bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical guidelines for early hepatocellular carcinoma treatment options: a systematic review and bibliometric analysis
Authors: Wu Chun-Ying , Lin Lee-Yuan , Lee Teng-Yu , Hsu Yao-Chun , Yeh Chun-Chieh , Chen Chiehfeng , Kang Yi-No , Huang Tsai-Wei 
Published: July 2024

Background:
Hepatocellular carcinoma remains a major cause of cancer-related mortality worldwide, with treatment options including radiofrequency ablation (RFA) and surgical resection. This study evaluates the evolving guidelines for these treatments to identify the current consensus and divergences.

Method:
The authors conducted a systematic review following PRISMA 2020 guidelines of documents from 2017 to 2024 by major liver societies. The AGREE-II framework assessed guideline quality. This study is registered with PROSPERO (CRD42022342266).

Results:
The authors analyzed 23 guidelines and noted significant shifts in treatment recommendations over recent updates. This analysis reveals an increasing endorsement of RFA for certain patient groups and sustained strong support for surgical resection based on robust evidence levels. All demonstrated high quality, with the 2023 Japan Guidelines receiving the highest AGREE-II score. A significant finding was the low level of stakeholder involvement in the development of guidelines.

Conclusion:
The study highlights the dynamic nature of clinical guidelines for early-stage hepatocellular carcinoma, underscoring the need for ongoing updates and direct, high-quality comparative studies. The evolving recommendations for RFA, especially its role in managing small, localized tumors, reflect its emerging importance in the treatment paradigm.
Comparing health care outcomes before and after employing nurse practitioners in cardiovascular hospitals in Japan: A retrospective chart review
Authors: Suzuki Miho , Sekiguchi Natsuko , Saitoh Masato , Koda Masahide , Harada Nahoko , Honda Kazuya , Araki Tomoko , Kudo Takemi , Watanabe Takako 
Published: July 2024

ABSTRACT

Background:
There are approximately 872 certified nurse practitioners (NPs) in Japan as of April 2024. However, research on the results of their specific activities is still scarce.

Purpose:
This study aimed to compare health care outcomes before (i.e., 2019) and after (i.e., 2021) employing NPs in cardiovascular hospitals in Japan.

Methodology:
We conducted a retrospective chart review and analyzed 114 patients who underwent cardiac surgery in Hospital A and 381 patients who received pacemaker implantation/replacement in Hospital B. Hospital A hired one NP for cardiac surgery service, and Hospital B hired one NP for pacemaker device service. The NPs assisted in the surgical procedures and provided postsurgical management.

Results:
In Hospital A, the median length of hospitalization and intubation were shorter in 2021 than in 2019 (p = .02 and .01, respectively). In Hospital B, medical fee reimbursement was lower in 2021 (p < .001) than in 2019, and the median procedure duration was shorter (p = .01), which remained statistically significant after controlling for age, comorbidities, and device types. Some outcomes improved following the employment of NPs, whereas others remained unchanged.

Conclusions:
Nurse practitioners managed surgical patients well and contributed to the quality care of cardiovascular medicine.

Implications:
The employment of NPs in Japan is encouraged because even a single NP can have a positive, although not large, impact on patients and organizations.
Improving oral health screening and dental referrals for patients with diabetes in a community health clinic
Authors: McGowen Joy , Shaw Kathy 
Published: July 2024

ABSTRACT

Background:
Oral health screening and access to dental care in adults with diabetes lead to improved health outcomes and quality of life. Patients with barriers to accessing health services have a greater risk of poor medical and dental outcomes. People with diabetes are more likely to have periodontal disease and less likely to visit a dentist.

Local Problem:
Oral screening and dental referrals were not being done at a community health clinic in Plano, Texas.

Methods:
The aim of this 6-month quality-improvement project was to increase oral health screenings in adults with diabetes from 0% to 80%; subaim was to increase access to dental services by increasing referrals from 0% to 50%. Adults with diabetes without insurance or dental care in the past 12 months were eligible for the project (n = 263). Outcome measures were tracked using a longitudinal chart.

Interventions:
Eligible patients were screened and referred to a dental office with an income-based financial assistance program using Plan-Do-Study-Act methodology. Staff education, referral order set, and follow-up calls were additional processes implemented.

Results:
Fifty-two percent of eligible patients were screened, 35.9% were referred to dental services, and 17.7% of those referred established care with dental clinic.

