saif , Hassan Ibrahim Fawzy , Omar Amr S. 
Published: August 2024

Background:
Cardiac arrest remains a critical condition with high mortality and catastrophic neurological impact. Extracorporeal cardiopulmonary resuscitation (ECPR) has been introduced as an adjunct in cardiopulmonary resuscitation modalities. However, survival with good neurological outcomes remains a major concern. This study aims to explore our early experience with ECPR and identify the factors associated with survival in patients presenting with refractory cardiac arrest.

Methods:
This is a retrospective cohort study analyzing 6-year data from a tertiary center, the country reference for ECPR. This study was conducted at a national center of ECPR. Participants of this study were adult patients who experienced witnessed refractory cardiopulmonary arrest and were supported by ECPR. ECPR was performed for eligible patients as per the local service protocols.

Results:
Data from 87 patients were analyzed; of this cohort, 62/87 patients presented with in-hospital cardiac arrest (IHCA) and 25/87 presented with out-of-hospital cardiac arrest (OHCA). Overall survival to decannulation and hospital discharge rates were 26.4% and 25.3%, respectively. Among survivors (n = 22), 19 presented with IHCA (30.6%), while only 3 survivors presented with OHCA (12%). A total of 15/87 (17%) patients were alive at 6-month follow-up. All survivors had good neurological function assessed as Cerebral Performance Category 1 or 2. Multivariate logistic regression to predict survival to hospital discharge showed that IHCA was the only independent predictor (odds ratio: 5.8, P = 0.042); however, this positive association disappeared after adjusting for the first left ventricular ejection fraction after resuscitation.

Conclusions:
In this study, the use of ECPR for IHCA was associated with a higher survival to discharge compared to OHCA. This study demonstrated a comparable survival rate to other established centers, particularly for IHCA. Neurological outcomes were comparable in both IHCA and OHCA survivors. However, large multicenter studies are warranted for better understanding and improving the outcomes.
Plasma Clozapine and N-Desmethylclozapine (Norclozapine) Concentrations and the Clozapine/Norclozapine Ratio
Authors: Flanagan Robert James , Obee Stephen John , Kim Alice Hyun Min , Every-Palmer Susanna 
Published: August 2024

Abstract

Background
Smoking enhances plasma clozapine clearance, but the magnitude of the effect across the dose and age ranges is unclear.

Methods
We audited clozapine dose and predose plasma clozapine and N-desmethylclozapine (norclozapine) concentrations by sex and smoking habit in samples submitted for clozapine TDM, 1996–2017.

Results
There were 105,316/60,792 and 34,288/31,309 samples from male/female smokers/nonsmokers, respectively. There were distinct dose–median plasma concentration trajectories for male/female smokers/nonsmokers across the range <50 to >850 mg d−1. For both sexes, the percentage difference in median plasma clozapine in nonsmokers versus smokers averaged 50% but was greatest for men (76%) and women (59%) in the 151 to 250 mg d−1 dose band. In men, the percentage difference declined steadily to 34% at doses of ≥850 mg d−1. In women, the difference after falling initially remained relatively constant at 40% to 54%. The pattern in median plasma clozapine/norclozapine ratio by plasma clozapine concentration and dose groups was independent of sex and smoking habit, but increased with plasma clozapine concentration (higher ratio at higher concentrations) and also changed with dose. Median plasma clozapine concentration and median clozapine dose by sex and smoking habit were similar up to age 60 years. Proportional weight gain was similar over time in smokers and nonsmokers of either sex.

Implications
These data explain the variations in the effect size of starting or stopping smoking on plasma clozapine concentration at constant dose reported in different studies. Changes in smoking habit in patients prescribed clozapine require prompt dose adjustment.
The feasibility of targeted axillary dissection for breast cancer axillary surgery de-escalation after neoadjuvant therapy: a prospective cohort study
Authors: Fan Qing-Da , Bi Zhao , Gong Li-Guo , Chen Peng , Cong Bin-Bin , Duan Bao-wei , Chen Yu-Guang , Qiu Peng-Fei , Wang Yong-Sheng 
Published: August 2024

Purpose:
Targeted axillary dissection (TAD) after neoadjuvant therapy (NAT) includes the removal of both marked and sentinel lymph nodes (SLNs). The aim was to investigate the optimization of TAD localization techniques after NAT in breast cancer patients.

