bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anal Adenocarcinoma Treated in the Era of Total Neoadjuvant Therapy and Nonoperative Management
Authors: Feferman Yael , Rosen Roni , Gebran Selim , Yuval Jonathan B. , Kerioui Marion , Gonen Mithat , Wei Iris H. , Widmar Maria , Nash Garrett M. , Weiser Martin R. , Paty Philip B. , Hajj Carla , O’Brien Diana Roth , Romesser Paul B. , Crane Christopher , Smith J. Joshua , Aguilar Julio Garcia , Pappou Emmanouil P. 
Published: December 2023

BACKGROUND:
Anal adenocarcinoma bears a treatment strategy unique to other anal cancers.

OBJECTIVE:
To describe oncologic outcomes of total neoadjuvant therapy followed by watch and wait for anal adenocarcinoma.

DESIGN:
Retrospective analysis.

SETTING:
This study was conducted at a comprehensive cancer center.

PATIENTS:
Patients with anal adenocarcinoma treated between 2004 to 2019 were selected.

INTERVENTIONS:
Fifty-four patients received neoadjuvant therapy and were divided into two groups according to their treatment strategy: total neoadjuvant therapy versus single-neoadjuvant modality therapy.

MAIN OUTCOME MEASURES:
Organ preservation, tumor regrowth, local failure, distant metastasis rates, recurrence-free, and overall survival.

RESULTS:
The study included 70 patients with anal adenocarcinoma. Fifty-four patients (77%) received neoadjuvant therapy, of whom 30 (42%) received total neoadjuvant therapy and 24 (34%) received single neoadjuvant modality. Twenty-three (33%) patients achieved complete clinical response and were managed by watch-and-wait. The proportion of patients able to continue to watch-and-wait was higher after receiving total neoadjuvant therapy (60%) compared to single neoadjuvant modality therapy (20%) (p = 0.004). A tumor regrowth rate of 22% was observed in the total neoadjuvant therapy group. The 5-year overall survival rate was 70% (95% CI: 59%, 83%), including 61% (95% CI: 42%, 88%) for the total neoadjuvant therapy and 65% (95% CI: 48%, 88%) for single neoadjuvant modality groups. Colostomy was avoided in 50% of patients that received total neoadjuvant therapy and 83% watch and wait patients. Five-year recurrence-free survival rates of 55% (95% CI: 39%, 79%) and 30% (95% CI 15%, 58%) were observed in the total neoadjuvant therapy and single neoadjuvant modality groups, respectively.

LIMITATIONS:
Retrospective nature.

CONCLUSIONS:
This is the first report in the literature describing the safety and feasibility of non-operative management for anal adenocarcinoma. Anal adenocarcinoma treated with total neoadjuvant therapy and nonoperative management achieve comparable regrowth rates to those observed in rectal cancer, with similar oncologic outcomes to traditional treatment strategies. See Video Abstract.
Predictive Factors for Successful Same-Day Discharge Following Minimally Invasive Colectomy and Stoma Reversal
Authors: Paradis Tiffany , Robitaille Stephan , Wang Anna Y. , Gervais Camille , Liberman A. Sender , Charlebois Patrick , Stein Barry L. , Fiore Julio F. , Feldman Liane S. , Lee Lawrence 
Published: December 2023

BACKGROUND:
Same-day discharge following minimally invasive colorectal surgery is a safe, effective practice in specific patients that can enhance the efficiency of enhanced recovery pathways.

OBJECTIVE:
To identify predictive factors associated with success or failure of same day discharge.

DESIGN:
Prospective cohort study from January 2020 to March 2023.

SETTINGS:
Tertiary colorectal center.

PATIENTS:
Adult patients eligible for same day discharge with remote postdischarge follow-up included those with minimal comorbidities, residing neat the hospital, having sufficient home support, and owning a mobile device.

INTERVENTIONS:
Patients were discharged on the day of surgery upon meeting specific criteria, including adequate pain control, tolerance of oral intake, independent mobility, urination, and the absence of complications. Successful same-day discharge was defined as discharge on the day of surgery without unplanned visits in the first 72 hours.

MAIN OUTCOME MEASURES:
Factors associated with successful or failed same day discharge after minimally invasive colorectal surgery.