Conclusions:
Interventions were successful in improving access to dental care, although target goal was not met. Creating systems that facilitate interdisciplinary care improved health equity and standards of health in chronic disease.
Knowledge of Patients’ Activation Level Changes Expert US Physicians’ Communication in GERD Management
Authors: Kamal Afrin N. , Achalu Sudharshan , Jani Shilpa , Triadafilopoulos George , Clarke John O. , Wang C. Jason 
Published: July 2024

Background:
Gastroesophageal reflux disease (GERD) is common. Treatment is to manage symptoms, but medication nonadherence is common. To date, little emphasis has been on understanding patient behaviors and reasons for medication nonadherence.

Methods:
We performed a cross-sectional survey study among expert gastroenterologists specializing in esophageal disease. Survey studies consisted of a 6-item questionnaire measuring physician knowledge of patient activation, the Clinician Support for Patient Activation Measure (CS-PAM), and an adapted 20-item Patient Assessment of Chronic Illness Care (PACIC). All question stems were specified to GERD management.

Results:
Thirty-six experts participated. Most indicated hearing the term patient engagement before this survey (88.9%), but fewer were aware of the term patient activation (33.3%). Respondents were then made aware of the clinical significance of patient activation and asked, based on this knowledge, the likelihood that patients' activation level before the clinic would impact their communication. Responses varied between “to a great extent” and “not at all.” Overall, CS-PAM activation scores were high, indicating a high level of support for patient activation. Lastly, respondents indicated their frequency of participating in partnership-building behaviors with patients. More than half (52.8%) of expert physicians “almost always” asked how GERD affected their lives, while less often asked patients about their health habits (22.2%), help set specific goals to improve their eating or exercise lifestyle (19.4%), or refer patients to a dietician, health educator, or counselor for their GERD (11.1%).

Conclusion:
Patient activation is an important strategy and may provide a behavioral approach to address medication adherence in GERD.
Comparing the Use of Crotaline-Polyvalent Immune Fab (Ovine) Versus Observation in Children
Authors: Rohl Stephen , Meredith Mark , Anderson Tucker , Clark Alexander , Snider Mark , Bruccoleri Rebecca , Williams Saralyn , Hayes Tristan , Tolley Elizabeth , Gienapp Andrew J. , Seger Donna 
Published: July 2024

Objectives
In the United States, studies are inconclusive regarding the indications for polyvalent antivenom administration for crotaline envenomation. We compared polyvalent antivenom administration versus observation used at 2 separate institutions. We hypothesized that deferring antivenom leads to increased hospital length of stay and surgical interventions.

Methods
Retrospective chart review of children who presented to Le Bonheur Children's Hospital (LBCH) in Memphis, Tennessee, and Monroe Carell Jr Children's Hospital at Vanderbilt (MCJCHV) in Nashville, Tennessee, from 2009 to 2021. Patient demographics, treatment utilization, bite location, and outcomes from both sites were statistically examined.

Results
A total of 183 patients met the inclusion criteria (123 at LBCH, 60 at MCJCHV). At LBCH, mean age was 9.2 years, 54% were male, and 79% of known snakes identified as copperheads. At MCJCHV, mean age was 8.9 years, 65% were male, and 88% of known snakes identified as copperheads. The most commonly envenomated areas for both sites were the foot (42%), hand (27%), and ankle (26%). Patients at LBCH were managed with antivenom only 25% of the time, whereas 75% were observed; 82% of MCJCHV patients were managed with antivenom (P < 0.001). There were no significant differences in length of stay (mean, 1.5 days at LBCH and 1.8 days at MCJCHV; P = 0.136) or surgical intervention (3.3% of LBCH encounters, 5.0% of MCJCHV encounters; P = 0.685). Secondary outcomes aside from coagulopathy and admission location (intensive care unit vs floor) were also not significant.

