bluuebunny/crossref_metadata_2025_split huggingface dataset:
Round Bodies Detected by Treponema pallidum Immunohistochemical Stain in Two Cases of Cutaneous Syphilitic Gummata
Authors: Birmingham Suzanne W. , Saeed Lina , Thurlow Charles M. , Vilfort Kendra , Pillay Allan , Rojek Nathan W. , Doan Linda T. , Lee Bonnie A. 
Published: November 2023

Abstract:
Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.
Evaluation of the ‘Sip Til Send’ regimen before elective caesarean delivery using bedside gastric ultrasound
Authors: Harnett Colleen , Connors Jesse , Kelly Shane , Tan Terry , Howle Ryan 
Published: November 2023

BACKGROUND
Pre-operative fasting is routinely advocated to avoid pulmonary aspiration. The European Society of Anaesthesiology and Intensive Care (ESAIC) recommends a fasting period of 2 h for liquids before surgery. Liberal drinking policies such as the ‘Sip Til Send’ are a suggested alternative to maintain hydration before surgery.

OBJECTIVES
To compare residual gastric volumes in fully fasted nonlabouring parturients before elective caesarean delivery with the ‘Sip Til Send’ with water liberal drinking protocol. Our hypothesis was the ‘Sip Til Send’ would be noninferior to standard fasting at minimising the residual gastric volume immediately before surgery.

DESIGN
A paired cohort prospective observational pragmatic study using gastric ultrasound, analysed by an operator blinded to the fasting status of each scan.

SETTING
A tertiary maternity hospital in Dublin, Ireland. The study was conducted between January and June 2023.

PARTICIPANTS
Pregnant women about to undergo elective caesarean delivery who had followed ESAIC fasting guidelines before admission.

INTERVENTIONS
Each participant underwent two pairs (semi-recumbent and the semi-recumbent right lateral positions) of standardised ultrasound examinations of the gastric antrum: the order of these scans was randomised. The first pair of scans occurred on admission before the ‘Sip Til Send’ protocol commenced, the other pair just before spinal anaesthesia for caesarean delivery, after a variable time following the ‘Sip Til Send’ protocol.

MAIN OUTCOME MEASURE
The primary outcome was the difference in antral cross-sectional area (CSA) between the fully fasted women on admission and the same women after following the ‘Sip Til Send’ protocol until just before spinal anaesthesia.

RESULTS
Fifty-eight women were randomised for the study: 55 and 54 scans in the semi-recumbent position on admission, and 55 and 54 scans in the right lateral position just before spinal anaesthesia. The mean differences (95% CI) in CSA in the semi-recumbent and RL positions were 0.07 (-0.39 to 0.53) cm2 and 0.04 (-0.60 to 0.68) cm2, respectively. Since the of 95% CIs did not cross the predefined noninferiority margin of 0.88 cm2, ‘Sip Til Send’ was noninferior to fully fasting in in terms of the antral CSA.

CONCLUSION
The ‘Sip Til Send’ protocol of liberal hydration with water was noninferior to standard fasting prior to elective caesarean delivery.

TRIAL REGISTRY NUMBER
NCT05783427 ClinicalTrials.gov
Nuclear Acly protects the liver from ischemia-reperfusion injury
Authors: Gao Wenbin , Zhang Liping , Li Ziru , Wu Tong , Lang Chunhui , Mulholland Michael W. , Zhang Weizhen 
Published: November 2023

Background and Aims:
Hepatic ischemia-reperfusion (IR) injury is the most common complication that occurs in liver surgery and hemorrhagic shock. ATP citrate lyase (Acly) plays a pivotal role in chromatin modification via generating acetyl-CoA for histone acetylation to influence biological processes. We aim to examine the roles of Acly, which is highly expressed in hepatocytes, in liver IR injury.

Approach and Results:
The functions of Acly in hepatic IR injury were examined in the mouse model with a hepatocyte-specific knockout of Acly. The Acly target genes were analyzed by CUT&RUN assay and RNA sequencing. The relationship between the susceptibility of the steatotic liver to IR and Acly was determined by the gain of function studies in mice. Hepatic deficiency of Acly exacerbated liver IR injury. IR induced Acly nuclear translocation in hepatocytes, which spatially fueled nuclear acetyl-CoA. This alteration was associated with enhanced acetylation of H3K9 and subsequent activation of the Foxa2 signaling pathway. Nuclear localization of Acly enabled Foxa2-mediated protective effects after hypoxia-reperfusion in cultured hepatocytes, while cytosolic Acly demonstrated no effect. The presence of steatosis disrupted Acly nuclear translocation. In the steatotic liver, restoration of Acly nuclear localization through overexpression of Rspondin-1 or Rspondin-3 ameliorated the IR-induced injury.

