bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) of Main Tumor in Breast Cancer in Prediction of Occult Axillary Lymph Node Metastasis
Authors: Kora Amir Tarek Borham , Othman Amal Ibrahim Ahmed , Mohamed Aya Yassin Ahmed 
Published: August 2023

Background
In breast cancer, the axillary lymph node (ALN) status has been well established to be a significant prognostic factor and essential for treatment decisions that consider systemic and locoregional approaches. Axillary lymph node dissection (ALND) was performed to examine pathologic information regarding axillary lymph node during breast surgery (e.g. breast conserving surgery or mastectomy), which may cause critical complications such as lymphedema, pain, and movement restriction.

Aim of the Work
To assess the clinical significance of total lesion glycolysis (TLG) and metabolic tumor volume (MTV) of primary breast cancer using 18F-FDG PET/CT. To predict positive axillary lymph node metastasis in clinically negative axillary lymph nodes in breast cancer patients.

Methods
Between November 2020 and May 2021, The study was carried out on 40 female breast cancer patients with clinically negative axillary lymph nodes who had undergone surgical resection of the primary breast tumor followed by sentinel lymph node biopsy only or axillary lymph node dissection along with sentinel lymph node biopsy.

Results
We found that, 10 (25.0%) of total 40 patients were proven to have ALN metastasis based on the final pathology. A primary breast tumor with TLG &gt; 6.2 &MTV &gt; 4 was associated with a significantly higher prevalence of ALN metastasis than tumors with TLG ≤ 6.2& MTV ≤ 4.

Conclusion
We suggest that the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary breast tumor were independent predictive factors for ALN metastasis. Since the incidence of pathologic ALN metastasis in breast cancer with cN-ALN is not negligible, volume-based PET/CT parameters of primary breast tumors upon preoperative workup may be potentially helpful to enhance the negative predictive value for occult ALN metastasis and to determine patient selection for surgical procedures.
Role of Artificial Intelligence in CXR Interpretation in Pediatric Intensive Care Unit Ain Shams University
Authors: Mahmoud Maha , Arafa Ahmed , Mohammad Shaimaa Abdelsattar , Yacoub George Ezzat Elkess 
Published: August 2023

Background
Artificial intelligence (AI) is a branch of computer science in which statistical techniques are used to classify, simulate, or optimize data based on previous observations. An AI system can interpret and prioritize abnormal chest X-rays with critical findings, potentially reducing the backlog of exams and bringing urgently needed care to patients more quickly.

Aim of the Work
Our study aims to test the diagnostic performance of the AI system in PICU CXR interpretation regarding its sensitivity, specificity, as well as its accuracy. we also investigate the effect of AI aid on residents performance regarding diagnostic accuracy, sensitivity time consumption.

Patients and Methods
This was a Cross sectional study which conducted at Pediatric Ain Shams University Hospitals from January to June 2021. The study was performed on convenient sample consists of 30 CXRs done at the Ain Shams Pediatric hospital intensive care unit and meeting the study inclusion criteria.

Results
Overall in this study we found that the resident diagnostic accuracy, sensitivity and time consumption improved across a large number of clinical CXRs findings as well as strengthening of the residents agreement with the expert radiologist when assisted by the deep-learning model. Effective implementation of the model has the potential to improve clinical practice. Research is underway to assess the generalizability of results to various clinical environments and health systems.

Conclusion
We raised the possibility of the potential use of AI systems in future radiology workflows for preliminary interpretations that target the most prevalent findings, leaving the final reads to be done by a more experienced radiologist in a suitable practice atmosphere to catch any potential misses from the less-prevalent fine-grained findings.
Vesical Imaging-Reporting and Data System (VI-RADS): Inter-Observer Agreement and Impact of Reader's Experience
Authors: Taha Shohenda Magdy , Taha Noha Mohamed , Hussein Rasha S 
Published: August 2023

Background
The Vesical Imaging Reporting and Data System (VI-RADS) is based on multiparametric MRI (mpMRI), to provide accurate information to differentiate between muscleinvasive bladder cancer (MIBC) and non-muscle –invasive bladder cancer (NMIBC).

Aim of the Work
To evaluate inter-observer agreement according to observer experience and diagnostic performance of the new scoring system based on magnetic resonance imaging called Vesical Imaging-Reporting and Data System (VI-RADS) to differentiate between invasive and non-invasive bladder cancer.

