bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of the continuous supraclavicular brachial plexus block using the proximal longitudinal oblique approach and the interscalene brachial plexus block for arthroscopic shoulder surgery
Authors: Kim Yeon Ju , Kim Hyungtae , Kim Sehee , Kang Mi-Ra , Kim Ha-Jung , Koh Won Uk , Lee Sooho , Ro Young-Jin 
Published: December 2023

BACKGROUND
Continuous interscalene brachial plexus block (ISB) is widely used for arthroscopic shoulder surgery, but the incidence of hemidiaphragmatic paresis (HDP) has been reported to reach 100%. Several methods, including injections distal to the C5–C6 nerve roots, have been attempted to reduce the HDP incidence. However, catheter placement distal to the C5–C6 nerve roots interferes with the surgical site.

OBJECTIVE
Our primary objective was to describe a new technique, the supraclavicular brachial plexus block (SCB), using the proximal longitudinal oblique approach (PLO-SCB), which can facilitate catheter placement and, when compared with ISB, to test whether this would provide noninferior analgesia and spare the phrenic nerve.

DESIGN
Prospective, randomised, double-blind study.

SETTING
Operating rooms, postanaesthesia care unit, and wards.

PATIENTS
Seventy-six patients aged 20 to 80 years scheduled for arthroscopic shoulder surgery.

INTERVENTIONS
Patients were randomly assigned to the continuous PLO-SCB (n = 40) or the continuous ISB (n = 40) groups. All patients received an initial low-volume single-injection (5 ml 0.75% ropivacaine) followed by a patient-controlled infusion of 0.15% ropivacaine.

MAIN OUTCOME MEASURES
The primary outcomes were the incidence of HDP and pain scores. Secondary outcomes were respiratory function, postoperative analgesic consumption, sensory and motor function, and complications.

RESULTS
The HDP incidence was significantly lower in the PLO-SCB group than in the ISB group at 30 min after block injection: 0% (0 of 38 patients) and 73.7% (28 of 38 patients), respectively (P < 0.001). Similarly, at 24 h after surgery, the incidences were 23.7% (9 of 38 patients) and 47.4% (18 of 38 patients) in the PLO-SCB and ISB groups, respectively (P = 0.002). Median [IQR] NRS pain scores at rest measured after surgery in the ISB and PLO-SCB groups were similar: immediately after surgery, 1 [0 to 2] vs. 1 [0 to 1], P = 0.06); at 30 min, 2 [0.25 to 2] vs. 1 [0 to 2], P = 0.065); and at 24 h 2 [0.25 to 3] vs. 1 [0 to 3], P = 0.47, respectively.

CONCLUSION
For major shoulder surgery, compared with continuous ISB, continuous PLO-SCB was more sparing of diaphragmatic and respiratory function while providing noninferior analgesia. Catheter placement via the PLO approach is feasible without interfering with the surgical field.

TRIAL REGISTRATION
Registered by the Clinical Trial Registry of Korea (Seoul, Korea; KCT0004759, http: cris.nih.go.kr, principal investigator: Hyungtae Kim).
Flap Survival after Reconstructive Surgery for Pressure Ulcers: A Cohort Study
Authors: Nööjd Mari , Wyckman Alexander , Steinvall Ingrid , Elmasry Moustafa 
Published: December 2023

Background:
Pressure ulcers are troublesome for patients and require considerable resources to resolve. Previous studies have focused on recurrence, whereas there are few studies on flap survival. The aim was to describe the group and to analyze possible factors for flap survival.

Method:
A descriptive retrospective analysis of all operations between 2008 and 2020 was carried out. Flap survival at 40 days was assessed. A flap was classified as a failure if a reoperation with removal or replacement was planned before, or in connection with, the first return visit. Variables of patient demographics, details of the pressure ulcers, and surgical treatment and care were analyzed with multivariable logistic regression for their effect on flap survival.

Results:
A total of 111 flaps were included [78 (70%) with random blood supply and 33 (30%) with axial or perforator-based blood supply]; 54 (49%) of the flaps were fasciocutaneous. Body mass index was 25 (IQR 22–28). Flap survival rate was 90%. Variables associated with flap failure were higher body mass index, congenital spinal cord injury, type of blood supply to the flap, and the use of methylene blue to guide debridement of the wound.

