bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is antibiotic prophylaxis generally safe and effective in surgical and non-surgical scenarios? Evidence from an umbrella review of randomized controlled trials
Authors: Liu Linhu , Jian Zhongyu , Wang Menghua , Yuan Chi , Li Ya , Ma Yucheng , Jin Xi , Li Hong , He Yazhou , Liu Changhai , Li Sheyu , Wang Kunjie 
Published: November 2023

Background:
We aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and non-surgical scenarios and assess the strength of evidence.

Materials and Methods:
We performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence.

Results:
75 meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For non-surgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in non-emergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation.

Conclusions:
Antibiotic prophylaxis in surgical and non-surgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.
Identification of patients with favorable prognosis after resection in intermediate-stage hepatocellular carcinoma
Authors: Lee Han Ah , Yoo Jeong-Ju , Chun Ho Soo , Park Yewan , Kim Hwi Young , Kim Tae Hun , Seo Yeon Seok , Lee Minjong , Sinn Dong Hyun 
Published: November 2023

Backgrounds:
It is unclear which patients benefit from resection in intermediate stage-hepatocellular carcinoma (HCC). We aimed to identify high-risk patients for early recurrence among patients with resectable intermediate-stage HCC.

Methods:
This multicenter retrospective study included patients who underwent resection or trans-arterial chemoembolization (TACE) for intermediate-stage HCC (2008–2019). Multivariable Cox proportional analysis was performed to identify high-risk patients when treated with resection. A prediction score for 2-year recurrence-free survival (RFS) was developed using the training cohort and validated. The 2-year RFS in each risk group was compared with that in TACE group, after propensity score matching (PSM).

Results:
A total of 1,686 patients were included (480 and 1,206 patients in the resection and TACE groups). During a median follow-up of 31.4 months, the 2-year RFS was significantly higher in the resection (47.7%) than in the TACE group (19.8%) (adjusted hazard ratio [aHR]=1.471, 95% CI=1.199–1.803, P<0.001). On multivariate analysis, alpha-fetoprotein ≥5.0 ng/mL (aHR=0.202), ALBI grade ≥2 (aHR=0.709), tumor number ≥3 (aHR=0.404), and maximal tumor size ≥5 cm (aHR=0.323) were significantly associated with the lower risks of 2-year RFS in the resection group. The newly developed Surgery Risk score in BCLC-B (SR-B score) with four significant risk factors showed an area under the curve of 0.801 for the 2-year RFS and was validated. Based on SR-B score, low-risk patients had a significantly higher 2-year RFS (training: aHR=5.834; validation: aHR=5.675) than high-risk patients (all P<0.001) did. In a PSM cohort, low-risk resection group had a significantly higher (aHR=3.891); high-risk resection group had a comparable 2-year RFS to those treated with TACE (aHR=0.816).

Conclusions:
Resection may be beneficial for resectable intermediate-stage HCC based on the SR-B score.
Revolutionizing sphincter preservation in ultra-low rectal cancer: exploring the potential of transanal endoscopic intersphincteric resection (taE-ISR) - A propensity score-matched cohort study
Authors: Xu Ximo , Zhong Hao , You Jun , Ren Mingyang , Fingerhut Abe , Zheng Minhua , Li Jianwen , Yang Xiao , Song Haiqin , Zhang Sen , Ding Chengsheng , Abuduaini Naijipu , Yu Mengqin , Liu Jingyi , Zhang Yi , Kang Liang , Cai Zhenghao , Feng Bo 
Published: November 2023

Background:
With the optimization of neoadjuvant treatment regimens, the indications for intersphincteric resection (ISR) have expanded. However, limitations such as unclear surgical field, impaired anal function, and failure of anal preservation still exist. Transanal total mesorectal excision can complement the drawbacks of ISR. Therefore, this study combined these two techniques and proposed transanal endoscopic intersphincteric resection (taE-ISR), aiming to explore the value of this novel technique in anal preservation for low rectal cancer.