Patients and Methods
This study included 38 patients who were diagnosed with Transitional Cell Carcinoma (TCC) who underwent multiparametric Magnetic Resonance Imaging (mpMRI) at the department of Radiodiagnosis in Ain-Shams University from April 2021 till October 2021. Three radiologists with different levels of experience reviewed and scored all MRI examinations according to VI-RADS, compared them with the histopathological findings and inter-observer agreement was assessed.

Results
This study included 38 patients; the patients’ age ranged from 47 to 83 years old with mean age 62.26 (+8.18 SD). The total number of lesions in all cases were 43; 12 of them (27.9 %) were non-muscle-invasive urothelial carcinoma and 31 (72.1%) were muscle invasive. Using a VI-RADS score of 4 or greater as the cutoff value, the sensitivity, specificity, accuracy, PPV, and NPV for reader 1 were 96.8%, 83.3 %, 93%, 93.8%, and 90.9%, and for reader 2 were 93.5 %, 91.7%, 93%, 96.7% and 84.6%, and finally for reader 3 were 96.8%, 83.3%, 93 %, 93.8% and 90.9%. The agreement was excellent between each reader with the pathology and the readers with each other (Kappa over 0.75).

Conclusion
The Vesical Imaging-Reporting and Data System (VI-RADS) is an effective comprehensive scoring system, with satisfactory sensitivity, specificity, and diagnostic value for detecting detrusor muscle invasion. We can recommend VI-RADS scoring for use in the prediction of detrusor muscle invasion in patients with bladder cancer, but further multicenter validation studies containing multiple magnetic field strength devices also must be conducted.
Hepatocellular Carcinoma in Hepatitis C Virus Patients after Treatment by Directly Acting Antiviral Drugs Compared to Hepatitis C Virus Non Treated Patients
Authors: Mahmoud Ahmed Abd Elhamid , Aly Heba Ismail Saad , Montasser Iman Mohamed Fawzy , EL Gindy Eman Mohamed 
Published: August 2023

Background
Hepatocellular carcinoma (HCC) is one of the most prevalent cancers globally. It is considered as leading cause of cancer related death that occurs mostly in patients with underlying significant liver fibrosis and cirrhosis.

Objective
to compare characteristics and behavior of de novo Hepatocellular carcinoma (HCC) in chronic HCV patients who received direct acting antiviral treatment with those who didn't receive DAAs.

Patients and Methods
The study was conducted on patients with de novo HCC presented at HCC Clinic and Tropical medicine department at Ain Shams University Hospitals from January 2019 to January 2020. Total number of HCC cases visited the HCC clinic was 382 patients. 196 patients with de novo HCC were enrolled in the study according to inclusion criteria and divided into two groups: Group (A): included 79 patients with de novo HCC that received DAAs according to NCCVH. 64 males (81%), 15 females (19%) with mean age of 60 years. Group (B): included 117 patients with de novo HCC that didn’t receive DAAs treatment before; 82 males (70.1%) 35 females (29.9%) with a mean age of 61.9 years.

Results
In the current study we found there was no difference in tumor aggressiveness between patients with de novo HCC following DAA and patients with HCC that didn’t receive DAA regarding different scoring system except for Child pugh score was significantly higher in group (A), and for BCLC staging was significantly more advanced in group(A). The Current study revealed 69 patients (87.3%) of Group (A) achieved SVR with DAAs. with no significant statistical value between different regimens of DAAs regarding relapsing rate or behavior of HCC.

Conclusion
Despite the great advance in HCV treatment in the era of DAA drugs, HCC remains to be a great risk for cirrhotic patients. Moreover, patients with a history of HCC have to be closely monitored before and after treatment with DAA. There were no difference between studied group regarding tumor size, tumor number, tumor site, tumor extension, tumor metastasis, vascular invasion or AFP. but lymph node invasion was more significant in group (A). There were no difference between studied group regarding Child grade, FIB-4 score or PST. Patients of group (A) showed more advanced liver disease regarding BCLC stage than those of group (B).
Pneumococcal Vaccination in Adults
Authors: Walter Joseph , Rudawsky Nicole 
Published: August 2023

