bluuebunny/crossref_metadata_2025_split huggingface dataset:
Somatic Genomic Profiling of Pancreatic Ductal Adenocarcinomas From a Diverse Cohort of Patients
Authors: Riner Andrea N. , Velazquez-Villarreal Enrique I. , Rajpara Seeta , Qian Jing , Jin Yuxin , Loza Donna , Akki Ashwin , Herremans Kelly M. , Raj Rohit , Williams Terence M. , Merchant Nipun , George Thomas J. , Hughes Steven J. , Stern Mariana C. , Reams Renee , Redda Ken , Wilkie Diana J. , Odedina Folakemi T. , Chamala Srikar , Han Bo , Agyare Edward , Craig David W. , Carpten John D. , Trevino Jose G. 
Published: February 2025

Objectives
Black/African American (B/AA) pancreatic ductal adenocarcinoma (PDAC) patients have worse clinical outcomes than White patients and are underrepresented in genomic databases. We aimed to expand our understanding of the PDAC somatic landscape from a diverse cohort.

Materials and Methods
Formalin-fixed paraffin-embedded specimens from 24 surgically resected PDAC cases were collected, with self-reported race/ethnicity. Whole exome sequencing was performed on malignant and benign tissue. Bioinformatics analysis included deduction of genetic ancestry and somatic mutational analysis, with comparisons to public datasets.

Results
Out of 24 cases, 17 identified as B/AA race; genetic ancestry analysis confirmed proportions of Sub-Saharan African ancestry greater than 47%. The most commonly mutated genes included KRAS, TP53, SMAD4, and CDKN2A. Comparison of mutations in our cohort versus publicly available, predominantly White datasets showed higher mutation frequencies of ATM, RREB1, BRCA1/2, KDM6A, ARID1A, BRAF, and MYC (P < 0.04). When cohorts were combined and analyzed by race, no mutation frequencies differences were observed, including KRAS.

Conclusions
Genomic analysis of PDAC tumors from B/AA and White patients demonstrate similarities in mutation frequencies. Larger studies are needed to further understand molecular characterizations across continental subpopulations. This study provides further rationale for equitable representation of diverse patients in genomic databases and clinical trials.
Intratumoral Injection of Cytotoxic Drugs Plus Hapten Elicits Significant Immune Responses in Sentinel Lymph Nodes
Authors: Yu Baofa , Zhang Jian , Han Yan , Gao Feng , Jing Peng , Zhang Peicheng , Jing Guoqin , Zhou Shengjun , Wang Huan-You 
Published: February 2025

Objectives
Studying the sentinel lymph nodes (SLNs) to define the metastasis and the mechanisms of abscopal effect.

Method
Using scRNA-seq to investigate the cellular and genomic changes of SLNs before or after treatment of the primar pancreatic carcinoma site by intratumoral injection of cytotoxic chemotherapy drugs plus hapten.

Result
A very significant decrease of SLN carcinoma cells, but increased macrophages, monocytes, CD8 T-effector cells, and fibroblasts. At the genomic and functional levels, the above treatment increased the ability of angiogenesis, epithelial mesenchymal transition (EMT), and cancer-associated fibroblast (CAF) signaling. In addition, matricellular proteins were upregulated.

Alternative conclusion
Our study demonstrated a marked reduction in carcinoma cells within SLNs following treatment, alongside a notable increase in inflammatory and stromal cells, which suggested a dynamic reorganization of the lymph node microenvironment rather than straightforward tumor growth. The absence of significant enlargement of SLNs, despite the increase in cellular density, may be attributed to the remodeling effects induced by the treatment. The observed upregulation of angiogenic factors, EMT pathways, and CAF signaling highlighted a complex interaction between tumor and immune responses. These findings provided new insights into the abscopal effect, revealing how targeted therapies can modulate lymph node microenvironments to enhance local immune responses and potentially improve systemic antitumor efficacy.
Enhancing Pain Assessment Among Post-Surgery Patients at a Tertiary Hospital in China
Authors: Liu Chengxiang , Li Sainan , Zhou Juan , Zhao Huihui , Zhou Ruhuan , Zhu Chen , Chen Shan , Chen Hong , Zhang Miao 
Published: February 2025

Background:
Postoperative pain is a common complication that can delay recovery and increase hospital stays and costs. Accurate pain assessments are essential for effective management.

Local Problem:
Compliance with evidence-based pain assessment protocols in the Anesthesia Intensive Care Unit (AICU) at a teaching hospital in Hefei, China, was suboptimal.

