bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Giant Basal Cell Carcinoma in the Maxillofacial Region
Authors: Pupić-Bakrač Jure , Pupić-Bakrač Ana , Matoc Lovro , Knežević Josip 
Published: January 2025

Introduction
Giant basal cell carcinoma (GBCC) is a rare and aggressive subtype of basal cell carcinoma (BCC), characterized by a diameter of ≥5 cm and a potential for deep tissue invasion. This study aimed to present our experience with the surgical management of GBCC in the maxillofacial region, focusing on resection and immediate reconstruction strategies.

Methods
We conducted a retrospective analysis of 5926 patients with BCC in the maxillofacial region from 2010 to 2020, with a specific emphasis on 32 patients diagnosed with GBCC. Associations between patient and tumor characteristics were analyzed, treatment approaches evaluated, and clinical outcomes assessed.

Results
The cohort comprised 20 males (62.5%) and 12 females (37.5%) (P > 0.05), with a median age of 71 years (range: 40–86 years). The median time from tumor onset to presentation was 4 years (range: 2–7 years). A total of 24 GBCCs (75%) developed de novo, whereas 8 (25%) were recurrent BCCs (P < 0.05). The median tumor diameter was 8 cm (range: 5–15 cm), with local invasiveness extending to cartilage in 31.25% of cases, facial muscles in 29.41%, neural tissues in 21.87%, and bone in 18.75%. Surgical resections included orbital exenteration (3 cases, 9.38%), total parotidectomy (2 cases, 6.25%), partial maxillectomy (2 cases, 6.25%), frontal craniofacial resection (2 cases, 6.25%), partial petrosectomy with mastoidectomy (1 case, 3.13%), and near-total rhinectomy (1 case, 3.13%). For reconstruction, a skin graft was used in 3 patients (9.38%), local skin flaps in 15 (46.88%), locoregional flaps in 10 (31.25%), and free flaps in 4 (12.5%). The 5-year overall survival, disease-free survival, and disease-specific survival for the cohort were 87.5%, 93.75%, and 96.88%, respectively.

Conclusions
Our findings suggest that a single-stage procedure featuring aggressive surgical resection and reconstruction achieves low complication rates, excellent oncologic control, and acceptable cosmetic outcomes.
Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience
Authors: Hassanain Hala , Connor Ashton A. , Brombosz Elizabeth W. , Patel Khush , Elaileh Ahmed , Basra Tamneet , Kodali Sudha , Victor David W. , Simon Caroline J. , Cheah Yee Lee , Hobeika Mark J. , Mobley Constance M. , Saharia Ashish , Dhingra Sadhna , Schwartz Mary , Maqsood Anaum , Heyne Kirk , Kaseb Ahmed O. , Vauthey Jean-Nicolas , Gaber A. Osama , Abdelrahim Maen , Ghobrial R. Mark 
Published: January 2025

Background.
Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce recurrence, as shown with other malignancies.

Methods.
Medical records of patients undergoing LT for HCC at a single center between January 2016 and December 2022 were retrospectively reviewed. Patients were stratified into 3 groups: (1) recipients of adjuvant sorafenib, (2) nonrecipients at high recurrence risk, and (3) nonrecipients at low risk by explant pathology features. The outcomes were overall survival (OS) and recurrence-free survival (RFS). Adjuvant sorafenib recipients were also propensity score matched 1:2 to nonadjuvant recipients based on recurrence risk features.

Results.
During the study period, 273 patients with HCC underwent LT and 16 (5.9%) received adjuvant sorafenib therapy. Adjuvant sorafenib recipients were demographically similar to nonrecipients and, on explant pathology, had greater tumor burden, lymphovascular invasion, and poorer differentiation (all P < 0.001). Adverse events were observed in 12 adjuvant sorafenib recipients (75%). OS was similar among the 3 groups (P = 0.2), and adjuvant sorafenib was not associated with OS in multivariable analysis (hazard ratio, 1.31; 95% confidence interval, 0.45-3.78; P = 0.62). RFS was significantly lower in sorafenib patients (hazard ratio, 6.99; 95% confidence interval, 2.12-23.05; P = 0.001). Following propensity matching, adjuvant sorafenib use was not associated with either OS (P = 0.24) or RFS rates (P = 0.65).

