bluuebunny/crossref_metadata_2025_split huggingface dataset:
A detective of intramural ectopic pregnancy: The use of pituitrin under hysteroscopy combined with laparoscopy
Authors: Guo Yanchao , Feng Tongfu , Du Xin 
Published: March 2023

Rationale:Intramural pregnancy is a rare ectopic pregnancy in which the gestational sac is implanted between the muscle walls. Due to the lack of specific clinical manifestations, it is easy to misdiagnose or miss them. If it is allowed to get worse, the uterus will burst, and there will be a lot of bleeding in the later stages, which could lead to the death of the patient.Patient concerns:The patient had no history of uterine surgery, embryo transplantation, or any other operations. She complained of having abdominal distention and swelling of the waist but no vaginal bleeding or lower abdomen discomfort.Diagnoses:According to her transvaginal ultrasonography, we highly suspected ectopic pregnancy. Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, pituitrin helped find the gestational sac, and the pathology report confirmed that it was an intramural pregnancy.Interventions:Hysteroscopy combined with laparoscopy is an effective treatment option that can prevent life-threatening problems. During the surgery, we used pituitrin to help find the gestational sac. The use of pituitrin can minimize bleeding during a uterine operation and indicate the location of an intramural pregnancy, helping surgeons to complete the operation successfully.Outcomes:The patient recovered quickly and was discharged on the 4th day after surgery, with a significant decrease in human chorionic gonadotrophin (HCG) levels from 14,792.26 mIU/mL before surgery to 1071.40 mIU/mL at discharge. During the follow up, her HCG level dropped to 50.90 mIU/mL on the 14th day after the surgery. She monitored the HCG levels intermittently until they fell within the normal range.Lessons:Intramural pregnancy is a rare form of ectopic pregnancy, and it is difficult to diagnose early on. This may result in uterine rupture or even life-threatening hemorrhage. If an intramural pregnancy is suspected in early pregnancy, hysteroscopy combined with laparoscopy is advised, and if necessary, low-dose posterior pituitary hormone can enhance uterine contractions and better reveal the position of the gestational sac within the uterine wall.
Nephron-sparing surgery for primary mucinous adenocarcinoma of renal pelvis in horseshoe kidney: A case report
Authors: Li Dapeng , Zhang Wei , Wang Jun , Wang An , Wu Mingming , Wei Yangguang 
Published: March 2023

Rationale:
Mucinous adenocarcinoma of the renal pelvis is extremely rare in malignancy of the renal pelvis, and <100 cases have been reported so far. However, horseshoe kidneys appear to be more prone to this mucinous gland metaplasia. Due to the lack of a specific diagnostic basis, it is difficult to confirm the diagnosis before surgery, which is easy to cause misdiagnosis.

Patient concerns:
We report a 64-year-old male patient who found a cystic mass in the left kidney during physical examination. CT examination showed a horseshoe kidney with a cystic mass 9.5 × 8.0 cm in front of the left kidney, lacking obvious diagnostic features.

Diagnosis:
It was misdiagnosed as cystic teratoma before the operation, and was diagnosed as mucinous adenocarcinoma of the renal pelvis through pathological examination after the operation.

Interventions:
Resection of the tumor by nephron-sparing surgery and postoperative chemotherapy.

Outcomes:
No tumor recurrence was found at 6 years of follow-up. After 7 years, the patient had multiple metastases in the abdominal wall and peritoneum, and no tumor recurrence was found in the urinary system. The patient received chemotherapy again and survived well.

Lessons:
The prognosis of nephron-sparing tumor resection for MRAP is not significantly different from that of radical nephroureterectomy + bladder cuff excision. Because it can reduce the risk that patients can not tolerate follow-up chemotherapy due to abnormal renal function after surgery, which may be more beneficial in patients with kidney abnormalities or chronic disease.
Investigating the potential added value of [18F]FDG-PET/CT in long COVID patients with persistent symptoms: a proof of concept study
Authors: Chen Linda L. , van de Burgt Alina , Smit Frits , Audhoe Rowena S. , de Boer Sandra M. , van Velden Floris H.P. , de Geus-Oei Lioe-Fee 
Published: March 2023

Objective
Since the end of 2019, the coronavirus disease 2019 (COVID-19) virus has infected millions of people, of whom a significant group suffers from sequelae from COVID-19, termed long COVID. As more and more patients emerge with long COVID who have symptoms of fatigue, myalgia and joint pain, we must examine potential biomarkers to find quantifiable parameters to define the underlying mechanisms and enable response monitoring. The aim of this study is to investigate the potential added value of [18F]FDG-PET/computed tomography (CT) for this group of long COVID patients.

