bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term management and treatment of acute intermittent porphyria with recurring attacks using pharmacological prophylaxis
Authors: Kuo Hung-Chou , Ro Long-Sun , Lin Chia-Ni , Chen Hui-Yu 
Published: December 2023

Background:There is no definitive guidance on whether patients with acute intermittent porphyria (AIP) with recurrent attacks need pharmacological prophylactic treatment.Methods:The management strategies for patients with frequent (defined as ≥4 annualized attack rate (AAR) and less frequent attacks (<4 AAR), including treatment for acute attacks and duration of prophylaxis (weekly heme arginate 3 mg/kg body weight and/or investigational drug, givosiran), were summarized. The AAR for the following periods were presented: the first 2 years after diagnosis, before/after prophylaxis, and the most recent 2 years.Results:A total of 29 patients with AIP were included, 19 (34.5%) had <4 AAR and 10 (65.6%) had ≥4 AAR in the first 2 years after diagnosis. All patients experienced reduced attacks during the treatment course, 23 (79.3%) were attack-free during the most recent 2 years. Among the 9 patients who received prophylaxis (7 heme arginate; 1 givosiran, 1 heme arginate followed by givosiran), 5 (55.6%) were attack-free in the most recent 2-year period and prophylaxis was discontinued because there had been no attacks for >1 year. For patients without prophylaxis (n = 20), 18 (90.0%) were attack-free in the most recent 2-year period and 15 (75.0%) experienced attacks only in the first 2 years after diagnosis.Conclusions:Prophylaxis could be considered for patients with AIP with ≥4 biochemically confirmed attacks/year after routine treatment of 1–2 years, during which the severity and frequency of attacks should be closely monitored to determine the necessity of pharmacologic prophylaxis. More studies are needed to reach a consensus on the use of pharmacological prophylaxis and treatment of AIP.
Inhibition of CAF-1 histone chaperone complex triggers cytosolic DNA and dsRNA sensing pathways and induces intrinsic immunity of hepatocellular carcinoma
Authors: Chan For-Fan , Yuen Vincent Wai-Hin , Shen Jialing , Chin Don Wai-Ching , Law Cheuk-Ting , Wong Bowie Po-Yee , Chan Cerise Yuen-Ki , Cheu Jacinth Wing-Sum , Ng Irene Oi-Lin , Wong Carmen Chak-Lui , Wong Chun-Ming 
Published: December 2023

Background and Aims:Chromatin assembly factor 1 (CAF-1) is a replication-dependent epigenetic regulator that controls cell cycle progression and chromatin dynamics. In this study, we aim to investigate the immunomodulatory role and therapeutic potential of the CAF-1 complex in HCC.Approach and Results:CAF-1 complex knockout cell lines were established using the CRISPR/Cas9 system. The effects of CAF-1 in HCC were studied in HCC cell lines, nude mice, and immunocompetent mice. RNA-sequencing, ChIP-Seq, and assay for transposase accessible chromatin with high-throughput sequencing (ATAC-Seq) were used to explore the changes in the epigenome and transcriptome. CAF-1 complex was significantly upregulated in human and mouse HCCs and was associated with poor prognosis in patients with HCC. Knockout of CAF-1 remarkably suppressed HCC growth in both in vitro and in vivo models. Mechanistically, depletion of CAF-1 induced replicative stress and chromatin instability, which eventually led to cytoplasmic DNA leakage as micronuclei. Also, chromatin immunoprecipitation sequencing analyses revealed a massive H3.3 histone variant replacement upon CAF-1 knockout. Enrichment of euchromatic H3.3 increased chromatin accessibility and activated the expression of endogenous retrovirus elements, a phenomenon known as viral mimicry. However, cytosolic micronuclei and endogenous retroviruses are recognized as ectopic elements by the stimulator of interferon genes and dsRNA viral sensing pathways, respectively. As a result, the knockout of CAF-1 activated inflammatory response and antitumor immune surveillance and thereby significantly enhanced the anticancer effect of immune checkpoint inhibitors in HCC.Conclusions:Our findings suggest that CAF-1 is essential for HCC development; targeting CAF-1 may awaken the anticancer immune response and may work cooperatively with immune checkpoint inhibitor treatment in cancer therapy.
Impact of acute silent ischemic lesions on clinical outcomes of carotid revascularization
Authors: Wang Jie , Wang Tao , Yang Bin , Chen Yanfei , Gao Peng , Wang Yabin , Chen Jian , Chen Fei , Luo Jichang , Yang Renjie , Min Xiaoli , Ma Yan , Jiao Liqun 
Published: December 2023

Background:
Previous literature has established an association between acute silent ischemic lesions (ASILs) and elevated susceptibility to future adverse clinical outcomes. The present study endeavors to scrutinize the prognostic significance of pre-procedural ASILs, as detected through diffusion-weighted imaging and apparent diffusion coefficient metrics, in relation to subsequent adverse events—namely, stroke, myocardial infarction, and all-cause death—following carotid revascularization in a cohort of patients with symptomatic carotid stenosis.

