bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Space Expander of Laparoscopic Rectal Cancer Surgery for Overweight or Obese Patients
Authors: Chen Guofeng , Lu Yu , Zhu Jiyun , Huang Yi , Chen Jian , Chen Kaibo 
Published: March 2023

Background/Need Laparoscopic rectal cancer surgery (LRCS) has become a preferred approach for its minimal invasion and fast postoperative recovery. But it is challenging for the tumors of the middle and lower rectum, especially for overweight or obese patients. Methodology We present a space expander of laparoscopic rectal cancer surgery, which is a simple tool to widen the perirectal space, as to facilitate the procedure of total mesorectal excision (TME) during the rectal cancer surgery. It has several advantages of lower demand for an assistant, less risk of surgical complications and good feasibility. Device Description It is designed as a cylindrical shape, and it is the first invented device to help surgeons safely perform accurate TME on overweight or obese patients during LRCS. With this method, we are able to dissect the rectal wall circumferentially in a safe and quick way. Preliminary Results Our previous pig experiments indicated that the learning curve for this technique was as short as 10 minutes. Current status Further clinical trials will be conducted on its efficacy and safety in the future.
Endovascular treatment for anterior cerebral artery occlusions
Authors: Ozdemir Gokhan , Eren Fettah , Aygul Recep , Kizildag Nazım , Kocaturk Idris , Mammadi Azer , Ersoy Ayse Nur , Ildiz Omer Faruk , Gunduz Zehra Betul , Korez Muslu Kazım 
Published: March 2023

Background We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment. Methods Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment. Results Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary. Conclusions Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions.
Systematic review of the relationship between Hollenhorst plaques and cerebrovascular events
Authors: Ghoneim Baker Moustafa , Westby Daniel , Elsharkawi Mohamed , Said Marwa , Walsh Stewart R 
Published: March 2023

Background Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death.1 Aim To evaluate the association between the presence of asymptomatic cholesterol retinal emboli and the risk of cerebrovascular events, with assessment of the need for carotid intervention. Methods PubMed, Embase, and Cochrane Library databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. Results Initial search revealed 43 in Medline and 46 in Embase databases. Twenty-four potentially eligible studies were included after duplicate and non-related studies were excluded based on title and abstract. Three more studies were identified from reference lists. Seventeen studies were included in the final analysis. Asymptomatic cholesterol emboli were present in 1343 patients. Approximately 17.8% ( n = 181) had history of either cerebro-vascular Accident (CVA) or transient ischaemic attacks (TIAs) at presentation (more than 6 months). Nine studies mentioned the incidence of cerebrovascular events during follow-up. Of 780 patients, 93 evolved to stroke, TIAs, or death from a major carotid event during the follow-up period (6–86 m), an incidence of about 12%. Death due to stroke was documented in 3 studies ( n = 12). Conclusion The presence of asymptomatic retinal emboli indicates a risk of a cerebrovascular event when compared to patients with no plaques seen on fundoscopy. The evidence suggests that these patients warrant referral for medical optimization of cardiovascular risk factors. Currently, there is no recommendation to support carotid endarterectomy in patients with Hollenhorst plaques, or retinal emboli, and further studies are needed to assess this.
Development of a nomogram for predicting pathological complete response in luminal breast cancer patients following neoadjuvant chemotherapy
Authors: Garufi Giovanna , Carbognin Luisa , Sperduti Isabella , Miglietta Federica , Dieci Maria Vittoria , Mazzeo Roberta , Orlandi Armando , Gerratana Lorenzo , Palazzo Antonella , Fabi Alessandra , Paris Ida , Franco Antonio , Franceschini Gianluca , Fiorio Elena , Pilotto Sara , Guarneri Valentina , Puglisi Fabio , Conte Pierfranco , Milella Michele , Scambia Giovanni , Tortora Giampaolo , Bria Emilio 
Published: March 2023