Methods
For this proof of concept study, we evaluated [18F]FDG-PET/CT scans of long COVID patients and controls. Two analyses were performed: semi-quantitative analysis using target-to-background ratios (TBRs) in 24 targets and total vascular score (TVS) assessed by two independent nuclear medicine physicians. Mann–Whitney U-test was performed to find significant differences between the two groups.

Results
Thirteen patients were included in the long COVID group and 25 patients were included in the control group. No significant differences (P < 0.05) were found between the long COVID group and the control group in the TBR or TVS assessment.

Conclusion
As we found no quantitative difference in the TBR or TVS between long COVID patients and controls, we are unable to prove that [18F]FDG is of added value for long COVID patients with symptoms of myalgia or joint pain. Prospective cohort studies are necessary to understand the underlying mechanisms of long COVID.
Intraoperative Factors Modifying the Risk of Postoperative Pulmonary Complications After Living Donor Liver Transplantation
Authors: Oh Eun Jung , Kim Jeayoun , Kim Bo-Guen , Han Sangbin , Ko Justin S. , Gwak Mi Sook , Kim Gaab Soo , Choi Eun Ah , Kang Jiyeon , Park Hye Yun 
Published: March 2023

Background.
The relationship between intraoperative anesthetic management and postoperative pulmonary complications (PPCs) after liver transplantation is not fully understood. We aimed to determine the intraoperative contributors to PPC.

Methods.
The retrospectively collected cohort included 605 patients who underwent living donor liver transplantation. PPCs comprised respiratory failure, respiratory infection, pulmonary edema, atelectasis (at least moderate degree), pneumothorax, and pleural effusion (at least moderate degree). The presence and type of PPC were evaluated by 2 pulmonary physicians. Logistic regression analysis was performed to determine the association between perioperative variables and PPC risk.

Results.
Of the 605 patients, 318 patients (52.6%) developed 486 PPCs. Multivariable analysis demonstrated that PPC risk decreased with low tidal volume ventilation (odds ratio [OR] 0.62 [0.41-0.94], P = 0.023) and increased with greater driving pressure at the end of surgery (OR 1.08 [1.01-1.14], P = 0.018), prolonged hypotension (OR 1.85 [1.27-2.70], P = 0.001), and blood albumin level ≤3.0 g/dL at the end of surgery (OR 2.43 [1.51-3.92], P < 0.001). Survival probability at 3, 6, and 12 mo after transplantation was 91.2%, 89.6%, and 86.5%, respectively, in patients with PPCs and 98.3%, 96.5%, and 93.4%, respectively, in patients without PPCs (hazard ratio 2.2 [1.3-3.6], P = 0.004). Graft survival probability at 3, 6, and 12 mo after transplantation was 89.3%, 87.1%, and 84.3%, respectively, in patients with PPCs and 97.6%, 95.8%, and 92.7%, respectively, in patients without PPCs (hazard ratio 2.3 [1.4-3.7], P = 0.001).

Conclusions.
We found that tidal volume, driving pressure, hypotension, and albumin level during living donor liver transplantation were significantly associated with PPC risk. These data may help determine patients at risk of PPC or develop an intraoperative lung-protective strategy for liver transplant recipients.
Intraoperative Red Blood Cell Transfusion and Primary Graft Dysfunction After Lung Transplantation
Authors: Subramaniam Kathirvel , Loor Gabriel , Chan Ernest G. , Bottiger Brandi A. , Ius Fabio , Hartwig Matthew G. , Daoud Daoud , Zhang Qianzi , Wei Qi , Villavicencio-Theoduloz Mauricio A. , Osho Asishana A. , Chandrashekaran Satish , Noguchi Machuca Tiago , Van Raemdonck Dirk , Neyrinck Arne , Toyoda Yoshiya , Kashem Mohammed A. , Huddleston Stephen , Ryssel Naomi R. , Sanchez Pablo G. 
Published: March 2023

Background.
In this international, multicenter study of patients undergoing lung transplantation (LT), we explored the association between the amount of intraoperative packed red blood cell (PRBC) transfusion and occurrence of primary graft dysfunction (PGD) and associated outcomes.

Methods.
The Extracorporeal Life Support in LT Registry includes data on LT recipients from 9 high-volume (>40 transplants/y) transplant centers (2 from Europe, 7 from the United States). Adult patients who underwent bilateral orthotopic lung transplant from January 2016 to January 2020 were included. The primary outcome of interest was the occurrence of grade 3 PGD in the first 72 h after LT.