RESULTS:
A total of 175 (85.3%) patients were discharged on the day of surgery with 14 (8%) patients having an unplanned visit within 72 hours. Overall 161 (78.5%) patients were categorized as same-day discharge success and 44 (21.5%) patients as same-day discharge failure. The same-day discharge failure group had a higher Charlson Comorbidity Index (3.7, 2.8, p = 0.03). Mean length of stay (0.8, 3.0, p = 0.00), 30-day complications (10%, 48%, p = 0.00) and readmissions (8%, 27%, p = 0.00) were higher in the same-day discharge failure group. Regression analysis showed that failed same-day discharge was associated with higher comorbidities (OR 0.79, 95% CI 0.66, 0.95) and prolonged postanesthesia-care-unit time (OR 0.99, 95% CI 0.99, 0.99). Individuals who received a regional-nerve-block (OR 4.1, 95% CI 1.2, 14) and those who did not consume postoperative opioids (OR 4.6, 95% CI 1-21) were more likely to have successful same-day discharge.

LIMITATIONS:
Single center study.

CONCLUSIONS:
Our findings indicate that comorbidities and prolonged post-anesthesia care unit stays were associated with same day discharge failure, while regional nerve blocks and minimal postoperative opioids were related to success. These factors may inform future research aiming to enhance colorectal surgery recovery protocols. See Video Abstract.
The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction–associated steatotic liver disease and alcohol-associated liver disease
Authors: Younossi Zobair M. , Stepanova Maria , Al Shabeeb Reem , Eberly Katherine E. , Shah Dipam , Nguyen Veronica , Ong Janus , Henry Linda , Alqahtani Saleh A. 
Published: December 2023

Background:
The high prevalence of obesity in the United States drives the burden of NASH, recently renamed as metabolic dysfunction–associated steatohepatitis (MASH). We assessed the most recent trends in liver transplantation in the United States.

Methods:
The Scientific Registry of Transplant Recipients (SRTR 2013-2022) was used to select adult (18 years or above) candidates who underwent liver transplant.

Results:
There were 116,292 candidates who underwent liver transplant with known etiology of chronic liver disease. In candidates without HCC, the most common etiology was alcohol-associated liver disease (ALD), increasing from 23% (2013) to 48% (2022), followed by NASH/MASH, which increased from 19% to 27%; the rates of viral hepatitis decreased (chronic hepatitis C: 28%–4%; chronic hepatitis B: 1.8%–1.1%) (all trend p<0.01). The proportion of HCC decreased from 25% (2013–2016) to 17% (2021-2022). Among HCC cohort, the proportion of chronic hepatitis C decreased from 60% (2013) to 27% (2022), NASH/MASH increased from 10% to 31%, alcohol-associated liver disease increased from 9% to 24% (trend p<0.0001), and chronic hepatitis B remained stable between 5% and 7% (trend p=0.62). The rapid increase in the proportion of NASH/MASH in HCC continued during the most recent study years [20% (2018), 28% (2020), 31% (2022)]; the trend remained significant after adjustment for age, sex, ethnicity, obesity, and type 2 diabetes.

Conclusions:
Liver transplant etiologies in the United States have changed over the last decade. Alcohol-associated liver disease and NASH/MASH remain the 2 most common indications for transplantation among those without HCC, and NASH/MASH is the most common in patients with HCC.
Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach
Authors: LEE Eun-Hyun , LEE Young Whee , KANG Eun Hee , KANG Hyun-Jung 
Published: December 2023

ABSTRACT

Background
Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management.

Purpose
This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes.

Methods
A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 (N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples.

Results
Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management.

Conclusion/Implications for Practice
This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.
Large Single-center Experience with Long-term Outcomes of EUS-guided Transmural Gallbladder Drainage
Authors: Trieu Judy A , Gilman Andrew J. , Hathorn Kelly , Baron Todd H. 
Published: December 2023

Goals:
To describe the long-term outcomes of patients after EUS-guided gallbladder drainage (EUS-GBD), including those who underwent standardized stent exchanges for permanent plastic stents.

Background:
EUS-GBD has become one of the first-line alternatives for gallbladder decompression, with outcomes and safety profiles comparable to that of percutaneous gallbladder drainage. However, the long-term outcomes of EUS-GBD are not well-described. We report our single-center experience of a large cohort who underwent EUS-GBD.

Study:
Patients who underwent EUS-GBD from August 2014 to December 2022 were included in the study. Patient demographics, comorbidities, and procedure details were recorded. Patients were followed until complete stent removal, end of study period, or death. Short and long-term outcomes include technical and clinical success, stent patency, recurrent cholecystitis, cholecystectomy, and death.

Results:
During the study period, 128 patients were included. One hundred and one patients had benign indications for EUS-GBD, including cholecystitis and choledocholithiasis. Of those with malignant indications, 23 of 27 had distal malignant biliary obstruction. Technical and clinical successes were 95.3% and 95.1%, respectively. Stents were exchanged for 2 permanent double pigtail plastic stents in 43.0%. The mean stent patency was 421 days (488 d among those still alive) without any recurrent cholecystitis.

