bluuebunny/crossref_metadata_2025_split huggingface dataset:
What’s Going on in the Hospital?: A Qualitative Study Investigating Patient Experiences of Prolonged Hospitalization After Video-assisted Thoracoscopic Surgery
Authors: Donsel Pernille O. , Missel Malene 
Published: August 2023

Background:
Patients with lung cancer in “enhanced recovery after surgery” programs are offered the prospect of early hospital discharge before undergoing surgery. Little is known about what patients experience when hospitalization lasts longer than expected.

Objective:
To explore patient experiences of prolonged hospitalization in an “enhanced recovery after surgery” program following video-assisted thoracoscopic surgery lobectomy.

Methods:
Fifteen face-to-face, nonstructured interviews were conducted with patients who had undergone surgery and were hospitalized for 7 days or more.

Results:
Six themes emerged regarding experiences and coping strategies: lacking information, drawing boundaries, coping with boredom, time for existential thoughts, relying on other patients for reflection, and sufficient time to worry about the aftermath. The analysis was based on Gadamer’s philosophical hermeneutical approach and Antonovsky’s theory of sense of coherence (SOC).

Conclusions:
Patients had various strategies for coping with their situation when hospitalized for a prolonged period in an “enhanced recovery after surgery” program. Health care professionals had an important role in supporting patients’ individual coping strategies to help patients maintain a SOC.

Implications for Practice:
The findings can be used to understand how patients experience hospitalization when their trajectory deviates from standardized programs. Need for an individual approach to patients is recommended.

Foundational:
The results indicate an important role for nursing care in “enhanced recovery after surgery” programs and underscore that an individualized approach to patients can bolster coping strategies and thus a SOC.
Analysis of factors related to endometrial cancer in postmenopausal women with endometrial thickening
Authors: Ai Fangfang , Qin Xiaopei , Zhou Liane , Wang Shijun 
Published: August 2023

Abstract

Objective
To investigate the factors related to endometrial cancer (EC) in postmenopausal women with endometrial thickening and the value of endometrial thickness (ET) in predicting EC.

Methods
A retrospective study of 385 referrals to our department for hysteroscopic diagnostic curettage assessment was carried out. Univariate analysis and multiple logistic regression analysis were used to identify the independent contributors to the development of EC. The ability of ET to predict EC was evaluated by receiver operating characteristic curve analysis.

Results
The follow-up period from the identification of endometrial thickening to pathological confirmation of EC was from 2 weeks to 3 months. In the postmenopausal bleeding (PMB) group, a total of 47 participants’ specimens were pathologically malignant. Older age and polypoid mass-like lesions (P < 0.001) were independent factors associated with EC. The optimal critical value of ET in predicting EC was 9.5 mm, with a sensitivity and specificity of 70.21% and 70.67%, respectively. In the non-PMB group, six participants had evidence of malignant pathology, and only polypoid mass-like lesions were an independent factor associated with EC (P < 0.001).

Conclusions
For postmenopausal women with increased ET and PMB, older age, thicker ET, and polypoid mass-like lesions on transvaginal ultrasound were independent associated factors for EC. An ET greater than 9.5 mm is a threshold for predicting EC. For postmenopausal women with increased ET without PMB, the incidence of endometrial malignancy is low. If the woman has polypoid mass-like lesions on transvaginal ultrasound, she should receive further attention.
Loss of TAZ after YAP deletion severely impairs foregut development and worsens cholestatic hepatocellular injury
Authors: Gabdulkhakova Adelya , Krutsenko Yekaterina , Zhu Junjie , Liu Silvia , Poddar Minakshi , Singh Sucha , Ma Xiaochao , Nejak-Bowen Kari , Monga Satdarshan P.S. , Molina Laura M. 
Published: August 2023

Background:
We previously showed that loss of yes-associated protein 1 (YAP) in early liver development (YAPKO) leads to an Alagille syndrome-like phenotype, with failure of intrahepatic bile duct development, severe cholestasis, and chronic hepatocyte adaptations to reduce liver injury. TAZ, a paralog of YAP, was significantly upregulated in YAPKO hepatocytes and interacted with TEA domain family member (TEAD) transcription factors, suggesting possible compensatory activity.

Methods:
We deleted both Yap1 and Wwtr1 (which encodes TAZ) during early liver development using the Foxa3 promoter to drive Cre expression, similar to YAPKO mice, resulting in YAP/TAZ double knockout (DKO) and YAPKO with TAZ heterozygosity (YAPKO TAZHET). We evaluated these mice using immunohistochemistry, serum biochemistry, bile acid profiling, and RNA sequencing.

