bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does anastomotic leakage after intersphincteric resection for ultralow rectal cancer influence long-term outcomes? A retrospective observational study
Authors: Liu Feifan , Zhang Bin , Xiang Jianbin , Zhuo Guangzuan , Zhao YuJuan , Zhou Yiming , Ding Jianhua 
Published: May 2023

Abstract
Purpose
To determine whether anastomotic leakage (AL) following intersphincteric resection (ISR) for ultralow rectal cancer (uLRC) is associated with long-term negative outcomes.
Methods
Between June 2011 and January 2022, 236 consecutive patients who underwent ISR with diverting ileostomy for uLRC were included. The primary outcome was long-term clinical consequences of AL, including chronic stricture, stoma reversal, oncological and functional results.
Results
Forty-one (17.4%) patients developed symptomatic AL, whereas only two (0.8%) required re-laparotomy due to severe leakage. Patients with leaks had a significantly increased incidence of chronic stricture (29.3% vs 8.7%, P = 0.001) and stoma non-reversal (34.1% vs 4.6%, P < 0.0001) than controls. The severe consequences were particularly common in patients with anastomotic separation, resulting in 60% of those presenting with chronic stricture and 50% ending up with stoma non-reversal. After a median follow-up of 59 (range, 7-139) months, AL did not compromise long-term oncological outcomes, including tumor recurrence (9.8% vs 5.6%, P = 0.3), 5-year disease-free and overall survival (73.4% vs 74.8% and 85.1% vs 85.4%, P = 0.56 and P = 0.55). A total of 149 patients with bowel continuity who completed self-assessment questionnaires were enrolled for functional evaluation. The median follow-up was 24 (range, 12–94) months after ileostomy reversal, and functional results were comparable between patients with and without leaks.
Conclusion
AL is an unfortunate reality for patients who underwent ISR for uLRC, but the rate of severe leakage is limited. Leaks contribute to possible adverse impacts on chronic stricture and stoma non-reversal, especially for patients with anastomotic separation. However, long-term oncological and functional results may not be compromised.
Immune Microenvironment Analysis and Establishment of Response Prediction Model for PD-1 Blockade Immunotherapy in Glioblastoma Based on Transcriptome Deconvolution
Authors: Wong David , Yin Yanhui 
Published: May 2023

Abstract
Purpose
Only a small proportion of GBM patients obtain survival benefit from PD-1 blockade immunotherapy due to the highly heterogeneous and suppressed immune micro-environment of GBM. We aimed at revealing the characteristics of tumor micro-environment (TME) of GBM related to response to PD-1 inhibitors and constructing a response prediction model for screening patients possibly benefit from PD-1 inhibitors.
Methods
Based on the composition and expression profiles of cell subpopulations calculated by deconvoluting the GBM bulk RNA-seq, differentially expressed genes analysis and gene set enrichment analysis (GSEA) were performed to explore genes and pathways related to response to PD-1 inhibitors. Further by combining least absolute shrinkage and selection operator (LASSO) regression and expression correlation with PD-L1, the response prediction genes of PD-1 inhibitors were identified and the response model was constructed through binary logistic regression.
Results
The comparison of abundances of infiltrating immune cells showed that the abundance of M0 macrophages of responders was lower while the abundance of activated DCs was higher before PD-1 inhibitors treatment; the abundances of plasma cells and M0 macrophages of responders were lower after PD-1 inhibitors treatment. In addition, GSEA showed that the main up-regulation pathways in the tumor microenvironment of responders before PD-1 inhibitors treatment included the regulation of T-helper 1 type immune response, the positive regulation of natural killer cell mediated cytotoxicity, p53 signaling pathway, homotypic cell-cell adhesion and etc., the main down-regulation pathways include the activation pathways of microglia and myeloid leukocytes, Ras signaling pathway and etc. Afterwards, ITGAX, LRRFIP1 and FMN1 were identified as the key response prediction genes of PD-1 inhibitors and the response prediction model based on them showed good predictive performance with potential value of clinical application in its validation and verification.
Conclusions
ITGAX, LRRFIP1 and FMN1 were identified as the response prediction genes of PD-1 inhibitors and the response prediction model based on them was proved to have potential clinical value.
Natural root canal deviation and dentin thickness of mandibular first molars assessed by microcomputed tomography
Authors: Amorim Carolina Alonso , Marceliano-Alves Marília F. , Gomes Isabelle Louise , Provenzano José C. , Alves Flávio R. F. 
Published: May 2023

