bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and composition of nephrolithiasis in a Lebanese tertiary care center
Authors: Degheili Jad A. , Heidar Nassib Abou , Yacoubian Aline , Moussawy Mouhamad , Bachir Bassel G. 
Published: May 2024

Introduction:
Nephrolithiasis is a common affliction with a prevalence of 12% in men and 7% in women. The incidence rate diverges with geographic location. Arab countries report high nephrolithiasis prevalence rates, with Saudi Arabia being the highest (20.1%). To date, there is little knowledge about the demographics and composition of stones in Lebanon.

Methods:
A retrospective chart review was performed on stone composition at the American University of Beirut Medical Center, between 2005 and 2018. Patients’ demographics and stone characteristics were obtained from electronic medical records. Analysis of frequencies and Chi-square test were adopted for potential risk factor correlations by the Statistical Package for the Social Sciences (SPSS).

Results:
A total of 626 stone analyses were performed. Male patients predominated (69%). The mean age was 46.58 ± 16.5 years, and mean body mass index was 28.63 ± 5.6, for both sexes. Calcium oxalate was the most predominant stone in both sexes (70%). Uric acid stones followed (~16%), and calcium oxalate phosphate stones were the third most common (5%). Incidence of kidney stones peaks in the summer, with 11.86% presenting in July. Around 60% presented with flank pain to the Emergency Department, and 32% ended up with spontaneous passage of stones by medical expulsive therapies alone, with no further surgical intervention. Diabetes and hypertension were significantly correlated with stone recurrence in our cohort.

Conclusion:
There is a significant gender disparity in stone prevalence in Lebanon. Calcium oxalate is the most common type in both sexes. Future investigations of dietary and environmental factors are recommended from our region.
Factors affecting use of flexible ureteroscope in large renal stones; stone size or stone composition
Authors: Elbakary Mohamed Rady 
Published: May 2024

Introduction:
After advances in flexible ureteroscopes’ design, accessories, and lithotripters, flexible ureteroscope has been used widely for the treatment of large renal calculi >2 cm.

Objectives:
The objective was to evaluate the role of flexible ureteroscopy with laser lithotripsy in the treatment of large renal calculi >2 cm and find out which factor can affect the results.

Patients and Methods:
Prospectively, we have studied 47 patients who have passed through flexible ureteroscopy with laser lithotripsy for renal calculi >2 cm. Preoperative, operative, and postoperative data were recorded. Results and complications were recorded, too.

Results:
In 47 patients, the mean stone size is 26.2 ± 4.1 cm and the total stone-free rate (SFR) is 89.4%, while in stone size ≤3 cm, the SFR is 90.7%, and for stone size >3 cm, the SFR is 75%. Overall stone density is 1020 ± 286 HU. The SFR is 95.5% in stones ≤1000 HU and 84% in stones >1000 HU. The mean operative time is 99.2 ± 29.3 min. The intraoperative complications are 17%, while postoperative complications are 36% and all complications are mild.

Conclusion:
Flexible ureterorenoscopy (FURS) is safe and effective for the treatment of large renal calculi >2 cm. Stones >3 cm may have lower results even after staged therapy.
Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy
Authors: Alsunbul Abdulrahman , Alakrash Hamad , AlMuaiqel Muaiqel , Aldughiman Abdullah W. , Albalawi Abdulaziz , Al-Gadheeb Abdullah S. , El-Tholoth Hossam S. , Alzahrani Tarek , Alzahrani Ahmed 
Published: May 2024

Objective:
The objective of the study is to evaluate the safety, efficacy, and long-term outcome of en bloc renal pedicle control during laparoscopic nephrectomy and nephroureterectomy.

Patients and Methods:
A total of 126 nephrectomies and nephroureterectomies that underwent en bloc renal pedicle control using the endovascular stapler (45 or 60 mm vascular reload) were retrospectively analyzed. Perioperative outcomes, including the risk of arteriovenous fistula (AVF), hospital stay, and estimated blood loss, were recorded. Complications were reported using Clavien classification.