Conclusions:
Our results indicate that Acly regulates histone modification by means of nuclear AcCoA production in hepatic IR. Disruption of Acly nuclear translocation increases the vulnerability of the steatotic liver to IR. Nuclear Acly thus may serve as a potential therapeutic target for future interventions in hepatic IR injury, particularly in the context of steatosis.
Nervous System Involvement in Hospitalized Patients With COVID-19
Authors: Harirchian Mohammad Hossein , Ghabaee Mojdeh , Sarraf Payam , Ranji-Burachaloo Sakineh , Agah Elmira , Mousavi Seyed Vahid , Abkhoo Aminreza , Amani Kiana , Javadian Nina , Farahmand Ghasem , Magrouni Hannah , Alizadeh Boroujeni Fatemeh , Nazari Fatemeh , Ghafouri Shima , Hosseinzadeh Maryam , Enayati Sonya , Kabiri Samaneh , Pasebani Yeganeh , Rafati Ali , Azizmohammad Looha Mehdi , Tafakhori Abbas , Jameie Melika 
Published: November 2023

Abstract

Background
COVID-19 patients with neurological manifestations have poorer outcomes. We investigated the association between clinicodemographic and laboratory findings with poorer outcomes among COVID-19 inpatients with neurological manifestations.

Methods
This was a retrospective study of consecutive medical records (March–April 2020). Neurological manifestations (altered level of consciousness, acute cerebrovascular disease, ataxia, seizure, headaches, dizziness/vertigo, muscle weakness, and peripheral neuropathies) were categorized into serious and nonserious.

Results
Of 119 COVID-19 inpatients, 38 with neurological manifestations were included (age, 63.7 ± 13.4 years; male, 65.8%), of whom 27 (71.1%) had serious manifestations. Muscle weakness (57.9%), impaired consciousness (47.4%), and acute cerebrovascular disease (23.7%) were the most frequent manifestations. The in-hospital mortality rate was 28.9%. Patients with serious manifestations were significantly older (66.9 vs 55.7, P = 0.018), with significantly higher white blood cell count (6.8 vs 5.1 × 103/μL, P = 0.023), direct bilirubin (0.3 vs 0.2 mg/dL, P = 0.030), prothrombin time (PT) (15.4 vs 14.4 seconds, P = 0.006), international normalized ratio (1.2 vs 1.1, P = 0.005), and model for end-stage liver disease (MELD) scores (10 vs 7, P = 0.011), compared with those with nonserious manifestations. In addition, the nonsurvivors had higher potassium (4.5 vs 4.0 mEq/L, P = 0.021), total bilirubin (1.1 vs 0.6 mg/dL, P = 0.008), and MELD scores (12 vs 8, P = 0.025) compared with the survivors. After adjustment, we found significant impacts of age (adjusted odds ratio [aOR], 1.11; P = 0.032), PT (aOR, 5.04; P = 0.019), and MELD score (aOR, 1.27, P = 0.047) on poorer outcomes.

Conclusions
Older age, higher white blood cell count, bilirubin, PT, international normalized ratio, potassium, and MELD scores were associated with poorer outcomes in COVID-19 inpatients with neurological manifestations.
Predictive Factors of Apathy in Stroke Survivors During the Recovery Period
Authors: Wang Pao-Chen , Pai Hsiang-Chu 
Published: November 2023

ABSTRACT

BACKGROUND: Apathy may be an important predictor of depression and significantly negatively affect the quality of life and functional recovery of stroke survivors. However, the evidence reflects the inconsistent findings of studies on the impact of individual-related variables on apathy in patients with stroke. OBJECTIVES: This study examines the relationships among stroke survivors' individual characteristics, background variables, disease-related variables, and apathy; furthermore, we identify predictors of apathy. METHODS: In this cross-sectional correlational study, the participants were recruited from a medical university hospital. Three measurement tools were used: individual and background variables, the modified Rankin Scale, and the Apathy Evaluation Scale. Hierarchical multiple regression analysis was used to identify the predictors of apathy. RESULTS: Participants included 100 stroke survivors with a mean age of 59.9 (12.1) years. The prevalence of apathy among stroke survivors was 27%. Stroke survivors' economic sources (β = 0.430, P = .001), perceived family support (β = −0.163, P = .048), and modified Rankin Scale (β = 0.283, P = .001) accounted for 43.7% of the variance in survivor apathy. CONCLUSION: The results of this study clarified which individual characteristics, background variables, and disease-related variables are key predictors of apathy in patients with stroke.
PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant pancreatic cancer patients
Authors: Gong Mengyuan , Zhang Bo , Wang Xueni , Zhu Zeen , Li Wei , Han Liang , Wu Zheng , Ma Qingyong , Wang Zheng , Qian Weikun 
Published: November 2023