Abstract
Objective: To assess the centralization and dentin thickness of mesial root canals by microcomputed tomography (micro-CT).
Methods: Ninety-nine mandibular molars Vertucci’s type IV mesial canals were scanned by micro-CT. The mesiodistal deviation; and the centroid were calculated for mesiobuccal (MB) and mesiolingual (ML) canals (apical 4 mm and full canal).
Results: The centroid was deviated in MB and ML canals in full canal (MB=0.83 mm, 0.02-2.30 mm, and ML=0.83 mm, 0.05-3.99 mm), and in 4mm (MB=0.18mm,0.01-1.01 mm and ML=0.21 mm, 0.01-1.01 mm). In the full canal, both MV (69%) e ML (57%) deviated to mesial (M). In 4 mm, the deviation was M in 51% for MB canals and 52% of ML to distal (D). The dentin thickness was similar for MB and ML canals and their walls. Distal wall was lower for MB canal (0.07 mm) and M wall the higher in the MB canal (2.46 mm).
Conclusions: There is no centrality of mesial canals in mandibular first molars. The M deviation was frequent in the full canal. Dentin thickness were similar between mesial canals.
DNA-hypomethylation in the TNF-alpha gene predicts rheumatoid arthritis classification in patients with early inflammatory symptoms
Authors: Pitaksalee Rujiraporn , Parmar Rekha , Hotgett Richard , Emery Paul , Ponchel Frederique 
Published: May 2023

AbstractBiomarkers for the classification of rheumatoid arthritis (RA), and particularly of anti-citrullinated peptide antibody (ACPA) negative patients, remains an important hurdle for the early initiation of treatment despite the use of 2010 classification criteria. Taking advantage of DNA-methylation patterns specific to early RA, quantitative methylation-specific qPCR (qMSP) offers a robust technology for the development of biomarker. We developed assays and established their value as RA classification biomarkers.Methods: DNA-methylation data were screened to select candidate to design for qMSP assays. 8 assays were developed and tested on 2 early inflammatory arthritis cohorts. Logistic regression and bootstrapping were used to demonstrate added value.Result: Differentially methylated CpG data were screened for candidate-CpG meeting the qMSP assay requirements. The top CpG candidate was in theTNFgene, for which we successfully developed a qMSP-assay. Significant lower DNA-methylation levels were observed in RA (p < 4x10− 9), with high predictive value (OR < 0.54/AUC < 0.198) in 2 cohorts (n = 127/n = 157). Regression using both cohorts showed improved accuracy = 87.7% and AUC = 0.944 over the model using only clinical variables (accuracy = 85.2%, AUC = 0.917). Similar data were obtained in ACPA-negative patients (n = 167, accuracy = 82.6%, AUC = 0.930) compared to clinical variable model accuracy = 79.5%, AUC = 0.892. Bootstrapping using 2000 datasets confirmed that the AUCs for the clinical + TNF-qMSP model had significant added value in both analysis.Conclusion: The qMSP technology is robust and can successfully be developed with high specificity of the TNF qMSP-assay for RA in patients with early inflammatory arthritis. It should assist classification in ACPA-negative patients providing a means of reducing delay to diagnosis and treatment.
Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda
Authors: Makabayi-Mugabe Rita , Musaazi Joseph , Zawedde-Muyanja Stella , Kizito Enock , Fatta Katherine , Namwanje-Kaweesi Hellen , Turyahabwe Stavia , Nkolo Abel 
Published: May 2023