Results:

En bloc pedicle control was employed in 126 laparoscopic nephrectomies and nephroureterectomies on 126 patients with a mean age of 55.7 years (range: 18–94) and a mean body mass index of 29.2 kg/m2 (range: 17–42). All laparoscopic nephrectomies were performed or supervised by one of three minimally invasive surgeons using identical surgical techniques, even in cases of multiple hilar vessels. During follow-up with a mean 23.3 months (range: 12–48), no patients presented with radiological or clinical signs of AVF (91 patients where followed up with either Doppler ultrasound, computed tomography with contrast, or magnetic resonance imaging for different indications). The mean operative time was 91.8 min (range: 45–215). Intraoperative blood transfusion was required in two cases. Diaphragmatic injury occurred in one case but was repaired laparoscopically. Open conversion occurred in two cases with severe colonic adhesions and injury, with one requiring primary repair, and the other managed with a colostomy. One patient developed fever; two patients developed paralytic ileus. Hospital stay mode was 5 days, ranging from 3 to 10 days.

Conclusion:

En bloc renal pedicle control during laparoscopic nephrectomies is safe with reasonable operative time, and there were no indications of AVF with this technique over the long term.
Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Authors: Li Gan-Bin , Wang Chen-Tong , Zhang Xiao , Qiu Xiao-Yuan , Chen Wei-Jie , Lu Jun-Yang , Xu Lai , Wu Bin , Xiao Yi , Lin Guo-Le 
Published: May 2024

BACKGROUND
Intestinal flora disorder (IFD) poses a significant challenge after laparoscopic colonic surgery, and no standard criteria exists for its diagnosis and treatment.
AIM
To analyze the clinical features and risk factors of IFD.
METHODS
Patients with colon cancer receiving laparoscopic surgery were included using propensity-score-matching (PSM) methods. Based on the occurrence of IFD, patients were categorized into IFD and non-IFD groups. The clinical characteristics and treatment approaches for patients with IFD were analyzed. Multivariate regression analysis was performed to identify the risk factors of IFD.
RESULTS
The IFD incidence after laparoscopic surgery was 9.0% (97 of 1073 patients). After PSM, 97 and 194 patients were identified in the IFD and non-IFD groups, respectively. The most common symptoms of IFD were diarrhea and abdominal, typically occurring on post-operative days 3 and 4. All patients were managed conservatively, including modulation of the intestinal flora (90.7%), oral/intravenous application of vancomycin (74.2%), and insertion of a gastric/ileus tube for decompression (23.7%). Multivariate regression analysis identified that pre-operative intestinal obstruction [odds ratio (OR) = 2.79, 95%CI: 1.04–7.47, P = 0.041] and post-operative antibiotics (OR = 8.57, 95%CI: 3.31–23.49, P < 0.001) were independent risk factors for IFD, whereas pre-operative parenteral nutrition (OR = 0.12, 95%CI: 0.06–0.26, P < 0.001) emerged as a protective factor.
CONCLUSION
A stepwise approach of probiotics, vancomycin, and decompression could be an alternative treatment for IFD. Special attention is warranted post-operatively for patients with pre-operative obstruction or early use of antibiotics.
Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients
Authors: Yang Hao , Yang Gang , Wu Wen-Ya , Wang Fang , Yao Xue-Quan , Wu Xiao-Yu 
Published: May 2024