Materials and Methods:
Subjects were extracted from a comprehensive retrospective dataset involving symptomatic carotid stenosis cases that underwent carotid revascularization at a tertiary healthcare institution in China, spanning January 2019 to March 2022. Of the 2,663 initially screened patients (symptomatic carotid stenosis=1,600; asymptomatic carotid stenosis=1,063), a total of 1,172 individuals with symptomatic carotid stenosis were retained for subsequent analysis. Stratification was implemented based on the presence or absence of ASILs. The primary endpoint constituted a composite measure of in-hospital stroke, myocardial infarction, or all-cause death. Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) treatment modalities were individually subjected to propensity score-matched analyses.

Results:
Among the 584 subjects who underwent CEA, 91 ASIL-positive and 91 ASIL-negative (NASIL) cases were propensity score-matched. Notably, the ASIL cohort demonstrated a statistically significant augmentation in the risk of primary outcomes relative to the NASIL group (10.99% vs. 1.10%; absolute risk difference, 9.89% [95% CI, 3.12%-16.66%]; RR, 10.00 [95% CI, 1.31-76.52]; P=0.01). Similarly, within the 588 CAS-treated patients, 107 ASIL-positive and 107 NASIL cases were matched, revealing a correspondingly elevated risk of primary outcomes in the ASIL group (9.35% vs. 1.87%; absolute risk difference, 7.48% [95% CI, 1.39%-13.56%]; RR, 5.00 [95% CI, 1.12-22.28]; P=0.02).

Conclusions:
ASILs portend an elevated risk for grave adverse events post-carotid revascularization, irrespective of the specific revascularization technique employed—be it CEA or CAS. Thus, ASILs may serve as a potent biomarker for procedural risk stratification in the context of carotid revascularization.
Changing patterns and surgical outcomes of small bowel obstruction in the era of minimally invasive surgery for colorectal cancer
Authors: Liang Jin-Tung , Liao Yu-Tso , Chen Tzu-Chun , Huang John , Hung Ji-Shiang 
Published: December 2023

Introduction:
This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC).

Methods:
Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups.

Results:
The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n=68/1544 vs. 9.7%, n=156/1604, P<0.0001). Compared with the TOS group, the MIS group had significantly different (P<0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to (P<0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3–12 months) onset (64.7%), while that in the TOS group (P<0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more (P<0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien–Dindo classification ≧3, 11.8 vs. 14.1%, P=0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower (P=0.016) in the MIS group than in the TOS group.

Conclusions:
The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur.
A Novel Partial Nephrectomy Technique Using Blunt Dissection, Clipping of Intrarenal Vessels, Followed by Closure Using a Fibrin Sealant and Sliding Clips
Authors: Aschwanden Fabian J. , Ditsch Dominic , von Wallenberg Fabian , Affentranger Andres , Treumann Thomas , Mattei Agostino , Fankhauser Christian D. 
Published: December 2023

ABSTRACT

Purpose:
We describe a surgical technique for robotic-assisted partial nephrectomy, including 3 novel steps to facilitate resection and suturing. This approach minimizes positive surgical margins and the risk of postoperative bleeding.

Materials and Methods:
This article describes a retrospective study of a single-surgeon series, including 49 patients. The study approach includes descriptive analysis of the Intraoperative Adverse Incident Classification, analysis of postoperative complications using the Clavien-Dindo Classification, and description of pathological and oncological outcomes.

Results:
The median operative time was 221 minutes (IQR: 196-263), and the median ischemia time was 20 minutes (IQR: 12-24). Intraoperative Adverse Incident Classification Grade 1 complications occurred in 2 patients (4%). Conversion to open partial nephrectomy was necessary in 1 patient (2%). Postoperative complications were reported in 7 patients (14%). Of these, 3 patients (6%) experienced a Clavien-Dindo Classification Grade 2 complication, 2 patients (4%) experienced a Grade 3a complication, 1 patient (2%) experienced a Grade 3b complication, and 1 patient (2%) experienced a Grade 4a complication. Endovascular coiling and blood transfusion were necessary in 2 patients (4%), and 2 patients (4%) were readmitted. A positive surgical margin was reported in 1 patient (2%). Metastatic relapse occurred in 1 patient (2%) 535 days after surgery who did not have a positive surgical margin.

