bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonablative Fractional Laser Treatment Is Associated With a Decreased Risk of Subsequent Facial Keratinocyte Carcinoma Development
Authors: Benson Travis A. , Hibler Brian P. , Kotliar Dylan , Avram Mathew 
Published: February 2023

BACKGROUND
Keratinocyte carcinoma (KC) is the most common type of nonmelanoma skin cancer. Currently, prophylactic treatment options are limited. Nonablative fractional lasers (NAFL) have received the Food and Drug Administration approval for the treatment of actinic damage; however, their role in KC prophylaxis is not known.

OBJECTIVE
The aim of this study is to determine whether NAFL treatment is associated with a decrease in subsequent facial KC development.

MATERIALS AND METHODS
A retrospective cohort study of patients with a history of facial KC treated at the Massachusetts General Hospital Dermatology Laser and Cosmetic Center between 2005 and 2021 was conducted.

RESULTS
Forty-three NAFL-treated patients with a history of facial KC and 52 matched control subjects were included in the study. The rate of subsequent facial KC development was 20.9% in NAFL-treated patients and 40.4% in control subjects (RR 0.52, p = .049). Control subjects developed new facial KC significantly sooner than NAFL-treated patients (p = .033). When controlling for age, gender, and skin type, control subjects were more likely to develop new facial KC than NAFL-treated patients (hazard ratio 2.65, p = .0169).

CONCLUSION
NAFL treatment was associated with a decreased risk of subsequent facial KC development and may have a benefit for KC prophylaxis.
Local Recurrence Rates of Malignant Melanoma After Mohs Micrographic Surgery Are Lowest With 5- to 10-mm Initial Margins: A Systematic Review and Meta-Analysis
Authors: Campbell Elliott H. , Crum Olivia M. , Chelf Cynthia J. , Demer Addison M. , Brewer Jerry D. 
Published: February 2023

BACKGROUND
Current consensus guidelines have discouraged the use of sub-0.5-cm (in situ) and sub-1-cm (invasive) margins when performing Mohs micrographic surgery (Mohs) for melanoma, with minimal evidence to guide this recommendation.

OBJECTIVE
To compare melanoma local recurrence rates after Mohs based on initial margin size.

MATERIALS AND METHODS
A systematic review and meta-analysis was conducted with search terms including Mohs micrographic surgery, surgical margin, recurrent disease, and melanoma.

RESULTS
Forty-three studies were included. The 5- to 10-mm margin category had a statistically significant lower local recurrence compared with 1- to 5-mm and 5-mm categories. Recurrence for 1- to 5-mm, 5-mm, 5- to 10-mm, and 10-mm categories were 2.3% (CI 0.8–3.5, p < .001), 1.4% (CI 0.6–2.2, p < .001), 0.3% (CI 0.2–0.5, p < .001), and 6.1% (CI -6.7 - 18.8, p = .349), respectively. Number of stages for 1 to 5, 5, 5 to 10, and 10-mm categories were 1.8, 1.8, 1.6, and 1.6, respectively. There was no statistically significant difference between the groups (p = .694).

CONCLUSION
Five- to 10-mm margins were associated with the lowest local recurrence rates. A 5- to 10-mm initial margin should be considered where other factors (tumor characteristics, anatomical or functional considerations) allow.
Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit: a review
Authors: Fan Xinhui , Bian Yuan , Wang Guoying , Liu Weikang , Gao Luyao , Pan Yuhui , Cao Shengchuan , Yuan Qiuhuan , Wei Shujian , Xu Feng , Chen Yuguo 
Published: February 2023

Abstract
Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients, point-of-care ultrasound is widely used in the field of emergency and critical care medicine. Researchers have established several classic operating protocols for different diseases, such as acute respiratory failure, shock, and cardiac arrest, in the emergency department and intensive care unit. With further development in the portability and popularity of ultrasonic equipment, it is expected to be used as a new type of technology for physical examination, including inspection, palpation, percussion, auscultation, and insonation, which will improve the clinical medicine practice in the future.
Pregnancy Complicated With a Giant Pancreatic Tumor and Decompensation of Liver Cirrhosis: A Case Report and Literature Review
Authors: Yu Yi , Teng Lirong , Liu Juntao , Liu Xinyan , Peng Ping , Zhou Qian , Liu Congcong 
Published: February 2023