ABSTRACT:
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently updated the adult pneumococcal vaccine recommendations to include two new pneumococcal conjugate vaccines (PCVs): PCV15 and PCV20. The authors review the updated guideline recommendations, their advantages and disadvantages, and nursing implications.
HOCUS POCUS: ultrasound beyond regional anesthesia in the ambulatory setting
Authors: Arumugam Sivasenthil , Siddaiah Harish , Kalagara Hari 
Published: August 2023

Purpose of review
Application of ultrasound in clinical anesthesia practice extends beyond regional anesthesia. In this review, we have discussed other point of care applications of ultrasound in perioperative care and anesthetic management with special emphasis on ambulatory practice.

Recent findings
Point of care ultrasound (POCUS) for anesthesiologists has gained widespread interest and popularity. Recent literature has highlighted multiple perioperative POCUS applications on various organ systems and its benefits. We have analyzed the recent available data and evidence for perioperative POCUS, its benefits and limitations in perioperative medicine.

Summary
Perioperative POCUS skill is a natural extension of ultrasound guided regional anesthesia. Utilizing POCUS in the perioperative period would accelerate the level of appropriate care, safety and improve outcomes in ambulatory centers. More anesthesiologists embracing POCUS would enhance patient care in a timely fashion at the ambulatory centers. POCUS in ambulatory practice can be valuable in avoiding delay or cancellation of surgeries and improving patient satisfaction.
Effect of neuromuscular block on surgical conditions during laparoscopic surgery in neonates and small infants
Authors: Wu Lei , Wei Siwei , Xiang Zhen , Yu Eryou , Chen Zheng , Qu Shuangquan , Du Zhen 
Published: August 2023

BACKGROUND
Neuromuscular block (NMB) is routinely used in paediatric and adult anaesthesia to facilitate endotracheal intubation and optimise surgical conditions. However, there are limited data regarding NMB and optimising the conditions for laparoscopic surgery in neonates and small infants.

OBJECTIVE
The goal of this study was to determine the effect of NMB on the conditions for laparoscopic surgery in neonates and small infants.

DESIGN
A randomised controlled trial.

SETTING
Single-centre Children's Hospital, conducted from November 2021 to December 2022.

PATIENTS
One hundred and two ASA I–II neonates and small infants aged up to 60 weeks postmenstrual age who were scheduled to undergo an elective laparoscopic Ladd's procedure were included in the study.

INTERVENTIONS
Patients were randomised into three groups: no NMB group, shallow NMB group and moderate NMB group. Each group was given different doses of rocuronium to achieve the target depth of NMB.

MAIN OUTCOME MEASURES
The primary outcome was the quality of the surgical conditions evaluated with the Leiden-Surgical Rating Scale (L-SRS) by a blinded surgeon. Secondary outcomes included tracheal intubating conditions and adverse events.

RESULTS
The percentage of L-SRS scores of 4 or 5 was similar among the three groups at all the assessment times (P > 0.05 for each time interval). The distribution of L-SRS scores was also similar among the three groups. There were no significant differences in operating condition scores between the groups at any time interval (P > 0.05 for each time interval). The incidence of adverse events during anaesthesia induction was significantly higher in the no NMB group (51.4%) than in the other two groups (13.6% and 14.7%) (adjusted P = 0.012 and adjusted P = 0.003). In particular, clinically unacceptable intubation conditions occurred in 12 patients (34.3%) in the no NMB group, significantly more than in the shallow NMB group (6.1%, adjusted P = 0.012) and moderate NMB group (2.9%, adjusted P = 0.003). There was no statistically significant difference in the incidence of adverse events in the PACU among the three groups (P = 0.103).

CONCLUSIONS
The depth of NMB was not associated with superior surgical conditions during laparoscopic surgery, but it was associated with a reduction in adverse events during induction and maintenance of anaesthesia in neonates and small infants.

TRIAL REGISTRATION
Registered at www.chictr.org.cn (ChiCTR2100052296).
The evolving role of emergency medicine in family planning services
Authors: Preiksaitis Carl , Henkel Andrea 
Published: August 2023

Purpose of review
The emergency department serves as an essential access point for a variety of healthcare services. This review will examine the recent expansion of family planning and reproductive health services in the emergency department.

