bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reopening the capsular bag by removing the capsular proliferative membrane to enable secondary in-the-bag intraocular lens implantation in pediatric aphakic eyes
Authors: Zhou Yue , Zhang Yu , Chen Hui , Bai Bingyu , Wang Qiwei , Lin Zhuoling , Li Jing , Zhang Xiulan , Chen Wan , Chen Weirong 
Published: October 2023

Purpose:
To present a surgical technique for reopening the capsular bag in pediatric aphakia.

Setting:
Zhongshan Ophthalmic Center, Guangzhou, China.

Design:
Case series study.

Methods:
Consecutive pediatric patients with bilateral aphakia requiring secondary intraocular lens (IOL) implantation between July 2021 and June 2022 were included. The diameter of the capsular proliferative membranous ring (PMR) and position of IOL implantation were documented. Various parameters of capsular bag opening during primary cataract removal and secondary surgery were also analyzed.

Results:
48 eyes were included with a mean follow-up of 8.1 ± 4.4 months. Using the surgical technique developed in this study, the capsular bag was successfully reopened with in-the-bag (ITB) implantation in 43 eyes (89.6%). ITB implantation was accomplished in all eyes with an outer diameter of PMR ≤5.5 mm and in 3 of 8 eyes (37.5%) with an outer diameter of PMR >5.5 mm. A positive correlation was observed between the primary and secondary anterior capsular opening diameters (ACODs) (r = 0.422, P = .007) and the primary and secondary posterior capsular opening diameters (PCODs) (r = 0.619, P < .001). The inner diameter of PMR was found to be positively correlated with secondary PCOD (r = 0.728, P < .001) and the outer diameter with secondary ACOD (r = 0.669, P < .001).

Conclusions:
This was a safe and effective surgical technique for pediatric secondary IOL implantation with maximum preservation of the peripheral capsule. Aphakic eyes with an outer diameter of PMR ≤5.5 mm are preferred for secondary ITB implantation.
Effect of tibolone vs hormone replacement therapy on climacteric symptoms and psychological distress
Authors: Hsiao Sheng-Mou , Liao Shih-Cheng 
Published: October 2023

Background:
The objective was to elucidate the effect of tibolone vs hormone replacement therapy (HRT) on climacteric symptoms and psychological distress.

Methods:
All consecutive women with climacteric symptoms were allocated to receive tibolone (2.5 mg) or estradiol valerate (1 mg) plus medroxyprogesterone acetate (2.5 mg).

Results:
The improvement in “feeling dizzy or faint” after tibolone treatment was more prominent than that after HRT (−0.7 ± 0.8 vs −0.0 ± 0.9, p = 0.004). In addition, other climacteric symptoms, including anxiety, depression, somatic symptoms, and vasomotor symptoms, and sexual function improved after tibolone and HRT, but there were no between-group differences. Psychological distress assessment demonstrated that somatic complaints, obsessive-compulsive symptoms, depressive symptoms, hostility, additional symptoms, and the General Symptom Index improved after tibolone treatment and HRT, but there were no between-group differences. Personality traits assessment revealed that neuroticism improved after tibolone treatment.

Conclusion:
Tibolone seems more beneficial than HRT in treating symptoms of dizziness and faintness. Both tibolone and HRT could improve psychological distress.
Diagnostic Yield, Radiation Exposure, and the Role of Clinical Decision Rules to Limit Computed Tomographic Pulmonary Angiography–Associated Complications
Authors: Perelas Apostolos , Kirincich Jason , Yadav Ruchi , Ennala Sravanti , Wang Xiaofeng , Sadana Divyajot , Duggal Abhijit , Krishnan Sudhir 
Published: October 2023

Objectives
Computed tomographic pulmonary angiography (CT-PA) is associated with significant cost, contrast, and radiation exposure. Clinical decision rules (CDRs) reduce the need for diagnostic imaging; however, their utility in the medical intensive care unit (MICU) remains unknown. We explored the diagnostic yield and complications associated with CT-PA (radiation exposure and contrast-induced acute kidney injury [AKI]) while investigating the efficacy of CDRs to reduce unnecessary testing.