Background:
Partly due to the limited effect of chemotherapy or other therapeutic strategies, which may be due to the insufficient knowledge of the tumor promotion markers and targets, pancreatic cancer (PC) holds the position of one of the most malignant tumors. This study aims to find a diagnosis/therapeutic molecule that can predict the prognosis of PC with different gene background.

Methods:
The Cancer Genome Atlas (TCGA) pancreatic duct adenocarcinoma (PAAD)–based single nucleotide polymorphisms and gene expression data were used to find the differentially expressed genes (DEGs) between KRAS/TP53 mutant samples and no gene mutation samples. Gene Set Enrichment Analysis (GSEA)-based Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and R-based gene oncology (GO) or immune cell invasion assay were used to explore the above DEGs involved pathways. The single-center PC cohort accompanied with next-generation sequence testing was used to verify the TCGA PAAD–based bioinformatic results.

Results:
First, we found PC patients who harbored KRAS and/or TP53 gene mutation have poor overall survival. Besides, the enrichment analysis showed that mutant KRAS/TP53 was correlated with PC tumor-promotion–related pathways and immune microenvironment. Next, we detected that prostate stem cell antigen (PSCA) was one of the most differential genes in KRAS/TP53 mutant PC tissues. Indeed, the bioinformatic analysis and our clinical data showed that PSCA was a biomarker of poor prognosis in PC.

Conclusion:
PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant PC patients.
Treatment strategies to prevent or mitigate the outcome of postpancreatectomy hemorrhage: a review of randomized trials
Authors: Montorsi Roberto M. , Zonderhuis Babs M. , Daams Freek , Busch Olivier R. , Kazemier Geert , Marchegiani Giovanni , Malleo Giuseppe , Salvia Roberto , Besselink Marc G. 
Published: November 2023

Background:
Postpancreatectomy hemorrhage (PPH) is a leading cause for surgical mortality after pancreatic surgery. Several strategies for the prevention and management of PPH have been studied in randomized controlled trials (RCTs) but a systematic review is lacking. The authors systematically reviewed RCTs regarding the impact of treatment strategies on the incidence and outcome of PPH.

Material and methods:
Eligible RCTs reporting on impact of treatment on the rate of PPH were identified through a systematic literature search using the Evidence Map of Pancreatic Surgery (2012–2022). Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for RCTs. Various definitions of PPH were accepted and outcome reported separately for the International Study Group for Pancreatic Surgery (ISGPS) definition.

Results:
Overall, 99 RCTs fulfilled the eligibility criteria with a pooled 6.1% rate of PPH (range 1–32%). The pooled rate of PPH defined as ISGPS grade B/C was 8.1% (range 0–24.9%). Five RCTs reported five strategies that significantly reduced the rate of PPH. Three concerned surgical technique: pancreatic anastomosis with small jejunal incision, falciform ligament wrap around the gastroduodenal artery stump, and pancreaticojejunostomy (vs pancreaticogastrostomy). Two concerned perioperative management: perioperative pasireotide administration, and algorithm-based postoperative patient management. No single RCT specifically focused on the treatment of patients with PPH.

Conclusion:
This systematic review of RCTs identified five strategies which reduce the rate of PPH; three concerning intraoperative surgical technique and two concerning perioperative patient management. Future studies should focus on the treatment of patients with PPH as RCTs are currently lacking.
Preliminary report on a novel technique for endoscopic transaxillary thyroidectomy: A case control study
Authors: Liu Yang , Wang Jiazhong , Chen Shuo , Lv Hao , Yu Shuo , Ran Xiaoli , Gao Nan , Sun Yun , Cao Gang 
Published: November 2023

Background:
Endoscopic transaxillary approaches to thyroidectomy have been well described and gasless transaxillary endoscopic thyroidectomy (GTET) is the most popular method. However, this require a single long axillary incision which is longer than most remote access thyroidectomy procedures. We improved the GTET and provided a novel way to access the thyroid. The purpose of this study was to test the feasibility of our novel transaxillary thyroidectomy procedure and to attempt to reduce the size of the scar and reduce the flap creation area.