Conclusions
The use of antivenom did not impact hospital length of stay or surgical interventions. Our results should be interpreted cautiously as our study reflects regional experiences with snake species in the Southeast United States and not North America as a whole. Other institutional differences in management and smaller n at MCJCHV may have contributed to different outcomes. Further study is needed to determine intermediate and long-term effects of deferring antivenom use.
Late Identification of Perinatal Transmission of HIV in an Infant at High Risk
Authors: O’Grady Thomas J. , Kaufman Suzanne , Stolz Amanda , Styer Linda M. , Haskin Lisa , Suresh Prapitha , Ryman Nko L. , Shah Dipal , Sullivan Timothy J. , Torian Lucia , Gonzalez Charles , Parker Monica M. , Swain Carol-Ann 
Published: July 2024

The focus of this case study is the delayed diagnosis of a perinatal HIV transmission, which was identified when the infant reached 4 months of age, and the social conditions and structural determinants that contributed to the increased transmission risk. Despite adhering to the diagnostic testing protocols and neonatal antiretroviral (ARV) guidelines of the New York State Department of Health, this transmission still occurred. This transmission event prompted strategies to address criminalization of substance use during pregnancy and a reevaluation of the HIV testing and treatment protocols, including the timing of testing. Obtaining a diagnostic specimen at birth before initiating prophylactic or presumptive therapy, without causing delays in therapy, and incorporating HIV-1 DNA or RNA testing 2 to 6 weeks after discontinuing ARV therapy might have facilitated earlier detection and a quicker resumption of ARV therapy for this high-risk infant. Subsequently, the New York State HIV perinatal testing guidelines were updated. These changes included the recommendation to obtain a diagnostic specimen at birth before initiating ARV medications, whenever feasible, without causing delays in ARV initiation. Additionally, an extra virologic diagnostic test is recommended at 2 to 6 weeks after discontinuing ARVs for infants at high risk of perinatal HIV transmission, especially those with possible DNA or RNA suppression due to ARV prophylaxis or presumptive HIV therapy.
Living Donor Availability Improves Patient Survival in a North American Center
Authors: Li Zhihao , Jones Owen , Magyar Christian T.J. , Claasen Marco P.A.W. , Ivanics Tommy , Choi Woo Jin , Rajendran Luckshi , Winter Erin , Bucur Roxana , Rukavina Nadia , Jaeckel Elmar , Selzner Nazia , Sayed Blayne A. , Ghanekar Anand , Cattral Mark , Sapisochin Gonzalo 
Published: July 2024

Objective:
Assess the impact of having a living donor on waitlist outcomes and overall survival through an intention-to-treat analysis.

Background:
Living-donor liver transplantation (LDLT) offers an alternative to deceased donation in the face of organ shortage. An as-treated analysis revealed that undergoing LDLT, compared to staying on the waiting list, is associated with improved survival, even at Model for End-stage Liver Disease-sodium (MELD-Na) score of 11.

Methods:
Liver transplant candidates listed at the Ajmera Transplant Centre (2000-2021) were categorized as pLDLT (having a potential living donor) or pDDLT (without a living donor). Employing Cox proportional-hazard regression with time-dependent covariates, we evaluated pLDLT’s impact on waitlist dropout and overall survival through a risk-adjusted analysis.

Results:
Of 4,124 candidates, 984 (24%) had potential living donors. The pLDLT group experienced significantly lower overall waitlist dropouts (5.2%vs. 34.4%, P<0.001) and mortality (3.8%vs. 24.4%, P<0.001) compared to the pDDLT group. Possessing a living donor correlated with a 26% decline in the risk of waitlist dropout (adjusted hazard ratio 0.74, 95%CI 0.55-0.99, P=0.042). The pLDLT group also demonstrated superior survival outcomes at 1- (84.9%vs. 80.1%), 5- (77.6%vs. 61.7%), and 10-year (65.6%vs.52.9%) from listing (log-rank P<0.001) with a 35% reduced risk of death (adjusted hazard ratio 0.65, 95%CI 0.56-0.76, P<0.001). Moreover, the predicted hazard ratios consistently remained below 1 across the MELD-Na range 11-26.

Conclusions:
Having a potential living donor significantly improves survival in end-stage liver disease patients, even with MELD-Na scores as low as 11. This emphasizes the need to promote awareness and adoption of LDLT in liver transplant programs worldwide.
Surgery and Surgical Training Before Graduate Medical Education
Authors: Alseidi Adnan A. , Craver H. William , Dennis Andrew J. , Fingeret Abbey , Fried Gerald M. , Mason Bonnie Simpson , Sudan Ranjan , Yang Stephen C. , Ford Henri R. 
Published: July 2024

Objective:
To update and add to the first report commissioned by the Blue Ribbon Committee (BRC) about 20 years prior.

Background:
Following a summit in late 2022 commissioned by the American Board of Surgery regarding competency-based reforms in surgical education and through a partnership with the American College of Surgeons and other stakeholders, a BRC-II on surgical education was formed. The BRC-II would have 7 subcommittees. This paper details the work of the Medical Student Subcommittee within the BRC-II.