Methods
All CT-PAs performed in an academic MICU for 4 years were retrospectively reviewed. The Wells and revised Geneva scores (CDRs) and radiation dose per CT-PA were calculated, and the incidence of post–CT-PA AKI was recorded.

Results
A total of 439 studies were analyzed; the diagnostic yield was 11% (48 PEs). Positive CT-PAs were associated with a higher Wells score (5.8 versus 3.2, P < 0.001), but similar revised Geneva scores (6.4 versus 6.0, P = 0.32). A Wells score of ≥4 had a positive likelihood ratio of 2.1 with a negative predictive value of 98.2. More than half (88.9%) of patients with a Wells score of ≤4 developed an AKI, with 55.6% of those having recovery of renal function.

Conclusions
There is overutilization of CT-PA in the MICU. The Wells score retains its negative predictive value in critically ill adult patients and may aid to limit radiation exposure and contrast-induced AKI in MICU.
Fracture Risk and Association With TDF Use Among People With HIV in Large Integrated Health Systems
Authors: Hechter Rulin C. , Zhou Hui , Leyden Wendy A. , Yuan Qing , Pak Katherine J. , Lam Jennifer O. , Alexeeff Stacey , Lea Alexandra , Hu Haihong , Marcus Julia L. , Rivera Adovich S. , Adams Annette L. , Horberg Michael A. , Towner William J. , Lo Joan C. , Silverberg Michael J. 
Published: October 2023

Background:
Greater decline in bone health among people with HIV (PWH) has been documented but fracture risk and the impact of specific antiretroviral therapy (ART) regimens remain unclear.

Setting:
Retrospective analyses of electronic health record data from 3 US integrated health care systems.

Methods:
Fracture incidence was compared between PWH aged 40 years or older without prior fracture and demographically matched people without HIV (PWoH), stratified by age, sex, and race/ethnicity. Multivariable Cox proportional hazards models were used to estimate fracture risk associated with HIV infection. The association of tenofovir disoproxil fumarate (TDF) use and fracture risk was evaluated in a subset of PWH initiating ART.

Results:
Incidence of fracture was higher in PWH [13.6/1000 person-years, 95% confidence interval (CI): 13.0 to 14.3, n = 24,308] compared with PWoH (9.5, 95% CI: 9.4 to 9.7, n = 247,313). Compared with PWoH, the adjusted hazard ratio (aHR) for fracture among PWH was 1.24 (95% CI: 1.18 to 1.31). The association between HIV infection and fracture risk increased with age, with the lowest aHR (1.17, 95% CI: 1.10 to 1.25) among those aged 40–49 years and the highest aHR (1.89, 95% CI: 1.30 to 2.76) among those aged 70 years or older. Among PWH initiating ART (n = 6504), TDF was not associated with significant increase in fracture risk compared with non-TDF regimens (aHR: 1.18, 95% CI: 0.89 to 1.58).

Conclusions:
Among people aged 40 years or older, HIV infection is associated with increased risk of fractures. Bone health screening from the age of 40 years may be beneficial for PWH. Large cohort studies with longer follow-up are needed to evaluate TDF effect and the potential benefit of early screening.
Brief Report: The Virome of Bladder Tumors Arising in People Living With HIV
Authors: Starrett Gabriel J. , Foster Haidn , Sigel Keith , Liu Yuxin , Engels Eric A. 
Published: October 2023

Background:
People living with HIV (PLWH) have elevated risk for developing virus-related cancers. Bladder cancer risk is not increased in PLWH but is elevated among immunosuppressed solid organ transplant recipients (SOTRs). BK polyomavirus and, to a lesser extent, other viruses have been detected in bladder cancers from SOTRs.

Objective:
To characterize the virome of bladder tumors in PLWH.