Conclusions.
In this single-center analysis, adjuvant sorafenib was not associated with OS. Recipients were observed to have shorter RFS, likely due to the increased prevalence of high-risk features, and sorafenib use was associated with high frequencies of adverse events.
Association of a Liver Allocation Policy Change With Domestic Travel for Liver Transplantation
Authors: Ross-Driscoll Katie , Kubal Chandrashekhar , Ayuk-Arrey Arrey-Takor , Fridell Jonathan , Axelrod David 
Published: January 2025

Background.
In 2020, liver allocation policy in the United States was changed to allow for broader organ sharing, which was hypothesized to reduce patient incentives to travel for transplant. Our objective was to describe patterns of travel for domestic liver transplant pre- and post–acuity circle (AC) implementation.

Methods.
Incident adult liver transplant listings between August 16, 2016, and February 3, 2020 (pre-AC) or June 13, 2020, and December 3, 2023 (post-AC) were obtained from the Scientific Registry of Transplant Recipients. We used previously defined geographic catchment areas to classify patients as (1) no travel, (2) travel to a neighboring region, and (3) travel beyond a neighboring region. We used multinomial logistic regression to identify characteristics associated with travel and cause-specific hazards modeling to estimate the association between travel and time to deceased donor transplant, stratified by model for end-stage liver disease (MELD) score and AC era.

Results.
Among 83 033 liver candidates, 76% were listed in their home region. Black race, lower educational attainment, increased neighborhood social deprivation, and Medicaid were significantly associated with decreased odds of traveling beyond a neighboring region. After AC, traveling beyond a neighboring region was associated with an increased hazard of transplant for patients with a MELD score <15 (cause-specific hazard ratio [csHR]: 1.25; 95% confidence interval [CI], 1.11-1.40), MELD score 15–24 (csHR: 1.19; 95% CI, 1.07-1.31), and MELD score 25–34 (csHR: 1.15; 95% CI, 1.01-1.32).

Conclusions.
Travel frequency, geographic patterns of travel, and characteristics associated with travel were largely unchanged after AC. Changes to allocation policy alone may not equalize patient means or desire to travel for transplant care.
Analysis of Outcomes and Factors Influencing Community-Acquired Pressure Injury
Authors: Yang Xiuru , Zhang Dan , Zhang Hongmei , Cui Liangliang , Hu Qin , Hu Yang , Wen Dan , Ma Yanfei , He Qiuhong 
Published: January 2025

PURPOSE:
The purpose of this study was to analyze the outcomes and influencing factors of patients with community-acquired pressure injuries (CAPIs) and provide insights for clinical practice.

DESIGN:
Retrospective cohort study.

SUBJECTS AND SETTING:
We reviewed medical records of 413 patients with a total of 522 CAPIs. Patients with CAPIs who were hospitalized at Mianyang Central Hospital, Sichuan Province, China, between December 2021 and December 2022.

METHODS:
Depending on CAPI outcome at the time of discharge, the patients were split into “improvement” and “no improvement” groups. Factors influencing CAPI outcomes were examined using univariate analysis followed by multivariate analysis (logistic regression).

RESULTS:
A majority of patients (n = 324, 78.5%) showed improvement, and 89 (21.5%) showed no improvement. Logistic regression analysis showed statistically significant associations between CAPI outcomes and Braden Scale for Pressure Sore Risk scores, Barthel Index for Activities of Daily living scores, along with serum albumin, hemoglobin, interleukin-6, and C-reactive protein levels.

CONCLUSIONS:
The outcomes of patients with CAPIs were influenced by the Braden score, the Barthel score, serum albumin and hemoglobin levels, as well as inflammatory markers, including interleukin-6 and C-reactive protein. To effectively treat and care for patients with CAPIs, nurses should develop customized nursing interventions based on the unique characteristics of patients.
Quality of Life and Adaptation of People With a Colostomy Plug
Authors: Diniz Iraktânia Vitorino , Mendonça Ana Elza Oliveira de , Almeida Ana Maria de , Oliveira Simone Helena Dos Santos , Silva Isabelle Pereira da , Costa Isabelle Katherinne Fernandes , Soares Maria Júlia Guimarães Oliveira 
Published: January 2025

PURPOSE:
The purpose of this study was to examine health-related quality of life and adaptation of persons with a colostomy before and after use of a colostomy plug.