Methods:
This evidence-based implementation project, conducted from December 2023 to August 2024, utilized the Joanna Briggs Institute (JBI) Implementation Framework and Model of Evidence-Based Health Care. A baseline audit of 23 nurses and 50 patients was followed by a post-implementation audit. Data were analyzed using JBI’s PACES software.

Interventions:
Educational programs and stakeholder focus groups were introduced to enhance compliance with pain assessment protocols.

Results:
Compliance with 3 audit criteria increased by 66% to 92% following the intervention.

Conclusions:
The project successfully enhanced compliance with evidence-based pain assessment, improving postoperative pain management in the AICU.
Utility of preoperative syphilis screening on the detection of syphilis at a tertiary care center: a retrospective cohort study
Authors: Hanai Shogo , Doi Yohei , Honda Hitoshi 
Published: February 2025

Abstract

Background
The incidence of syphilis has been rising globally but effective screening strategies are lacking. Preoperative syphilis screening is commonly performed at Japanese hospitals for infection prevention purposes. However, its effectiveness in improving subsequent management is unclear.

Methods
A retrospective cohort study was conducted to assess the effectiveness of universal preoperative syphilis screening testing implemented at a Japanese tertiary care hospital from April 2017 to March 2023. The annual prevalence of positive preoperative treponemal tests was tracked, and subsequent clinical management for patients with a positive test result was investigated. Attributes of patients with a positive result who were more likely to receive further evaluation were also elucidated.

Results
In total, 82,439 patients underwent surgery during the study period. Preoperative treponemal testing was performed in 94.8% (78,170/82,439) of the patients. A positive test result was recorded in 544 (0.70%) with an annual positivity rate ranging from 0.61 to 0.83%, whereas the proportion of presumed active syphilis ranged from 0.02 to 0.08%. A total of 85 patients with a positive syphilis screening test, a nontreponemal test with a positive titer, and without history of syphilis were identified. Of those, only 45 patients (52.9%) received further evaluation.

Conclusion
The positivity of preoperative treponemal testing was low despite the rising incidence of syphilis in Japan, and the prevalence of presumed active syphilis identified during the preoperative period was even smaller. Routine treponemal testing in the preoperative setting had limited utility in effectively identifying patients with active syphilis.
POCUS Standoff: Comparing Ultrasound Interfaces for Soft Tissue Foreign Body Imaging
Authors: Vega Carolina , Lindsay Robert , Shokraneh Keyon , Willard Celia S. , Gleeson Timothy , Kapoor Monica , Nalbandian Ari , Binder Zachary 
Published: February 2025

Background:
Point-of-care ultrasound can be used to identify foreign bodies (FBs) in soft tissue. Imaging interfaces such as standoff pads and water baths can improve image resolution for superficial soft tissue structures. Our objective was to determine the optimal interface for FB detection. We hypothesized that water baths would be associated with the greatest FB detection accuracy and image quality.

Methods:
Prospective analysis of ultrasound imaging interfaces to detect FBs. 18 emergency physicians in training were enrolled: 8 interns, 8 senior residents, and 2 fellows. Four imaging interfaces were compared: gel, saline bag standoff, water bath, and a novel proposed interface: water-filled patient belongings bag (PBB). Standardized FBs (wood, plastic, and metal) were inserted into porcine models, which were imaged by participants using the interfaces. The primary outcome was the accuracy of FB detection for the interfaces. Secondary outcomes included time to FB detection, image quality, and impact of training level. Ultrasounds were reviewed by 2 blinded ultrasound fellowship-trained emergency physicians to determine FB visibility and image quality. Data analysis was performed using the χ2 test and Kruskal-Wallis test with GraphPad Prism Software.

Results:
Eighteen participants completed 16 stations. Two hundred eighty-eight ultrasounds total. Interface types demonstrated a trend of greatest accuracy for PBB, followed by water bath, gel, and saline bag. Gel was significantly more accurate than saline bag (P=0.0120). Gel did not have a significant difference from PBB (P=0.1425) or water bath (P=0.125). As training level increased, time to FB detection significantly decreased (P=0.02), and accuracy increased. Accuracy for fellows was significantly greater than for senior residents (P=0.0473) and interns (P=0.0027). There was a trend of greater accuracy in senior residents from interns.However, there was ﻿no significant difference (P=0.0729).