Methods:
The subcommittee’s work, supported by staff from the American College of Surgeons, entailed a thorough literature review, which involved collating and aggregating the findings, identifying key challenges and opportunities, and committing to draft recommendations. These recommendations were then presented and refined through discussions with the BRC at large in multiple virtual and in-person settings.

Results:
The subcommittee’s work is detailed below and further summarized in table format. The section below elucidates the medical student education continuum and discusses the pertinent topics of recruitment, surgical engagement in medical student training and the surgical image, training for the current surgical practice model, trainee selection for graduate medical education, and optimizing the transition from undergraduate medical education to graduate medical education.

Conclusions:
The last 2 decades have shown significant changes and shifts in medical education and surgical practice. The findings of BRC-II in this manuscript help to structure the current and future necessary improvements, focusing on different aspects of medical student education.
The Fingerprint of Scalp-EEG in Drug-Resistant Frontal Lobe Epilepsies
Authors: Kalss Gudrun , Pelliccia Veronica , Zimmermann Georg , Trinka Eugen , Tassi Laura 
Published: July 2024

Purpose:
Scalp-EEG incompletely covers the frontal lobe cortex. Underrepresentation of frontobasal or frontomesial structures, fast ictal spreading, and false lateralization impede scalp-EEG interpretation. Hence, we investigated the significance of scalp-EEG in the presurgical workup of frontal lobe epilepsy.

Methods:
Using descriptive statistical methods and Pearson chi-squared test for group comparisons, we retrospectively investigated postsurgical outcome, interictal epileptiform discharges (iiEDs), and electrographic seizure patterns on scalp-EEG in 81 consecutive patients undergoing resective epilepsy surgery within the margins of the frontal lobe.

Results:
Postoperatively, patients with frontopolar iiEDs (n = 7) or concordant frontopolar iiED focus and seizure-onset (n = 2) were seizure free (n = 7/7, Engel Ia). MRI-positive patients with frontopolar iiEDs or frontopolar seizure-onset (n = 1/8 Engel Id, n = 7/8 Engel Ia) underwent surgery without stereo-EEG. Thirteen of 16 patients with frontolateral (n = 8/10, Engel Ia), or left frontobasal (n = 5/6, Engel Ia) seizure-onset undergoing further stereo-EEG, were seizure-free postoperatively. Seizure-onset prevalent over one electrode (n = 37/44 Engel I, p = 0.02), fast activity (FA)/flattening at seizure-onset (n = 29/33 Engel I, p = 0.02), FA/flattening during the seizure (n = 38/46 Engel I, p = 0.05), or focal rhythmic sharp-/spike-/polyspike-and-slow waves during the seizure (n = 24/31, Engel Ia, p = 0.05) were favorable prognostic markers. Interictal polyspike waves (p = 0.006 for Engel Ia) and interictal paroxysmal FA (p = 0.02 for Engel I) were unfavorable prognostic markers.

Conclusions:
Frontopolar scalp-EEG findings serve as biomarkers for predicting favorable surgical outcome in lesional frontal lobe epilepsy. Consequently, careful analysis of scalp-EEG assists in bypassing stereo-EEG in these patients.
The interpretation attributed to observed gaze shifts affects their social-cueing effect
Authors: Zehngut Amit , Yuval-Greenberg Shlomit 
Published: July 2024

AbstractIn an environment busy with abundant stimulation, individuals must rely on attentional cues to select the most relevant targets. As social creatures, a crucial strategy involves monitoring where others are focusing their attention and following them, assuming that locations attended by others are more likely to yield benefits than other locations. Given that gaze shifts represent a visible shift in attention, mirroring the gaze shifts of others can serve as an effective, social-attentional strategy. Indeed, research demonstrates that observing others redirect their gaze results in a reflexive shift of attention, reflected by improved perceptual performance for objects located at the gazed-at positions. This phenomenon is known as thegaze cueing effect(GCE). However, gaze shifts may not always align with the direction of attention. Individuals often avert their gaze while they are engaged in demanding cognitive tasks. Such gaze shifts signify internal focus rather than shifting attention outward. Here we hypothesize that the response to a gaze-shift cue is not reflexive but is contingent upon social context. In two pre-registered experiments, participants viewed videos of gaze shifts and engaged in a perceptual task, with one group primed to perceive the gaze shifts as reflecting cognitive processing rather than overt attentional shifts. Results indicated that GCE was suppressed in this group, suggesting that GCE is influenced by contextual cues framing the nature of the gaze shifts. These findings suggest that social attention is flexible and depends on the specific interpretation of the social context.
Bona fidecytotoxic iNKT cells with superior antitumour responses identified in mice and humans
Authors: de Amat Herbozo Carolina , Wong Stephanie WY , Kuypers Meggie , Ilango Guy , Liu Zhewei , Mathews Jessica A , Nguyen Albert , Veillette André , Gommerman Jennifer L , Baranek Thomas , Crome Sarah Q , Tsao Ming Sound , Sacher Adrian G , Paget Christophe , Mallevaey Thierry 
Published: July 2024