Design:
Retrospective case series.

Methods:
We sequenced DNA and RNA from archived formalin-fixed bladder tumors from PLWH. Nonhuman reads were assembled and matched to a database of known viruses.

Results:
Fifteen bladder tumors from PLWH (13 carcinomas, 2 benign tumors) were evaluated. Fourteen tumors were in men, and the median age at diagnosis was 59 years (median CD4 count 460 cells/mm3). All but 1 tumor yielded both sufficient DNA and RNA. One bladder cancer, arising in a 52-year-old man with a CD4 count of 271 cells/mm3, manifested diverse Alphatorquevirus DNA and RNA sequences. A second cancer arising in a 58-year-old male former smoker (CD4 count of 227 cells/mm3) also showed Alphatorquevirus and Gammatorquevirus DNA sequences. Neither tumor exhibited viral integration.

Conclusions:

Alphatorqueviruses and Gammatorqueviruses are anelloviruses, which have also been detected in bladder cancers from SOTRs, but anelloviruses are common infections, and detection may simply reflect increased abundance in the setting of immunosuppression. The lack of detection of BK polyomavirus among bladder tumors from PLWH parallels the lower level of bladder cancer risk seen in PLWH compared with SOTRs, indirectly supporting a role for BK polyomavirus in causing the excess risk in SOTRs.
Which Intervention Synergies Maximize AGYW's HIV Outcomes? A Classification and Regression Tree Analysis of Layered HIV Prevention Programming
Authors: Mathur Sanyukta , Mahapatra Bidhubhusan , Mishra Raman , Heck Craig J. , Mbizvo Michael 
Published: October 2023

Introduction:
Intersecting behavioral, social, and structural factors increase adolescent girls' (AG) and young women's (YW) HIV vulnerability. Yet, understanding of optimal intervention synergies remains limited. We identified intervention combinations that statistically maximized reductions in AGYW's HIV-related risk.

Methods:
Using data collected in 2018 with Zambian AG (n = 487, aged 15–19 years) and YW (n = 505, aged 20–25 years) after 12–14 months exposure to Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (multisectoral HIV program), we used classification and regression trees to explore relationships between interventions (safe space/social asset building [SAB] and provision of/linkage to youth-friendly health services [YFHS], education social protection [Educ], economic social protection [Econ]) and HIV-related outcomes (HIV testing, consistent condom use, transactional sex, and sexual violence experience from partners and nonpartners).

Results:
Overall, 59.9% completed SAB and 81.5%, 35.4%, and 29.6% received YHFS, Educ, and Econ, respectively. For AG, HIV testing improved (from 73% to 83%) with exposure to all interventions, condom use improved with Econ (from 33% to 46%), transactional sex reduced with SAB + Educ, and sexual violence from partners and nonpartners reduced with Educ and SAB, respectively. For YW, HIV testing increased with Educ (from 77% to 91%), condom use increased with SAB + YFHS (from 36% to 52%), transactional sex reduced with combinations of all interventions, and sexual violence from partners reduced with YFHS and from nonpartners with SAB + Econ.

Conclusions:
Tailored interventions might be more effective than uniform combination intervention packages in reducing AGYW's HIV risk. AG benefitted most from SAB and/or Educ while YFHS, Educ, and/or SAB reduced YW's HIV-related risk. Educational and asset-building interventions could have the greatest impact on AGYW's HIV risk.
FDG PET/CT in a Case of Thoracic SMARCA4-Deficient Undifferentiated Tumor
Authors: Guo Jia , Liao Zhongjian , Chen Qing , Dong Aisheng , Huang Mouqing 
Published: October 2023