Abstract
Background:
Health facility-based directly observed therapy (HF DOT) is the main strategy for the management of patients with drug-resistant tuberculosis (DR TB) in Uganda, however, this still yields sub-optimal treatment outcomes. We set out to assess the effectiveness of community-based directly observed therapy (CB DOT) for the treatment of DR TB in Uganda.
Methods:
Using a previously developed patient-centered model for CB DOT, we assigned community health workers (CHWs) as primary caregivers to patients diagnosed with DR TB. CHWs administered daily DOT to patients in their homes. Once a month, patients received travel vouchers to attend clinic visits for treatment monitoring. We assessed the effectiveness of this model using a quasi-experimental pre and post-study. From December 2020 to March 2022, we enrolled adult DR-TB patients on the CB DOT model. We collected retrospective data from patients who had received care using the HF DOT model during the year before the study started. The adjusted effect of CB DOT versus HF DOT on DR TB treatment success was estimated using modified Poisson regression model with robust cluster variance estimator.
Results:
We analyzed data from 264 DR TB patients (152 HF DOT, 112 CB DOT). The majority were males (67.8%) with a median age of 36 years (IQR 29 to 44 years). Baseline characteristics were similar across the comparison groups, except for educational level. The treatment success rate in the CB DOT group was 12% higher than that in the HF DOT (adjusted prevalence ratio (aPR)= 1.12 [95%CI 1.01, 1.24],
P-value=0.03). Males were less likely to achieve treatment success compared to their female counterparts (aPR=0.87 [95% CI 0.78, 0.98], P-value=0.02). A total of 126 (47.7%) of 264 patients reported at least one adverse event. The HF DOT group had a higher proportion of patients with at least one adverse event compared to the CB DOT group (90/152 [59.2%] versus 36/112 [32.1], P-value<0.01). The model was acceptable among patients (93.6%) and health workers (94.1%).
Conclusions:
CB DOT for DR-TB care is effective and results in better treatment outcomes than HF DOT. The cost-effectiveness of this model of care should be further evaluated.
Prognostic impact of the HS-mGPS on patients undergoing radical surgery for hepatocellular carcinoma Authorship
Authors: Luo Baoyang , Zhang Yun , Yang Yong , Ji Tianhao , Shi Longqing , Wu Kejia , Qu Zhen , Chen Jing , Cai Huihua , Sun Donglin , Duan Yunfei , Lu Yunjie 
Published: May 2023

Abstract
Objiective: Our study aimed to assess the ability of High-Sensitivity modified Glasgow Prognostic Score (HS-mGPS) predicting survival in patients undergoing radical surgery for hepatocellular carcinoma (HCC) and to compare the impact with other Inflammation-Based Prognostic Scoring systems including Glasgow Prognostic Score (GPS) and modified GPS (mGPS).
Methods: Our study evaluated 293 patients with HCC who had undergone hepatectomy at the Third Affiliated Hospital of Soochow University between 2010 and 2018. The HS-mGPS, mGPS, and GPS were calculated based on particular cut-off values of preoperative C-reactive protein and albumin, and the correlations between HS-mGPS and clinicopathological parameters were evaluated. Univariate and multivariate survival analyses were conducted by Kaplan–Meier method and Cox proportional hazards model.
Result: Kaplan-Meier and univariate survival analyses demonstrated that higher scores of the HS-mGPS, GPS and mGPS were all associated with significantly lower overall survival (OS) (all p < 0.001). In multivariate survival analysis, the HS-mGPS (p = 0.010) was an independent risk factor for poor OS in patients with HCC undergoing hepatectomy, along with the maximal tumor diameter (p < 0.001), microvascular invasion(MVI)( p = 0.008), and BCLC stage(p = 0.001). Based on the receiver operating characteristic (ROC) curve and AUC (areas under the curve) values, HS-mGPS was superior to GPS and mGPS for predicting the long-term prognosis of patients with resectable HCC.
Conclusion: Preoperative HS-mGPS is a superior prognostic score in predicting poor long-term outcomes after HCC patients undergoing radical surgery.
Diastereoselective Green Synthesis of Pyrrolo[1,2-a]quinolines via [3+2] Cycloaddition Reaction: Insights from Molecular Electron Density Theory
Authors: Mohammad-Salim Haydar , Mondal Asmita , de Julián-Ortiz Jesus Vicente , Acharjee Nivedita 
Published: May 2023