Conclusions:
Our novel 3 surgical steps during robotic-assisted partial nephrectomy allow an oncologically safe resection with a low risk of postoperative complications.
Microbiomes in Post–Digital Rectal Exam Urine Samples are Linked to Prostate Cancer Risk
Authors: Crawford E. David , Martin Rick , Phillips Caleb D. , Stanton Whitney N. , van Bokhoven Adrie , Lucia M. Scott , Arangua Paul B. , La Rosa Francisco G. , Grasmick Zachary , Terlecki Ryan , Meagher Margaret F. , Hirano Daisaku , Nickel J. Curtis , Werahera Priya N. 
Published: December 2023

Abstract

Purpose:
Bacterial species including Cutibacterium acnes (C. acnes) have been associated with different inflammatory and neoplastic conditions in prostate cancer (PCa) tissue samples, but their clinical impact is unknown. Using next-generation sequencing (NGS)–based clinical reports, we investigated the differential abundance and incidence of microbiomes in post–digital rectal exam (DRE) urine samples from patients with PCa and a matched control group at low risk of PCa.

Materials and Methods:
A total of 200 post-DRE urine samples were analyzed, 100 from patients with histopathologically confirmed PCa and 100 from men at very low risk of PCa with PSA <1.5 ng/mL as controls. Bacterial and fungal communities were characterized by NGS of 16S and internal transcribed spacer (ITS) loci, respectively, with species' relative abundances provided on physicians' clinical reports. The differential abundance and incidence of species between cancer and control groups were evaluated.

Results:
Microbes were reported in 39% and 56% of PCa and control group samples, respectively. C. acnes had a significantly higher relative abundance in patients with PCa vs controls (P < .05), and C. acnes incidence rates were also nominally higher in patients with PCa as compared with controls (12.82% and 7.27%, respectively). By contrast, Finegoldia magna (F. magna) had a significantly higher relative abundance (P < .05) and incidence rate (P < .05) in controls as compared with patients with PCa.

Conclusions:

C. acnes was among the most prevalent bacterial species in PCa urine samples. F. magna identified in the low-risk group is responsible for production of equol, a soy metabolite associated with lowering risk of PCa, suggesting a role in prostate cancer chemoprevention.
A case of truncal complex regional pain syndrome: literature review
Authors: Alhammadi Nouf A. , Alqahtani Hanan 
Published: December 2023

Introduction and importance:
Complex regional pain syndrome is a rare and chronic pain disorder characterized by an abnormal level of pain disproportionate to the initiating cause, often manifesting well after the triggering event.

Case presentation:
The authors present a free past medical history 33-year-old female, employed as a nurse in an intensive care unit, presented with a 9-year history of diffuse back pain. Her symptoms initially emerged at the neck with muscle spasms and restricted neck mobility, eventually progressing along the spine. Notably, the pain became episodic and intensified over time, significantly impeding her daily activities. Analgesic (non-steroidal anti-inflammatory drugs) treatments proved ineffective, and a distinct feature emerged—a change in skin colour to dark purple spots on her back, accompanied by hyperhidrosis and extreme tenderness. Despite an exhaustive evaluation involving bloodwork, inflammatory markers, serological tests, and radiographic imaging, a definitive diagnosis remained elusive until she responded positively to Pregabilin.

Clinical discussion:
Although typically associated with extremities, this case challenges the conventional understanding of complex regional pain syndrome by showcasing its manifestation in the truncal region. The patient’s clinical history, examination findings, and diagnostic journey are detailed herein, shedding light on the complexity and diagnostic considerations associated with this condition.

Conclusion:
The case underscores the importance of a comprehensive approach and prompts a reevaluation of the existing guidelines to encompass such atypical presentations.
Examination of the traction effect in an artificial muscle-type dynamic traction orthosis using computed tomography
Authors: Nakayama Jun , Fukui Nobuyoshi , Sunagawa Kosaku , Ogawa Kazunori , Oka Hisao , Denno Kakuro 
Published: December 2023

Background:
Dart-throwing motion from radial dorsiflexion to palmar flexion has recently attracted attention as a functional movement direction of the wrist joint. We developed a novel artificial muscle-type dynamic traction orthosis (DTSaM) that includes these movements. This prospective crossover controlled study aimed to compare the traction effects in the presence and absence of DTSaM using computed tomography.