Abstract
Thoracic SMARCA4-deficient undifferentiated tumor is a rare, newly recognized poorly differentiated tumor with poor prognosis. FDG PET/CT findings of thoracic SMARCA4-deficient undifferentiated tumor are rarely reported. We describe FDG PET/CT findings in a case of thoracic SMARCA4-deficient undifferentiated tumor. The tumor presented as a pleural mass, destroyed the adjacent ribs, and showed intense FDG uptake with SUVmax of 12.7. This case indicates that thoracic SMARCA4-deficient undifferentiated tumor should be included in the differential diagnosis of FDG-avid pleural lesions.
Extramedullary Hematopoiesis in Treated Diffuse Large B-Cell Lymphoma of Bone
Authors: Chaouki Amine , Roelants Véronique , Gheysens Olivier , Bailly Sarah , Krug Bruno 
Published: October 2023

Abstract
A 65-year-old man with a history of diffuse large B-cell bone lymphoma of the right radius underwent an interim FDG PET/CT after 2 cycles of chemotherapy. Besides a complete metabolic response on the primary site, images revealed a hypermetabolic nodule in the posterior mediastinum, not present on the initial images. The metabolic activity of the nodule was similar to that of the reactive bone marrow and disappeared, concomitantly to the normalization of the medullar signal on the posttreatment images. The similarity and synchronous metabolic activity evolution in the nodule and bone marrow indicate extramedullary hematopoiesis.
Asymptomatic Penetrating Atherosclerotic Ulcer Findings on 18F-FDG PET/CT
Authors: Murad Vanessa , Ortega Claudia , Hanneman Kate , Chung Jennifer , Metser Ur 
Published: October 2023

Abstract
We present a case of an 84-year-old man with a history of smoking, hypertension, and coronary artery disease with an incidental spiculated left apical pulmonary nodule, suspicious for a stage I non–small cell lung cancer. 18F-FDG PET/CT performed for staging, which confirmed a small metabolically active pulmonary nodule. As an incidental finding, there was focal FDG uptake in the proximal descending aorta corresponding to a partially thrombosed outpouching of the aortic wall, in keeping with a penetrating atherosclerotic ulcer.
PSMA Radioligand Therapy in Prostate Cancer
Authors: Almeida Ludmila Santiago , Etchebehere Elba Cristina Sá de Camargo , García Megías Irene , Calapaquí Terán Adriana K. , Hadaschik Boris , Colletti Patrick M. , Herrmann Ken , Giammarile Francesco , Delgado Bolton Roberto C. 
Published: October 2023

AbstractDiagnosis and treatment of prostate cancer are complex and very challenging, being a major health care burden. The efficacy of radioligand therapy with prostate-specific membrane antigen agents has been proven beneficial in certain clinical indications. In this review, we describe management of prostate cancer patients according to current guidelines, especially focusing on the available clinical evidence for prostate-specific membrane antigen radioligand therapy.
Synchronous Endometrial Cancer Detected on 68Ga-DOTATATE PET/CT
Authors: Mohammadinejad Payam , Kim Alex , Koshevarova Victoria , Murphy Micah , Shagun FNU , Bhargava Peeyush 
Published: October 2023

Abstract
A 50-year-old woman with history of metastatic neuroendocrine tumor underwent a follow-up PET/CT with 68Ga-DOTATATE. An enlarged uterus with diffuse increased uptake warranted further investigation with an MRI that showed mass-like thickening of the endometrium, T2 hyperintensity, lobulated contour, and invasion of more than 50% of the myometrium. Biopsy revealed endometrial carcinoma with mucinous features. Mild to moderate uptake of the 68Ga-DOTATATE by the uterus can be a normal physiological finding; however, it should prompt further investigation, particularly in a postmenopausal woman with concerning imaging or clinical findings.
Objective Changes in Pelvic Floor Muscle Strength and Length in Women With High-Tone Pelvic Floor Dysfunction After Pelvic Floor Physical Therapy (RELAX Trial)
Authors: Volpe Lena J. , Zugelder Morgan , Kotarinos Rhonda , Kotarinos Elizabeth , Kenton Kimberly , Geynisman-Tan Julia 
Published: October 2023

Importance
Although pelvic floor physical therapy (PFPT) is effective in treating high-tone pelvic floor dysfunction (HTPFD), data on the mechanism of improvement are limited.

