bluuebunny/crossref_metadata_2025_split huggingface dataset:
CDK4/6 inhibitors, PI3K/mTOR inhibitors, and HDAC inhibitors as second-line treatments for hormone receptor-positive, HER2-negative advanced breast cancer: a network meta-analysis
Authors: Ji Danyang , Luo Yang , Wang Jiayu , Chen Shanshan , Lan Bo , Ma Fei , Xu Binghe , Fan Ying 
Published: August 2023

Abstract
Background
This study sought to compare the benefits and safety of agents including Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) inhibitors, and histone deacetylase (HDAC) inhibitors as second-line treatments for these patients by conducting a comprehensive systematic review and network meta-analysis.

Methods
The Medline, Embase and Cochrane Library databases were searched for randomized trials comparing CDK4/6 inhibitors, PI3K/mTOR inhibitors, or HDAC inhibitors vs. placebo with the addition of exemestane or fulvestrant as second-line treatments in patients with HR + advanced breast cancer up to December 16, 2021. Outcomes of interest were progression-free survival (PFS), overall response rate (ORR), overall survival (OS), clinical benefit rate (CBR), and grade 3–4 adverse drug events (ADEs). The present study was conducted according to the Cochrane Collaboration and PRISMA statements. The overall effect was pooled using the random effects model.

Results
Seventeen studies with a total of 9,100 participants were included in the current study. Compared with placebo plus fulvestrant, PFS was significantly improved by CDK4/6 inhibitor plus fulvestrant, mTOR inhibitor plus fulvestrant, mTOR inhibitor plus exemestane, and PI3K inhibitor plus fulvestrant, but not HDAC inhibitor plus exemestane. While mTOR inhibitor plus exemestane was the best regimen (SUCRA value 89.5%), the mTOR inhibitor plus exemestane regimen induced more severe adverse events (SAEs) than the HDAC inhibitor plus exemestane regimen [OR, 95% CI: 2.40 (1.40–4.10)].

Conclusion
mTOR inhibitor and CDK4/6 inhibitor-based regimens demonstrated superior clinical efficacy and comparable safety profiles as second-line treatment in patients with HR-positive, HER2-negative advanced breast cancer.
Diagnosis of thoracic outlet syndrome with the lower trunk compression of brachial plexus by high-frequency ultrasonography
Authors: Chen Dingzhang , Gong Wenqing , Wang Jing , Hao Jikun , Zhao Rui , Zheng Minjuan 
Published: August 2023

Abstract
Background
Thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus (BP) is difficult to diagnosis. This study aimed to summarize the features of thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus observed on high-frequency ultrasonography (HFUS).

Methods
The ultrasound data of 27 patients who had TOS with the lower trunk compression of brachial plexus were collected and eventually confirmed by surgery. The imaging data were compared, and the pathogenesis of TOS was analyzed on the basis of surgical data.

Results
TOS occurred predominantly in females (70.4%). Most cases had unilateral involvement (92.6%), mainly on the right side (66.7%). The HFUS features of TOS can be summarized as follows: (1) Lower trunk compression. HFUS revealed focal thinning that reflected compression at the level of the lower trunk; furthermore, the distal part of the nerve was thickened for edema (Affected side: 0.49 ± 0.12 cm vs. Healthy side: 0.38 ± 0.06, P = 0.009), and the cross-sectional area of brachial plexus cords was markedly greater on the injured side than on the healthy side (0.95 ± 0.08 cm² vs. 0.65 ± 0.11 cm², P = 0.004). (2) Hyperechoic fibromuscular bands behind the compressed nerve (mostly the scalenus minimus muscle). (3) Abnormal bony structures: cervical ribs or elongated transverse processes of the 7th cervical vertebra (C7). Surgical results showed that the etiological factors contributing to TOS were (1) muscle hypertrophy and/or fibrosis (100%) and (2) cervical ribs/elongated C7 transverse processes (20.7%).