BACKGROUND
Da Vinci Robotics-assisted total mesorectal excision (TME) surgery for rectal cancer is becoming more widely used. There is no strong evidence that robotic-assisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.
AIM
To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.
METHODS
A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023. The patients were divided into a robot-assisted group (the R-TME group) and a laparoscopic group (the L-TME group), and the short-term efficacy of the two groups was compared.
RESULTS
There were 45 elderly patients (≥ 60 years) in the R-TME group and 50 elderly patients (≥ 60 years) in the L-TME group. There were no differences in demographics, conversion rates, or postoperative complication rates. The L-TME group had a longer surgical time than the R-TME group [145 (125, 187.5) vs 180 (148.75, 206.25) min, P = 0.005), and the first postoperative meal time in the L-TME group was longer than that in the R-TME (4 vs 3 d, P = 0.048). Among the sex and body mass index (BMI) subgroups, the R-TME group had better outcomes than did the L-TME group in terms of operation time (P = 0.042) and intraoperative assessment of bleeding (P = 0.042). In the high BMI group, catheter removal occurred earlier in the R-TME group than in the L-TME group (3 vs 4 d, P = 0.001), and autonomous voiding function was restored.
CONCLUSION
The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery; however, robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis. Optimizing the learning curve can shorten the operation time, reduce the recovery time of gastrointestinal function, and improve the prognosis.
Effect of the extrahepatic bile duct anatomy on choledocholithiasis and its clinical significance
Authors: Cao Zheng , Zhou Jia , Wei Li , He Hai-Yu , Li Jun 
Published: May 2024

BACKGROUND
A comprehensive understanding of the extrahepatic bile duct anatomy is vital to guide surgical procedures and perform endoscopic retrograde cholangiography. Anatomical irregularities within the extrahepatic bile duct may increase susceptibility to bile duct stones.
AIM
To investigate the anatomical risk factors associated with extrahepatic bile ducts in patients diagnosed with choledocholithiasis, with a specific focus on preventing stone recurrence after surgical intervention and endoscopic lithotomy.
METHODS
We retrospectively analyzed the medical records of 124 patients without choledocholithiasis and 108 with confirmed choledocholithiasis who underwent magnetic resonance cholangiopancreatography examinations at our center between January 2022 and October 2022. Logistic regression analyses were conducted to identify the anatomical risk factors influencing the incidence of common bile duct stones.
RESULTS
Multivariate logistic regression analysis revealed that several factors independently contributed to choledocholithiasis risk. Significant independent risk factors for choledocholithiasis were diameter of the common hepatic [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI): 1.07-1.92, adjusted P value = 0.016] and common bile (aOR = 1.68, 95%CI: 1.27-2.23, adjusted P value < 0.001) ducts, length of the common hepatic duct (aOR = 0.92, 95%CI: 0.84-0.99, adjusted P value = 0.034), and angle of the common bile duct (aOR = 0.92, 95%CI: 0.89–0.95, adjusted P value < 0.001).
CONCLUSION
The anatomical features of the extrahepatic bile duct were directly associated with choledocholithiasis risk. Key risk factors include an enlarged diameter of the common hepatic and bile ducts, a shorter length of the common hepatic duct, and a reduced angle of the common bile duct.
Clinical study on microscopic syndrome differentiation and traditional Chinese medicine treatment for liver stomach disharmony in chronic gastritis
Authors: Bai Chun-Yan , Tian Wei , Zhang Qian 
Published: May 2024