Results:
DKO mice were embryonic lethal, but their livers were similar to YAPKO, suggesting an extrahepatic cause of death. Male YAPKO TAZHET mice were also embryonic lethal, with insufficient samples to determine the cause. However, YAPKO TAZHET females survived and were phenotypically similar to YAPKO mice, with increased bile acid hydrophilicity and similar global gene expression adaptations but worsened the hepatocellular injury. TAZ heterozygosity in YAPKO impacted the expression of canonical YAP targets Ctgf and Cyr61, and we found changes in pathways regulating cell division and inflammatory signaling correlating with an increase in hepatocyte cell death, cell cycling, and macrophage recruitment.

Conclusions:
YAP loss (with or without TAZ loss) aborts biliary development. YAP and TAZ play a codependent critical role in foregut endoderm development outside the liver, but they are not essential for hepatocyte development. TAZ heterozygosity in YAPKO livers increased cell cycling and inflammatory signaling in the setting of chronic injury, highlighting genes that are especially sensitive to TAZ regulation.
NIS2+™, an effective blood-based test for the diagnosis of at-risk nonalcoholic steatohepatitis in adults 65 years and older
Authors: Sanyal Arun J. , Magnanensi Jérémy , Majd Zouher , Rosenquist Christian , Vera Delphis M. , Almas James P. , Connelly Margery A. 
Published: August 2023

Background:
Older patients are at increased risk for at-risk NASH, defined as NASH with NAFLD activity scores (NAS) ≥4 and significant fibrosis (F ≥ 2). The aim of this study was to compare the performance of 2 new blood tests, NIS4® and NIS2+™, with FIB-4, NFS, ELF™, and alanine aminotransferase (ALT) for the diagnosis of at-risk NASH in a cohort of patients aged ≥65 years.

Methods:
The clinical performance of multiple blood-based tests was assessed for their ability to detect at-risk NASH using the RESOLVE-IT diag cohort, a large population of patients with metabolic risk who were screened for potential inclusion in the RESOLVE-IT phase 3 trial.

Results:
The study cohort (n = 2053) included patients with the full histological spectrum of NAFLD, with patients having liver fibrosis stages F0–4 and NAS scores 0–8. NIS4® and NIS2+™ showed similar assay performance in patients who were <65 versus ≥65 years of age (AUROC = 0.80 vs. 0.78, p = 0.47; 0.81 vs. 0.83 p = 0.45, respectively) for the identification of at-risk NASH. In patients ≥65 (n = 410), NIS2+™ exhibited the highest AUROC compared to NIS4®, FIB-4, NFS, ELF™, and ALT (AUROC = 0.83 vs. 0.78, 0.68, 0.58, 0.69, 0.74, respectively; all p ≤ 0.0009). For NIS2+™, the sensitivity and NPV for ruling-out at-risk NASH at the 0.46 cutoff were 90.2% and 86.0%, and the specificity and PPV for ruling-in at-risk NASH at the 0.68 cutoff were81.1% and 76.3%, respectively.

Conclusions:
The clinical performance of NIS2+™ was superior for the diagnosis of at-risk NASH in patients ≥65 years of age. These data support the clinical value of this blood-based test for the diagnosis of at-risk NASH in older adults.
Histone methyltransferase KMT5C drives liver cancer progression and directs therapeutic response to PARP inhibitors
Authors: Tong Yu , Wang Fan , Li Songling , Guo Wenyun , Li Qianyu , Qian Yifei , Li Linfeng , Zhao Huifang , Zhang Yonglong , Gao Wei-Qiang , Liu Yanfeng 
Published: August 2023

Background and Aims:
Epigenetic plasticity is a major challenge in cancer-targeted therapy. However, the molecular basis governing this process has not yet been clearly defined. Despite the considerable success of poly(ADP-ribose) polymerase inhibitors (PARPi) in cancer therapy, the limited response to PARPi, especially in HCC, has been a bottleneck in its clinical implications. Herein, we investigated the molecular basis of the histone methyltransferase KMT5C (lysine methyltransferase 5C) that governs PARPi sensitivity and explored a potential therapeutic strategy for enhancing PARPi efficacy.