Conclusion
TOS with the lower trunk compression of brachial plexus can be diagnosed accurately and reliably by high-frequency ultrasound.
Pseudoarthrosis after anterior cervical discectomy and fusion: rate of occult infections and outcome of anterior revision surgery
Authors: Calek Anna-Katharina , Winkler Elin , Farshad Mazda , Spirig José Miguel 
Published: August 2023

Abstract
Background
Pseudoarthrosis after anterior cervical discectomy and fusion (ACDF) is relatively common and can result in revision surgery. The aim of the study was to analyze the outcome of patients who underwent anterior revision surgery for pseudoarthrosis after ACDF.

Methods
From 99 patients with cervical revision surgery, ten patients (median age: 48, range 37–74; female: 5, male: 5) who underwent anterior revision surgery for pseudoarthrosis after ACDF with a minimal follow up of one year were included in the study. Microbiological investigations were performed in all patients. Computed tomography (CT) scans were used to evaluate the radiological success of revision surgery one year postoperatively. Clinical outcome was quantified with the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the North American Spine Society Patient Satisfaction Scale (NASS) 12 months (12–60) after index ACDF surgery. The achievement of the minimum clinically important difference (MCID) one year postoperatively was documented.

Results
Occult infection was present in 40% of patients. Fusion was achieved in 80%. The median NDI was the same one year postoperatively as preoperatively (median 23.5 (range 5–41) versus 23.5 (7–40)), respectively. The MCID for the NDI was achieved 30%. VAS-neck pain was reduced by a median of 1.5 points one year postoperatively from 8 (3–8) to 6.5 (1–8); the MCID for VAS-neck pain was achieved in only 10%. Median VAS-arm pain increased slightly to 3.5 (0–8) one year postoperatively compared with the preoperative value of 1 (0–6); the MCID for VAS-arm pain was achieved in 14%. The NASS patient satisfaction scale could identify 20% of responders, all other patients failed to reach the expected benefit from anterior ACDF revision surgery. 60% of patients would undergo the revision surgery again in retrospect.

Conclusion
Occult infections occur in 40% of patients who undergo anterior revision surgery for ACDF pseudoarthrosis. Albeit in a small cohort of patients, this study shows that anterior revision surgery may not result in relevant clinical improvements for patients, despite achieving fusion in 80% of cases.

Level of evidence
Retrospective study, level III.
Modified hindfoot alignment radiological evaluation and application in the assessment of flatfoot
Authors: Liang Jing-Qi , Zhang Yan , Liu Liang , Wen Xiao-Dong , Liu Pei-Long , Yang Xin-Quan , Liang Xiao-Jun , Zhao Hong-Mou 
Published: August 2023

AbstractBackgroundAlignment is indispensable for the foot and ankle function, especially in the hindfoot alignment. In the preoperative planning of patients with varus or valgus deformity, the precise measurement of the hindfoot alignment is important. A new method of photographing and measuring hindfoot alignment based on X-ray was proposed in this study, and it was applied in the assessment of flatfoot.MethodsThis study included 28 patients (40 feet) with flatfeet and 20 volunteers (40 feet) from January to December 2018. The hindfoot alignment shooting stand independently designed by our department was used to take hindfoot alignment X-rays at 10 degree, 15 degree, 20 degree, 25 degree, and 30 degree. We measured the modified tibio-hindfoot angle (THA) at the standard hindfoot aligment position (shooting at 20 degree) and evaluated consistency with the van Dijk method and the modified van Dijk method. In addition, we observed the visibility of the tibiotalar joint space from all imaging data at five projection angles and evaluated the consistency of the modified THA method at different projection angles. The angle of hindfoot valgus of flatfoot patients was measured using the modified THA method.ResultsThe mean THA in the standard hindfoot aligment view in normal people was significantly different among the three evaluation methods (P < .001). The results from the modified THA method were significantly larger than those from the Van Dijk method (P < .001) and modified Van Dijk method (P < .001). There was no significant difference between the results of the modified THA method and the weightbearing CT (P = .605), and the intra- and intergroup consistency were the highest in the modified THA group. The tibiotalar space in the normal group was visible in all cases at 10 degree, 15 degree, and 20 degree; visible in some cases at 25 degree; and not visible in all cases at 30 degree. In the flatfoot group, the tibiotalar space was visible in all cases at 10 degree, visible in some cases at 15 degree and 20 degree, and not visible in all cases at 25 degree and 30 degree. In the normal group, the modified THA was 4.84 ± 1.81 degree at 10 degree, 4.96 ± 1.77 degree at 15 degree, and 4.94 ± 2.04 degree at 20 degree. No significant differences were found among the three groups (P = .616). In the flatfoot group, the modified THA of 18 feet, which was visible at 10 degree, 15 degree and 20 degree, was 13.58 ± 3.57 degree at 10 degree, 13.62 ± 3.83 degree at 15 degree and 13.38 ± 4.06 degree at 20 degree. There were no significant differences among the three groups (P = .425).ConclusionsThe modified THA evaluation method is simple to use and has high inter- and intragroup consistency. It can be used to evaluate hindfoot alignment. For patients with flatfeet, the 10 degree position view and modified THA measurement can be used to evaluate hindfoot valgus.
Risk factors for postoperative acute ischemic stroke in advanced-aged patients with previous stroke undergoing noncardiac surgery: a retrospective cohort study
Authors: Xiao Wei , Yang Shuyi , Feng Shuai , Wang Chunxiu , Huang Hao , Wang Chaodong , Zhong Chonglin , Zhan Shubin , Yao Dongxu , Wang Tianlong 
Published: August 2023