Background: Given the low chance of response to neoadjuvant chemotherapy (NACT) in luminal breast cancer (LBC), the identification of predictive factors of pathological complete response (pCR) represents a challenge. A multicenter retrospective analysis was performed to develop and validate a predictive nomogram for pCR, based on pre-treatment clinicopathological features. Methods: Clinicopathological data from stage I–III LBC patients undergone NACT and surgery were retrospectively collected. Descriptive statistics was adopted. A multivariate model was used to identify independent predictors of pCR. The obtained log-odds ratios (ORs) were adopted to derive weighting factors for the predictive nomogram. The receiver operating characteristic analysis was applied to determine the nomogram accuracy. The model was internally and externally validated. Results: In the training set, data from 539 patients were gathered: pCR rate was 11.3% [95% confidence interval (CI): 8.6–13.9] (luminal A-like: 5.3%, 95% CI: 1.5–9.1, and luminal B-like: 13.1%, 95% CI: 9.8–13.4). The optimal Ki67 cutoff to predict pCR was 44% (area under the curve (AUC): 0.69; p < 0.001). Clinical stage I–II (OR: 3.67, 95% CI: 1.75–7.71, p = 0.001), Ki67 ⩾44% (OR: 3.00, 95% CI: 1.59–5.65, p = 0.001), and progesterone receptor (PR) <1% (OR: 2.49, 95% CI: 1.15–5.38, p = 0.019) were independent predictors of pCR, with high replication rates at internal validation (100%, 98%, and 87%, respectively). According to the nomogram, the probability of pCR ranged from 3.4% for clinical stage III, PR > 1%, and Ki67 <44% to 53.3% for clinical stage I–II, PR < 1%, and Ki67 ⩾44% (accuracy: AUC, 0.73; p < 0.0001). In the validation set (248 patients), the predictive performance of the model was confirmed (AUC: 0.7; p < 0.0001). Conclusion: The combination of commonly available clinicopathological pre-NACT factors allows to develop a nomogram which appears to reliably predict pCR in LBC.
Antiviral Effects of the Plant Family Amaryllidaceae
Authors: Nair Jerald J , van Staden Johannes 
Published: March 2023

Background In spite of the significant progress in modern medicine, viruses continue to be a formidable challenge to human health. The use of plants for the remediation of viral-borne diseases stretches back to the very dawn of mankind. Among bulbous plants, the Amaryllidaceae is one of the most popular families exploited in the traditional remediation of infectious diseases. Methods This account details the findings from a literature search carried out on the antiviral properties of the Amaryllidaceae. The keyword engaged in the search was “antiviral” in combination with the words “Amaryllidaceae,” “Amaryllidaceae specie,” and “Amaryllidaceae alkaloid.” Results Thirty-six taxa from 13 countries, notably in Africa and parts of Asia, have been cited as traditional remedies for viral diseases. Alcoholic bulb extracts of 18 species were evaluated against 23 different pathogens from 13 viral families. A wide range of activities was observed, with the whole-plant methanol extract of Zephyranthes candida seen to be the most striking (IC50 0.0019 µg/mL against poliovirus). The active principles in the main were isoquinoline alkaloids, of which lycorine impressed against the Avian influenza virus (strain H5N1). The mechanisms underlying the antiviral effects were seen to be related to the inhibition of DNA, RNA, and protein synthesis as well as inhibitory effects toward reverse transcriptase and protease enzymes. Conclusion Amaryllidaceae provides a richly diverse platform for antiviral drug research. Such endeavors have been fortified by the significant amounts of information emerging from indigenous knowledge systems. Ongoing studies will continue to target the active entities, particularly from taxa with verifiable ethnomedicinal backgrounds.
Quantitative evaluation for intravascular structures of vertebral artery dissection with a novel zoomed high-resolution black-blood MR imaging
Authors: Minakuchi Kiyomi , Fukuda Hitoshi , Miyake Hirohisa , Maeda Tomonori , Fukui Naoki , Moriki Akihito , Morimoto Masanori , Ueba Tetsuya 
Published: March 2023

Background Although non-stroke vertebral artery dissection (VAD) is diagnosed using MRI, detecting the subtle intravascular structure remains challenging. This study aimed to evaluate the validity of quantitative intravascular scanning based on novel zoomed high-resolution black blood (Z-HB) MRI for distinguishing VAD from other vessel pathologies. Methods Twenty-one patients with non-stroke VAD and 18 with symptomatic atherosclerotic plaques in their vertebral artery underwent Z-HB MRI and subsequent profile curve processing. Axial Z-HB imaging was obtained from dissected and normal segments in patients with VAD and atherosclerotic plaque in patients with ischemia. We investigated the qualitative categorization of the scanning patterns of the intravascular signals. We also evaluated the quantitative ability of each profile curve to discriminate multiple vessel pathologies by analyzing the receiver operating characteristics curves. Results Profile curve processing of 140 Z-HB images categorized the intravascular signal patterns into luminal, asymmetrical, and omega types. The asymmetrical type included both dissecting and atherosclerotic vessels, and the omega type included dissecting and normal vessels. In the asymmetrical type, quantitative evaluation successfully distinguished intramural hematomas of VAD from atherosclerotic plaque with an area under the curve of 0.80. The intimal flap of the VAD was distinguished from the blood flow artifact of the normal vessel with an area under the curve of 0.93 in the omega type. Conclusions A combination of novel Z-HB MRI and profile curve processing provided an ultra-high-resolution analysis of the intravascular structure of non-stroke VAD and successfully distinguished VAD from normal vessels or atherosclerotic plaques.
The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic–pituitary–thyroid axis
Authors: Hoermann Rudolf , Pekker Mark J. , Midgley John E. M. , Dietrich Johannes W. 
Published: March 2023