Results.
We included 729 patients who underwent bilateral orthotopic lung transplant between January 2016 and November 2020. LT recipient population tertiles based on the amount of intraoperative PRBC transfusion (0, 1–4, and >4 units) were significantly different in terms of diagnosis, age, gender, body mass index, mean pulmonary artery pressure, lung allocation score, hemoglobin, prior chest surgery, preoperative hospitalization, and extracorporeal membrane oxygenation requirement. Inverse probability treatment weighting logistic regression showed that intraoperative PRBC transfusion of >4 units was significantly (P < 0.001) associated with grade 3 PGD within 72 h (odds ratio [95% confidence interval], 2.2 [1.6-3.1]). Inverse probability treatment weighting analysis excluding patients with extracorporeal membrane oxygenation support produced similar findings (odds ratio [95% confidence interval], 2.4 [1.7-3.4], P < 0.001).

Conclusions.
In this multicenter, international registry study of LT patients, intraoperative transfusion of >4 units of PRBCs was associated with an increased risk of grade 3 PGD within 72 h. Efforts to improve post-LT outcomes should include perioperative blood conservation measures.
Multicenter Validation of a Urine CXCL10 Assay for Noninvasive Monitoring of Renal Transplants
Authors: Ho Julie , Schaub Stefan , Jackson Annette M. , Balshaw Robert , Carroll Robert , Cun Sylvia , De Serres Sacha A. , Fantus Daniel , Handschin Joelle , Hönger Gideon , Jevnikar Anthony M. , Kleiser Marc , Lee Jar-How , Li Yan , Nickerson Peter , Pei Rui , Pochinco Denise , Shih Remi , Trinh Michael , Wang Jason , Nguyen Julie , Knechtle Stuart 
Published: March 2023

Background.
Urine CXCL10 (C-X-C motif chemokine ligand 10, interferon gamma-induced protein 10 [IP10]) outperforms standard-of-care monitoring for detecting subclinical and early clinical T-cell–mediated rejection (TCMR) and may advance TCMR therapy development through biomarker-enriched trials. The goal was to perform an international multicenter validation of a CXCL10 bead-based immunoassay (Luminex) for transplant surveillance and compare with an electrochemiluminescence-based (Meso Scale Discovery [MSD]) assay used in transplant trials.

Methods.
Four laboratories participated in the Luminex assay development and evaluation. Urine CXCL10 was measured by Luminex and MSD in 2 independent adult kidney transplant trial cohorts (Basel and TMCT04). In an independent test and validation set, a linear mixed-effects model to predict (log10-transformed) MSD CXCL10 from Luminex CXCL10 was developed to determine the conversion between assays. Net reclassification was determined after mathematical conversion.

Results.
The Luminex assay was precise, with an intra- and interassay coefficient of variation 8.1% and 9.3%; showed modest agreement between 4 laboratories (R 0.96 to 0.99, P < 0.001); and correlated with known CXCL10 in a single- (n = 100 urines, R 0.94 to 0.98, P < 0.001) and multicenter cohort (n = 468 urines, R 0.92, P < 0.001) but the 2 assays were not equivalent by Passing–Bablok regression. Linear mixed-effects modeling demonstrated an intercept of −0.490 and coefficient of 1.028, showing Luminex CXCL10 are slightly higher than MSD CXCL10, but the agreement is close to 1.0. After conversion of the biopsy thresholds, the decision to biopsy would be changed for only 6% (5/85) patients showing acceptable reclassification.

Conclusions.
These data demonstrate this urine CXCL10 Luminex immunoassay is robust, reproducible, and accurate, indicating it can be readily translated into clinical HLA laboratories for serial posttransplant surveillance.
Cardiovascular Outcomes in De Novo Kidney Transplant Recipients Receiving Everolimus and Reduced Calcineurin Inhibitor or Standard Triple Therapy: 24-month Post Hoc Analysis From TRANSFORM Study
Authors: Sommerer Claudia , Legendre Christophe , Citterio Franco , Watarai Yoshihiko , Oberbauer Rainer , Basic-Jukic Nikolina , Han Jackie , Gawai Apurva , Bernhardt Peter , Chadban Steve 
Published: March 2023

Background.
The comparative impact of everolimus (EVR)-based regimens versus standard of care (mycophenolic acid+standard calcineurin inhibitor [MPA+sCNI]) on cardiovascular outcomes in de novo kidney transplant recipients (KTRs) is poorly understood. The incidence of major adverse cardiac events (MACEs) in KTRs receiving EVR+reduced CNI (rCNI) or MPA+sCNI from the TRANSplant eFficacy and safety Outcomes with an eveRolimus-based regiMen study was evaluated.