Methods:
From November 2020 to 2022, the authors prospectively enrolled 107 lymph node-positive breast cancer patients at Shandong Cancer Hospital, all of them received complete cycles of NAT. Before treatment, patients were randomly divided into three groups: group A, marked node with clip (n=34); group B, marked node with 125I seed (n=32); and group C, marked node with both a clip and 125I seed (n=41). Dual tracers were used to search for SLNs after NAT. The primary endpoint was the detection rate of marked nodes and false-negative rate (FNR).

Results:
The detection rates using the TAD localization technique were 82.6% (28/34), 100% (32/32), and 100% (41/41) for groups A, B, and C, respectively (P>0.05). The FNR rates were 15.8%, 5.9%, and 5.6% among groups A, B, and C, respectively (P>0.05). The FNR rates in cN1 patients were 5.1%, 2.7%, and 2.6%, among these three groups, respectively (P>0.05). The change in distance between 125I seeds and clips in axillary lymph nodes was <3 mm. The FNR rates of TAD guided by dye tracers, radiolabeled tracers, and dual tracers were 5.4%, 5.2%, and 3.4%, respectively (P>0.05). The negative predictive values were 93.0%, 93.0%, and 95.2%, respectively (P>0.05).

Conclusion:
Considering the inexpensive and high detection rate of 125I seeds, it is recommended to use 125I seeds for localizing metastatic nodes in neoadjuvant setting. The TAD guided by dye tracer is also a feasible option for axillary de-escalation surgery after NAT in countries or regions without access to radiolabeled colloid.
Electrical stimulation of the vestibular nerve: evaluating effects and potential starting points for optimization in vestibular implants
Authors: ten Hoor Marieke , van de Berg Raymond , Pérez Fornos Angélica , Stultiens Joost Johannes Antonius 
Published: August 2024

Purpose of review
Oscillopsia and unsteadiness are common and highly debilitating symptoms in individuals with bilateral vestibulopathy. A lack of adequate treatment options encouraged the investigation of vestibular implants, which aim to restore vestibular function with motion-modulated electrical stimulation. This review aims to outline the ocular and postural responses that can be evoked with electrical prosthetic stimulation of the semicircular canals and discuss potential approaches to further optimize evoked responses. Particular focus is given to the stimulation paradigm.

Recent findings
Feasibility studies in animals paved the way for vestibular implantation in human patients with bilateral vestibulopathy. Recent human trials demonstrated prosthetic electrical stimulation to partially restore vestibular reflexes, enhance dynamic visual acuity, and generate controlled postural responses. To further optimize prosthetic performance, studies predominantly targeted eye responses elicited by the vestibulo-ocular reflex, aiming to minimize misalignments and asymmetries while maximizing the response. Changes of stimulation parameters are shown to hold promise to increase prosthetic efficacy, together with surgical refinements and neuroplastic effects.

Summary
Optimization of the stimulation paradigm, in combination with a more precise electrode placement, holds great potential to enhance the clinical benefit of vestibular implants.
Updates on the use of neuromodulation in geriatric patients
Authors: Kennedy Lauren N. , Griebling Tomas L. , Souders Colby P. 
Published: August 2024

Purpose of review
In light of the updated AUA/SUFU guidelines on the diagnosis and treatment of overactive bladder (OAB), increased utilization of advanced therapies is expected in the coming years. The primary aim of this review is to summarize existing outcome and safety data on the use of neuromodulation in geriatric patients, as well as highlight recent advances in neuromodulation that may be particularly advantageous in the geriatric population.

Recent findings
There are mixed data demonstrating efficacy of sacral neuromodulation by decade of life, with older individuals most often demonstrating lower odds of progressing to stage 2 implantation. However, a large majority of patients still undergo stage 2 implantation with no significant increase in complications reported when compared to younger cohorts. Neuromodulation is broadening to have wider indications outside of OAB, which may be particularly beneficial in the elderly population (fecal incontinence, nonobstructive urinary retention, and constipation). Posterior tibial nerve stimulation remains a well tolerated and efficacious treatment for OAB, with new FDA-approved implantable devices joining the commercial market, which may expand access for elderly populations.