Approach and Results:
We identified KMT5C, a trimethyltransferase of H4K20, as a targetable epigenetic factor that promoted liver tumor growth in mouse de novo MYC/Trp53

−/−
and xenograft liver tumor models. Notably, induction of KMT5C by environmental stress was crucial for DNA repair and HCC cell survival. Mechanistically, KMT5C interacted with the pivotal component of homologous recombination repair, RAD51, and promoted RAD51/RAD54 complex formation, which was essential for the activation of dsDNA breaks repair. This effect depended on the methyltransferase activity of KMT5C. We further demonstrated that the function of KMT5C in promoting HCC progression was dependent on RAD51. Importantly, either a pharmacological inhibitor (A196) or genetic inhibition of KMT5C sensitized liver cancer cells to PARPi.

Conclusions:
KMT5C played a vital role in promoting liver cancer progression by activating the DNA repair response. Our results revealed a novel therapeutic approach using the KMT5C inhibitor A196, concurrent with olaparib, as a potential HCC therapy.
Prognostic significance of acute kidney injury stage 1B in hospitalized patients with cirrhosis: A US nationwide study
Authors: Patidar Kavish R. , Cullaro Giuseppe , Naved Mobasshir A. , Kabir Shaowli , Grama Ananth , Orman Eric S. , Piano Salvatore , Allegretti Andrew S. 
Published: August 2023

Understanding the prognostic significance of acute kidney injury (AKI) stage 1B [serum creatinine (sCr) ≥1.5 mg/dL] compared with stage 1A (sCr < 1.5 mg/dL) in a US population is important as it can impact initial management decisions for AKI in hospitalized cirrhosis patients. Therefore, we aimed to define outcomes associated with stage 1B in a nationwide US cohort of hospitalized cirrhosis patients with AKI. Hospitalized cirrhosis patients with AKI in the Cerner-Health-Facts database from January 2009 to September 2017 (n = 6250) were assessed for AKI stage 1 (≥1.5–2-fold increase in sCr from baseline) and were followed for 90 days for outcomes. The primary outcome was 90-day mortality; secondary outcomes were in-hospital AKI progression and AKI recovery. Competing-risk multivariable analysis was performed to determine the independent association between stage 1B, 90-day mortality (liver transplant as a competing risk), and AKI recovery (death/liver transplant as a competing risk). Multivariable logistic regression analysis was performed to determine the independent association between stage 1B and AKI progression. In all, 4654 patients with stage 1 were analyzed: 1A (44.3%) and 1B (55.7%). Stage 1B patients had a significantly higher cumulative incidence of 90-day mortality compared with stage 1A patients, 27.2% versus 19.7% (p < 0.001). In multivariable competing-risk analysis, patients with stage 1B (vs. 1A) had a higher risk for mortality at 90 days [sHR 1.52 (95% CI 1.20–1.92), p = 0.001] and decreased probability for AKI recovery [sHR 0.76 (95% CI 0.69–0.83), p < 0.001]. Furthermore, in multivariable logistic regression analysis, AKI stage 1B (vs. 1A) was independently associated with AKI progression, OR 1.42 (95% CI 1.14–1.72) (p < 0.001). AKI stage 1B patients have a significantly higher risk for 90-day mortality, AKI progression, and reduced probability of AKI recovery compared with AKI stage 1A patients. These results could guide initial management decisions for AKI in hospitalized patients with cirrhosis.
Microsurgical clipping of multiple aneurysms through the unilateral pterional approach via the extended lateral corridor (PAVEL): a case report
Authors: Khoshnevisan Alireza , Kankam Samuel B. , Farahbakhsh Farzin , Ahmadi Maryam , Shafizadeh Milad 
Published: August 2023

Introduction and importance:
The application of pterional approach via the extended lateral corridor (PAVEL) for aneurysms of the distal basilar artery has been associated with significant successes. However, this approach has been rarely used to manage multiple aneurysms in patients who are not candidates for endovascular intervention.

Case presentation:
A 58-year-old male patient was referred to our neurosurgical unit with severe headache, nausea and vomiting, and neck pain. The patient had a history of hypertension but no past surgical history. A computerized tomography scan showed subarachnoid hemorrhage in the basal cisterns. Also, three-dimensional cerebral vascular imaging revealed three aneurysms involving the left middle cerebral artery, the basilar artery apex, and the left superior cerebellar artery. Due to his comorbidities and the severity of his symptoms, an endovascular intervention was not possible. The patient underwent the PAVEL approach to clip these three aneurysms. Following surgery, the patient had temporary right-sided hemiparesis and left-side ptosis, which improved 3 months after surgery.