Conclusions:
The findings show factors that can be modified to improve future results, including a normalized body mass index and use of methylene blue in surgery to outline wound edges and depth, as this has been shown to protect against flap failure. Our data suggest that random flaps, such as V-Y, are preferable to axial flaps in the studied group.
Preoperative systemic inflammation response index: Clinicopathologic predictor of pathological complete response in HER2-positive breast cancer patients receiving neoadjuvant systemic therapy
Authors: Wu Hong-Yu , Lin Chin-Yao , Tzeng Yen-Dun , Hung Chih-Chiang , Liu Shiuh-Inn , Yin Chun-Hao , Chen Jin-Shuen , Chen Yao-Shen , Yang Jie-Ru 
Published: December 2023

Background:
Multiple pretreatment systemic inflammatory markers (SIMs) have been reported as predictors of pathological complete response (pCR) after neoadjuvant systemic therapy (NST) in patients with breast cancer (BC). However, the most significant SIM remains to be conclusively identified, and variations among different molecular subtypes remain unknown. The objective of the study was to identify the most significant SIM in patients with human epidermal growth factor receptor 2 (HER2) positive BC, to construct a pCR-predictive nomogram combining it with other clinicopathologic factors, and to evaluate its prognostic value on survival.

Methods:
We retrospectively reviewed the findings for 240 patients with stage I-III HER2-positive BC who underwent NST and subsequent surgery at Kaohsiung and Taichung Veterans General Hospital from 2011 to 2021. Clinicopathologic factors were analyzed by stepwise logistic regression with backward selection. The data were used to construct a nomogram plot for determining the pCR probability. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival (DFS) and overall survival (OS).

Results:
Among the pretreatment SIMs, only the systemic inflammation response index (SIRI) was significantly related to pCR, with an optimal cutoff value of 1.27 × 109/L. Stepwise logistic analyses indicated that clinical N stage, HER2 immunohistochemistry score, hormone receptor status, targeted therapy regimen, and SIRI were independent predictors of pCR, with an area under the curve of 0.722. The Hosmer-Lemeshow test and calibration curve revealed that the predictive ability was a good fit to actual observations. A nomogram was constructed based on the logistic model. The external validation of the model also revealed satisfactory discrimination and calibration. Kaplan-Meier analysis showed that patients with SIRI <1.27 had longer DFS and OS.

Conclusion:
Pretreatment SIRI <1.27 is predictive of pCR, DFS, and OS in HER2-positive BC. Our nomogram could efficiently predict pCR and facilitate clinical decision-making before neoadjuvant treatment.
Performance status as a prognostic surrogate in hepatocellular carcinoma: Role of albumin–bilirubin and easy-albumin–bilirubin grade
Authors: Liao Jia-I , Ho Shu-Yein , Hou Ming-Chih , Liu Po-Hong , Hsu Chia-Yang , Huo Teh-Ia 
Published: December 2023

Background:
Performance status (PS) is associated with the severity of liver cirrhosis and is also an important survival determinant in hepatocellular carcinoma (HCC). Albumin–bilirubin (ALBI) grade and easy (EZ)-ALBI grade have been proposed to evaluate liver dysfunction in HCC, but their role in patients with different PS is unclear. We aimed to investigate the prognostic role of ALBI and EZ-ALBI grade in a large HCC cohort with variable PS.

Methods:
A total of 3355 newly diagnosed HCC patients between 2002 and 2018 were identified and retrospectively analyzed. Independent prognostic predictors associated with survival were investigated using the Cox proportional hazards model.

Results:
Patients with poor PS had decreased survival compared with those with good PS. In the Cox model, creatinine ≥1.2 mg/dL, α-fetoprotein (AFP) ≥20 ng/mL, vascular invasion, distant metastasis, total tumor volume >100 cm3, presence of ascites, ALBI grades 2 and 3, EZ-ALBI grade 2 and grade 3, PS 1–4, and noncurative treatment were independently associated with higher mortality in the entire cohort (all p < 0.001). ALBI grade and EZ-ALBI grade can well stratify overall survival in subgroup patients with PS 0, PS 1–2, and PS 3–4 (all p < 0.001).

Conclusion:
Patients with good PS have better long-term survival compared with those with poor PS. ALBI and EZ-ALBI grade can discriminate long-term outcome in the entire cohort as well as in patients with different PS. ALBI and EZ-ALBI are objective and feasible prognostic models to evaluate liver dysfunction in HCC patients independent of PS.
The effect of radiotherapy on patients with pathological stage IIB breast cancer after breast-conserving surgery or mastectomy: A cohort study
Authors: Pan Yi-Ying , Lai Tzu-Yu , Shiau Cheng-Ying , Tseng Ling-Ming , Lai I-Chun , Liu Yu-Ming , Huang Pin-I 
Published: December 2023

Background:
Breast cancer is one of the most common cancers in women, and treatment options include surgery, systemic therapies, and radiotherapy (RT). While postoperative RT plays an important role in reducing local recurrence rates and improving survival outcomes, its exact impact on patients with pathological stage IIB breast cancers remains unidentified.