Material and methods:
Four high-volume centers were involved. After 1:1 propensity score matching, patients with low rectal cancer underwent taE-ISR (n=90) or ISR (n=90) were included. Baseline characteristics, perioperative outcomes, pathological results, and follow-up were compared between the two groups. A nomogram model was established to assess the potential risks of anal preservation.

Results:
The incidence of adjacent organ injury (0.0% vs. 5.6%, P=0.059), positive distal resection margin (1.1% vs. 8.9%, P=0.034), and incomplete specimen (2.2% vs. 13.3%, P=0.012) were lower in taE-ISR group. Moreover, the anal preservation rate was significantly higher in taE-ISR group (97.8% vs. 82.2%, P=0.001). Patients in the taE-ISR group showed a better disease-free survival (P=0.044) and lower cumulative recurrence (P=0.022) compared to the ISR group. Surgery procedure, tumor distance, adjacent organ injury, and adjuvant therapy were factors influencing anal preservation in patients with ultra-low rectal cancer.

Conclusion:
taE-ISR technique was safe, feasible, and improved surgical quality, anal preservation rate and survival outcomes in ultra-low rectal cancer patients. It held significant clinical value and showed promising application prospects for anal preservation.
Risk of congestive heart failure and mortality following lymphovenous anastomosis: a nationwide population-based retrospective cohort study
Authors: Lee Joon Seok , Kang Hyun Su , Chung Jae-Ho , Ryu Jeong Yeop 
Published: November 2023

Background:
Lymphovenous anastomosis (LVA) enables lymphatic fluid to drain into the venous system. However, no study has investigated the association between LVA and heart failure (HF) caused by fluid overload in blood circulating system. Purpose of our study was to determine whether LVA increases the risk of HF and mortality.

Material and Methods:
This nationwide retrospective study evaluated total of 1,400 lymphedema patients who underwent LVA and two control cohorts with 28,000 lymphedema who did not undergo LVA and 70,000 age- and sex-matched participants from the Korean National Health Insurance database were included. Blood pressure, body mass index (BMI), glucose and cholesterol levels, smoking history, and comorbidities were obtained during National Health Insurance Service – Health Screening (NHIS-HealS). The incidence, adjusted risk for HF, and mortality were evaluated.

Results:
Adjusted HRs for HF were 1.20 (confidence interval [CI], 1.03–1.40) and 1.30 (CI, 1.12–1.50) referenced by the general population control cohort and patients with lymphedema without LVA, respectively. In age-, sex-, body mass index (BMI)-, and smoking status-stratified analyses, heightened risk of heart failure was evident across all sexes, spanning both young and old age groups, encompassing individuals with various smoking statuses, and those with a BMI of 18.5 or higher. Among these groups, the risk was notably greater in males compared to females, higher in younger individuals as opposed to older ones, and further elevated within the BMI range of 18.5 to 25.

Conclusions:
LVA is associated with an increased HF risk, independent of cardiovascular risk factors and of associated comorbidities. This association is prominent in participants aged <50 years, in males, and in the normal-to-obese (BMI ≥18.5 kg/m2) group. Among patients with lymphedema, LVA did not significantly affect mortality.
Single Institution Evaluation of Electromagnetic Navigation Bronchoscopy for Diagnosis of Pulmonary Lesions
Authors: Greco Anthony , Smith Clarissa B. , Shi Xiaosong , Postigo Maykol 
Published: November 2023

Background:
Electromagnetic navigation bronchoscopy (ENB) utilizes three-dimensional reconstructions based on computed tomography to guide the biopsy of pulmonary lesions. Various limitations have been described; however, supporting data have been limited by small sample sizes.

Methods:
Cases of ENB for evaluation of a pulmonary lesion at a single institution during a 1-year span were reviewed for demographics, lesion location, procedural details, and final tissue diagnosis. ENB was performed by 3 pulmonologists using the Veran platform with rapid on-site evaluation. T test or Mann-Whitney U test compared continuous variables and χ2 or Fisher exact test compared categorical variables as appropriate. A patient with a negative or inconclusive biopsy was followed for 1 year postprocedure.