Abstract
Pregnancy with solid pseudopapillary tumor of the pancreas (SPTP) is rare. Because pregnancy hormones may cause tumor progression, the management and treatment of SPTP need to balance the safety of pregnant women and fetuses with surgical treatment. We reported a case of a giant pancreatic tumor diagnosed during pregnancy that was considered to be SPTP. Examinations also showed hepatitis B virus infection and severe decompensation of liver cirrhosis. Medical termination of pregnancy was performed. The patient has lived with the tumor until now without surgery. We retrieved the published case reports, summarized the clinical characteristics of pregnancy with SPTP, and explored its management during the perinatal period. Most patients with SPTP have a good prognosis with good maternal and fetal outcomes, and it is important to choose an appropriate treatment method and timing. However, pregnancy combined with decompensated liver cirrhosis needs to be terminated in a timely manner because of its high-risk status.
Urban-rural differences in epidemiology and risk factors of menopause syndrome in middle-aged Chinese women
Authors: An Junxia , Li Lifei 
Published: February 2023

Abstract

Objective
To compare the prevalence and severity of menopausal symptoms and investigate their associated factors among rural and urban middle-aged Chinese women.

Methods
A descriptive, cross-sectional study of 4,580 urban and 2,729 rural randomly sampled participants aged 40 to 55 years in Gansu Province, China, was conducted. Questionnaires assessing the sociodemographic information and menstrual and reproductive histories of the participants were administered. The modified Kupperman scale was used to assess the presence and severity of menopausal symptoms. Binary and ordinal logistic regression analyses were performed to identify factors associated with the occurrence and severity of menopausal syndrome, respectively, according to the modified Kupperman Menopausal Index score rank.

Results
The natural menopausal age of the rural women was significantly lower than that of the urban women (rural: 47.22, urban: 47.98; P < 0.05). Furthermore, rural women had a higher prevalence (rural: 56.35%, urban: 43.47%) and severity (rural: 11.40%, urban: 6.61%) of menopausal syndrome than the urban women (P < 0.05). For both the urban and rural women, the prevalence and severity of most menopausal symptoms increased as menopause progressed. The three most prevalent symptoms in both the urban and rural women were fatigue (rural: 70.43%, urban: 68.19%), muscle/joint pain (rural: 62.84%, urban: 59.32%), and vertigo (rural: 57.42%, urban: 47.44%). Positive associations between menopausal symptoms and age, residence, body mass index, level of education, time of pregnancy, menstrual cycle, and presence of chronic diseases were observed.

Conclusions
Rural women experience more frequent and severe menopausal syndrome than do urban women.
Effectiveness of vaginal estriol with lactobacilli on urinary symptoms in postmenopausal women: a randomized-controlled trial
Authors: Jongjakapun Apiwat , Somboonporn Woraluk , Temtanakitpaisan Teerayut 
Published: February 2023

Abstract

Objective
The aim of this study was to compare the effects of a vaginal tablet containing estriol (0.03 mg) plus lactobacilli (E3/L) with placebo on lower urinary tract symptoms (LUTS) in postmenopausal women (PMW).

Methods
This randomized, double-blinded, placebo-controlled trial was conducted at Srinagarind Hospital in Khon Kaen, Thailand. PMW with at least one LUTS, such as frequency, nocturia, dysuria, urgency, or stress or urgency urinary incontinence, were recruited. Participants were randomly assigned to receive either an E3/L tablet or placebo, administered vaginally daily at bedtime for 2 weeks, then twice a week for another 2 weeks. Symptom severity score was assessed using a visual analog scale (VAS), and quality of life (QOL) was measured using the validated Thai version of the Incontinence Impact Questionnaire-Short Form. The primary outcome was proportion of the PMW with LUTS improvement. Secondary outcomes were symptom severity score, participant satisfaction, QOL, and adverse events. Relative risk and 95% confidence intervals (CIs) were calculated using the chi-square or Fisher's exact test. An independent-sample and paired t test were used to compare means.

Results
Thirty-eight participants in each group completed the study. The proportion of PMW whose symptoms improved (both in terms of most bothersome symptom and overall) did not differ significantly between the two groups. Relative risk was 1.00 (95% CI, 0.74-1.36) and 0.90 (95% CI, 0.71-1.15), respectively. There were no differences in symptom severity score, participant satisfaction, or QOL.

Conclusions
A 1-month course of vaginal E3/L does not appear to improve LUTS in PMW.
Evaluation of 28-day estradiol and progesterone vaginal rings in a phase 1 clinical pharmacokinetic study
Authors: Hull Louise , Stuckey Bronwyn G. A. , Hartman Kimberly , Zack Nadene , Friend David R. 
Published: February 2023

Abstract

Objective
The aim of this work is to develop a combination of 17β-estradiol (E2) and progesterone (P4) in a single-dose intravaginal ring (IVR) for the treatment of vasomotor symptoms (VMS) and genitourinary syndrome of menopause while providing endometrial protection. The objective of this study was to evaluate DARE-HRT1, a 28-day IVR that continuously delivers E2 and P4, in a phase 1 clinical trial to assess its pharmacokinetics.