SUMMARYAdoptive cell therapies (ACT) using unmodified or engineered invariant Natural Killer T (iNKT) cells are in clinical trials for cancer treatment. While promising, outcomes are still suboptimal, possibly due to iNKT cell heterogeneity. This study identified unique iNKT cell populations with strong cytotoxic activity in mice and humans. In mice, iNKT1c cells showed potent CD1d-dependent and -independent antitumor functions, with responses influenced by NK receptors. IL-15 enhances their cytolytic activity, while retinoic acid is essential for their generation. In humans, terminally differentiated CD57+iNKT cells showed marked NK-receptor expression and most effectively killed C1R tumor cellsin vitro. These cells appeared activated/exhausted within tumors of non-small cell lung cancer patients. Additionally, a central memory-like CD62L+CD4-iNKT subset efficiently expanded and generated cytotoxic CD57+iNKT cellsin vitro, making them an appealing candidate for ACT. This study paves the way for the design of more effective iNKT cell-based immunotherapies.
γ-aminobutyric acid receptor B signaling drives glioblastoma in females in an immune-dependent manner
Authors: Pathak Asmita , Palasalava Sravya , Knott Maxon V. , Colon Bruno , Ciervo Erika , Zhou Yadi , Mitchell Jonathan , Pumar Oriana Teran , Wong Harrison K. A. , Zhang Li , Susic Nikola , Shah Khushi Hemendra , Kay Kristen , Chin Diana , Johnson Sadie , Cheng Feixiong , Lyssiotis Costas A. , Watson Dionysios C. , Ceccarelli Michele , Shah Ashish , Wahl Daniel R. , Lathia Justin D. , Bayik Defne 
Published: July 2024

ABSTRACTSex differences in immune responses impact cancer outcomes and treatment response, including in glioblastoma (GBM). However, host factors underlying sex specific immune-cancer interactions are poorly understood. Here, we identify the neurotransmitter γ-aminobutyric acid (GABA) as a driver of GBM-promoting immune response in females. We demonstrated that GABA receptor B (GABBR) signaling enhances L-Arginine metabolism and nitric oxide synthase 2 (NOS2) expression in female granulocytic myeloid-derived suppressor cells (gMDSCs). GABBR agonist and GABA analog promoted GBM growth in females in an immune-dependent manner, while GABBR inhibition reduces gMDSC NOS2 production and extends survival only in females. Furthermore, female GBM patients have enriched GABA transcriptional signatures compared to males, and the use of GABA analogs in GBM patients is associated with worse short-term outcomes only in females. Collectively, these results highlight that GABA modulates anti-tumor immune response in a sex-specific manner, supporting future assessment of GABA pathway inhibitors as part of immunotherapy approaches.
AlphaFold Model Quality Self-Assessment Improvement Via Deep Graph Learning
Authors: Verburgt Jacob , Zhang Zicong , Kihara Daisuke 
Published: July 2024

AbstractIn the past several years significant advances have been made in the field of deep-learning based computational modeling of proteins, with DeepMind’s AlphaFold2 being among the most prominent. Alongside the atom coordinates, these computationally modeled protein structures typically contain self-confidence metrics that can be used to gauge the relative modeling quality of individual residues, or the protein as a whole. Unfortunately, these scores are not always accurate, and may sometimes annotate poorly modeled regions of the protein as high confidence. Here, we introduce EQA-Fold to address this problem. EQA-Fold overhauls the LDDT prediction head of AlphaFold to provide more accurate self-confidence scores. We show that EQA-Fold is able to provide more accurate self-confidence scores than the standard AlphaFold architectures, as well as recent Model Quality Assessment protocols.