bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of absorbed dose to salivary glands in mCRPC patients undergoing 177 Lu- PSMA-617 radioligand therapy using quantitative SPECT-CT at single time point: a single-center feasibility study
Authors: Kaur Komalpreet , Nagi Shreya , Satapathy Swayamjeet , Aggarwal Piyush , Sood Ashwani , Mittal Bhagwant Rai 
Published: November 2023

Objective

177Lu-PSMA-617-radioligand therapy (RLT) has shown promising therapeutic role in patients with metastatic castration-resistant prostate cancer. However, off-target action in salivary glands often presents with xerostomia. Personalized dosimetry can help in optimizing the treatment, however, has so far been tedious due to multiple time-point imaging. In this prospective study, we intended to estimate the absorbed dose delivered to the salivary glands in patients undergoing 177Lu-PSMA-617-RLT using quantitative SPECT/CT at a single time point.

Methods
Patients undergoing 177Lu-PSMA-617 RLT were included in this prospective study. Post-therapy whole-body images and regional quantitative single time-point SPECT/CT were acquired at 24 h with high-energy collimator. The data was processed and analyzed using Q.Metrix software. A scaling factor, that is, the time-integrated activity conversion factor was applied for the image acquired at 24 h. Absorbed doses were computed using MIRD scheme and OLINDA software.

Results
A total of 21 patients (mean age: 66 ± 9 years) were included. The value of mean absorbed dose for the parotid glands was 1.90 ± 1.31Gy (range: 0.26–6.23) and that for the submandibular glands was 1.37 ± 0.94Gy (range: 0.16–3.65). The mean absorbed doses per administered activity for the parotid and submandibular glands were 0.26 ± 0.18 Gy/GBq and 0.19 ± 0.12 Gy/GBq, respectively. The absorbed doses were estimated for one cycle of therapy and were well within acceptable limits. None of the patients experienced dryness of mouth.

Conclusion
Single time-point dosimetry with quantitative SPECT/CT is feasible and can be standardized to estimate the absorbed dose to salivary glands instead of multiple time-point acquisitions.
Case report: Total obstruction of the left main bronchus by a blood clot leads to pneumonectomy in a pregnant woman
Authors: Ziani Hicham , Chibani Amine , Slaihi Zakariae , Benhalima Abdelkader , Armel Bouchra , ElHamzaoui Hamza , Elazzouzi Imane , Eddouali Amine , Ghattab Selma , Elarfaoui Manal , Alilou Mustapha 
Published: November 2023

Introduction and importance:
Airway obstruction resulting from blood clot formation is observed across various clinical scenarios and is often preceded by hemoptysis. This condition can significantly compromise respiratory function, potentially leading to life-threatening ventilatory distress.

Case presentation:
In this report, the authors present a case of acute airway obstruction associated with hemoptysis in an 18-week pregnant woman admitted to the emergency department for acute respiratory distress. Clinical and radiographic evidence strongly suggested the presence of an endobronchial blood clot causing focal airway obstruction. Diagnosis was confirmed through direct endoscopic evaluation.

Clinical discussion:
Initial attempts to remove the obstructing clot from the airway involved lavage, aspiration, and forceps extraction by using a bronchoscope. In cases in which these measures proved ineffective, other management strategies include rigid bronchoscopy, embolization, and surgical resection.

Conclusion:
Central airway obstruction is a critical condition caused by numerous factors such as tumours or blood clots. Treatment focuses on securing the airway, ensuring breathing, and using tools such as bronchoscopy for diagnosis and treatment. Surgery is considered a last resort when other methods are ineffective.
The Impact of COVID-19 on Psychiatric Acuity in a Community Psychiatric Hospital
Authors: Mahgoub Yassir , Forrest Lauren N. , Luther Joy , Singh Nirmal , Kibler Jason , Noel Jason , Zug David , Swigart Alison , Kunkel Elisabeth 
Published: November 2023

Abstract
The COVID-19 pandemic has had extensive impacts on mental health care delivery. Anecdotal observations of inpatient care teams at Pennsylvania Psychiatric Institute suggested increased patient acuity during the pandemic. The authors found no consensus definition for measuring psychiatric acuity in the literature. We performed an interrupted time series analysis to identify whether COVID-19 was associated with changes in several hospital parameters that might reflect our patients' access to psychiatric services and acuity. We found increases in inpatient parameters for length of stay, rates of involuntary admissions, and the incidence of restraints, seclusion, and 1:1 observation orders. Observing these increasing trends can inform mitigation efforts to improve the quality of mental health care treatment and care delivery. We suggest the use of these metrics for objective measurements of psychiatric acuity.
Schizotypy Moderates the Relationship Between Sleep Quality and Social Cognition
Authors: Hammer Lillian A. , Springfield Cassi R. , Tighe Caitlan A. , Oswalt Sophia , Bonfils Kelsey A. 
Published: November 2023