BACKGROUND
Chronic gastritis (CG) is a common gastrointestinal disorder characterized by inflammation of the stomach lining. Liver-stomach disharmony (LSD) syndrome is believed to contribute to CG symptoms.
AIM
To evaluate the efficacy and safety of microcosmic syndrome differentiation and Chinese herbal medicine (CHM) treatment in patients with CG and LSD syndrome.
METHODS
Sixty-four patients with CG and LSD syndrome were randomly divided into two groups: The treatment group received CHM based on microcosmic syndrome differentiation and the control group received conventional Western medicine. The treatment course lasted 12 wk. The primary outcome was improvement in dyspeptic symptoms, measured using the Nepean Dyspepsia Index. The secondary outcomes included the improvement rate of endoscopic findings, histopathological findings, and microcosmic syndrome scores and the incidence of adverse events.
RESULTS
After 12 wk of treatment, the treatment group showed significantly greater improvement in dyspeptic symptoms than the control group (93.75% vs 65.63%, P < 0.01). The treatment group also showed a significantly higher improvement rate in endoscopic findings than the control group (81.25% vs 53.13%, P < 0.05). The improvement rates of histopathological findings and microcosmic syndrome scores were not significantly different between the two groups (P > 0.05). No serious adverse events were observed in either group.
CONCLUSION
Microcosmic syndrome differentiation and CHM treatment can effectively improve dyspeptic symptoms and endoscopic findings in patients with CG and LSD syndrome and have a good safety profile. Further studies with larger sample sizes and longer follow-up periods are required to confirm the long-term efficacy and mechanism of action of this treatment.
Mesenchymal-epithelial transition factor amplification correlates with adverse pathological features and poor clinical outcome in colorectal cancer
Authors: Yu Qiu-Xiao , Fu Ping-Ying , Zhang Chi , Li Li , Huang Wen-Ting 
Published: May 2024

BACKGROUND
Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related mortality worldwide. Mesenchymal-epithelial transition factor (MET ) gene participates in multiple tumor biology and shows clinical potential for pharmacological manipulation in tumor treatment. MET amplification has been reported in CRC, but data are very limited. Investigating pathological values of MET in CRC may provide new therapeutic and genetic screening options in future clinical practice.
AIM
To determine the pathological significance of MET amplification in CRC and to propose a feasible screening strategy.
METHODS
A number of 205 newly diagnosed CRC patients undergoing surgical resection without any preoperative therapy at Shenzhen Cancer Hospital of Chinese Academy of Medical Sciences were recruited. All patients were without RAS/RAF mutation or microsatellite instability-high. MET amplification and c-MET protein expression were analyzed using fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC), respectively. Correlations between MET aberration and pathological features were detected using the chi-squared test. Progression free survival (PFS) during the two-year follow-up was detected using the Kaplan-Meier method and log rank test. The results of MET FISH and IHC were compared using one-way ANOVA.
RESULTS
Polysomy-induced MET amplification was observed in 14.4% of cases, and focal MET amplification was not detected. Polysomy-induced MET amplification was associated with a higher frequency of lymph node metastasis (LNM) (P < 0.001) and higher tumor budding grade (P = 0.02). In the survival analysis, significant difference was detected between patients with amplified- and non-amplified MET in a two-year follow-up after the first diagnosis (P = 0.001). C-MET scores of 0, 1+, 2+, and 3+ were observed in 1.4%, 24.9%, 54.7%, and 19.0% of tumors, respectively. C-MET overexpression correlated with higher frequency of LNM (P = 0.002), but no significant difference of PFS was detected between patients with different protein levels. In terms of concordance between MET FISH and IHC results, MET copy number showed no difference in c-MET IHC 0/1+ (3.35 ± 0.18), 2+ (3.29 ± 0.11) and 3+ (3.58 ± 0.22) cohorts, and the MET -to-CEP7 ratio showed no difference in three groups (1.09 ± 0.02, 1.10 ± 0.01, and 1.09 ± 0.03).
CONCLUSION
In CRC, focal MET amplification was a rare event. Polysomy-induced MET amplification correlated with adverse pathological characteristics and poor prognosis. IHC was a poor screening tool for MET amplification.
Prognostic factors associated with gastrointestinal dysfunction after gastrointestinal tumor surgery: A meta-analysis
Authors: Song Jia , Zhou Cong , Zhang Tian 
Published: May 2024