Abstract
The [3 + 2] cycloaddition (32CA) reaction between cyclic azomethine ylide (generated from N-phenacylquinolinium bromide) and N-arylmaleimide, leading to pyrrolo[1,2-a]quinolone, has been investigated using the Molecular Electron Density Theory (MEDT) at the B3LYP/6-311 + + G(d,p) computational level. This study focuses on the zwitter-ionic type 32CA reaction, highlighting its polar character with the electronic flux from the azomethine ylide to the alkene. The reaction proceeds with complete endo-stereoselectivity, and the activation parameters show minimal variations in different solvents, consistent with experimental observations. The activation energy is associated with the depopulation of the N2-C1 and C4-C5 bonding regions, formation of non-bonding electron density at N2 nitrogen and creation of pseudoradical centers at C3, C4 and C5. These findings suggest that the formation of new covalent bonds does not occur at the transition states, in line with the presence of non-covalent interactions at the interatomic bonding regions, as revealed by the topological analysis of the Quantum Theory of Atoms-in-Molecules (QTAIM).
Three in four undescribed plant species are threatened with extinction
Authors: Bachman Steven , Lughadha Eimear Nic , Brown Matilda 
Published: May 2023

AbstractMany thousands of plant species remain unknown to science, most being range-restricted and/or rare – both factors that increase extinction risk. Here, we show that more than 75% of species described after 2020 would qualify as threatened if assessed for the IUCN Red List. We recommend that newly described species are assumed to be threatened and encourage taxonomists to partner with assessors at the time of description to formally evaluate the extinction risk of new species using the IUCN Red List Categories and Criteria.
Magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary public hospitals, West Oromia, Ethiopia, 2022
Authors: Benti Aliyi , Tesgera Debrework , Alemshet Esayas 
Published: May 2023

Abstract
Introduction: Laparotomy surgery is an incision in the abdominal cavity to treat serious abdominal disease and save the patient's life. It is performed in both elective and emergency conditions and results in significant deaths in both developed and developing countries, including Ethiopia. Studies of in-hospital mortality among patients undergone laparotomy surgery and associated factors are limited.
Objective: To assess the magnitude of in-hospital mortality and its associated factors among patients undergone laparotomy at tertiary hospitals, West Oromia, Ethiopia, 2022.
Method: An institutional retrospective cross-sectional study was donefrom January 1, 2017 to December 31, 2021. Data were collected using systematic random sampling and basedstructured and pre-tested abstraction sheet from 548 patient chars and registries.Data were checked for completeness, consistency, coded, importedusing EPI data version 4.6, cleaned and analyzedusing SPSS version 25. Variables with p < 0.2 in bi-variable logistic regression analysis were included in themultivariate logistic regression analysis. The model fitness was checked by the Hosmer-Lemeshow test. Using the adjusted odds ratio with 95% CI and a p-value of 0.05, statistical significance was declared.
Results: A total of 512 patient records were reviewed and the response rate was 93.43%. The overall in-hospital mortality rate was 7.42% [95% CI: 5.4-9.8]. American Anaesthesiology Association physiological status of patients ≥ III [AOR=7.64 (95% CI: 3.12-18.66)], systolic blood pressure <90 mmHg at admission [AOR=6.11 (95% CI: 1.98-18.80)], presence of preoperative sepsis [AOR= 3.54 (95% CI: 1.53-8.19)], Intensive care unit admission [AOR = 4.75 (95% CI: 1.50-14.96)], and hospital stay ≥14 days [(AOR = 6.76 (95% CI: 2.50-18.26)] were significantly associated with in-hospital mortality after laparotomy surgery.
Concussion: In this study,overall in-hospital mortality was high. TheAmerican Society of Anaesthesiologists identifies the patient's physical condition early, requires appropriate intervention,and pays special attention to patients: low systolic blood pressure, preoperative sepsis, admission to the hospital, Intensive care unit and prolonged hospital stay, in order to improve patient outcomes after laparotomy surgery.
Complications associated with loop ileostomy: analysis of risk factors
Authors: Matsumoto Yoshiko , Aisu Naoya , Kajitani Ryuji , Nagano Hideki , Yoshimatsu Gumpei , Hasegawa Suguru 
Published: May 2023