Abstract
Poor sleep quality has been tied to worse social cognition. Social cognitive deficits have been noted in those with high schizotypy. Yet, no study has assessed whether schizotypy moderates the relationship between sleep quality and social cognition, which may be vital to our understanding of contributors to social functioning. We conducted a cross-sectional analysis of associations of sleep quality and social cognition, with potential moderation by schizotypy. Participants (n = 906) completed self-report measures of schizotypy, sleep quality, and social cognition. Levels of schizotypy significantly moderated some of the relationships between sleep and social cognition. For participants low in total or interpersonal schizotypy, worse sleep quality was associated with worse theory of mind scores. For participants low in total, disorganized, or cognitive perceptual schizotypy, worse sleep quality was associated with worse self-reported cognitive empathy. For those high in these facets of schizotypy, worse sleep quality was associated with better self-reported cognitive empathy. These results suggest that the individual facets of schizotypy provide additional information and, therefore, are important to assess when examining social cognition and sleep.
PYCR1, BANF1, and STARD8 Expression in Gastric Carcinoma: A Clinicopathologic, Prognostic, and Immunohistochemical Study
Authors: Harb Ola A. , Elfeky Mariem A. , Alabiad Mohamed Ali , Hemeda Rehab , Allam Ahmed S. , El Hawary Amr T. , Elbaz Mohammed , Sharaf Ahmed L. , Gertallah Loay M. , Abdelaziz Ahmed Mesbah , Shalaby Amany Mohamed , Alorini Mohammed , Yahia Amar Ibrahim Omer , Negm Mohamed 
Published: November 2023

Background:
It will be important to understand the molecular pathways of gastric cancer (GC) occurrence and progression, thus detecting predictive and prognostic biomarkers of GC. Pyrroline-5-carboxylate reductase 1 (PYCR1) was upregulated in many cancers, suggesting its possible roles in carcinogenesis and tumor metastases. Barrier-of-autointegration factor 1 (BANF1) is a protein family that plays essential roles in maintaining the integrity of an intact cellular genome. Rho-GTPs are molecular switches that control many signal transduction pathways in normal cells, including 3 subgroups from 1 to 3 (DLC1-3). DLC-3, known as StAR-related lipid transfer domain protein 8 (STARD8), and its role in cancers were not sufficiently studied. The study aimed to investigate the significance of PYCR1, BANF1, and STARD8 protein expression in GC tissues and normal gastric mucosa retrieved from patients with GC to detect prognostic roles of expression.

Patients and Methods:
Specimens were collected from 100 patients with gastric carcinoma. After the application of the inclusion criteria of the study, we prepared 100 paraffin blocks from samples of the 100 included patients; each block included samples from gastric carcinoma and adjacent non-neoplastic gastric mucosa. We assessed the expression of PYCR1, BANF1, and STARD8 using immunohistochemistry in all studied samples. We followed patients for the detection of disease progression and survival rates. We correlate PYCR1, BANF1, and STARD8 expression with clinical, pathologic, and prognostic parameters.

Results:
Overexpression of PYCR1 and BANF1 and decreased expression of STARD8 was found in gastric carcinoma tissues than adjacent non-neoplastic gastric mucosa (P<0.001), and was positively associated with high grade (P=0.006), depth of tumor invasion, presence of lymph nodes metastases and advanced stage (P=0.001), high incidence of GC progression, recurrence, unfavorable disease-free survival (P=0.003) and unfavorable overall survival rates (P<0.001). Thus, it was revealed that; in univariate and multivariate analyses, levels of PYCR1, BANF1, and STARD8 are associated with the overall survival rate of GC patients.