Clinical discussion:
In this article, we present a narrated video of the intraoperative management of the three aneurysms and discussed the benefit and likely complications of this procedure.

Conclusion:
The PAVEL approach provides a single approach for multiple anterior and posterior circulation aneurysms instead of multiple procedures, thus minimizing patient postsurgical morbidity and mortality.
A rare case of SCHMID metaphyseal chondrodysplasia associated with hypothyroidism,growth hormone deficiency and celiac disease: case report
Authors: Chreitah Ahmad , Bress Fatima , Aljanati Omar , Alkilany Zeina , Mohammed Aria , Kherbek Fatima 
Published: August 2023

Introduction and importance:
SCHMID metaphyseal chondrodysplasia is a rare cause of short stature with a good prognosis regarding other types of chondrodysplasia in reason of the normal integrity of the growth plate.

Case presentation:
The authors present a rare case of 4-year-2-month-old boy referred to our Unit for harmonious short stature, he had a waddling gait, subtle micromelia, and hyperlordosis, no special facies.

Clinical discussion:
The skeletal scan made the diagnosis of SCHMID metaphyseal chondrodysplasia. The first laboratory workup showed elevated thyroid stimulating hormone and anti-tissue transglutaminase immunoglobulin A. The duodenal biopsies confirmed the diagnosis of coeliac disease. Treatment of levothyroxine was initiated with a gluten-free diet .6 years later, his re-evaluation showed a low insulin-like growth factor 1 and low growth hormone peaks confirming the diagnosis of growth hormone deficiency, Growth hormone therapy was initiated with an adjusted dose of levothyroxine.

Conclusion:
Other causes of short stature should not be missed when diagnosing chondrodysplasia, and further investigations should be carried out to detect other concomitant disorders since metaphyseal chondrodysplasia is a rare cause for short stature while hypothyroidism and coeliac disease are relatively common.
Management of acute aortic services during the COVID-19 pandemic: a retrospective cohort study from the Middle East
Authors: Manla Yosef , Bhatnagar Gopal , Khan Naureen , Al Badarin Firas , AlJabery Yazan , Kakar Vivek , Aleinati Tareq , Bayrak Yusuf , AlMahmeed Wael , Sänger Stefan , Bafadel Ahmed , Göbölös Laszlo 
Published: August 2023

Background:
COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, the authors investigated the impact of the COVID-19 pandemic on their urgent aortic program.

Methods:
The authors included consecutive patients presenting with TAAD (n=36) in the years 2019 and 2020 [pre-pandemic period (2019; n=16) and the pandemic era (2020; n=20)] at a tertiary care centre. Patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes, and length of stay were determined retrospectively using chart review and were compared between both years.

Results:
An increase occurred in the absolute number of TAAD referrals during the pandemic era. Patients were featured by younger age of presentation (pre-pandemic group: 47.6±18.7, and the pandemic group: 50.6±16.2 years, P=0.6) in contrast to Western data but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital stay [20 (10.8–56) vs. 14.5 (8.5–53.3) days, P=0.5] and intensive care unit stay [5 (2.3–14.5) vs. 5 (3.3–9.3) days, P=0.4] were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference. There was no significant difference in the rates of in-hospital mortality between both groups [12.5% (2) vs. 10% (2), P=0.93].

Conclusions:
Compared with the pre-pandemic era (2019), there was no difference in resource utilisation and clinical outcomes of patients presenting with TAAD during the first year of COVID-19 pandemic (2020). Structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in critical healthcare scenarios. Future studies are required to further investigate aortic care delivery during such challenging pandemics.
Safety and efficacy of pimecrolimus versus vehicle for the treatment of atopic dermatitis in adults and paediatric population: a systematic review and meta-analysis
Authors: Akhtar Sareema E. , Shakil Saad , Farooqui Sabeeh K. , Khedro Tarek , Alzufairi Ahmad L. , Niaz Muhammad A. , Syed Saifullah , Jiffry Riaz , Alsubai Abdulla K. , Almesri Abdullah , Ismail Hebatalla , Khan Kashif A. , Al-Hindawi Ahmed , Ali Hussein K. , Falodun Timothy , Tabassi Aysa , Tabassi Aylin , Almas Talal 
Published: August 2023

Introduction:
Atopic dermatitis remains a widespread problem affecting various populations globally. While numerous treatment options have been employed, pimecrolimus remains a potent and viable option. Recently, there has been increasing interest in comparing the safety and efficacy of pimecrolimus with its vehicle.