Methods.
The incidence of MACE was determined for all randomized patients receiving at least 1 dose of the study drug. Factors associated with MACEs were determined by logistic regression. Risk of MACE out to 3 y post-study was calculated using the Patient Outcome in Renal Transplantation equation.

Results.
MACE occurred in 81 of 1014 (8.0%; EVR+rCNI) versus 89 of 1012 (8.8%; MPA+sCNI) KTRs (risk ratio, 0.91 [95% confidence interval [CI], 0.68-1.21]). The incidence of circulatory death, myocardial infarction, revascularization, or angina was similar between the arms. Incidence of MACE was similar between EVR+rCNI and MPA+sCNI arms with a higher incidence in prespecified risk groups: older age, pretransplant diabetes (15.1% versus 15.9%), statin use (8.5% versus 10.8%), and low estimated glomerular filtration rate (Month 2 estimated glomerular filtration rate <30 versus >60 mL/min/1.73 m2; odds ratio, 2.23 [95% CI, 1.02-4.86]; P = 0.044), respectively. Predicted risk of MACE within 3 y of follow-up did not differ between the treatment arms.

Conclusions.
Cardiovascular morbidity and mortality were similar between de novo KTRs receiving EVR+rCNI and MPA+sCNI. EVR+rCNI is a viable alternative to the current standard of care in KTRs.
Analyses of vaccine-specific circulating and bone marrow-resident B cell populations reveal benefit of delayed vaccine booster dosing with blood-stage malaria antigens
Authors: Barrett JR , Silk SE , Mkindi CG , Kwiatkowska KM , Hou MM , Lias AM , Kalinga WF , Mtaka IM , McHugh K , Bardelli M , Davies H , King LDW , Edwards NJ , Chauhan VS , Mukherji P , Rwezaula S , Chitnis CE , Olotu AI , Minassian AM , Draper SJ , Nielsen CM 
Published: March 2023

AbstractWe have previously reported primary endpoints of a clinical trial testing two vaccine platforms for delivery ofPlasmodium vivaxmalaria DBPRII: viral vectors (ChAd63, MVA) and protein/adjuvant (PvDBPII with 50µg Matrix-M™ adjuvant). Delayed boosting was necessitated due to trial halts during the pandemic and provides an opportunity to investigate the impact of dosing regimens. Here, using flow cytometry – including agnostic definition of B cell populations with the clustering tool CITRUS – we report enhanced induction of DBPRII-specific plasma cell and memory B cell responses in protein/adjuvant versus viral vector vaccinees. Within protein/adjuvant groups, delayed boosting further improved B cell immunogenicity as compared to a monthly boosting regimen. Consistent with this, delayed boosting also drove more durable anti-DBPRII serum IgG. In an independent vaccine clinical trial with theP. falciparummalaria RH5.1 protein/adjuvant (50µg Matrix-M™) vaccine candidate, we similarly observed enhanced circulating B cell responses in vaccinees receiving a delayed final booster. Notably, a higher frequency of vaccine-specific (putatively long-lived) plasma cells were detected in the bone marrow of these delayed boosting vaccinees by ELISPOT and correlated strongly with serum IgG.Finally, following controlled human malaria infection withP. vivaxparasites in the DBPRII trial,in vivogrowth inhibition was observed to correlate with DBPRII-specific B cell and serum IgG responses. In contrast, the CD4+ and CD8+ T cell responses were impacted by vaccine platform but not dosing regimen, and did not correlate within vivogrowth inhibition in a challenge model. Taken together, our DBPRII and RH5 data suggest an opportunity for dosing regimen optimisation in the context of rational vaccine development against pathogens where protection is antibody-mediated.
A Video Segmentation Pipeline for Assessing changes in Pupil Response to Light After Cannabis Consumption
Authors: Steinhart Benjamin , Brooks-Russell Ashley , Kosnett Michael J. , Subramanian Prem S. , Wrobel Julia 
Published: March 2023