Conclusions:
We showed that overexpression of PYCR1 and BANF1 and decreased expression of STARD8 in GC tissues was associated with poor prognosis and GC progression.
Mortality and Timing of Withdrawal of Life-Sustaining Therapies After Out-of-Hospital Cardiac Arrest: Two-Center Retrospective Pediatric Cohort Study*
Authors: Vassar Rachel , Mehta Nehali , Epps Lane , Jiang Fei , Amorim Edilberto , Wietstock Sharon 
Published: November 2023

OBJECTIVES:
Pediatric out-of-hospital cardiac arrest (OHCA) is associated with substantial morbidity and mortality. Limited data exist to guide timing and method of neurologic prognostication after pediatric OHCA, making counseling on withdrawal of life-sustaining therapies (WLSTs) challenging. This study investigates the timing and mode of death after pediatric OHCA and factors associated with mortality. Additionally, this study explores delayed recovery after comatose examination on day 3 postarrest.

DESIGN:
This is a retrospective, observational study based on data collected from hospital databases and chart reviews.

SETTING:
Data collection occurred in two pediatric academic hospitals between January 1, 2016, and December 31, 2020.

PATIENTS:
Patients were identified from available databases and electronic medical record queries for the International Classification of Diseases, 10th Edition (ICD-10) code I46.9 (Cardiac Arrest). Patient inclusion criteria included age range greater than or equal to 48 hours to less than 18 years, OHCA within 24 hours of admission, greater than or equal to 1 min of cardiopulmonary resuscitation, and return-of-spontaneous circulation for greater than or equal to 20 min.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One hundred thirty-five children (65% male) with a median age of 3 years (interquartile range 0.6–11.8) met inclusion criteria. Overall, 63 of 135 patients (47%) died before hospital discharge, including 34 of 63 patients (54%) after WLST. Among these, 20 of 34 patients underwent WLST less than or equal to 3 days postarrest, including 10 of 34 patients who underwent WLST within 1 day. WLST occurred because of poor perceived neurologic prognosis in all cases, although 7 of 34 also had poor perceived systemic prognosis. Delayed neurologic recovery from coma on day 3 postarrest was observed in 7 of 72 children (10%) who ultimately survived to discharge.

CONCLUSIONS:
In our two centers between 2016 and 2020, more than half the deaths after pediatric OHCA occurred after WLST, and a majority of WLST occurred within 3 days postarrest. Additional research is warranted to determine optimal timing and predictors of neurologic prognosis after pediatric OHCA to better inform families during goals of care discussions.
Knockdown of ZEB1 Inhibits Hypertrophic Scarring through Suppressing the Wnt/β-Catenin Signaling Pathway in a Mouse Model
Authors: Jin Rui , Deng Zhizhong , Liu Fei , Lu Lin , Ding Feixue , Shen Yirui , Wang Hayson Chenyu , Chang Mengling , Peng Zhiyou , Liang Xiao 
Published: November 2023

Background:
Hypertrophic scars (HSs) cause functional impairment and cosmetic deformities following operations or burns (30% to 94%). There is no target therapy yet because the pathogenesis of HS progression is not well known. In tissue fibrosis, abnormal up-regulation of zinc finger E-box binding homeobox 1 (ZEB1) is an important cause for extracellular matrix (ECM) overexpression, which is the main molecular change in HSs. The authors hypothesized that ZEB1 knockdown inhibits HS formation.

Methods:
ZEB1 expression in human HS and transforming growth factor-β1–induced fibroblasts were identified by polymerase chain reaction (PCR) and Western blotting. ZEB1 was knocked down by small interfering RNA in HS fibroblasts (HSFs) and the mouse HS model (C57/BL6 male mice aged 8 to 12 weeks). After 8 hours of transfection, HSFs were subjected to PCR, Western blotting, and Cell Counting Kit-8 apoptosis, migration, and contraction assays. Mouse HSs were analyzed by hematoxylin and eosin staining, PCR, and Western blotting after 56 days.

Results:
ZEB1 was up-regulated in HS tissue (2.0-fold; P < 0.001). ZEB1 knockdown inhibited HSF activity (0.6-fold to 0.7-fold; P < 0.001); the expression of fibrotic markers (0.4-fold to 0.6-fold; P < 0.001); and β-catenin, cyclinD1, and c-Myc expression (0.5-fold; P < 0.001). In mouse HS models, HS skin thickness was less (1.60 ± 0.40 mm versus 4.04 ± 0.36 mm; P < 0.001) after ZEB1 knockdown.

Conclusions:
ZEB1 knockdown inhibits HS formation both in vitro and in vivo. However, this is an in vitro mouse model, and more validation is needed.