Conclusion:
EUS-GBD demonstrates prolonged stent patency and minimal long-term adverse events, particularly among patients who underwent stent exchanges for permanent plastic stents. EUS-GBD is also promising for patients presenting with choledocholithiasis and biliary colic who are not surgical candidates.
Fluid therapy in diabetic ketoacidosis
Authors: Ramanan Mahesh , Delaney Anthony , Venkatesh Balasubramanian 
Published: December 2023

Purpose of review
To evaluate recent evidence (2021–2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed.

Recent findings
Balanced crystalloid solutions, compared to the commonly recommended and used 0.9% sodium chloride solution (saline), may result in better outcomes for patients with diabetic ketoacidosis, including faster resolution of acidosis, less hyperchloremia and shorter hospital length of stay. Upcoming results from randomized trials may provide definitive evidence on the use of balanced crystalloid solutions in diabetic ketoacidosis. Evidence remains scarce or conflicting for the use of “two-bag” compared to conventional “one-bag” fluid, and rates of fluid administration, especially for adult patients. In children, concerns about cerebral oedema from faster fluid administration rates have not been demonstrated in cohort studies nor randomized trials.

Summary
Fluid therapy is a key aspect of diabetic ketoacidosis management, with important evidence gaps persisting for several aspects of management despite recent evidence.
Controversies and future directions in the management of gallbladder cancer
Authors: Lendoire Javier , Gil Luis 
Published: December 2023

AbstractGallbladder cancer (GBC) is a rare malignancy worldwide, with 140,000 new patients each year and more than 100,000 deaths annually. The review aims to address the controversial aspects of managing GBC. Regional differences of the study worldwide remain pending, and comparative mutational profiles will provide more information on the pathogenesis of GBC. However, certain pathologic aspects are discussed, such as the staging of early GBC, outcome differences between T2 pathologically staged patients, and the necessity of a uniform pathologic report. The surgical management of GBC is still under debate. The extent of liver resection, type of lymphadenectomy, and selection of patients for extended resection are aspects of the disease that require revision. Laparoscopic and robotic approaches were initially slow to develop. However, with time, they have demonstrated their value in the surgical management of GBC. The OMEGA survey, performed to analyze the management practice of surgical treatment of GBC worldwide, demonstrated differences from the recommended guidelines. The OMEGA study, the largest cohort study, examined the outcomes of surgical intervention in 3676 patients from 133 centers. Regarding future directions, the value of collaborative efforts between centers and regions must be emphasized to better understand the different aspects of the disease and globally improve therapeutic strategies for GBC.
Early Mobility and Crawling: Beliefs and Practices of Pediatric Physical Therapists in the United States
Authors: Kretch Kari S. , Dusing Stacey C. , Harbourne Regina T. , Hsu Lin-Ya , Sargent Barbara A. , Willett Sandra L. 
Published: December 2023

Purpose:
To characterize beliefs of pediatric physical therapists (PTs) in the United States regarding the role of crawling in infant development and clinical practice.

Methods:
Pediatric PTs reported their beliefs about early mobility and crawling, clinical approaches related to early mobility and crawling, and agreement with the removal of crawling from the Centers for Disease Control and Prevention (CDC)'s updated developmental milestone checklists in an online survey. Analyses examined associations between information sources and beliefs, between beliefs and clinical approaches, and between beliefs and CDC update opinions.

Results:
Most participants believed that crawling was important (92%) and linked to a variety of positive developmental outcomes (71%-99%) and disagreed with its removal from the CDC checklists (79%). Beliefs were linked with clinical approaches focused on promoting crawling and discouraging other forms of mobility.

Conclusions:
Further research is needed to determine whether pediatric PTs' beliefs and clinical practices are supported by evidence.
Adrenalectomy Improves Body Weight, Glucose, and Blood Pressure Control in Patients with Mild Autonomous Cortisol Secretion
Authors: Koh Jung-Min , Song Keeho , Kwak Mi Kyung , Suh Sunghwan , Kim Beom-Jun , Sung Tae-Yon , Hong Jun Hyuk , Jeong Byong Chang , Kim Jae Hyeon , Lee Seung Hun 
Published: December 2023

Objective:
To assess the metabolic effects of adrenalectomy in patients with mild autonomous cortisol secretion (MACS).

Background:
Despite retrospective studies showing the association of adrenalectomy for MACS with beneficial metabolic effects, there have been only two randomized prospective studies with some limitations to date.