Conclusions:
PBBs may be a viable alternative interface for soft tissue FB detection. PBBs, water baths, and gel should be considered prior to saline standoffs.
Keloid Excision With Primary Closure Combined With Superficial Radiation Therapy (SRT-100)
Authors: Tsai Sheng-Lin , Tsai Yu-Chi , Weng Yu-Tse , Huang Wen-Yen , Wang Chih-Hsin 
Published: February 2025

Background
Surgery plus radiotherapy is associated with fewer recurrences after keloid treatment. However, the side effects of radiotherapy are of concern. Superficial radiation therapy has a low energy, targets the skin, and spares deeper structures, making it ideal for keloid treatment. Many studies have reported good outcomes after surgery combined with superficial radiation therapy. This study provided data on Taiwanese patients who underwent keloid excision with simple primary closure and superficial radiation therapy.

Methods
We retrospectively collected data from patients who underwent keloid excision with postoperative radiotherapy at our hospital. All patients underwent keloid excision and primary wound closure without Z-plasty or a local flap. Subsequently, patients underwent 2 or 3 fractions of superficial radiation therapy (SRT) on postoperative days 0, 1, and 2 (in 3 fractions). We collected data on the patients' preoperative Vancouver Scar Scale (VSS), 2-month follow-up VSS score, recurrence, and side effects.

Results
In total, 16 keloids in 12 patients were treated with excision, primary closure, and superficial radiation therapy. The mean preoperative VSS was 8.69 ± 1.79, whereas the mean 2-month postoperative VSS was 3.56 ± 0.70. Most of the keloids were followed up for more than 6 months. No keloid recurrence was observed. A side effect of radiotherapy is hyperpigmentation of the skin surrounding the surgical scar.

Conclusions
Keloid excision with primary closure combined with postoperative SRT leads to a good outcome with no recurrence and a shorter incision wound that satisfies patients and reduces the complications of hyperpigmentation.
Reconstruction of Posttraumatic Distal Limb Defects With Free Superficial Circumflex Iliac Artery Perforator Flap
Authors: Tung Yuan-Chang , Chen Yen-Kai , Lin Ying-Sheng 
Published: February 2025

Introduction
Soft tissue defects in the distal limbs are common after traumatic injury. Repairing such defects is challenging because of the lack of adjacent soft tissue for direct closure or use of a local flap, and functional and aesthetic issues are more prominent in the hands and feet. Thin, unbulky free tissue transfer is ideal for achieving functional and aesthetically pleasing reconstructions. This study reports the use of free superficial circumflex iliac artery perforator (SCIP) flap to reconstruct posttraumatic distal limb defect.

Patients and Methods
Thirteen patients with distal limb defects following traumatic injury underwent microsurgical reconstruction with SCIP flap between 2017 and 2022. The defects were located in the upper extremities in 8 patients and lower extremities in 5 patients. Flap thinning was performed to minimize bulkiness, thus restoring functionality and an aesthetically satisfactory appearance.

Results
The patients' average age was 39.8 ± 15.3 years. The average flap size was 13.5 ± 3.4 × 6.7 ± 1.5 cm, and the average pedicle length was 5.2 ± 1.3 cm. Two flaps failed because of unsalvageable venous thrombosis, whereas 2 flaps had salvageable vessel thrombosis. Other flaps survived without major complications. During the average follow-up duration of 7.4± 4.8 months, the functional and aesthetic outcomes were satisfactory after an average of 1 ± 1.2 times of flap revisions.

Conclusions
With a thin skin paddle, SCIP flap is an available option for posttraumatic distal limb defect reconstruction without much effort of further revisions.
A Novel T-Shaped Design of the Forehead Flap in Columella Reconstruction
Authors: Yen Cheng-I , Chang Chun-Shin , Chen Hung-Chang , Yang Shih-Yi , Chang Shu-Yin , Hsiao Yen-Chang 
Published: February 2025

Abstract
Reconstruction of the columella is challenging because of its unique contours, narrow horizontal dimension, paucity of adjacent soft tissues, and tenuous vascularity. For larger defects or defects with poor outcomes after composite graft or local flap reconstruction, forehead flaps have been used due to their robust blood supply and sufficient tissue. However, we found an increased risk of flap dehiscence between the forehead flap and the upper lip since the connection is only approximately 0.5-cm wide.
In this series, we proposed a novel modification of a T-shaped forehead flap in columella reconstruction. We created a subcutaneous pocket and inserted the distal de-epithelialized part of the flap into the pocket to obtain greater connection and contact between the two tissues. Between February 2017 and June 2023, 23 patients were treated with our proposed surgical method. The mean follow-up time was 34.5 months (range, 7 months to 80 months). All uneven wounds healed uneventfully within 2 weeks. No disruption of the columellar edge or other complications were noted. Our novel T-shaped design for columella reconstruction is a safe, straightforward, and reliable technique. The method is technically simple and has a low learning curve. This approach may decrease the risk of flap disruption in columella reconstruction and yield a superior aesthetic result, with which patients are satisfied.
Feasibility of Intraoperative Somatosensory Evoked Potential Monitoring for Resection of Brachial Plexus Schwannomas
Authors: Yao Wen-Teng , Hsu Hsiu-Han , Liang Muh-Lii , Huang Hsuan-Yu , Lao Amy Hsuan-Chih , Yu Chia-Meng , Tung Kwang-Yi , Chen Hsuen-Li , Yang Shan-Chiao , Tu Chih-Peng , Tsai Ming-Feng 
Published: February 2025