Objectives
This study aimed to compare squeeze intravaginal closure force after 6 weeks of PFPT in women affected by HTPFD and, secondarily, to describe changes in levator dimensions and short-term effects of PFPT on bladder, bowel, and pain symptoms.

Methods
We conducted a prospective cohort study of patients undergoing 6 sessions of PFPT for the diagnosis of HTPFD. At baseline, we measured intravaginal closure force using an instrumented speculum, levator hiatal dimension using a 3-dimensional endovaginal ultrasonography, and symptom severity using 3 validated questionnaires. Intravaginal closure force and symptoms were reevaluated after the second, fourth, and sixth PFPT sessions, and levator hiatus was reevaluated at the sixth session.

Results
Twenty-six women were enrolled and 22 completed 6 sessions and are included in the analysis. Contrary to our hypothesis, mean ± SD vaginal closure force (N) did not demonstrate a significant change (3.27 ± 2.34 vs 3.67 ± 2.02 N, P = 0.18). However, mean levator hiatal area (cm2) increased between visit 1 (13.71 ± 1.77 cm2) and visit 6 (14.43 ± 2.17 cm2, P = 0.05), as did the transverse diameter (3.83 ± 0.03 vs 3.95 ± 0.03 cm, P = 0.04). Survey responses demonstrated significant improvements across all measures of genitourinary symptoms, pain, lower gastrointestinal symptoms and quality-of-life measures after 6 sessions of PFPT.

Conclusion
Although the levator hiatal area increased after 6 sessions of PFPT (suggesting muscle lengthening), we were unable to demonstrate that this changed the force generated by pelvic floor muscles as measured by a speculum.
Perioperative Outcomes for Same- Versus Next-Day Discharge After Benign Vaginal Hysterectomy
Authors: Burger Kristina A. , Robison Elizabeth H. , Nekkanti Silpa , Hundley Andrew F. , Hudson Catherine O. 
Published: October 2023

Importance
While same-day discharge (SDD) after laparoscopic hysterectomy is well supported, studies for vaginal hysterectomy (VH) are lacking.

Objective
The aim of the study was to compare 30-day complications for SDD versus next-day discharge (NDD) after benign VH.

Study Design
This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2019. Vaginal hysterectomy with or without urogynecology procedures was identified by Current Procedural Terminology codes. The primary outcome was 30-day composite complications of SDD versus NDD after VH. Secondary outcomes compared reoperations rates, time to and reasons for reoperation, and complications between the groups. Composite complications included death, major infection or wound complication, thromboembolism, transfusion, cardiopulmonary complication, renal insufficiency/failure, stroke, or reoperation. Unadjusted and adjusted odds ratios were determined using univariate and multivariate analysis.

Results
Of 24,277 people included, 4,073 (16.8%) were SDD, which were more likely to be younger (P < 0.001), less likely to have hypertension (23.4 vs 18.3%, P < 0.0001) or diabetes (4.5 vs 3.3%, P = 0.001), and had shorter surgical procedures (100.7 ± 47.5 vs 111.2 ±57.5 minutes, P < 0.0001). There was no difference in composite complications after SDD versus NDD and this remained true in multivariate analysis (2.0 vs 2.3%, P = 0.30, SDD; adjusted odds ratio, 0.9; 95% confidence interval, 0.7–1.1). There was no difference in reoperation rates (0.9 vs 0.9%, P = 0.94) or reasons for reoperation. Time to first complication was shorter for SDD versus NDD (11 vs 13 days, P = 0.47).

Conclusion
In our cohort of low-risk patients, SDD after VH with or without urogynecology procedures did not have an increased odds of 30-day composite complications.
The Injured Monocyte: The Link to Chronic Critical Illness and Mortality Following Injury
Authors: Cuschieri Joseph , Kornblith Lucy , Pati Shibani , Piliponsky Adrian 
Published: October 2023

ABSTRACT

Background
This study aimed to understand the altered innate immune response in severely injured patients leading to chronic critical illness (CCI). Specifically, it focused on characterizing the monocyte populations and their correlation with CCI development and long-term complications.