Methods:
In this retrospective cohort study, patients with newly diagnosed pathological stage IIB breast cancer who underwent surgery and postoperative RT were included. The data were collected from medical records, and survival outcomes were assessed using the Kaplan-Meier method, log-rank tests, and Cox regression models.

Results:
In total, 350 patients participated in this study. Overall survival, locoregional recurrence-free survival, event-free survival, and distant metastasis-free survival rates did not significantly differ between those who received RT and those who did not. Multivariate analyses revealed that patients who received anthracycline or taxane chemotherapy had better survival outcomes.

Conclusion:
Our findings demonstrated that postoperative RT had no significant effect on overall survival, locoregional recurrence, event-free survival, or distant metastasis rates in patients with pathological stage IIB breast cancer. However, anthracycline- and taxane-based chemotherapies were associated with improved outcomes. These findings demonstrated the complexities of treating such patient populations with multimodal therapies. Further research is needed to ensure optimal postoperative RT in patients with pathological stage IIB breast cancer. Clinicians must consider individual patient characteristics and incorporate comprehensive treatment approaches to ensure successful outcomes in this population.
Long-term oncological outcomes of transanal versus laparoscopic total mesorectal excision for mid-low rectal cancer: a retrospective analysis of 2502 patients
Authors: Li Ze , Liu Huashan , Luo Shuangling , Hou Yujie , Zhou Yebohao , Zheng Xiaobin , Zhang Xingwei , Huang Liang , Zeng Ziwei , Kang Liang 
Published: December 2023

Background:
Transanal total mesorectal resection (taTME) has recently emerged as a promising surgical approach for the treatment of mid-low rectal cancer. However, there is limited evidence on the long-term survival outcomes associated with taTME. This retrospective study aimed to compare the overall survival (OS), disease-free survival (DFS), and cancer-specific survival of taTME and laparoscopic TME (laTME) in patients with mid-low rectal cancer.

Materials and Methods:
From July 2014 to June 2022, a total of 3627 patients were identified from two prospective cohorts: the laparoscopic rectal surgery cohort and the CNTAES cohort. To balance the baseline characteristics between the taTME and laTME groups, propensity score matching (PSM) was performed.

Results:
A total of 2502 patients were included in the study. Prior to PSM, the laTME group comprised 1853 patients, while the taTME group comprised 649 patients. The 5-year OS (82.9% vs. 80.4%, P=0.202) and 5-year DFS (74.4% vs. 72.5%, P=0.167) were comparable between the taTME and laTME groups. After PSM, the taTME group showed no statistically significant difference in the 5-year OS (83.1% vs. 79.2%, P=0.101) and 5-year DFS (74.8% vs. 72.1%, P=0.135) compared to the laTME group. Subgroup analysis further suggested that taTME may potentially reduce the risk of death [hazard ratio 0.652; (95% CI, 0.452–0.939)] and disease recurrence [hazard ratio 0.736; (95% CI, 0.562–0.965)] specifically in patients with low rectal cancer.

Conclusion:
In this study, taTME demonstrated comparable oncologic safety to laTME in patients with mid-low rectal cancer. Moreover, the results indicate that taTME may confer potential survival benefits for patients with low rectal cancer.
Development of therapeutic cancer vaccines using nanomicellar preparations
Authors: Qin Yan , Zeng Wen-Feng , Liang Wei 
Published: December 2023

Abstract
Cancer treatment is a multifaceted challenge, and therapeutic vaccines have emerged as a promising approach. The micellar preparation efficiently encapsulates antigen polypeptides and enhances antigen presentation through the major histocompatibility class I pathway, promoting cytotoxic T lymphocyte immune responses. Moreover, it enables codelivery of both antigen and adjuvant to the same target antigen-presenting cells. Combining the micellar vaccine with traditional cancer treatments (such as chemotherapy, radiotherapy, and surgery) has demonstrated improved efficacy in murine tumor models. Overall, the polyethylene glycol–phosphatidylethanolamine micelle-based vaccine presents a promising platform for cancer therapeutic vaccines. By leveraging the strengths of various treatment modalities, this innovative vaccine approach holds the potential to revolutionize cancer therapy and bring new possibilities for cancer patients.
Endonasal Endoscopic Optic Canal Decompression for Nontraumatic Optic Neuropathy: Long-Term Visual Outcomes in 36 Patients
Authors: Manet Romain , Calvanese Francesco , Jannelli Gianpaolo , Delaidelli Alberto , Fricker Jules , Verrecchia Sarah , Froment Tilikete Caroline , Jouanneau Emmanuel 
Published: December 2023

Background:
The management of compressive optic neuropathy (CON) arising from nontraumatic compression of the optic nerve within the optic canal (OC) remains a topic of controversy. In this study, our aim was to assess the effectiveness and safety of endonasal endoscopic optic nerve decompression (EEOND). In addition, we conducted an analysis of prognostic factors that could potentially influence visual outcomes.