BACKGROUND
Explore the risk factors of gastrointestinal dysfunction after gastrointestinal tumor surgery and to provide evidence for the prevention and intervention of gastrointestinal dysfunction in patients with gastrointestinal tumor surgery.
AIM
To investigate the potential risk factors for gastrointestinal dysfunction following gastrointestinal tumor surgery and to present information supporting the prevention and management of gastrointestinal dysfunction in surgery patients.
METHODS
Systematically searched the relevant literature from PubMed, Web of Science, Cochrane Library, Embase, CNKI, China Biomedical Database, Wanfang Database, and Weipu Chinese Journal Database self-established until October 1, 2022. Review Manager 5.3 software was used for meta-analysis after two researchers independently screened literature, extracted data, and evaluated the risk of bias in the included studies.
RESULTS
A total of 23 pieces of literature were included, the quality of which was medium or above, and the total sample size was 43878. The results of meta-analysis showed that the patients were male (OR = 1.58, 95%CI: 1.25-2.01, P = 0.002) and ≥ 60 years old (OR = 2.60, 95%CI: 1.76-2.87, P < 0.001), physical index ≥ 25.3 kg/m2 (OR = 1.6, 95%CI: 1.00-1. 12, P = 0.040), smoking history (OR = 1.89, 95%CI: 1.31-2.73, P < 0.001), chronic obstructive pulmonary disease (OR = 1.49, 95%CI: 1.22-1.83, P < 0.001), enterostomy (OR = 1.47, 95%CI: 1.26-1.70, P < 0.001), history of abdominal surgery (OR = 2.90, 95%CI: 1.67-5.03, P < 0.001), surgical site (OR = 1.2, 95%CI: 1.40-2.62, P < 0.001), operation method (OR = 1.68, 95%CI: 1.08-2.62, P = 0.020), operation duration (OR = 2.65, 95%CI: 1.92-3.67, P < 0.001), abdominal adhesion grade (OR = 2.52, 95%CI: 1.90-3.56, P < 0.001), postoperative opioid history (OR = 5.35, 95%CI: 3.29-8.71, P < 0.001), tumor TNM staging (OR = 2.58, 95%CI: 1.84-3.62, P < 0.001), postoperative blood transfusion (OR = 2.92, 95%CI: 0.88-9.73, P = 0.010) is a risk factor for postoperative gastrointestinal dysfunction in patients with gastrointestinal tumors.
CONCLUSION
There are many factors affecting gastrointestinal dysfunction in gastrointestinal patients after surgery. Clinical staff should identify relevant risk factors early and implement targeted intervention measures on the basis of personalized assessment to improve the clinical prognosis of patients.
Multi-modal imaging for the diagnosis of spontaneous visceral artery dissection: A case report
Authors: Pu Yang , Luo Yan 
Published: May 2024

BACKGROUND
Spontaneous visceral artery dissection (SVAD) is a rare condition that affects the visceral arteries, such as the celiac, superior mesenteric, and inferior mesenteric arteries, without involving the aorta. Organ ischemia or hemorrhage from vessel rupture can occur in SVAD; therefore, prompt detection and management is essential. Contrast-enhanced computed tomography (CECT) has been used to diagnose most of the previous cases, but few studies have explored the potential of contrast-enhanced ultrasound (CEUS) for early detection of this disease.
CASE SUMMARY
A 53-year-old male presented with complaints of poor appetite and abnormal liver function for the past 6 months. He had previously undergone transabdominal splenectomy, esophagogastric devascularization, and cholecystectomy for gallstones and severe portal hypertension. Liver ultrasound was performed in our department to assess liver status. An abnormal hepatic artery spectrum was observed, and dissection involving both the celiac artery and the common hepatic artery was observed. A CEUS was then performed and clearly showed the entry site of the intimal tear and the false lumen, and dissection was subsequently confirmed by CECT. The patient was asymptomatic; therefore, treatment to control the blood pressure was provided, and follow-up was recommended. After 6 months of follow-up, the celiac artery was found to be dilated with an adherent thrombus visible in the wall, and the common hepatic artery was occluded with the presence of collateralization. Despite these findings, no significant changes in liver function were observed.
CONCLUSION
Multi-modal imaging is effective in diagnosing SVAD, and conservative treatment is a choice for asymptomatic patients.