Abstract
Purpose: Loop ileostomy is a common surgical procedure but is associated with complications such as outlet obstruction (OO), parastomal hernia (PH), and high-output stoma (HOS). This study aimed to identify risk factors for these complications and their causal relationships.Methods: The study included 188 consecutive patients who underwent loop ileostomy between April 2016 and September 2021. Clinical factors and postoperative stoma-related complications (OO, HOS, and PH) were analyzed retrospectively. Stoma-related factors were evaluated by computed tomography (CT). The incidence, clinical course, and risk factors for the stoma-related complications were investigated.Results: OO was diagnosed in 28 cases (15.7%), PH in 57 (32%), and HOS in 57 (31.8%). A small longitudinal stoma diameter at the rectus abdominis level on CT and a right-sided stoma were significantly associated with OO. Creation of an ileostomy for anastomotic leakage was independently associated with HOS. Higher body weight and a large longitudinal stoma diameter at the rectus abdominis level on CT were significantly associated with PH. There was a significant relationship between occurrence of OO and occurrence of HOS; however, the association of occurrence of OO with that of PH was marginal.Conclusion: This study identified key risk factors for OO, HOS, and PH as complications of loop ileostomy and their causal relationships. Our findings may contribute to prevention and management of complications related to loop ileostomy.
Left atrial giant myxoma with mitral valve obstruction
Authors: Escobar Johao , Rivera Mario Rodriguez , Aguiluz Andrea , Larios Javier 
Published: May 2023

Abstract
Myxomas are the most common primary cardiac tumors, predominantly found in the left atrium. They can present with various symptoms, including cardiac manifestations such as heart failure, arrhythmias, stroke, and systemic findings. Surgical resection of myxomas has a favorable prognosis with low complication rates. This case report presents a 41-year-old man with dyspnea, abdominal distension, and edema diagnosed with a giant left atrial myxoma. Successful surgical removal resulted in symptom resolution. Cardiac myxomas are rare, with a prevalence of about 0.03% in the general population. Clinical manifestations, including intracardiac obstruction, embolization, and constitutional symptoms, depend on the tumor's location, size, and mobility. Echocardiography is essential for diagnosis, while additional imaging techniques such as CT and MRI can provide further information. Surgical excision is typically necessary to prevent embolization, with favorable outcomes, although there is a risk of arrhythmias, conduction abnormalities, recurrence, and development of new lesions.
Protocol to evaluate the efficacy and safety of tolvaptan in patients with ascites effusion after liver resection: An open-label, single-arm phase I/II study
Authors: Namba Yosuke , Kobayashi Tsuyoshi , Kuroda Shintaro , Hashimoto Masakazu , Takei Daisuke , Fukuhara Sotaro , Oshita Ko , Matsubara Keiso , Honmyo Naruhiko , Nakano Ryosuke , Sakai Hiroshi , Tahara Hiroyuki , Ohira Masahiro , Ide Kentaro , Ohdan Hideki 
Published: May 2023

Abstract
Background
In patients with chronic liver diseases such as cirrhosis, massive ascites after hepatic resection is the cause of prolonged hospitalization and worsening prognosis. Recently, the efficacy of tolvaptan in refractory ascites has been reported; however, there are no reports on the efficacy or safety of tolvaptan for refractory ascites after hepatic resection. This study aims to evaluate the efficacy of early administration of tolvaptan in patients with refractory ascites after hepatic resection.
Methods/design
This is an open-label, single-arm phase I/II study. This study subject will comprise patients scheduled for hepatic resection of a liver tumor. Patients with refractory ascites after hepatic resection (drainage volume on postoperative day 1 ≥ 5 mL/body weight 1 kg/day) will be treated with tolvaptan. The primary endpoint will include the maximum change in body weight after hepatic resection relative to the preoperative baseline. The secondary endpoints will include drainage volume, abdominal circumference, urine output, postoperative complication rate (heart failure, respiratory failure), number of days required for postoperative weight gain because of ascites to decrease to preoperative weight, change in improvement of postoperative pleural effusion, total amount of albumin or fresh frozen plasma transfusion, type and amount of diuretics used, and postoperative hospitalization days.
Discussion
This trial will evaluate the efficacy and safety of tolvaptan prophylaxis for refractory ascites after hepatic resection. As there are no reports demonstrating the efficacy of tolvaptan prophylaxis for refractory ascites after hepatic resection, we expect that these findings will lead to future phase III trials and provide valuable indications for the selection of treatments for refractory postoperative ascites.
Trial registration
The trial was prospectively registered at Japan Registry of Clinical Trials (jRCTs061220114).