Clinical Relevance Statement:
The discovery of ZEB1 as a mediator of HS formation might be a potential therapeutic target in HS treatment.
Carbon-Assisted Q-Switched Nd:YAG Laser and Microneedling Delivery of Botulinum Toxin: A Prospective Pilot Study
Authors: Turco Piergiorgio , Conforti Claudio , D’Andrea Francesco , La Padula Simone 
Published: November 2023

Background:
Carbon-assisted, Q-switched, neodymium-doped yttrium-aluminum-garnet laser treatment consists of applying a topical carbon suspension all over the face, followed by irradiation with a Q-switched 1064-nm neodymium-doped yttrium-aluminum-garnet laser. The delivery of multiple microdroplets of dilute onabotulinum toxin type A into the dermis has been investigated as a tool for facial rejuvenation. The aim of this study was to assess the effectiveness of the combined treatment with botulinum toxin and carbon peel laser (performed with a standardized technique) in patients with seborrhea, dilated pores, and wrinkles, and to demonstrate its benefits in improving the overall skin aspect.

Methods:
Patients enrolled in this prospective pilot study underwent 3 sessions of the combined treatment carried out 3 months apart. To evaluate the improvement of skin texture, wrinkles, dilated pores, and acne lesions, the Fitzpatrick Wrinkle Assessment Scale, the Physician Global Aesthetic Improvement Scale, a photographic scale for the pore assessment, and the Investigator Global Assessment of Acne scale were used. The FACE-Q was also administered to assess patient satisfaction. The scores obtained were compared using a paired t test.

Results:
Twenty patients were recruited. The differences between pretreatment and posttreatment scores were statistically significant (P < 0.05) on the Fitzpatrick Wrinkle Assessment Scale, Physician Global Aesthetic Improvement Scale, Investigator Global Assessment of Acne scale, FACE-Q, and photographic scale for the pore assessment.

Conclusions:
This combined protocol could be considered as a useful tool to treat skin flaws that affect texture, microroughness, and seborrhea and to reduce the size of enlarged pores. Its versatility allows for customized treatment with minimal discomfort to patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Conventional versus Robot-Assisted Immediate Breast Reconstruction: Reconstructive Outcome and Patient-Reported Outcome Measures
Authors: Kim Hyung Bae , Min Jae Chung , Lee Sae Byul , Kim Jisun , Ko Beom Seok , Kim Hee Jeong , Son Byung Ho , Han Hyun Ho , Eom Jin Sup 
Published: November 2023

Background:
In this study, the authors compared conventional and robot-assisted mastectomy and breast reconstruction. To the authors’ knowledge, this study is the first to report the results of robot-assisted mastectomy and breast reconstruction and provide a comparison of patient-reported outcomes.

Method:
This retrospective study included 473 breasts of 423 patients who underwent conventional mastectomy and breast reconstruction and 164 breasts of 153 patients who underwent robot-assisted mastectomy and breast reconstruction from July of 2019 to October of 2021. Demographic and oncologic data, reconstructive outcomes, and patient-reported outcomes (BREAST-Q) were evaluated. The results of implant-based and autologous breast reconstruction were evaluated separately.

Results:
Skin necrosis requiring surgical débridement occurred significantly more frequently in the conventional group (8.0%) than in the robot-assisted group (2.0%) in implant-based reconstruction (P = 0.035). At 6 to 12 months, patients who underwent robot-assisted breast reconstruction showed a higher Sexual Well-being score for implant-based reconstruction and a higher Physical Well-being score for autologous breast reconstruction than conventional breast reconstruction according to the BREAST-Q questionnaire.

Conclusions:
Robot-assisted mastectomy and breast reconstruction was associated with less skin necrosis and better patient-reported outcomes (Sexual Well-being for implant-based reconstruction and Physical Well-being for autologous breast reconstruction) than the conventional option. Robotic surgery could be a good option for mastectomy and breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
How Loneliness Gets Under the Skin: Inflammation Mediates the Relationship Between Loneliness and Gait Speed
Authors: MacAulay Rebecca K. , Timblin Holly R. , Tallman Morgan D. 
Published: November 2023

ABSTRACT

Objective
Loneliness is linked to interleukin 6 (IL-6), a marker of systemic inflammation, which chronically has deleterious effects on physical and mental health across the adult life span. This study investigated cross-sectional relationships among loneliness, IL-6, demographics, multimorbidity, depression, obesity, friendship quantity, and slowed gait.

Methods
Data from the Midlife Development in the United States Biomarker Project, a national adult sample (N = 822; age range, 26–78 years) was used for this study. The PROCESS macro tested the hypothesis that IL-6 would mediate the relationship between loneliness and gait, after adjusting for demographic and health risk factors.