Recent findings
An increasing number of patients present to emergency departments for early pregnancy loss (EPL), abortion care, and contraceptive management. Availability of comprehensive EPL management varies dramatically, possibly due to lack of provider knowledge or training. Particularly in remote settings, educational interventions – such as providing information about medication management and training in uterine aspiration – may standardize this management. Restrictive abortion laws raise concerns for changing and increased patient presentations to the emergency department for complications related to unsafe or self-managed abortion. Emergency medicine providers should anticipate that more patients will present without a prior ultrasound confirming intrauterine pregnancy prior to initiating no-touch or self-managed abortions. Particularly among pediatric patients, there may be a role for contraceptive counseling during an emergency department visit. Novel strategies, including web-based interventions and emergency department-based curricula for contraceptive counseling, may help reach those who otherwise may not seek reproductive healthcare in a clinic setting.

Summary
The intersection of emergency medicine and reproductive healthcare is a promising frontier for providing immediate, patient-centered, family planning care. Continued research and provider education are necessary to refine these approaches, address disparities, and respond to the changing reproductive healthcare landscape.
Transfusion thresholds in acute coronary syndromes
Authors: Mistry Nikhil , Jiang Helen , Chin Kyle , Hare Gregory M.T. , Verma Subodh , Mazer C. David 
Published: August 2023

Purpose of review
Anemia is prevalent in patients with acute coronary syndromes. In this setting, there is uncertainty and controversy surrounding the optimal transfusion strategy for managing anemia. The goal of this review is to summarize the current clinical evidence, guidelines, and future directions for managing transfusion in acute coronary syndromes.

Recent findings
There is limited evidence from randomized trials evaluating restrictive versus liberal transfusion in patients hospitalized with and/or for acute coronary syndromes. The results from these studies suggest clinical equipoise between transfusion strategies for short term outcomes, and a trend toward favoring a liberal strategy for long term major adverse cardiac events. There is inconsistency across clinical practice guidelines with respect to the optimal strategy for managing anemia and transfusion in acute coronary syndromes due to insufficient evidence.

Summary
More evidence is urgently needed to conclusively establish the optimal strategy for transfusion management in the setting of acute coronary syndromes. These data will directly inform harmonization of clinical practice guidelines. Future investigations should explore alternative strategies to hemoglobin for quantifying the degree of anemic stress for personalizing transfusion therapy, the effects on functional outcomes, and managing anemia following hospital discharge.
Minimization of facial synkinesis
Authors: Tikhtman Raisa , Hsieh Tsung-yen 
Published: August 2023

Purpose of review
To summarize the treatment options available for the management of postparalytic facial synkinesis which include facial rehabilitation, chemodenervation, and a spectrum of surgical interventions.

Recent findings
Facial rehabilitation and botulinum toxin chemodenervation represent the foundation of facial synkinesis management, with specific treatment paradigms directed by individual patient needs. Evolving surgical approaches range from isolated selective myectomies or neurectomies to combination approaches which may incorporate various types of nerve transfer with gracilis free muscle transplantation.

Summary
Postparalytic facial synkinesis bears significant patient morbidity due to aesthetic and functional implications. Management strategies must balance patient goals with treatment risks and typically progress stepwise from the least to most invasive interventions. Emerging techniques reveal a convergence in approaches to facial reanimation and synkinesis mitigation.
A Clinician’s Guide to Gluten Challenge
Authors: Singh Arunjot , Kleinhenz Julia , Brill Herbert , Fahey Lisa , Silvester Jocelyn A. , Sparks Brandon , Verma Ritu , Lee Dale , Mallon Daniel , Leonard Maureen M. 
Published: August 2023