Methods
This was an open-label, three-arm (group) study. Thirty-two (32) healthy postmenopausal women were recruited at two Australian sites. The average age was 57.2 years (47-69 y). The first arm received one ring for 28 days designed to release E2 at a rate of 80 μg/d and P4 at 4 mg/d (80/4 IVR); the second arm received a ring releasing E2 at 160 μg/d and P4 at 8 mg/d (160/8 IVR). The third arm received oral Estrofem (1 mg E2) and Prometrium (100 mg P4) both daily for 29 days. Blood samples were taken predose then intensively over the first day (day 1) and periodically thereafter over the remaining 27 days. After removal of the rings on the morning of day 29, intensive samples were collected. Similar procedures were conducted with women enrolled in the oral group. The plasma samples were analyzed for E2, estrone (E1), and P4 using validated bioanalytical methods.

Results
The baseline-adjusted steady-state plasma levels of E2 and P4 from 80/4 IVR were 20.4 ± 17.1 pg/mL and 1.32 ± 0.19 ng/mL (n = 10), respectively. The baseline-adjusted steady-state plasma levels of E2 and P4 from 160/8 IVR were 30.9 ± 8.7 pg/mL and 2.08 ± 0.50 ng/mL (n = 10), respectively. The baseline-adjusted average plasma concentrations of E2 and P4 at day 29 of the oral group were 35.4 ± 11.2 pg/mL and 0.79 ± 0.72 ng/mL (n = 11), respectively. The baseline-adjusted steady state of E1 from the 80/4 IVR and the 160/8 IVR were 22.1 ± 16.6 pg/mL (n = 10) and 25.2 ± 12.3 pg/mL (n = 10), respectively. The baseline-adjusted concentration of E1 in the oral arm was 209 ± 67.7 ng/mL (n = 11). The IVR were well tolerated, and no serious adverse events were reported.

Conclusions
The 80/4 IVR and 160/8 IVR gave similar steady-state concentrations of E2 as seen with drug products approved by the US Food and Drug Administration for treatment of VMS and genitourinary symptoms of menopause. The E2 concentrations of this study support the potential of DARE-HRT1, a promising new option for hormone therapy for treatment of VMS and vaginal symptoms associated with menopause.
Effect of ospemifene on vaginal microbiome in postmenopausal women with vulvovaginal atrophy
Authors: Alvisi Stefania , Ceccarani Camilla , Foschi Claudio , Baldassarre Maurizio , Lami Alessandra , Severgnini Marco , Camboni Tania , Consolandi Clarissa , Seracchioli Renato , Meriggiola Maria Cristina 
Published: February 2023

Abstract

Objectives
This study aimed (i) to compare the vaginal microbiome profiles of women suffering from vulvovaginal atrophy with that of healthy postmenopausal women and to (ii) assess the effect of ospemifene and systemic hormone treatment on the composition of the vaginal microbiome.

Methods
Sixty-seven postmenopausal women attending the Gynecology Clinic of Azienda Ospedaliero-Universitaria of Bologna (Italy) were enrolled. Of them, 39 received a diagnosis of atrophy and 28 were considered healthy controls. In the group of atrophic women, 20 were prescribed ospemifene and 19 received hormone treatment. The vaginal health index was calculated, and a vaginal swab was collected for the assessment of vaginal maturation index and the analysis of vaginal microbiome through 16S rRNA gene sequencing. Clinical/microbiological analyses were repeated after 3 months of treatment.

Results
The vaginal microbiome of atrophic women was characterized by a significant reduction of Lactobacillus (P = 0.002) and an increase of Streptococcus (P = 0.008) and Sneathia (P = 0.02). A positive correlation between vaginal health index/vaginal maturation index and Lactobacillus abundance was found (P = 0.002 and P = 0.035, respectively). Both therapeutic approaches effectively improved vaginal indices. Systemic hormone treatment induced changes in minority bacterial groups of the vaginal microbiome, whereas ospemifene was able to eliminate specific bacterial taxa, such as Staphylococcus (P = 0.04) and Clostridium (P = 0.01). Both treatments induced a trend in the increase of bifidobacteria.