Summary
The data are encouraging and support the use of neuromodulation in geriatric patients.
Clinicopathological and Molecular Characteristics of Rare EBV-associated Diffuse Large B-cell Lymphoma With IRF4 Rearrangement
Authors: Zhang Yuxiu , Li Anqi , Li Yimin , Ouyang Binshen , Wang Xuan , Zhang Lei , Xu Haimin , Gu Yijin , Lu Xinyuan , Dong Lei , Yi Hongmei , Wang Chaofu 
Published: August 2024

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare form of aggressive B-cell lymphoma with limited molecular information reported regarding interferon regulatory factor 4 (IRF4) status. Here, we presented 3 EBV-positive DLBCL cases with IRF4 rearrangement (EBV+DLBCL-IRF4-R) verified by fluorescence in situ hybridization (FISH). Three patients, including 1 male and 2 females (median age: 64 y; range: 45 to 68 y), had normal immune function. During a median follow-up of 12 months (range: 0 to 24 mo), 2 patients succumbed to the disease, and 1 patient achieved complete response. Three tumors were present in the mediastinum, stomach, and thalamus, respectively. All three tumors exhibited DLBCL morphology and were identified as the non-germinal center B-cell subtype, with EBV-encoded small RNA positivity ranging from 70% to 80%. RNA sequencing was able to identify RHOH and IGH as fusion partners of IRF4 in two cases. No MYC and BCL2 rearrangements were detected in 3 cases by FISH and RNA sequencing. Next-generation sequencing revealed a low mutation burden, and only IRF4 was recurrently mutated in two EBV+DLBCL-IRF4-R cases. Using the LymphGen 2.0 classifier, 1 case was classified as the MCD (including MYD88
L265P and CD79B mutations) subtype. We report rare EBV+DLBCL-IRF4-R that may enhance our understanding of the diverse spectrum of large B-cell lymphoma.
Radiomics Analysis for the Identification of Invasive Pulmonary Subsolid Nodules From Longitudinal Presurgical CT Scans
Authors: Singh Apurva , Roshkovan Leonid , Horng Hannah , Chen Andrew , Katz Sharyn I. , Thompson Jeffrey C. , Kontos Despina 
Published: August 2024

Purpose:
Effective identification of malignant part-solid lung nodules is crucial to eliminate risks due to therapeutic intervention or lack thereof. We aimed to develop delta radiomics and volumetric signatures, characterize changes in nodule properties over three presurgical time points, and assess the accuracy of nodule invasiveness identification when combined with immediate presurgical time point radiomics signature and clinical biomarkers.

Materials and Methods:
Cohort included 156 part-solid lung nodules with immediate presurgical CT scans and a subset of 122 nodules with scans at 3 presurgical time points. Region of interest segmentation was performed using ITK-SNAP, and feature extraction using CaPTk. Image parameter heterogeneity was mitigated at each time point using nested ComBat harmonization. For 122 nodules, delta radiomics features (ΔRAB= (RB-RA)/RA) and delta volumes (ΔVAB= (VB-VA)/VA) were computed between the time points. Principal Component Analysis was performed to construct immediate presurgical radiomics (Rs1) and delta radiomics signatures (ΔRs31+ ΔRs21+ ΔRs32). Identification of nodule pathology was performed using logistic regression on delta radiomics and immediate presurgical time point signatures, delta volumes (ΔV31+ ΔV21+ ΔV32), and clinical variable (smoking status, BMI) models (train test split (2:1)).

Results:
In delta radiomics analysis (n= 122 nodules), the best-performing model combined immediate pre-surgical time point and delta radiomics signatures, delta volumes, and clinical factors (classification accuracy [AUC]): (77.5% [0.73]) (train); (71.6% [0.69]) (test).

Conclusions:
Delta radiomics and volumes can detect changes in nodule properties over time, which are predictive of nodule invasiveness. These tools could improve conventional radiologic assessment, allow for earlier intervention for aggressive nodules, and decrease unnecessary intervention-related morbidity.
Canagliflozin Mitigates Acute Kidney Injury Secondary to Resuscitative Endovascular Balloon Occlusion of the Aorta in a Porcine Model of Hemorrhagic Shock
Authors: Tallowin Simon , Abel Biebele , Mysore Brinda , Mares John , Anderson Joseph A. , Propper Brandon W. , Stewart Ian J. , Burmeister David M. 
Published: August 2024

Objective:
We investigated the potential of acute canagliflozin administration to mitigate acute kidney injury (AKI) and attenuate deleterious pro-inflammatory cytokine release in a clinically relevant swine model of severe renal ischemia reperfusion injury (IRI) induced by hemorrhage and aortic occlusion.