Background: Thyroid hormones are controlled by the hypothalamic–pituitary–thyroid (HPT) axis through a complex network of regulatory loops, involving the hormones TRH, TSH, FT4, and FT3. The relationship between TSH and FT4 is widely used for diagnosing thyroid diseases. However, mechanisms of FT3 homeostasis are not well understood. Objective: We used mathematical modelling to further examine mechanisms that exist in the HPT axis regulation for protecting circulating FT3 levels. Methods: A mathematical model consisting of a system of four coupled first-order parameterized non-linear ordinary differential equations (ODEs) was developed, accounting for the interdependencies between the hormones in the HPT axis regulation. While TRH and TSH feed forward to the pituitary and thyroid, respectively, FT4 and FT3 feed backward to both the pituitary and hypothalamus. Stable equilibrium solutions of the ODE system express homeostasis for a particular variable, such as FT3, if this variable stays in a narrow range while certain other parameter(s) and system variable(s) may vary substantially. Results: The model predicts that (1) TSH-feedforward protects FT3 levels if the FT4 production rate declines and (2) combined negative feedback by FT4 and FT3 on both TSH and TRH production rates keeps FT3 levels insensitive to moderate changes in FT4 production rates and FT4 levels. The optimum FT4 and FT3 feedback and TRH and TSH-feedforward ranges that preserve FT3 homeostasis were found by numerical continuation analysis. Model predictions were in close agreement with clinical studies and individual patient examples of hypothyroidism and hyperthyroidism. Conclusions: These findings further extend the concept of HPT axis regulation beyond TSH and FT4 to integrate the more active sister hormone FT3 and mechanisms of FT3 homeostasis. Disruption of homeostatic mechanisms leads to disease. This provides a perspective for novel testable concepts in clinical studies to therapeutically target the disruptive mechanisms.
Sexuality of adolescent girls born with HIV in Senegal: an anthropological analysis
Authors: Laborde-Balen Gabrièle , Diop Maimouna , Sow Khoudia , Ndiaye Ndeye Bineta , Diop Karim , Taverne Bernard ,   The ETEA-VIH Study Group
Published: March 2023

Objectives: In Senegal, the dominant social norm upholds virginity before marriage and edifies abstinence for adolescents as a cardinal moral value. Currently, sex outside of marriage remains socially condemned. The onset of sex for adolescent girls born with HIV in Senegal brings up several challenges. In Dakar, initiatives, especially through digital applications, are being developed to support these young people. These programs are much rarer in rural settings. A study conducted in 2021 explored how adolescent girls born with HIV who live outside of Dakar experience sexuality, what socio-health constraints they face, and what support they receive from the healthcare system. Method: An anthropological study titled ‘Treatment Failure among Children and Adolescents Living with HIV in Senegal, Outside Dakar’ (ETEA-VIH, ANRS 12421) was conducted in 2021 in 14 regional hospitals and health centers. Semi-structured interviews were conducted with 87 HIV-positive children and adolescents, 95 parents/guardians, and 47 health care workers. Adolescent girls’ onset of sexuality was specifically analyzed for 40 adolescent girls age 12–19 years old. Results: Generally, parents feign oblivion about their children’s sexual lives. Mothers dread a pregnancy out of marriage because they are responsible for overseeing sex education and would be ‘blamed’ for the transgression. The occurrence of an unintended pregnancy can lead to exclusion from the family and a risk of transmitting HIV to the child due to the lack of medical and social support. HIV remains a stigmatizing disease that families keep secret. The risk of disclosure is a major concern. Despite sexual and reproductive health (SRH) programs, most healthcare workers are reluctant to discuss sexuality or to offer contraception to adolescent girls. Information spaces have been set up in some regional hospitals by associations trained in SRH. They are rarer in health centers. Accessibility to digital applications and discussion forums is limited due to the lack of smartphones and Internet access. Conclusion: In rural settings, HIV-positive adolescent girls are confronted with the silence that surrounds sexuality and HIV. An individualized approach and confidential access to contraception should be prioritized to support them with assistance from PLHIV associations.
Prevalence of leftover medicines, disposal practices, and associated factors in Arba Minch Town, Southern Ethiopia
Authors: Asmamaw Getahun , Agedew Tewodros , Tesfaye Besrat , Sasamo Samrawit , Gena Saude , Argeta Melkamu , Adio Aynoshe 
Published: March 2023