DESIGN:
Single group before-and-after study.

SUBJECTS AND SETTING:
The study sample comprised 19 people with a colostomy who attended an outpatient clinic João Pessoa, in Paraiba, Brazil. Inclusion criteria were: over 18 years, protruding colostomy, diameter 20 to 45 mm, elimination pattern of up to 3 solid or pasty fecal stools per day, and medical prescription for the use of the colostomy plug.

METHODS:
Data were collected between November 2018 and February 2019. Three outpatient visits per participant were completed; informed consent and baseline data were collected during clinic visit one. Data collected at baseline included demographic and pertinent clinic data. Stoma specific quality of life was measured using the City of Hope Quality of Life – Ostomy Questionnaire; adaptation to an ostomy was measured using the Scale for the Level of Adaptation of Ostomy Patients (SLAOP). Participants were also taught to use a colostomy plug during this visit. A second visit occurred between the 8th and 10th day of use; participants’ ability to use the device was assessed during this visit. A third visit occurred 30 to 35 days after plug use; instruments used to measure adaptation and health-related quality of life were readministered.

RESULTS:
Participants who had significantly higher scores for quality of life and adaptation were identified in people who used the plug in all dimensions of the Scale for Level of Adaptation of people with stomas and City of Hope Quality of Life – Ostomy Questionnaire, except for the interdependence mode. Significant, positive and strong correlations were identified between adaptation and quality of life before (r = 0.823; P = .000015) and after (r = 0.808; P = .000028) use of the colostomy plug.

CONCLUSION:
Findings suggest that use of a colostomy plug improved adaptation and quality of life in some patients living with a colostomy.
Diaper Dermatitis Algorithm and Scoring Tool in the Neonatal Intensive Care Unit (NICU)
Authors: Sharp Meredith 
Published: January 2025

PURPOSE:
The purpose of this quality improvement project was to implement and evaluate an algorithm for management and prevention of diaper dermatitis (DD) embedded in a scoring tool. The specific aim of the project was to decrease DD occurrences with a severity score of 3 to 4 by 25%.

PARTICIPANTS AND SETTING:
Quality improvement participants comprised 164 neonates; 89 were cared for prior to project implementation and 75 post-implementation. Data were collected over a 3-month period. The setting of this quality improvement project was a 98-bed, Level IV neonatal intensive care unit (NICU) located in the Midwestern United States (Oklahoma City, OK). The NICU is part of a freestanding children’s hospital affiliated with a university.

APPROACH:
Diaper dermatitis occurrences and severity scores were collected prior to and 3 months after the protocol was implemented in the NICU. We collected pre-implementation data, followed by staff education concerning the DD protocol. We also provide guidance for protocol implementation at the bedside and in our Electronic Medical Record. Data on DD rates and severity were provided during the National Database for Nurse Quality Indicators (NDNQI) prevalence days the 4th quarter of 2020 and the 1st quarter of 2021. We compared data before and after protocol implementation to evaluate its effect on DD rates and severity.

OUTCOMES:
Analysis before and after implementation of the protocol showed no significant differences in DD occurrences or severity scores. The unintended introduction of water-based cleansing wipes was identified as a confounding factor that we believe influenced outcomes. The DD scoring system and algorithm were permanently implemented for DD score quantification, DD management and treatment guidance, and ease of DD documentation with interventions, despite non-significant group differences.

IMPLICATIONS FOR PRACTICE:
Next steps for this project are to implement the water-based cleansing wipes facility wide, along with the scoring tool and DD prevention protocol.
Rapid and Sustained Resolution of Peristomal Pyoderma Gangrenosum With Aerosol Steroid Treatment
Authors: Mitsaki Kyriaki Stefania , Gaglani Bindi , Sethi Mieran 
Published: January 2025

BACKGROUND:
Peristomal pyoderma gangrenosum (PPG) is a non-infectious neutrophilic dermatosis most commonly seen in the context of ostomies in inflammatory bowel disease. The lack of established treatment guidelines and high-quality evidence in the form of randomized controlled trials present a major challenge in PPG management, owing to the rarity of the condition. Treatment can be further complicated by difficulties in maintaining the stoma pouch seal with conventional topical corticosteroids.