Abstract
Background
The current study aimed to investigate the incidence and risk factors for postoperative acute ischemic stroke (PAIS) in advanced-aged patients (≥ 75 years) with previous ischemic stroke undergoing noncardiac surgery.

Methods
In this single-center retrospective cohort study, all advanced-aged patients underwent noncardiac surgery from 1 January, 2019, to 30 April, 2022. Data were extracted from hospital electronic medical records. Multivariable logistic regression analysis was performed to determine predictors of PAIS. Multivariable linear or logistic regression analysis was performed to determine predictors of outcomes due to PAIS.

Results
Twenty-four patients (6.0%) of the 400 patients developed PAIS. Carotid endarterectomy (CEA), length of surgery and preoperative Modified Rankin scale (mRS) ≥ 3 were significant predictors of PAIS. CEA was associated with increased risk of PAIS (OR 4.14; 95%CI, 1.43–11.99). Each additional minute in length of surgery had slightly increased the risk of PAIS (OR, 1.01; 95%CI, 1.00-1.01). Compared with reference (mRS < 3), mRS ≥ 3 increased odds of PAIS (OR, 4.09;95%CI, 1.12–14.93). Surgery type and length of surgery were found to be significant predictors of in-hospital expense (P < 0.001) and hospital stays (P < 0.05).

Conclusions
CEA, length of surgery and preoperative mRS ≥ 3 may increase the development of PAIS in advanced-aged patients (≥ 75 years) with previous stroke undergoing noncardiac surgery. PAIS increased in-hospital mortality and prolonged hospital stay.
PIWIL2 restrains the progression of thyroid cancer via interaction with miR-146a-3p
Authors: Lu Xiaoxiao , Zhu Qingyun , Du Hong , Gu Mingjun , Li Xiangqi 
Published: August 2023

Abstract
Objective
The classical role of PIWIL2 is to regulate reproduction by binding to piRNA, but its tumor-related function has received increasing attention in recent years. This study aims to explore its role in the progression of thyroid cancer (TC).

Methods
First, we measured and analyzed the levels of PIWIL2 and miR-146a-3p in TC tissue and adjacent tissues as well as several TC cell lines. We demonstrated the clinical significance of PIWIL2 and miR-146a-3p through the survival rate. Based on these results, we selected TPC-1 and KTC-3 cell lines for our cell experiments. We treated these cell lines with PIWIL2 lentivirus, PIWIL2 siRNA, miR-146a-3p mimic, or miR-146a-3p inhibitor and measured cell proliferation, cell cycle, apoptosis, migration, and invasion. We used PCR and Western blot to quantify the mRNA and protein levels of PIWIL2, while we used luciferase reporter assay and RNA binding protein immunoprecipitation to explore the relationship between miR-146a-3p and PIWIL2. Finally, we developed a xenograft tumor model to confirm the effects of the miR-146a-3p/PIWIL2 axis on TC progression in vivo.