Objectives
The complex anatomical location of brachial plexus tumors is a formidable diagnostic and therapeutic challenge for surgeons. Intraoperative neurophysiologic monitoring enables the surgeon to proceed with more aggressive maneuvers for near total removal of the spinal cord tumor, such as somatosensory evoked potentials (SSEPs) monitoring. The present study aimed to describe the SSEP-assisted microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas.

Methods
Thirteen patients who underwent SSEP-guided microsurgery for brachial plexus schwannomas between October 2011 and December 2020 were included in our study.

Results
The mean age of the patients was 50 years (range, 29–64 years), with six tumors localized on the right, six on the left side and one on bilateral sides. Eight patients had preoperative motor/sensory dysfunction. Compared to preoperative Visual Analogue Scale (VAS) pain score, the postoperative VAS score significantly decreased in these patients (P = 0.005). No postoperative neurovascular injury was observed in the patients. Among patients who had a preoperative neurologic deficit, these preoperative neurologic deficits were relieved or improved after surgery. There was a low disability in the arm, shoulder, and hand after surgery.

Conclusions
Brachial plexus schwannomas is able to completely excised by SSEP-assisted delicately surgical techniques, contributing to a surgical benefit for the excision of brachial plexus schwannomas, particularly in patients with lower trunk involvement.
Effect of Laparoscopic versus Open Distal Pancreatectomy on Recurrence-Free Survival in Patients with Left-sided Pancreatic Cancer
Authors: Liu Chen , Cheng He , Wang Min , Cai Yunqiang , Jiang Chongyi , Tang Liang , Luo Guopei , Jin Kaizhou , Ji Shunrong , Xu Wenyan , Shi Si , Wang Xu , Liu Meng , Zhao Weihong , Xu Xiaowu , Xu Jin , Wu Weiding , Wang Wei , Liu Jianhua , Shao Chenghao , Peng Bing , Qin Renyi , Yu Xianjun ,   The Chinese Study Group for Pancreatic Cancer (CSPAC)
Published: February 2025

Objective:
The aim of this trial was to evaluate the oncological superiority of laparoscopic versus open distal pancreatectomy in left-sided pancreatic cancer.

Background:
The oncological efficacy of laparoscopic distal pancreatectomy in left-sided pancreatic cancer remains controversial.

Methods:
We performed a multi-center, open-label, randomized controlled trial of laparoscopic versus open distal pancreatectomy in left-sided pancreatic cancer patients. Candidates were recruited from six centers in China, and randomly assigned to receive either LDP or ODP. The primary outcome was recurrence-free survival, and the secondary outcomes were overall survival, R0 resection rate, and retrieved lymph node numbers.

Results:
Of the 481 eligible pancreatic cancer patients between Jan. 9, 2019 and Dec. 8, 2021, 306 candidates were initially enrolled and randomly assigned at 1:1 to receive either LDP or ODP. The last follow-up was performed on Dec. 15, 2023, and 130 patients in the LDP group and 129 patients in the ODP group were included for per-protocol analysis. Median RFS was 15.5 (12.5-18.5) months in the LDP group compared to 15 (9.5-20.5) months in the ODP group (P=0.471). The R0 resection rate in two groups was 88.5% versus 89.1%, respectively. Median retrieved lymph node numbers in two groups were similar (13.5 [10–20] versus 12 [7–17], P=0.165). Complications with a Clavien-Dindo score ≥ 3 occurred in 10 of 130 patients in the LDP group, and 11 of 129 patients in the ODP group.

Conclusion:
Although LDP did not provide significant oncological benefits for left-sided pancreatic cancer, it was safe and applicable appropriate. ClinicalTrials.gov NCT03792932.
Socioeconomic Disparities in the Progression of GERD and Barrett’s Esophagus to Esophageal Adenocarcinoma
Authors: Sarici Inanc S. , Eriksson Sven E. , Chaudhry Naveed , Zheng Ping , Chalikonda Sricharan , Bartlett David L. , Ayazi Shahin 
Published: February 2025

Objective:
To assess the impact of socioeconomic and other factors on progression from gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE) to esophageal adenocarcinoma (EAC).