Background:
Long-term canagliflozin use attenuates renal function decline and reduces AKI in diabetes mellitus and heart failure patients. Whilst several reports indicate prophylactic SGLT2 inhibition prevents AKI in IRI, the efficacy of acute administration on IRI and inflammation is not known.

Methods:
Female swine (n=16) underwent controlled hemorrhage of 25% blood volume, followed by 90 min of aortic occlusion at the level of the renal ostia (via Resuscitative Endovascular Balloon Occlusion of the Aorta). A single 300 mg dose of oral canagliflozin or vehicle (saline) was delivered 5 mins into aortic occlusion. Hemodynamic monitoring, markers of renal function (serum creatinine, blood urea nitrogen, proteinuria and urinary neutrophil gelatinase-associated lipocalin) and serum cytokine concentrations (including interleukins: IL-1RA, IL-6, IL-8, IL-10, IL-18; and Tumor necrosis factor alpha) were analyzed after IRI, and during a 6h critical care phase.

Results:
Compared to controls, animals receiving canagliflozin had less severe AKI, improved creatinine clearance, reduced proteinuria, and significantly lower tubular damage as evidenced by histopathology and urinary NGAL. Furthermore, the pro-inflammatory cytokine IL-6 was markedly attenuated without reduction in anti-inflammatory cytokines (IL-1RA and IL-10).

Conclusions:
A single dose of canagliflozin administered shortly into ischemic insult mitigates AKI and attenuates harmful pro-inflammatory cytokine release following trauma or surgery. These findings suggest a potential novel therapeutic role for canagliflozin in mitigating the effects of renal IRI worthy of further investigation.
A Computer Vision Algorithm to Predict Superior Mesenteric Artery Margin Status for Patients with Pancreatic Ductal Adenocarcinoma
Authors: Wang Jane , Ashraf Ganjouei Amir , Romero-Hernandez Fernanda , Foroutani Laleh , Bahceci Dorukhan , Deranteriassian Aletta , Casey Megan , Li Po-Yi , Houshmand Sina , Behr Spencer , Jamshidi Neema , Majumdar Sharmila , Donahue Timothy , Kim Grace E. , Wang Zhen Jane , Thornblade Lucas W. , Adam Mohamed , Alseidi Adnan 
Published: August 2024

Objective:
To evaluate the feasibility of developing a computer vision algorithm that uses preoperative computed tomography (CT) scans to predict superior mesenteric artery (SMA) margin status in patients undergoing Whipple for pancreatic ductal adenocarcinoma (PDAC), and to compare algorithm performance to that of expert abdominal radiologists and surgical oncologists.

Summary Background Data:
Complete surgical resection is the only chance to achieve a cure for PDAC; however, current modalities to predict vascular invasion have limited accuracy.

Methods:
Adult patients with PDAC who underwent Whipple and had preoperative contrast-enhanced CT scans were included (2010-2022). The SMA was manually annotated on the CT scans, and we trained a U-Net algorithm for SMA segmentation and a ResNet50 algorithm for predicting SMA margin status. Radiologists and surgeons reviewed the scans in a blinded fashion. SMA margin status per pathology reports was the reference.

Results:
Two hundred patients were included. Forty patients (20%) had a positive SMA margin. For the segmentation task, the U-Net model achieved a Dice Similarity Coefficient of 0.90. For the classification task, all readers demonstrated limited sensitivity, although the algorithm had the highest sensitivity at 0.43 (versus 0.23 and 0.36 for the radiologists and surgeons, respectively). Specificity was universally excellent, with the radiologist and algorithm demonstrating the highest specificity at 0.94. Finally, the accuracy of the algorithm was 0.85 versus 0.80 and 0.76 for the radiologists and surgeons, respectively.

Conclusions:
We demonstrated the feasibility of developing a computer vision algorithm to predict SMA margin status using preoperative CT scans, highlighting its potential to augment the prediction of vascular involvement.