Methods:
116 patients who underwent our novel transaxillary thyroidectomy procedure were compared with the patients who underwent open and GTET procedures. The patients’ demographics, outcomes, and complications were analyzed.

Results:
Although the operation time (121.48±23.91mins) was longer in the novel endoscopic group compare to the open group, it was shorter than GTET group. Intraoperative blood loss was similar between the groups. However, the novel procedure group had more drainage volume within 48 postoperative hours compare to other two groups. Despite the VAS pain score didn’t reveal a difference between the open and novel endoscopic procedure, it was lower in the novel procedure than GTET. The hospital stay days didn’t show a difference between the two groups. The number of resected central lymph nodes was similar between the groups. Differences didn’t reveal between the groups regarding to the complications rate.

Conclusion:
Our results showed that our novel transaxillary thyroidectomy procedure is feasible and safe. This procedure can be an alternative endoscopic transaxillary method for thyroidectomy.
The Impact of Race and Sex on the Clinical Outcomes of Homeless Patients With Alcoholic Liver Disease
Authors: Lee David U. , Kwon Jean , Han John , Chang Kevin , Kolachana Sindhura , Bahadur Aneesh , Lee Ki Jung , Fan Gregory H. , Malik Raza 
Published: November 2023

Background:
Among patients with alcoholic liver disease (ALD), homelessness poses significant medical and psychosocial risks; however, less is known about the effects of race and sex on the hospital outcomes of admitted homeless patients with ALD.

Methods:
The National Inpatient Sample database from 2012 to 2017 was used to isolate homeless patients with ALD, and the cohort was further stratified by race and sex for comparisons. Propensity score matching was utilized to minimize covariate confounding. The primary endpoints of this study include mortality, hospital length of stay, and hospital costs; secondary endpoints included the incidence of liver complications.

Results:
There were 3972 females/males postmatch, as well as 2224 Blacks/Whites and 4575 Hispanics/Whites postmatch. In multivariate, there were no significant differences observed in mortality rate, length of stay, and costs between sexes. Comparing liver outcomes, females had a higher incidence of hepatic encephalopathy [adjusted odds ratio (aOR) 1.02, 95% CI: 1.01-1.04, P<0.001]. In comparing Blacks versus Whites, Black patients had higher hospitalization costs (aOR 1.13, 95% CI: 1.03-1.24, P=0.01); however, there were no significant differences in mortality, length of stay, or liver complications. In comparing Hispanics versus Whites, Hispanic patients had longer length of hospital stay (aOR 1.12, 95% CI: 1.06-1.19, P<0.001), greater costs (aOR 1.15, 95% CI: 1.09-1.22, P<0.001), as well as higher prevalence of liver complications including varices (aOR 1.04, 95% CI: 1.02-1.06, P<0.001), hepatic encephalopathy (aOR 1.03, 95% CI: 1.02-1.04, P<0.001), and hepatorenal syndrome (aOR 1.01, 95% CI 1.00-1.01, P=0.03). However, there was no difference in mortality between White and Hispanic patients.

Conclusions:
Black and Hispanic ALD patients experiencing homelessness were found to incur higher hospital charges; furthermore, Hispanic patients also had greater length of stay and higher incidence of liver-related complications compared with White counterparts.
Trends and Variations in Pancreatic Cancer Mortality Among US Metro and Nonmetro Adults, 1999-2020
Authors: Ma Samuel , Sokale Itunu O. , Thrift Aaron P. 
Published: November 2023

Background:
Pancreatic cancer is the third leading cause of cancer deaths in the United States. Despite decreasing cancer mortality rates as a whole, pancreatic cancer death rates in the United States remain steady and demonstrate racial/ethnic disparities. Divergent cancer mortality trends have also been observed between metro and nonmetro populations. We therefore aimed to compare metro and nonmetro trends in pancreatic cancer mortality rates in the United States from 1999 to 2020 and investigate potential sex and racial/ethnic differences.

Methods:
We analyzed National Center for Health Statistics data for all pancreatic cancer deaths among individuals aged 25 years or older in the United States. We estimated the average annual percent change (AAPC) in age-standardized pancreatic cancer mortality rates in metro versus nonmetro areas by sex and race/ethnicity.