Summary Background Data:
Socioeconomic status (SES) influences outcomes in EAC, but its role in the progression from GERD and BE to EAC is not well-defined. Risk of progression may be influenced by access and engagement with endoscopic screening and surveillance, healthcare utilization, health literacy and other competing social determinants of health that vary with SES.

Methods:
Patients diagnosed with GERD between 2015 and 2023 across a regional network of 14 hospitals and >300 clinics were reviewed for BE and EAC. U.S. Census data on wealth, income, education and occupation were used to categorize patients into low, middle, and high SES groups. Univariate and multivariable analyses were conducted to evaluate the influence of demographic, clinical, and SES factors on progression to EAC from GERD and BE.

Results:
Among 162,542 GERD patients, 7,604 (4.70%) developed BE and 331 (0.20%) progressed to EAC. Unemployment, disability, lack of college education, and high school non-graduation were associated with progression to EAC (all P<0.0001). Independent predictors of disease progression included established demographic and clinical factors (all P<0.0001), lack of private insurance (OR:1.4, P<0.0001), and low SES (OR:1.6, P<0.0001). For BE to EAC progression, predictors were similar, including lack of private insurance (OR:2.0, P=0.015) and low SES (OR:2.0, P=0.028). Patients with low SES were less frequently endoscopically evaluated (4 per 1,000 vs. 10 per 1,000, P<0.0001) or diagnosed with BE (4 per 1,000 vs. 50 per 1,000, P<0.0001). They were also more likely to be diagnosed with early-onset EAC (13 per 1,000 vs. 5 per 1,000, P=0.0138) and metastatic EAC (77.4% vs. 53.1%, P=0.001). Among patients with BE, those with low SES had a higher rate of progression to EAC (1.77% vs. 0.95%, P=0.026).

Conclusion:
Low SES is associated with increased progression to EAC, with higher rates of early-onset and metastatic disease at diagnosis. Disparities in access to endoscopic screening and surveillance play a significant role, compounded by socioeconomic barriers such as limited healthcare engagement and competing social priorities. Integrating SES into risk stratification models alongside clinical factors is essential for improving early detection and reducing the burden of advanced disease.
Closer to home: Managing more than three rib fractures at level IV trauma centers
Authors: Lizak Adam , Allsbrook Anthony , Wilde-Onia Rebecca , Robins Lisa , Boyer Rebecca , Cipolla James , Thomas Peter , Castillo Roberto , Braverman Maxwell A. 
Published: February 2025

INTRODUCTION
Rib fractures remain a significant source of trauma admissions. In 2020, the Pennsylvania Trauma System Foundation standards changed to allow patients with more than three rib fractures to be admitted to level IV centers. The primary aim of this study was to evaluate outcomes of patients with more than three uncomplicated rib fractures admitted to level IV trauma centers.

METHODS
Our network database was queried for patients with isolated uncomplicated rib fractures between 2018 and 2022. Patients were stratified based on evaluation before or after the change in standards. Patients evaluated at level IV centers were compared for demographics, injury characteristics, transfer rate, and outcomes. Finally, 1:1 propensity score matching was used to create a matched group of patients with more than three rib fractures to assess outcomes based on admission to level IV versus level I/II centers.

RESULTS
A total of 1,070 patients with isolated rib fractures were admitted over the study period. Level IV centers evaluated 360 patients with 132 (36.6%) and 228 (63.3%) in the pre- and poststandard change periods. There was a significant reduction in transfers for isolated rib fractures (56% vs. 21% p < 0.01). Compared with patients with three or less rib fractures, those with more than three fractures had similar hospital length of stay (median [interquartile range (IQR)], 3 [2–5] vs. 2 [1–4]; p = 0.29) and mortality (0% vs. 2.3%, p = 0.22). After propensity match, there was no difference in age (median [IQR], 71 [60–81] vs. 73 [65–85]; p = 0.24), injury characteristics, hospital length of stay (median [IQR], 2.5 [2–5] vs. 2 [1–4]; p = 0.37), and mortality (1.7% vs. 0%, p = 0.30).

CONCLUSION
Change in state admission standards allowed for a reduction in transfer of patients with more than three isolated rib fractures. In a group of matched patients with more than three rib fractures, level IV centers had similar outcomes to level I or II centers.

LEVEL OF EVIDENCE
Clinical Research, Retrospective Study; Level III.