Results
We identified that PIWIL2 and miR-146a-3p exhibit opposite expression alterations in TC tissues and that PIWIL2 serves as a ‘sponge’ by adsorbing miR-146a-3p. Up-regulating PIWIL2 decelerated the proliferation, metastasis, and cell cycle progression of TPC-1 and KTC-3 cells, but accelerated the apoptosis of TC cells, while miR-146a-3p exhibited opposite effects. Finally, overexpressing PIWIL2 restrained the progression of TC in nude mice, which can be reversed by increasing miR-146a-3p expression. Inhibiting PIWIL2, on the other hand, promoted the progression of TC in vivo, which can be reversed by inhibiting miR-146a-3p.

Conclusion
PIWIL2 may inhibit the progression of TC by sponging miR-146a-3p, providing new insights into the early treatment, recrudescence treatment, and metastasis treatment of TC.
Fertility-enhancing hysteroscopic surgery; multi-center retrospective cohort study of reproductive outcome
Authors: Al-Husban Naser , Odeh Omar , AlRamahi Muataz , Qadri Sara , Al-Husban Hedaieh 
Published: August 2023

Abstract
Introduction
Hysteroscopic surgery and assisted reproduction technology are feasible ways to improve the reproductive outcome. Our aim was to study hysteroscopic septoplasty and myomectomy’s effect on infertility and reproductive performance.

Methods
Retrospective cohort of patients who had unexplained infertility and/or recurrent miscarriages and had myomectomy or septoplasty in the period September 2016-october 2021 with a total of 18 months’ follow up. The main outcome measures were spontaneous pregnancy, term pregnancy and miscarriage. For analysis, we used Statistical Package for Social Sciences (SPSS) version 20.

Results
One hundred and sixty-five patients were included. The mean age of patients was 39 years. 40 patients had septum resection and 125 patients had hysteroscopic myomectomy. A spontaneous pregnancy rate after surgery was achieved in 46 patients (27.9%). Out of the 64 patients who had failed IVF preoperatively, 32 patients (50%) had a successful IVF post-hysteroscopic surgery and there were more successful cases in the patients who had fibroid resection but this difference did not reach a statistical significance (P value 0.055). In the 79 pregnancies after surgery, preterm birth and miscarriage were seen in 10 patients (12.7%), similarly, respectively after septal or fibroid resection. Miscarriages were less post-operatively. Hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy rate (63.0% Vs 37.0%, P value 0.018), more term pregnancies (87.5% vs. 12.5%, P value 0.001) and less miscarriage rate (40%vs 60%, P value 0.003). Pregnancy post-operatively in patients with primary infertility was more statistically significantly associated with hysteroscopic myomectomy than with hysteroscopic septoplasty (95.8% vs. 4.2%, p value 0.030). In patients who got pregnant postoperatively there was no statistically significant difference in the mode of delivery.

Conclusion
In carefully selected patients with unexplained infertility and recurrent miscarriage, hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy, more term pregnancies and less miscarriage rates. More than metroplasty, hysteroscopic myomectomy led to higher spontaneous pregnancies in patients with primary infertility.

Trial registration
NCT05560295.
Assessment of lipoedema awareness among polish women- online survey study
Authors: Hansdorfer-Korzon Rita , Czerwińska Monika , Teodorczyk Jacek , Szamotulska Jolanta 
Published: August 2023

Abstract
Background
Lipoedema is an adipose tissue disorder that is still not fully understood. The primary purpose of this study is to explore the state of knowledge and understanding of lipoedema among Polish women. The secondary aim is to investigate the possible association between knowledge and factors such as BMI, self-reported symptoms, and age.

Methods
One hundred seventy polish women took part in an online survey study that was posted to social media groups and forums in January 2022. The survey consisted of 12 questions and aimed at assessing the basic knowledge about lipoedema.

Results
The least proportion of participants (4%) could correctly indicate the methods of lipoedema treatment. The accurate definition of lipoedema was indicated only by 7% of women, 12% identified characteristic features of lipoedema, and 37% correctly evaluated lipoedema curability. The greatest proportion of respondents knew the differences between obesity and lipoedema (50%).