Methods:
A prospective, multicenter study randomized 132 patients with adrenal incidentaloma without any features of Cushing’s syndrome but with serum cortisol>50 nmol/L after a 1 mg overnight dexamethasone suppression test (F-1mgODST) into an adrenalectomy group (n=66) or control group (n=66). The primary outcomes were changes in body weight, glucose, and blood pressure (BP).

Results:
Among the 118 participants who completed the study with a median follow-up duration of 48 months (range: 3–66), the adrenalectomy group (n=46) exhibited a significantly higher frequency of improved weight control, glucose control, and BP control (32.6%, 45.7%, and 45.7%, respectively) compared to the control group (n=46; 6.5%, P=0.002; 15.2%, P=0.002; and 23.9%, P=0.029, respectively) after matching for age and sex. Adrenalectomy (odds ratio [OR]=10.38, 95% confidence interval [95% CI]=2.09–51.52, P=0.004), body mass index (OR=1.39, 95% CI=1.08–1.79, P=0.010), and F-1mgODST levels (OR=92.21, 95% CI=5.30–1604.07, P=0.002) were identified as independent factors associated with improved weight control. Adrenalectomy (OR=5.30, 95% CI=1.63–17.25, P=0.006) and diabetes (OR=8.05, 95% CI=2.34–27.65, P=0.001) were independently associated with improved glucose control. Adrenalectomy (OR=2.27, 95% CI=0.87–5.94, P=0.095) and hypertension (OR=10.77, 95% CI=3.65–31.81, P<0.001) demonstrated associations with improved BP control.

Conclusions:
Adrenalectomy improved weight, glucose, and BP control in patients with MACS.
Variation in Hospital Performance for General Surgery in Younger and Older Adults
Authors: Brooks Ezra S. , Wirtalla Christopher J. , Rosen Claire B. , Finn Caitlin B. , Kelz Rachel R. 
Published: December 2023

Objective:
To compare hospital surgical performance in older and younger patients.

Background:
In-hospital mortality after surgical procedures varies widely among hospitals. Prior studies suggest that failure-to-rescue rates drive this variation for older adults, but the generalizability of these findings to younger patients remains unknown.

Methods:
We performed a retrospective cohort study of patients ≥18 years undergoing one of 10 common and complex general surgery operations in 16 states using the Healthcare Cost and Utilization Projects State Inpatient Databases (2016–2018). Patients were split into 2 populations: patients with Medicare ≥65 (older adult) and non-Medicare <65 (younger adult). Hospitals were sorted into quintiles using risk-adjusted in-hospital mortality rates for each age population. Correlations between hospitals in each mortality quintile across age populations were calculated. Complication and failure-to-rescue rates were compared across the highest and lowest mortality quintiles in each age population.

Results:
We identified 579,582 patients treated in 732 hospitals. The mortality rate was 3.6% among older adults and 0.7% among younger adults. Among older adults, high- relative to low-mortality hospitals had similar complication rates (32.0% vs 29.8%; P = 0.059) and significantly higher failure-to-rescue rates (16.0% vs 4.0%; P < 0.001). Among younger adults, high-relative to low-mortality hospitals had higher complications (15.4% vs 12.1%; P < 0.001) and failure-to-rescue rates (8.3% vs 0.7%; P < 0.001). The correlation between observed-to-expected mortality ratios in each age group was 0.385 (P < 0.001).

Conclusions:
High surgical mortality rates in younger patients may be driven by both complication and failure-to-rescue rates. There is little overlap between low-mortality hospitals in the older and younger adult populations. Future work must delve into the root causes of this age-based difference in hospital-level surgical outcomes.
The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection
Authors: Aliseda Daniel , Zozaya Gabriel , Martí-Cruchaga Pablo , Herrero Ignacio , Iñarrairaegui Mercedes , Argemí Josepmaría , Martínez De La Cuesta Antonio , Blanco Nuria , Sabatella Lucas , Sangro Bruno , Rotellar Fernando 
Published: December 2023

Objective:
Examine PHT impact on postoperative and survival outcomes in HCC patients after LR, specifically exploring distinctions between indirect signs and invasive measurements of PHT.

Summary Background Data:
PHT has historically discouraged LR in individuals with HCC, due to the elevated risk of morbidity, including liver decompensation (LD).

Methods:
A systematic review was conducted using 3 databases to identify prospective controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and OS in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: For aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method).

Results:
Nine studies involving 1,124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with HVPG ≥10 mmHg significantly increased the risk of overall complications, PHLF and LD. Despite elevated risks, the procedure resulted in a 5-year OS rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in MILR.

Conclusions:
LR with indirect PHT signs poses no increased risk of complications. Yet, in HVPG ≥10 mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. MI approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mmHg patients.