CASE:
We present a case of PPG treated with aerosol steroid inhaler, highlighting the need for innovative solutions in the management of the condition to maintain the stoma pouch seal.

CONCLUSION:
We achieved rapid and sustained resolution with the aerosol steroid, thus sparing the need for systemic agents, and we would like to advocate for its licensed use in PPG.
Geographic and Demographic Disparity in Firearm Injury: A 33-Year Retrospective Cohort Analysis of Florida Communities
Authors: Villa Brian P , Farach Sandra M , Velanovich Vic , Coughlin Emily , Penny Parker , Henning Jonathan , Lorch Steven , Herron Thomas , Mhaskar Rahul S , Diaz Jose J 
Published: January 2025

Background:
Firearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use.

Study Design:
The open-access FLHealthCHARTS was searched for firearm injuries from 1989-2022. Intentional firearm injury rates (IFIR) and unintentional firearm injury rates (UFIR) were collected as the number of injuries per 100,000 citizens, race and ethnicity. They were then stratified by severity of injury across county-level characteristic categories such as ruralness, Distressed Communities Index (DCI), and Concealed Carry Weapons (CCW) permit rates.

Results:
Of 123,484 firearm injuries reported, 109,745 were intentional and 13,739 unintentional. Since the late 1990s intentional firearm related deaths and hospitalizations have increased over time, with higher rates in socioeconomically at-risk and larger counties. Unintentional non-fatal hospitalizations have increased exponentially, with higher rates in distressed counties, but no effects of county size or ruralness. Unintentional deaths declined over time, with no significant county-level effects. Based on heatmap patterns, white citizens appear to be victims of more intentional firearm injuries in rural areas, while Black citizens were victims of more intentional firearm injuries in urban areas. The rate of CCW permit holders did not correlate to changes in UFIR or IFIR but patterns can be identified on a county-by-county basis.

Conclusion:
These results suggest that deaths remain a problem in all Florida county communities while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level one trauma hospitals to implement tailored education for high risk surrounding communities.
Histone methyltransferase DOT1L maintains identity and restricts cytotoxic potential of CD8 T cells
Authors: Malik Muddassir , de Leeuw Willem-Jan , Aslam Muhammad Assad , Kwesi-Maliepaard Eliza Mari , van den Brand Teun , van den Broek Bram , Kempers Maxime , Hoekman Liesbeth , Proost Natalie , van Welsem Tibor , de Wit Elzo , Borst Jannie , Jacobs Heinz , van Leeuwen Fred 
Published: January 2025

AbstractThe histone methyltransferase DOT1L is emerging as a central epigenetic regulator in immune cells. Loss of DOT1L during development of CD8 T cellsin vivoleads to gain of memory-features but has also been reported to compromise CD8 T cell viability and activity. Here, we determined the cell-intrinsic role of DOT1L in mature mouse CD8 T cells. After conditional deletion ofDot1L in vitro,CD8 T cells retainedin vivoproliferative capacity and anti-tumor reactivity. Moreover,Dot1Lknock-out CD8 T cells showed increased antigen-specific cytotoxicity towards tumor cellsin vitro.Mechanistically, loss of DOT1L resulted in an altered cell-identity program with loss of T-cell and gain of NK-cell features. These transcriptional changes were mediated by loss of DOT1L methyltransferase activity in a dose-dependent manner. Our findings show that ablation of DOT1L activity in mature CD8 T cells is well-tolerated and rewires their cell identity towards the NK-cell lineage, concomitantly enhancing intrinsic cytotoxic capacity.HighlightsDifferentiation and identity of cytotoxic T cells depend on the methyltransferase DOT1LDOT1L intrinsically limits the cytotoxic activity of mature CD8 T cellsDOT1L prohibits the acquisition of NK cell features in CD8 T cellsDOT1L maintains CD8 T cell identity through its catalytic activity in a dose-dependent manner
MenstLLaMA: A specialized large language model for menstrual health education in India
Authors: Adhikary Prottay Kumar , Motiyani Isha , Oke Gayatri , Joshi Maithili , Pathak Kanupriya , Singh Salam Michael , Chakraborty Tanmoy 
Published: January 2025