Results
Age (β = 0.292, p < .001), sex (β = 0.197, p < .001), body mass index (BMI, β = 0.374, p < .001), waist-hip ratio (β = 0.242, p < .001), and loneliness (β = 0.089, p = .025) but not multimorbidity (β = 0.043, p = .20), depression history (β = 0.022, p = .47), depression symptoms (β = 0.036, p = .28), and number of friends (β = 0.022, p = .46) contributed to the variance in IL-6. Serial mediation analyses supported the chained effect of loneliness on walking time through BMI and IL-6. Results also showed specific indirect effects of BMI and IL-6 on walking time, suggesting more than one pathway by which loneliness influences health.

Conclusions
These results suggest that loneliness may increase the risk of systemic inflammation, leading to slowed gait and adverse health outcomes. Psychosocial interventions that address loneliness may provide an optimal treatment target for reducing inflammation and preventing declines in health.
Analytic and Clinical Validity of Myositis-Specific Antibodies by Line-Blot Immunoassay Is Essential
Authors: Tseng Chih-Wei , Satoh Minoru , Hasegawa Tomoko , Tanaka Shin , Chen Yi-Ming 
Published: November 2023

Objectives
This study assessed the concordance between line blot (LB) and immunoprecipitation (IP) assays for detecting myositis-specific antibodies (MSAs) in idiopathic inflammatory myopathies (IIMs) and their association with IIM subtypes.

Methods
One hundred patients with IIM were enrolled, and MSA was detected using LB and IP. The IIM subtypes, including immune-mediated necrotizing myopathy–like, anti–tRNA synthetase syndrome–like, and clinically amyopathic dermatomyositis–like, were clinically diagnosed. The validity and reliability of the LB compared with the IP were evaluated. Optimal cutoff levels for LB were determined using various statistical methods including Cohen κ, Gwet's AC, diagnostic odds ratios, and receiver operating characteristic analysis.

Results
Line blot exhibited lower specificity and accuracy than IP in predicting IIM subtypes. Some MSAs performed better at higher LB cutoff values. Anti–signal recognition particle antibodies showed poor performance in predicting the immune-mediated necrotizing myopathy–like subtype using LB. Raising the cutoffs improved the reliability of anti–threonyl-tRNA synthetase and anti–signal recognition particle antibodies. Anti–histidyl-tRNA synthetase antibodies performed well at lower positivity, whereas diagnostic odds ratios increased for anti–transcription intermediary factor 1γ and anti–nuclear matrix protein 2 with higher cutoffs.

Conclusions
Inconsistencies between LB and IP have been observed in patients with IIM. Individual optimal cutoffs for MSA by LB correlating with IP were determined. Rheumatologists should consider the differences between LB and IP results when classifying IIM subtypes.
Sex-Related Differences of Left Atrial Strain in Patients With Hypertension Using Cardiac Magnetic Resonance Feature Tracking
Authors: Yang Zhaoxia , Wen Jinyang , Tang Dazong , Luo Yi , Xiang Chunlin , Xia Liming , Huang Lu 
Published: November 2023

Purpose:
Previous studies demonstrated the impact of sex on left ventricular (LV) strain in patients with essential hypertension. However, little is known about the effect of sex on left atrial (LA) strain in patients with hypertension. This study aimed to explore the sex-related differences of LA strain by using cardiac magnetic resonance feature tracking in patients with hypertension and preserved LV ejection fraction.

Materials and Methods:
One hundred and fifty hypertensive patients (100 men and 50 women) and 105 age-matched and sex-matched normotensive controls (70 men and 35 women) were retrospectively enrolled and underwent cardiac magnetic resonance examination. LA strain parameters included LA reservoir strain (εs), conduit strain (εe), pump strain (εa), and their corresponding strain rate (SRs, SRe, and SRa).

Results:
Men had significantly higher LV mass index, lower εs and εe than women in both patients and controls (all P<0.05). LA strain and strain rate were significantly reduced in hypertensive patients compared with controls, both in men and women (all P<0.05). In men, hypertension and its interaction were associated with increased LV mass index and decreased εs and εe. In multivariable analysis, men, LV ejection fraction, and LA minimum volume index remained independent determinants of εs and εe in all hypertensive patients (all P<0.05).

Conclusion:
LA strain was significantly impaired in hypertensive patients, and men had more impaired LA strain than women. These findings further emphasize the sex-related differences in the response of LA strain to hypertension in the early stage.