Results:
A total of 107 pulmonary lesions were evaluated. The population studied had a mean age of 67 and a median pulmonary lesion size of 26.0 mm. For malignant lesions, the pathologic diagnostic yield from ENB was 52.1% (37/71). The diagnostic yield of benign lesions was much lower at 16.7% (6/36). The overall procedural complication rate was 8.4% (9/107). Complications were more likely to occur in patients with malignant lesions. The most common complication was pneumothorax, occurring in 5.6% of all biopsies and 7.0% of patients with malignant lesions.

Conclusion:
This study demonstrates significant differences in diagnostic accuracy between lesions found to be malignant versus benign. Our observed complication rate was slightly higher than other groups have reported, with a greater frequency occurring in patients with malignant lesions; however, the rate of pneumothorax was still lower than computed tomography–guided transcutaneous biopsies.
Quantification of Mastoid Air Cells and Opacification of the Middle Ear in Primary Ciliary Dyskinesia
Authors: Nishida Eri , Sakaida Hiroshi , Kitano Masako , Takeuchi Kazuhiko 
Published: November 2023

Objective
To evaluate pneumatization and opacification of the temporal bone on computed tomography (CT) images in patients with primary ciliary dyskinesia (PCD).

Study Design
Retrospective case-control study.

Setting
Tertiary referral center.

Patients
Fifteen patients with PCD (30 ears) and 45 age-matched individuals without PCD (90 ears) as controls.

Intervention
Diagnostic only.

Main Outcome Measure(s)
Quantification of mastoid air cells in the PCD and control groups and comparison between them. Degree of middle ear opacification on CT images of the temporal bone in the PCD group.

Results
The volume of the mastoid air cells was 30% smaller in the PCD group than in the control group (p < 0.05). The suppression ratio, which is defined to indicate how much the average volume of mastoid air cells in the PCD group is suppressed relative to the control group, was 64% lower in the PCD group (p < 0.05). Opacification was noted in 47% of the mastoid air cells and 63% of the tympanic cavity on CT images of the temporal bone in the PCD group, which were significantly higher frequencies than in the control group (1.1% and 1.1%, respectively)

Conclusions
Compared with individuals without PCD, those with PCD showed a significantly smaller volume of mastoid air cells and a significantly higher frequency of opacification of mastoid air cells and tympanic cavity on temporal bone CT. Otitis media raises suspicion for PCD, and the otological manifestations of PCD reported here could help to narrow the differential diagnosis and facilitate early treatment.
Cladribine, cytarabine, and filgrastim based regimen in relapsed or refractory acute myeloid leukemia: A systematic review and meta-analysis
Authors: Cao Susu , Tao Qianshan , Wang Jia , Zhang Qing , Dong Yi 
Published: November 2023

Background:
To ascertain the efficacy and safety of cladribine, cytarabine, and filgrastim-based regimen in relapsed or refractory (R/R) AML patients.

Methods:
Clinical studies were searched in PubMed, Cochrane Library, Embase data. We selected available factors including complete remission (CR), overall response rate (ORR), overall survival (OS) to evaluate the efficacy, and early death (ED), and adverse events to evaluate safety.

Results:
15 records with 812 R/R AML patients were finally included and analyzed using the R software. Subgroups analysis was also conducted. The pooled CR rate for CLAG regimen, CLAG-M regimen, and CLAG combined with any other drugs regimen is 56% (95% CI: 46–66), 46% (95% CI: 34–56), 44% (95% CI: 26–64), respectively. The relapsed and refractory groups showed a CR rate of 68% (95% CI: 53–80), and 51% (95% CI: 45–58) with CLAG related regimens. As risk grade decreases, the pooled CR rate increases. Regarding the safety for CLAG-related protocols, systematic review was conducted.