Methods:
This retrospective cohort study was conducted between January 2015 and December 2021, involving adult patients (age > 18) diagnosed with CON and treated with EEOND at our specialized skull base expert center. The study evaluated the impact of surgery on visual acuity (VA), mean deficit (MD), and foveal threshold (FT) of the visual field (VF). These parameters were assessed preoperatively and at 3- and 12-month postoperative follow-ups. The relationship between clinical variables and the differences in postoperative to preoperative VA, MD, and FT of the visual field was analyzed through univariate and multivariate approaches.

Results:
Thirty-six patients (38 eyes) were included, with a mean age of 52 (±12) years, and a female predominance (78%). The mean ophthalmologic follow-up duration was 38 (±32) months. At the 12-month follow-up, 39% of the patients exhibited a VA improvement of ≥0.2 LogMAR. Partial VF improvement (MD improvement ≥25%) was observed in 55% of the patients, whereas 19% experienced complete recovery. In multivariate analysis, the presence of a type 4 OC was identified as the sole negative prognostic factor for visual improvement (VA and VF) at 12 months. Six patients (17%) encountered minor surgical complications, all of which were managed conservatively and had no impact on visual outcomes.

Conclusions:
Our study demonstrates that EEOND is a safe and effective procedure, even in cases of severe and long-lasting CON caused by nontraumatic compression of the optic nerve at the level of the OC.
Sleep Duration and Long-Term Mortality After Stroke: A Nationwide Analysis
Authors: Hassani Sara , Ovbiagele Bruce , Markovic Daniela , Towfighi Amytis 
Published: December 2023

AbstractBackgroundSleep duration is a key marker of ideal cardiovascular health in the American Heart Association’s new Life’s Essential 8 construct, but studies on outcomes in stroke survivors are scarce. We assessed the association between sleep duration and mortality among self-reported stroke survivors in a nationally representative U.S. sample.MethodsCross-sectional data (2005–2018) from the National Health and Nutrition Examination Surveys database in patients aged ≥18 (n=42,143) with a self-reported history of stroke (n=1,488) were linked to the 2019 National Death Index to determine the association between nightly sleep duration and mortality. Relationships between sleep duration (short: <7 hours, normal: 7-8 hours, long: >8 hours) and demographic characteristics were assessed. Relationships between sleep duration and mortality (all-cause and cardiovascular causes) were evaluated adjusting for demographic and clinical variables, with multivariable Cox regressions.ResultsAmong stroke survivors, prevalence of short sleep duration increased with younger age while prevalence of long sleep duration increased with older age (p<0.001). There were no significant sex differences in sleep duration. Long sleep duration was associated with higher all-cause mortality in the unadjusted model (HR 1.82, 1.44-2.31, p<0.0001). After adjustment for co-variates, (HR 1.36, 1.08-1.71, p=0.01), the association attenuated, but remained significant (HR 1.30, 1.02-1.65, p=0.03). Sensitivity analysis further verified the reliability of this conclusion. Short sleep duration was not associated with all-cause or cardiovascular mortality after adjusted analyses. There were no significant associations between long sleep duration and cardiovascular mortality.ConclusionLong sleep duration is independently associated with higher risk, all-cause mortality after stroke.
Human genetic evidence enriched for side effects of approved drugs
Authors: Minikel Eric Vallabh , Nelson Matthew R. 
Published: December 2023