AbstractDue to long-standing federal restrictions on cannabis-related research, the implications of cannabis legalization on traffic and occupational safety are understudied. Accordingly, there is a need for objective and validated measures of acute cannabis impairment that may be applied in public safety and occupational settings. Pupillary response to light may offer an avenue for detection that outperforms typical sobriety tests and THC concentrations. We developed a video processing and analysis pipeline that extracts pupil sizes during a light stimulus test administered with goggles utilizing infrared videography. The analysis compared pupil size trajectories in response to a light for those with occasional, daily, and no cannabis use before and after smoking. Pupils were segmented using a combination of image pre-processing techniques and segmentation algorithms which were validated using manually segmented data and found to achieve 99% precision and 94% F-score. Features extracted from the pupil size trajectories captured pupil constriction and rebound dilation and were analyzed using generalized estimating equations. We find that acute cannabis use results in less pupil constriction and slower pupil rebound dilation in the light stimulus test.
Gata3 is detrimental to regulatory T cell function in autoimmune diabetes
Authors: Kiaf Badr , Bode Kevin , Schuster Cornelia , Kissler Stephan 
Published: March 2023

AbstractRegulatory T cells (Tregs) protect against autoimmunity. In type 1 diabetes (T1D), Tregs slow the progression of beta cell autoimmunity within pancreatic islets. Increasing the potency or frequency of Tregs can prevent diabetes, as evidenced by studies in the nonobese diabetic (NOD) mouse model for T1D. We report herein that a significant proportion of islets Tregs in NOD mice expressGata3. The expression ofGata3was correlated with the presence of IL-33, a cytokine known to induce and expand Gata3+Tregs. Despite significantly increasing the frequency of Tregs in the pancreas, exogenous IL-33 was not protective. Based on these data, we hypothesized that Gata3 is deleterious to Treg function in autoimmune diabetes. To test this notion, we generated NOD mice with a Treg-specific deletion ofGata3. We found that deletingGata3in Tregs strongly protected against diabetes. Disease protection was associated with a shift of islet Tregs toward a suppressive CXCR3+Foxp3+population. Our results suggest that islet Gata3+Tregs are maladaptive and that this Treg subpopulation compromises the regulation of islet autoimmunity, contributing to diabetes onset.
ChatGPT in glioma patient adjuvant therapy decision making: ready to assume the role of a doctor in the tumour board?
Authors: Haemmerli Julien , Sveikata Lukas , Nouri Aria , May Adrien , Egervari Kristof , Freyschlag Christian , Lobrinus Johannes A. , Migliorini Denis , Momjian Shahan , Sanda Nicolae , Schaller Karl , Tran Sebastien , Yeung Jacky , Bijlenga Philippe 
Published: March 2023

ABSTRACTIntroductionChatGPT, a novel AI-based chatbot, sparked a lot of interest in the scientific community. Complex central CNS tumour cases require multidisciplinary expert recommendations that incorporate multimodal disease information. Thus, the potential of ChatGPT to integrate comprehensive treatment information may be of tremendous benefit for CNS tumour decision-making. We evaluated the ChatGPT recommendations for glioma management by a panel of CNS tumour experts.MethodsWe randomly selected 10 patients with primary CNS gliomas discussed at our institution’s Tumour Board. Patients’ clinical status, surgical, imaging, and immuno-pathology-related information was provided to ChatGPT and seven CNS tumour experts. The chatbot was asked to give the most likely diagnosis, the adjuvant treatment choice, and the regimen while considering the patient’s functional status. The experts rated the AI-based recommendations from 0 (complete disagreement) to 10 (complete agreement). An intraclass correlation agreement (ICC) was used to measure the inter-rater agreement.ResultsEight patients (80%) met the criteria for glioblastoma and two (20%) were low-grade gliomas. The experts rated the quality of ChatGPT recommendations as poor for diagnosis (median 3, IQR 1-7.8, ICC 0.9, 95% CI 0.7-1.0), good for treatment recommendation (7, IQR 6-8, ICC 0.8, 95% CI 0.4-0.9), good for therapy regimen (7, IQR 4-8, ICC 0.8, 95% CI 0.5-0.9), moderate for functional status consideration (6, IQR 1-7, ICC 0.7, 95% CI 0.3-0.9), and moderate for overall agreement with the recommendations (5, IQR 3-7, ICC 0.7, 95% CI 0.3-0.9). No difference were observed between the glioblastomas and low-grade glioma ratings.ConclusionsChatGPT performed poorly in classifying glioma types but was good for adjuvant treatment recommendations as evaluated by CNS Tumour Board experts. Even though the ChatGPT lacks the precision to replace expert opinion, it may become a promising tool to supplement experts, especially in low-resource settings.