Results:
Of the total 810,425 pancreatic cancer–related deaths identified from 1999 to 2020, 668,547 occurred in metro areas and 141,878 in nonmetro areas. Non-Hispanic Black individuals had the highest rates of pancreatic cancer mortality regardless of metropolitan status. In both metro and nonmetro areas, pancreatic cancer mortality rates among non-Hispanic White individuals increased over the study period (AAPC: metro, males, 0.32%; females, 0.27%; nonmetro, males, 0.77%; females, 0.62%). Non-Hispanic Black individuals in metro areas had a decrease in pancreatic cancer mortality (AAPC: males, −0.25%; females, −0.29%), but rates among non-Hispanic Black women in nonmetro areas increased (AAPC, 0.49%).

Conclusions:
There are variations not only in pancreatic cancer mortality by metro and nonmetro status but also by sex and race/ethnicity within these areas. Individuals who live in nonmetro areas have higher pancreatic cancer mortality rates and increasing death rates compared with their metro counterparts. These findings highlight the need for targeted cancer prevention strategies that are specific to metro or nonmetro populations.
Endoscopic Glue Injection Versus Endoscopic Human Thrombin Injection for Bleeding Gastric Varices—A Randomized Controlled Trial
Authors: Jhajharia Ashok , Ashdhir Prachis , Dhaked Gireesh , Sharma Hitesh 
Published: November 2023

Background:
Acute gastric variceal bleeding (AGVB) is a potentially fatal consequence of portal hypertension, accounting for 10% to 30% of all variceal bleeding. Although endoscopic cyanoacrylate glue injection is a common treatment for acute hemostasis, it has been linked to significant side effects. In the treatment of AGVB, there is limited evidence of the efficacy and relative safety of endoscopic human thrombin injection over glue injection.

Materials and Methods:
A total of 52 AGVB patients were randomized to receive either thrombin injection (25 patients) or glue injection (27 patients). The primary outcome was the incidence of any glue or thrombin injection-related post-therapy complications. Initial hemostasis, rebleeding, and mortality were all secondary end goals.

Results:
Both groups had comparable baseline data. Hemostasis of active bleeding at endoscopy was 100.0% (10/10) in the thrombin group and 87.5% (7/8) in the glue group (P=0.44). Treatment failure after 5 days occurred in 2 patients (6.1%) in the glue group compared with none in the thrombin group (P=0.165). Between 6 and 42 days after index bleeding, rebleeding occurred in 4 patients in the thrombin group compared with 6 patients in the glue group (P=0.728). In the thrombin group, none of the patients had post-treatment ulcers on gastric varices compared with 14.81% (4/27) that occurred in the glue group (P=0.045), a statistically significant observation. Overall, complications occurred in 4 (20%) and 11 (40.7%) patients in the thrombin and glue groups, respectively (P=0.105). Two patients in the glue group died.

Conclusion:
To achieve successful AGVB hemostasis, endoscopic thrombin injection has been proven efficacious. However, glue injection may be linked to a higher rate of rebleeding and post-therapy gastric variceal ulceration compared with thrombin.
Tislelizumab with gemcitabine and cisplatin as a neoadjuvant regimen for muscle-invasive bladder cancer: case series
Authors: Wang Ze , Wang Yapeng , Wang Shuo , Ran Qiang , Peng Song , Zhang Yao , Zhang Jun , Zhang Dianzheng , Wang Luofu , Lan Weihua , Liu Qiuli , Jiang Jun 
Published: November 2023

Introduction and importance:
The feasibility of combined tislelizumab with gemcitabine and cisplatin as a neoadjuvant regimen for muscle-invasive bladder cancer (MIBC) remains to be investigated.

Case presentation:
The neoadjuvant treatment not only shrunk tumours significantly but also lowered their stages from T4bN1M0, T3N0M0, and T3bN0M0 to pT1, pT0 and pTis, respectively. The treatment suppressed tumour cell proliferation and promoted luminal-to-basal transition.

Clinical discussion:
MIBC is an aggressive bladder cancer with poor prognosis. All three patients with MIBC benefited greatly from the neoadjuvant regimen (tislelizumab + gemcitabine + cisplatin). It appears that the effect of the treatment is independent of the levels of programmed death-ligand 1 nor the subtype of urothelial bladder cancer.

Conclusion:
Combination of tislelizumab with gemcitabine and cisplatin appeared to be a safe and efficacious neoadjuvant therapy for MIBC.