Methods
Over a 3-year period, we monitored patients with severe injuries for up to 1-year post-injury. CCI was defined as an ICU stay exceeding 14 days with persistent organ failure. Blood samples were collected on days 1 and 5 for monocyte phenotypic expression analysis using cytometry by time flight. The monocyte subpopulations studied were classical (CL), intermediate (INT), and non-classical (NC), along with cell surface receptor expression and activation.

Results
Out of 80 enrolled patients, 26 (32.5%) developed CCI. Patients with CCI had more severe injuries (injury severity score 32.4 + 5.2 vs. 29.6 + 4.1, p = 0.01) and received a higher number of red blood cells (8.9 + 4.1 vs. 4.7 + 3.8 units, p < 0.01) compared to those without CCI. In patients with CCI, the NC monocytes were significantly reduced by over 2-fold early, and significantly increased later, compared to those without CCI. Moreover, significant changes in intracellular cytokine expression and cell receptors were observed within each monocyte subpopulation in patients with CCI, indicating an increased pro-inflammatory phenotype but decreased phagocytic capacity and antigen presentation. The development of CCI and the presence of this unique monocyte phenotype were associated with a significantly increased risk of infection, discharge to a long-term care facility, and 1-year mortality of 27%.

Conclusions
Development of CCI following severe injury is associated with significant long-term morbidity and unacceptably high mortality. The altered NC phenotype with reduced phagocytic capacity and antigen presentation in patients developing CCI after severe injury is appears partially responsible. Early identification of this unique phenotype may help predict and treat patients at risk for CCI, leading to improved outcomes.

Level of Evidence
Level III, Prognostic/Epidemiological
A heterogenous population of extracellular vesicles mobilize to the alveoli postinjury
Authors: Costantini Todd W. , Park Dong Jun , Johnston William , Nakatsutsumi Keita , Kezios Jenny , Weaver Jessica L. , Coimbra Raul , Eliceiri Brian P. 
Published: October 2023

BACKGROUND
Acute lung injury and subsequent resolution following severe injury are coordinated by a complex lung microenvironment that includes extracellular vesicles (EVs). We hypothesized that there is a heterogenous population of EVs recruited to the alveoli postinjury and that we could identify specific immune-relevant mediators expressed on bronchoalveolar lavage (BAL) EVs as candidate biomarkers of injury and injury resolution.

METHODS
Mice underwent 30% TBSA burn injury and BAL fluid was collected 4 hours postinjury and compared with sham. Extracellular vesicles were purified and single vesicle flow cytometry (vFC) was performed using fluorescent antibodies to quantify the expression of specific cell surface markers on individual EVs. Next, we evaluated human BAL specimens from injured patients to establish translational relevance of the mouse vFC analysis. Human BAL was collected from intubated patients following trauma or burn injury, EVs were purified, then subjected to vFC analysis.

RESULTS
A diverse population of EVs were mobilized to the alveoli after burn injury in mice. Quantitative BAL vFC identified significant increases in macrophage-derived CD44+ EVs (preinjury, 10.8% vs. postinjury, 13%; p < 0.05) and decreases in IL-6 receptor alpha (CD126) EVs (preinjury, 19.3% vs. postinjury, 9.3%, p < 0.05). Bronchoalveolar lavage from injured patients also contained a heterogeneous population of EVs derived from myeloid cells, endothelium, and epithelium sources, with CD44+ EVs being highly detected.

CONCLUSION
Injury causes mobilization of a heterogeneous population of EVs to the alveoli in both animal models and injured patients. Defining EV release after injury will be critical in identifying diagnostic and therapeutic targets to limit postinjury acute lung injury.