AbstractSafety failures are an important factor in low drug development success rates. Human genetic evidence can select drug targets causal in disease and enrich for successful programs. Here, we sought to determine whether human genetic evidence can also enrich for labeled side effects (SEs) of approved drugs. We combined the SIDER database of SEs with human genetic evidence from genome-wide association studies, Mendelian disease, and somatic mutations. SEs were 2.0 times more likely to occur for drugs whose target possessed human genetic evidence for a trait similar to the SE. Enrichment was highest when the trait and SE were most similar to each other, and was robust to removing drugs where the approved indication was also similar to the SE. The enrichment of genetic evidence was greatest for SEs that were more drug specific, affected more people, and were more severe. There was significant heterogeneity among disease areas the SEs mapped to, with the highest positive predictive value for cardiovascular SEs. This supports the integration of human genetic evidence early in the drug discovery process to identify potential SE risks to be monitored or mitigated in the course of drug development.
Identification of an allele-specific transcription factor binding interaction that regulatesPLA2G2Agene expression
Authors: Hara Aki , Lu Eric , Johnstone Laurel , Wei Michelle , Sun Shudong , Hallmark Brian , Watkins Joseph C. , Zhang Hao Helen , Yao Guang , Chilton Floyd H. 
Published: December 2023

AbstractThe secreted phospholipase A2(sPLA2) isoform, sPLA2-IIA, has been implicated in a variety of diseases and conditions, including bacteremia, cardiovascular disease, COVID-19, sepsis, adult respiratory distress syndrome, and certain cancers. Given its significant role in these conditions, understanding the regulatory mechanisms impacting its levels is crucial. Genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs), including rs11573156, that are associated with circulating levels of sPLA2-IIA. Through Genotype-Tissue Expression (GTEx), 234 expression quantitative trait loci (eQTLs) were identified for the gene that encodes for sPLA2-IIA,PLA2G2A. SNP2TFBS (https://ccg.epfl.ch/snp2tfbs/) was utilized to ascertain the binding affinities between transcription factors (TFs) to both the reference and alternative alleles of identified SNPs. Subsequently, ChIP-seq peaks highlighted the TF combinations that specifically bind to the SNP, rs11573156. SP1 emerged as a significant TF/SNP pair in liver cells, with rs11573156/SP1 interaction being most prominent in liver, prostate, ovary, and adipose tissues. Further analysis revealed that the upregulation of PLA2G2A transcript levels through the rs11573156 variant was affected by tissue SP1 protein levels. By leveraging an ordinary differential equation, structured upon Michaelis-Menten enzyme kinetics assumptions, we modeled the PLA2G2A transcription’s dependence on SP1 protein levels, incorporating the SNP’s influence. Collectively, these data strongly suggest that the binding affinity differences of SP1 for the different rs11573156 alleles can influencePLA2G2Aexpression. This, in turn, can modulate sPLA2-IIA levels, impacting a wide range of human diseases.
Blood pressure variability, central autonomic network dysfunction and cerebral small vessel disease in APOE4 carriers
Authors: Lohman Trevor , Sible Isabel , Kapoor Arunima , Engstrom Allison C , Alitin John Paul , Gaubert Aimee , Rodgers Kathleen E , Bradford David , Mather Mara , Han S. Duke , Thayer Julian F. , Nation Daniel A 
Published: December 2023

AbstractBackgroundIncreased blood pressure variability (BPV) is a risk factor for cerebral small vessel disease (CSVD) and neurodegeneration, independent of age and average blood pressure, particularly in apolipoprotein E4 (APOE4) carriers. However, it remains uncertain whether BPV elevation is a cause or a consequence of vascular brain injury, or to what degree injury to the central autonomic network (CAN) may contribute to BPV-associated risk inAPOE4carriers.MethodsIndependently living older adults (n=70) with no history of stroke or dementia were recruited from the community and underwent 5 minutes of resting beat-to-beat blood pressure monitoring, genetic testing, and brain MRI. Resting BPV,APOEgenotype, CSVD burden on brain MRI, and resting state CAN connectivity by fMRI were analyzed. Causal mediation and moderation analysis evaluated BPV and CAN effects on CSVD inAPOE4carriers (n=37) and non-carriers (n=33).ResultsHigher BPV was associated with the presence and extent of CSVD inAPOE4carriers, but not non-carriers, independent of CAN connectivity (B= 18.92,P= .02), and CAN connectivity did not mediate the relationship between BPV and CSVD. InAPOE4carriers, CAN connectivity moderated the relationship between BPV and CSVD, whereby BPV effects on CSVD were greater in those with lower CAN connectivity (B= 36.43,P= .02).ConclusionsOlderAPOE4carriers with higher beat-to-beat BPV exhibit more extensive CSVD, independent of average blood pressure, and the strength of CAN connectivity does not mediate these effects. Findings suggest increased BPV is more likely a cause, not a consequence, of CSVD. BPV is more strongly associated with CSVD inAPOE4carriers with lower rsCAN connectivity, suggesting CAN dysfunction and BPV elevation may have synergistic effects on CSVD. Further studies are warranted to understand the interplay between BPV and CAN function inAPOE4carriers.