Methods:
Healthy participants with no history of finger disease (6 men: 6 fingers, 4 women: 4 fingers; average age [range]: 29.4 [34–24] years) were examined. The distance and area of the joint space between the radiolunate (RL) and capitolunate (CL) joints were evaluated using 2 types of computed tomography: automatic movement and DTSaM.

Results:
Participants with DTSaM showed more dilated joint space distance on the dorsal and central sides (p < 0.05) and larger joint space areas on the dorsal side (p < 0.05) of the RL and CL joints than those without orthosis. Significant differences in the magnitude of change in each joint were observed between the RL and CL joints regarding the joint space distance on the dorsal (p = 0.021) and central (p = 0.038) sides and the joint space area on the dorsal side (p = 0.044).

Conclusions:
The movement of the CL joint is important in the dorsiflexion direction. Our results suggest that the dilated CL joint allows dorsiflexion and that combined traction and dart-throwing motion exercises may be possible for wrist joint contracture.
Implementing Enhanced Recovery Pathways
Authors: Yuan Christina T. , Wu JunBo , Cardell Chelsea P. , Liu Tasnuva M. , Eidman Benjamin , Hobson Deborah , Wick Elizabeth C. , Rosen Michael A. 
Published: December 2023

Objective:
To explore barriers and facilitators to implementing enhanced recovery pathways, with a focus on identifying factors that distinguished hospitals achieving greater levels of implementation success.

Summary Background Data:
Despite the clinical effectiveness of enhanced recovery pathways, the implementation of these complex interventions varies widely. While there is a growing list of contextual factors that may affect implementation, little is known about which factors distinguish between higher and lower levels of implementation success.

Methods:
We conducted in-depth interviews with 168 perioperative leaders, clinicians, and staff from eight U.S. hospitals participating in the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Guided by the Consolidated Framework for Implementation Research, we coded interview transcripts and conducted a thematic analysis of implementation barriers and facilitators. We also rated the perceived effect of factors on different levels of implementation success, as measured by hospitals’ adherence with nine process measures over time.

Results:
Across all hospitals, factors with a consistently positive effect on implementation included information-sharing practices and the implementation processes of planning and engaging. Consistently negative factors included the complexity of the pathway itself, hospitals’ infrastructure, and the implementation process of “executing” (particularly in altering electronic health record systems). Hospitals with the greatest improvement in process measure adherence were distinguished by clinicians’ positive knowledge and beliefs about pathways and strong leadership support from both clinicians and executives.

Conclusions:
We draw upon diverse perspectives from across the perioperative continuum of care to qualitatively describe implementation factors most strongly associated with successful implementation of enhanced recovery pathways.
Lung Transplantation for People Living With HIV: Promising Mid-term Outcomes
Authors: Ralphs Asher S. , Anderson Scott T. , Langlais Blake T. , D’Cunha Jonathan , Reck dos Santos Pedro A. 
Published: December 2023

Background.
With increasing life expectancy, patients with HIV are more commonly acquiring other chronic diseases, such as end-stage lung disease, for which transplant may be the only effective solution. Until recently, HIV infection was considered a contraindication to lung transplant (LTx). As LTx in people living with HIV (PLWH) becomes more common, there remain limited data on outcomes in this population.

Methods.
Using the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research file, we identified LTx recipients with HIV by either serostatus or nucleic acid testing. A control group of confirmed HIV-negative LTx recipients was propensity score matched on age, body mass index, primary diagnosis, and year of transplant. Patient characteristics, transplant parameters, survival, and postoperative outcomes were compared.

Results.
Fifty-nine LTx recipients with HIV were identified and compared with 236 HIV-negative controls. Among PLWH, cytomegalovirus status was more frequently positive (76.3% versus 58.9%, P = 0.014), and the median Lung Allocation Score at match was higher (44 versus 39, P = 0.004). PLWH were more likely to undergo dialysis postoperatively (18.6% versus 8.9%, P = 0.033), although other complication rates were similar. Fifty-three percent of LTx for PLWH occurred since 2020. One-year survival for PLWH was 91.2% versus 88.6% for controls (P = 0.620). Three-year survival for a smaller subset was also not statistically significant (HIV versus control: 82.6% versus 77.8%, respectively, P = 0.687).

Conclusions.
There was no difference in 1-y survival for LTx recipients living with HIV compared with a matched control group, supporting this group of patients as viable candidates for LTx.