Methods:
The authors conducted a comprehensive search of several databases, including PubMed, COCHRANE, MEDLINE, and Cochrane Central, from inception to May 2022, using a wide search strategy with Boolean operators. The authors also employed backward snowballing to identify any studies missed in the initial search. The authors included randomized controlled trials in our meta-analysis and extracted data from the identified studies. The authors used Review Manager (RevMan) Version 5.4 to analyze the data, selecting a random-effects model due to observed differences in study populations and settings. The authors considered a P-value of 0.05 or lower to be statistically significant.

Results:
The authors initially identified 211 studies, of which 13 randomized controlled trials involving 4180 participants were selected for analysis. Our pooled analysis revealed that pimecrolimus 1% was more effective at reducing the severity of atopic dermatitis than its vehicles. However, no significant difference was observed in adverse effects between pimecrolimus and vehicle, except for pyrexia, nasopharyngitis, and headache, which were increased with pimecrolimus.

Conclusion:
Our meta-analysis showed that pimecrolimus 1% is more effective than vehicle, although the safety profile remains inconclusive. Pimecrolimus reduced the Investigator’s Global Assessment score, Eczema Area and Severity Index score, and severity of pruritus when compared to its vehicle, indicating a higher efficacy profile. This is one of the first meta-analyses to assess the efficacy and safety profile of pimecrolimus 1% against a vehicle and may assist physicians in making informed decisions.
Looping a suture under the coracoid process using a modified pelvic suture needle in coracoclavicular stabilization
Authors: Asavanapakas Panpaporn , Klabklay Prapakorn , Maliwankul Korakot , Chuaychoosakoon Chaiwat 
Published: August 2023

Introduction:
A distal clavicle fracture is a common shoulder injury. Coracoclavicular (CC) stabilization is a popular procedure for treating this injury. However, with this method, there is a technical difficulty in looping the suture under the coracoid base with instruments normally available in the operating room (OR). Herein, the authors describe modifying a pelvic suture needle to ease this process.

Case presentation:
An 18-year-old Thai female presented with left shoulder pain after a fall while cycling. The physical examination showed tenderness at the prominent distal clavicle. The radiograph of both clavicles showed a displaced distal clavicle fracture of the left shoulder. After discussing the treatment, she decided to have CC stabilization as the authors recommended.

Clinical discussion:
CC stabilization is one of the main surgical techniques used in treating an acute displaced distal clavicle fracture. The most important but difficult step of the CC stabilization is passing a suture under the coracoid base. To make this step easier, various commercial tools have been created, however, they are expensive ($1400–1500 per piece), and most operating rooms in resource-limited countries do not have them available. The authors modified a pelvic suture needle specifically for use in looping a suture under the coracoid process, which is hard to do with standard surgical tools.
A rare case of Guillain-Barrè syndrome with unilateral facial palsy and asymmetrical ascending weakness: a case report
Authors: Maharjan Suman , Bhattarai Birat , Basnet Sanjog , Pandey Suvekchya , Basnet Sarita , Shrestha Pawan , Thapa Kriti 
Published: August 2023

Introduction and Importance:
Guillain-Barrè syndrome is a life threatening postinfectious disease causing acute paralytic neuropathy that rarely presents with asymmetrical limb weakness (1%) and unilateral facial nerve palsy (4.9%).

Case Presentation:
A 39-year-old male presented with pain and weakness in the right lower limb with right sided facial weakness. The cranial nerve examination revealed lower motor neuron type right facial palsy (Bell ’s palsy). On rest neurological examination, he had decreased power in the right lower limb with an absent knee and ankle reflex on presentation. Later, the weakness was symmetrical in both lower limbs.

Clinical Discussion:
Cerebrospinal fluid analysis showed albuminocytologic dissociation with no cells and an elevated protein of 203.2 mg/dl. The nerve conduction study was abnormal in bilateral lower limbs suggesting severe demyelinating motor neuropathy. Intravenous Immunoglobulin was started with the dose of 25 gm (0.4 mg/kg) once daily for 5 days, that is, five doses. The patient started showing signs of recovery with the initial dose of immunoglobulin.

Conclusion:
The course of the disease usually recovers spontaneously and completely; however, plasma exchange and immunomodulatory therapy have shown improvement in patient with rapidly deteriorating symptoms.