SummaryBackgroundThe quality and accessibility of menstrual health education in developing nations, including India, remain inadequate due to challenges such as poverty, social stigma, and gender inequality. While community-driven initiatives aim to raise awareness, artificial intelligence (AI) offers a scalable solution for disseminating accurate information. However, existing general-purpose large language models (LLMs) are ill-suited for this task, suffering from low accuracy, cultural insensitivity, and overly complex responses. To address these limitations, we developedMenstLLaMA, a specialized LLM tailored to the Indian context, designed to deliver menstrual health education empathetically, supportively, and accessible.MethodsWe curated a novel, domain-specific dataset and benchmarked state-of-the-art LLMs to developMenstLLaMA, an empathic companion model. The evaluation employed an open-label benchmark design with a four-stage framework: (1) overlap with ground truth, (2) clinical relevance, (3) response diversity, and (4) user satisfaction. A panel of clinical experts (n=118) conducted expert evaluations, while participants (n=1,200) interacted with chatbots, includingMenstLLaMA, in 15–20-minute randomized sessions for user satisfaction assessment.FindingsMenstLLaMAwas compared against state-of-the-art general-purpose LLMs such as GPT-4o, Claude-3, and Mistral during the evaluation period using automated and human-based metrics.MenstLLaMAachieved the highest BLEU score (0.059) and BERTScore (0.911), outperforming competitors without requiring few-shot learning. Clinical experts consistently rated its responses superior to gold-standard answers. User case studies revealed high ratings in Understandability (4.7/5) and Relevance (4.3/5), with a moderate rating in Context Sensitivity (3.9/5).InterpretationMenstLLaMAdemonstrates exceptional accuracy, empathy, and user satisfaction in menstrual health education, bridging critical gaps left by general-purpose LLMs. Its potential for integration into broader health education platforms positions it as a transformative tool for menstrual well-being. Future research may explore its long-term impact on public perception and menstrual hygiene practices.
Polygenic contributions to lithium augmentation outcomes in antidepressant non-responders with unipolar depression
Authors: Kraft Julia , Buspavanich Pichit , Braun Alice , Panagiotaropolou Georgia , Schlattmann Peter , Buchbauer Hannah , Heilbron Karl , Heilbronner Urs , Schulze Thomas G. , Ripke Stephan , Ricken Roland , Adli Mazda 
Published: January 2025

AbstractObjectiveLithium augmentation (LA) is an effective treatment for patients with major depression after inadequate antidepressant response, but therapeutic outcomes vary considerably between individuals. Molecular studies could yield novel insights into treatment prediction to enable personalized therapy choices. Here, we investigated the effects of polygenic risk scores (PRS) for schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BIP) on clinical outcomes following LA.MethodsRecent GWAS summary statistics were used to construct disorder-specific PRS in lithium-augmented MDD patients who participated in a prospective study after poor response to at least one antidepressant drug. Depressive symptoms were assessed for four weeks or longer using the Hamilton Depression Rating Scale (HAMD). Hazard ratios (HR) of favorable outcomes, response (≥ 50% reduction in HAMD composite scores) and remission (HAMD ≤ 7), were estimated by Cox proportional hazards regression models adjusted for ancestry, demographic, and clinical covariates.ResultsIn 193 patients, BIP-PRS was positively associated with both response (HR = 1.29, 95% CI = 1.02-1.63, p = 0.03, Nagelkerke R2= 2.51%) and remission (HR = 1.52, 95% CI = 1.14-2.04, p = 0.004, Nagelkerke R2= 4.53%) after LA. Our data further suggest that individuals who carry a lower polygenic burden for MDD tend to respond better to LA (HR = 0.81, 95% CI = 0.66-1.00, p = 0.048, Nagelkerke R2= 1.99%). No associations were observed between SCZ-PRS and either clinical outcome (p > 0.05).ConclusionsOur findings indicate that individuals at higher polygenic risk for BIP and lower polygenic risk for MDD are more likely to benefit from augmentation with lithium. If replicated, PRS may inform future efforts to establish clinical prediction models for LA outcomes in unipolar depression.