Objective:The increased prevalence of leftover medicines in the community is currently a global concern due to the detrimental effects on the environment and health. However, several developing countries have failed to give sufficient consideration to the issue. The primary purpose of this study was to describe the prevalence of leftover medicines, disposal practices, and the factors affecting those in households in Arba Minch Town, Southern Ethiopia.Methods:A community-based, descriptive cross-sectional study was conducted among households in Bere Edigetber and Nech Sar of Arba Minch town, from June 25 to August 27, 2022. Data were gathered through face-to-face interviews with revalidated structured questionnaires. A multistage sampling technique was utilized to select each household.Results:Three hundred forty-eight households agreed to participate in a study, resulting in a 94.8% response rate. Of the study participant, 172 (49.4%) of the households had leftover medicines, with antibiotics being the most common (64% of 172). Subsidy of symptoms and saving for later use were two frequently cited reasons for the presence of leftover medicines in the house. Throwing leftover medicines in household garbage was the preferred method of disposal (>60%). Only 0.1% of respondents considered returning leftover medicines to healthcare facilities or professionals. A binary regression analysis identified four predictors for having leftover medicines. Medicines obtained without prescription were the strongest predictor (odds ratio = 3.7; p < 0.001), followed by higher family monthly income (odds ratio = 2.5; p = 0.005), those waived paying for medicine (odds ratio = 0.294; p = 0.049), and those used medications for acute diseases ( p = 0.048; odds ratio = 0.450). Respondents who had prior information on safe medicine disposal were 2.3 ( p = 0.04) more likely to dispose of possessed leftover medicines rather than keep them for future use.Conclusions:This study revealed a high prevalence of leftover medicines and their improper disposal in Arba Minch town. The preferred methods of leftover medicine disposal in this study deviate from conventional standards. Significant factor variables that predict having leftover medicines are attributed to purchasing medicine without a prescription, higher family monthly income, those waived paying for medicine, and those who used medications for acute diseases. Prior knowledge of proper disposal practices predicated the decision to dispose of on-hand leftover medicines or keep them for future use. These findings would be critical in developing strategies to reduce leftover medicines and promote proper disposal practices.
Risk Factors and Exit Strategy of Intraoperative Neurophysiological Monitoring Alert During Deformity Correction for Adolescent Idiopathic Scoliosis
Authors: Lee Choon Sung , Hwang Chang-Ju , Lee Dong-Ho , Cho Jae Hwan , Park Sehan 
Published: March 2023

Study Design Retrospective cohort study. Objective To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure. Methods We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared. Results Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve ( P < .001), number of levels fused ( P = .003), operative time ( P < .001), and EBL ( P < .001). The percentage of correction did not significantly differ between the 2 groups ( P = .348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred. Conclusion A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations.
‘The beauty and the less beautiful’: exploring the meanings of dying at ‘home’ among community and practitioner representatives and advocates across Canada
Authors: Funk Laura , Krawczyk Marian , Cherba Maria , Cohen S. Robin , Dujela Carren , Nichols Camille , Stajduhar Kelli 
Published: March 2023

Background: Significant structural and normative pressures privilege the ideal of dying at home in Canada. At the same time, the social complexities and meanings associated with dying in particular locations remain critically unexamined. Objective: The aim of this study is to explore how diverse community members, including health and social care stakeholders, talk about preferences for locations of dying, with a particular focus on meanings of dying at home. Design: Semi-structured virtual interviews were conducted with 24 community and practitioner representatives and advocates across Canada during the Covid-19 pandemic. This included compassionate community advocates, palliative care professionals and volunteers, bereaved carers, and members of queer, rural, and immigrant communities. Participants were asked about their own preferences for location of dying and elaborated on these aspects with regard to their client population or community group. Results: Our analysis illuminates how meanings of dying at home are connected to previous experiences and perceptions of institutional care. As such, participants’ perspectives are often framed as a rejection of institutional care. Dying at home also often signals potential for preserving ontological security and relational connection in the face of life-threatening illness. However, participants’ expertise simultaneously informs a sense that dying at home is often unattainable. At times, this awareness underpins interpretations of both preferences and choices as contingent on considerations of the nature and type of illness, concerns about impacts on families, and available resources. Conclusion: The ideal of dying at home is nuanced by identity, relational, and structural contexts. Knowledge from this study can inform realistic and practical person-centered planning across care settings. It can also help create more representative public policy and health system quality indicators regarding a ‘good death’ that do not rely on or perpetuate undeveloped and unrealistic assumptions about dying, home, and family care.