Conclusion:
The CLAG-related regimen is an effective and safe therapy for R/R AML patients, CLAG seems to have more superiority than CLAG combined therapy, though further studies including cladribine combination treatment protocols, are still needed to confirm our results further.
Exploring the mechanism of Erchen decoction in the treatment of atherosclerosis based on network pharmacology and molecular docking
Authors: Li Wenwen , Zhang Guowei , Zhao Zhenfeng , Zuo Yaoyao , Sun Zhenhai , Chen Shouqiang 
Published: November 2023

Background:Atherosclerosis (AS) is the cause of most cardiovascular diseases and imposes a huge economic burden on society. Erchen decoction (ECD) is an effective formula for treating AS, but its therapeutic mechanism remains unclear. This study will explore the mechanism of ECD mechanism for treating AS using network pharmacology and molecular docking.Methods:We searched ECD chemical composition information and related targets via Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and SwissTargetPrediction databases, and gene names correction was performed using the UniProt database. AS-related targets were retrieved from OMIM, GeneCards, and DrugBank databases, and Venny 2.1 were used for intersection analysis. Protein-protein interaction network was constructed by the STRING database, and an interactive network of the drug-component-target-disease was drawn using the Cytoscape 3.9.0 software. Gene ontology and Kyoto Gene and Genome Encyclopedia enrichment analysis were performed by the DAVID database, and molecular docking validation of vital active ingredients and action targets of ECD was performed using AutoDock Vina software.Results:The 127 active components of ECD act on AS by regulating 231 targets and 151 pathways. The 6 core components are quercetin, polyporenic acid C, 18α-hydroxyglycyrrhetic acid, glyuranolide, 3beta-hydroxychloroxy-24-methylene-8-lanostene-21-oic acid, and obacunone. They may regulate AS by regulating core target genes, such as JUN, SRC, AKT1, PTGS2, ESR1, AR, MAPK1, MAPK3, and RELA, and acting on multiple vital pathways, such as AGE-RAGE signaling pathway in diabetic complications, Lipid and AS, and Fluid shear stress and AS. Molecular docking showed that the selected target protein had good binding activity to the active ingredient.Conclusions:ECD has the characteristics of multi-components, multi-targets and multi-pathways in the treatment of AS. The results provide a theoretical basis for the clinical application of ECD and its mechanism.
Effects of sham acupuncture for chronic musculoskeletal pain syndrome: A systematic review and network meta-analysis of randomized controlled trials
Authors: Yu Chuan , Zhang Rui , Shen Bin , Li Xiang , Fang Yiyi , Jiang Yiyun , Jian Guofan 
Published: November 2023

Background:
Acupuncture has been widely used for chronic musculoskeletal pain syndrome (MPS). Due to the strong influence of sham acupuncture (SA) in clinical trials, the treatment of MPS by acupuncture remains controversial. Different types of SA procedures might produce different responses. The purpose of this systematic review was to assess the effect of SA on MPS.

Methods:
We searched 8 literature databases for randomized controlled trials (RCTs) on acupuncture for chronic MPS with SA as a control from database inception to November 29, 2022. SA included superficial acupuncture on non-acupoints (SANAs), non-penetration on acupoints (NPAs), and non-penetration on non-acupoints (NPNAs). Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. We conducted data analysis using the RevMan 5.3 and STATA 14 software packages, and traditional meta-analysis was adopted for direct comparison. A network meta-analysis (NMA) was executed using frequency models in which we combined all available direct and indirect evidence from RCTs. The pain-related indicators were set as primary outcomes, and GRADEpro online was implemented for the assessment of evidence quality.

Results:
Forty-two RCTs were included in this study, encompassing a total of 6876 patients and incorporating 3 types of SA procedures. In our traditional meta-analysis, true acupuncture (TA) was more effective than SANAs, NPAs, and NPANAs concerning MPS. In the NMA, TA was the most effective modality, followed by SANAs, NPAs and NPANAs, and then the blank control (BC). In this NMA and according to the therapeutic effects in the pain indicators, the rankings of SA were as follows: SANA (surface under the cumulative ranking curve [SUCRA], 65.3%), NPA (SUCRA, 46.2%), and NPANA (SUCRA, 34.2%). The quality of the evidence for outcomes ranged from “low” to “moderate.”