Conclusions
Awareness of lipoedema among women is deficient. A significant proportion of the respondents report the occurrence of lipoedema symptoms. In order to improve the situation of lipoedema patients, it is crucial to increase the knowledge about this condition both among medical professionals and the general public.
Development and pilot study of “Smart Cancer Care”: a platform for managing side effects of chemotherapy
Authors: Sin Cheolkyung , Kim Hyeyeong , Im Hyeon-Su , Ock Minsu , Koh Su-Jin 
Published: August 2023

Abstract
Background
As outpatient chemotherapy treatment increases, cancer patients receiving chemotherapy spend more time at home. In addition, since the types of chemotherapy are gradually expanding, it will be essential to prepare patient self-management strategies for various chemotherapy-related side effects. This study aimed to develop a platform (called Smart Cancer Care) to implement a chemotherapy side effect management program and to evaluate its feasibility.

Methods
Smart Cancer Care comprises an application for patients and a dashboard for medical staff. Thirty-two symptoms to be managed using Smart Cancer Care were summarized through a literature review and Delphi. Management guidelines were developed based on the severity of each symptom (3 stages), and installed in Smart Cancer Care according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 guidelines. To evaluate the feasibility of the developed application and medical dashboard, cancer patients and cancer treatment medical staff used Smart Cancer Care for 2 to 3 weeks and subsequently reported the experience of using them.

Results
The patient application provided a list of symptoms according to the cancer type and anticancer drug enabling presence and severity of each symptom to be evaluated. Patients received management guidelines for symptoms based on the symptom evaluation results. On the medical staff dashboard, administrators and authorized medical personnel could access and assess information regarding side effects and symptom severity submitted by the patient. The feasibility and usefulness of Smart Cancer Care were confirmed through a pilot test targeting 30 patients and 24 chemotherapy-related medical staff. For patients, the evaluation score for the “The program will be helpful when seeing medical staff” item was the highest. For medical staff, the score for the “By checking the patient’s symptoms using the program, it helps to take appropriate measures for the patient” item was the highest. Although minor corrections were raised, most patients and medical staff expected that Smart Cancer Care would help their treatment.

Conclusions
The configuration of the application and dashboard of Smart Cancer Care detailed in this study could be used for the development of a widely accepted platform to implement a chemotherapy side effect management program.
Association of housing adaptation services with the prevention of care needs level deterioration for older adults with frailty in Japan: a retrospective cohort study
Authors: Tsuchiya-Ito Rumiko , Hamada Shota , Iwagami Masao , Ninomiya Ayako , Ishibashi Tomoaki 
Published: August 2023

Abstract
Background
Housing adaptations are aimed at minimizing the mismatch between older adults’ functional limitations and their building environments. We examined the association of housing adaptations with the prevention of care needs level deterioration among older adults with frailty in Japan.

Methods
The subjects comprised individuals who were first certified as having care support levels (defined as frail, the lowest two of seven care needs levels) under the public long-term care insurance systems between April 2015 and September 2016 from a municipality close to Tokyo. The implementation of housing adaptations was evaluated in the first six months of care support certification. Survival analysis with Cox proportional hazards model was performed to examine the association between housing adaptations and at least one care needs level deterioration, adjusting for age, sex, household income level, certified care support levels, cognitive function, instrumental activities of daily living, and the utilization of preventive care services (designed not to progress disabilities). We further examined the differences in the association of the housing adaptation amount by categorizing the subjects into the maximum cost group (USD 1,345–1,513) or not the maximum cost group (< USD 1,345). All the subjects were followed until the earliest of deterioration in care needs level, deaths, moving out of the municipality, or March 2018.

Results
Among 796 older adults, 283 (35.6%) implemented housing adaptations. The incidence of care needs level deterioration was 19.3/1000 person-month of older adults who implemented housing adaptations, whereas 31.9/1000 person-month of those who did not. The adjusted hazard ratio (aHR) of care needs level deterioration was 0.69 (95% confidence interval (CI): 0.51–0.93). The aHRs were 0.51 (95% CI: 0.31–0.82) and 0.78 (95% CI: 0.57–1.07) in the maximum and not maximum cost groups, respectively.

Conclusions
Housing adaptations may prevent care needs level deterioration of older adults with frailty. Policymakers and health professionals should deliver housing adaptations for older adults at risk of increasing care needs.