Gluten challenge is an essential clinical tool that involves reintroducing or increasing the amount of gluten in the diet to facilitate diagnostic testing in celiac disease (CD). Nevertheless, there is no consensus regarding the applications of gluten timing, dosing, and duration in children. This review aims to summarize the current evidence, discuss practical considerations, and proposes a clinical algorithm to help guide testing in pediatric patients.
Childhood development, social circumstances, and long-term health concerns must be considered when identifying a candidate for gluten challenge. Based on previous studies, the authors suggest baseline serology followed by a minimum of 3–6 grams of gluten per day for over 12 weeks to optimize diagnostic accuracy for evaluation of CD. A formal provider check-in at 4–6 weeks is essential so the provider and family can adjust dosing or duration as needed. Increasing the dose of gluten further may improve diagnostic yield if tolerated, although in select cases a lower dose and shorter course (6–12 weeks) may be sufficient.
There is consensus that mild elevations in celiac serology (<10 times the upper limit of normal) or symptoms, while supportive are not diagnostic for CD. Current North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend histologic findings of intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy as the accurate and most appropriate endpoint for gluten challenge.
A feasibility study of application of purpose-design frame and 3-D clinical ultrasound in assessment and design of spinal orthoses for adolescent idiopathic scoliosis
Authors: Hassan Beygi Babak , Lou Edmond , Sin Sai Wing , Kwok Wing Kwan , Kee Ho Man , Wong Man Sang 
Published: August 2023

Background:
The immediate in-orthosis correction of adolescent idiopathic scoliosis (AIS) is a useful prognostic parameter for the long-term orthotic treatment outcome. The 3-D clinical ultrasound technique is considered a noninvasive alternative to assess scoliotic deformities that could be applied in the orthotic treatment of AIS.

Objective:
This study aimed to investigate the feasibility of a purpose-design assessment frame in estimating biomechanical effects of the controlling pads of a spinal orthosis under the guidance of the ultrasound system.

Methods:
Twenty-six subjects with AIS were recruited and arranged to position inside the assessment frame, and controlling pads were applied strategically while the scoliotic deformities were assessed by clinical ultrasound to obtain at least 30% curvature correction, and the body shape was then captured using a computer-aided design and computer-aided manufacture system, and spinal orthoses were subsequently fabricated. The preorthosis and immediate in-orthosis coronal and sagittal X-rays were used for comparison.

Results:
X-ray assessments showed that the mean coronal Cobb angle and lumbar lordosis of the subjects from the preorthosis to immediate in-orthosis visits decreased significantly (p < 0.05) from 29.6° to 16.6°, and from 47.2° to 35.3°, respectively.

Conclusions:
This feasibility study showed that the proposed method would have a good potential to improve orthotic treatment outcome in a documented approach that should be considered for implementation into routine clinical practice aiming to reduce the chance of deformity deterioration leading to surgical intervention. However, a controlled group study is required to compare the results.
Predictors of Cognitive Change in Parkinson Disease
Authors: Gasca-Salas Carmen , Duff-Canning Sarah , McArthur Eric , Armstrong Melissa J. , Fox Susan , Meaney Christopher A. , Tang-Wai David F. , Gill David , Eslinger Paul J. , Zadikoff Cindy , Marshall Fred J. , Mapstone Mark , Chou Kelvin L. , Persad Carol , Litvan Irene , Mast Benjamin T. , Gerstenecker Adam T. , Weintraub Sandra , Marras Connie 
Published: August 2023

Background:
Mild cognitive impairment is common in Parkinson disease (PD-MCI). However, instability in this clinical diagnosis and variability in rates of progression to dementia raises questions regarding its utility for longitudinal tracking and prediction of cognitive change in PD. We examined baseline neuropsychological test and cognitive diagnosis predictors of cognitive change in PD.

Methods:
Persons with PD, without dementia PD (N=138) underwent comprehensive neuropsychological assessment at baseline and were followed up to 2 years. Level II Movement Disorder Society criteria for PD-MCI and PD dementia (PDD) were applied annually. Composite global and domain cognitive z-scores were calculated based on a 10-test neuropsychological battery.

Results:
Baseline diagnosis of PD-MCI was not associated with a change in global cognitive z-scores. Lower baseline attention and higher executive domain z-scores were associated with greater global cognitive z-score worsening regardless of cognitive diagnosis. Worse baseline domain z-scores in the attention and language domains were associated with progression to MCI or PDD, whereas higher baseline scores in all cognitive domains except executive function were associated with clinical and psychometric reversion to “normal” cognition.

Conclusions:
Lower scores on cognitive tests of attention were predictive of worse global cognition over 2 years of follow-up in PD, and lower baseline attention and language scores were associated with progression to MCI or PDD. However, PD-MCI diagnosis per se was not predictive of cognitive decline over 2 years. The association between higher executive domain z-scores and greater global cognitive worsening is probably a spurious result.