Conclusions:
Compared with SA, TA was effective in treating MPS. The effects produced by different SA procedures were different, and the order of effects from greatest to least was as follows: SANA, NPA, and NPANA.
The impact of protrusion size on pain, range of motion, functional capacity, and multifidus muscle cross-sectional area in lumbar disc herniation
Authors: Kilic Rabia Tugba , Yildirimalp Sedef , Sayaca Cetin 
Published: November 2023

Objective:
To investigate the effect of protrusion amount on pain, lumbar mobility, physical dysfunction, and the cross-sectional area of the multifidus muscle in patients with lumbar disc herniation.

Methods:
54 male patients aged 20 to 50 years were included in this study in 2 groups. The control group (n = 18) consisted of patients with disc herniation without nerve root compression, and the study group (n = 36) consisted of patients with lumbar disc herniation and nerve root compression in 3 subgroups according to the amount of protrusion. The multifidus muscle cross-sectional area and the amount of protrusion were measured using Magnetic Resonance Imaging. Pain intensity was measured using the Visual Pain Scale, physical dysfunction was measured using the Oswestry Disability Index, flexion-extension was measured with TiltMeter, and trunk rotation was measured with smartphone applications called iPhone Compass.

Results:
There were no differences in pain levels (P > .05), mean trunk rotation movements of the affected and unaffected sides (P = .001, P = .001, P = .983, and P = .954, respectively), Oswestry Disability Index results (P = .967), or cross-sectional area sizes of the multifidus muscle (P = .866, P = .552, P = .787, respectively). There was a difference between the groups in terms of the mean trunk flexion and extension movement values (P = .001). The regression analysis indicated that there was no significant correlation between the binary variables, and the models exhibited a low explanatory rate for the dependent variable.

Conclusion:
A relationship has been identified between lumbar disc herniation and low back pain, lumbar movement limitation, and physical functionality. Nevertheless, subsequent to the regression analysis, it became evident that the binary variables did not exhibit a noteworthy relationship, leading to a decrease in the explanatory capacity of the models for the dependent variable. In forthcoming studies, it is advisable to contemplate the augmentation of the subject pool or the incorporation of multiple independent variables into the regression analysis as potential strategies to enhance the model capability in elucidating variations in the dependent variable.
Effectiveness of alpha-lipoic acid in patients with neuropathic pain associated with type I and type II diabetes mellitus: A systematic review and meta-analysis
Authors: Orellana-Donoso Mathias , López-Chaparro Michelle , Barahona-Vásquez Marisol , Santana-Machuca Andrés , Bruna-Mejias Alejandro , Nova-Baeza Pablo , Valenzuela-Fuenzalida Juan José 
Published: November 2023

Background:
This systematic review explores the most current evidence regarding the mechanisms of neuropathic pain in patients with different types of diabetes and how this pain affects different functional and structural components of the neuroanatomical pain pathways. The review also seeks to provide guidelines for the best approach and treatment for patients experiencing this type of pain. The objective is to determine the effectiveness of alpha-lipoic acid (ALA) in improving functional and symptomatic outcomes in patients with diabetes mellitus type I and type II.

Objective:
To determine the effectiveness of alpha-lipoic acid (ALA) in improving functional and symptomatic outcomes in patients with diabetes mellitus type I and type II.

Methods:
We systematically search MEDLINE (via PubMed), EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases.

Results:
The findings of this review show that different forms of ALA do not present statistically significant changes for any of the scales included, including total symptom score (standardized mean difference [SMD] = −3.59, confidence interval [CI] = −4.16 to −3.02, and P < .00001), neuropathy impairment score (SMD = −1.42, CI = −3.68 to 0.84, and P = .22), and neuropathy symptom checklist (SMD = −0.09, CI = −0.15 to −0.02, and P = .01).

Conclusion:
In comparison to the use of a placebo, the findings suggest that ALA does not exhibit significant differences in terms of pain reduction and different functional scales. Moreover, no specific dosages are identified to support the use of ALA for the reduction of neuropathic pain.