Conclusions
The vaginal microbiome of atrophic women differs significantly from that of healthy postmenopausal women. Ospemifene may lead to a condition of vaginal health, likely characterized by the reduction of “potentially harmful” bacteria.
The Impact of Travel Distance and Income on Breast Reconstruction after Mastectomy in a Rural Population
Authors: Clegg Devin J. , Salomon Brett J. , Porter Christopher G. , Mazonas Thomas W. , Heidel Robert E. , Chun Joseph T. , Herbig Kathleen S. , Stephenson Stacy M. , Lloyd Jillian M. , Boukovalas Stefanos 
Published: February 2023

Background:
Factors that influence breast reconstruction after mastectomy have been previously examined in national databases. The purpose of this study was to determine the impact of patient travel distance and income on breast reconstruction after mastectomy in a rural population.

Methods:
Retrospective review of mastectomy patients from 2017 to 2021 was performed from our prospectively enrolled tumor registry. Analysis included frequencies and percentages, descriptive statistics, χ
2 analysis, independent sample t tests, and multivariable analysis.

Results:
In total, 462 patients were included. Median BMI was 27.6 kg/m2, 96.1% of patients were White, and median age at diagnosis was 60.0 years. Reconstruction rate was 52.6%, and median length of follow-up was 24.6 months. No significant difference was found in the distance traveled by patients who underwent reconstruction (16.6 versus 16.7 miles; P = 0.94). Rates of reconstruction in patients who traveled 0–10 miles, 11–30 miles, and over 30 miles did not differ significantly (P = 0.16). Median household income was significantly different in reconstructed and nonreconstructed patients ($55,316.00 versus $51,629.00; P = 0.047). Rates of reconstruction were significantly higher in patients with median household income greater than $65,000 (P = 0.024). This difference was not significant on multivariable analysis.

Conclusions:
Travel distance did not significantly impact reconstruction rates after mastectomy, while household income did on univariable analysis. Studies at an institutional or regional level remain valuable, especially in populations that may not be accurately represented in larger database studies. Our findings highlight the importance of patient education, resource allocation, and multidisciplinary approach to breast cancer care, especially in the rural setting.
Methods to Account for CAP-88 PC-Omitted Nuclides in Radioactive Air Emissions From DOE Facilities
Authors: Harshman Amber , Scofield Patricia 
Published: February 2023

Abstract
Routine research and development activities at US Department of Energy facilities can result in the release of radioactive emissions, potentially exposing the public and the environment. Such emissions are subject to certain Clean Air Act regulations, specifically those outlined in 40 CFR Part 61, Subpart H, which are enforced by the US Environmental Protection Agency. Compliance is determined in part with a dose standard. Doses to members of the public from most US Department of Energy facility airborne emissions are modeled using CAP-88 PC software, the latest version of which contains more than 1,200 radionuclides. Radioactive effluents from US Department of Energy facilities may contain radioisotopes that are not available in CAP-88 PC, and those radioisotopes must still be evaluated to determine whether doses to members of the public are below established limits. CAP-88 PC-omitted radionuclides can be accounted for using alternate methods, including the use of surrogate radionuclides. This paper elucidates the process of accounting for CAP-88 PC-omitted radionuclides by providing criteria and rationale for surrogate selection, a compilation of surrogate radionuclides used in the past by US Department of Energy facilities, a discussion of alternate methods used to account for CAP-88 PC-omitted radionuclides and a comparison of methods and impacts on receptor doses. Ultimately, this paper aims to aid in the process of surrogate selection and consequently to simplify and expedite compliance with Clean Air Act regulations.
Particle Size Dependent Dissolution of Uranium Aerosols in Simulated Gastrointestinal Fluids
Authors: Yusuf Ibtisam , Hansson Edvin , Eriksson Mats , Roos Per , Lindahl Patric , Pettersson Håkan B. L. 
Published: February 2023

Abstract
Uranium aerosol exposure can be a health risk factor for workers in the nuclear fuel industry. Good knowledge about aerosol dissolution and absorption characteristics in the gastrointestinal tract is imperative for solid dose assessments and risk management. In this study, an in vitro dissolution model of the GI tract was used to experimentally study solubility of size-fractionated aerosols. The aerosols were collected from four major workshops in a nuclear fuel fabrication plant where uranium compounds such as uranium hexafluoride (UF6), uranium dioxide (UO2), ammonium uranyl carbonate, AUC [UO2CO3·2(NH4)2CO3] and triuranium octoxide (U3O8) are present. The alimentary tract transfer factor, fA, was estimated for the aerosols sampled in the study. The transfer factor was derived from the dissolution in the small intestine in combination with data on absorption of soluble uranium. Results from the conversion workshop indicated a fA in line with what is recommended (0.004) by the ICRP for inhalation exposure to Type M materials. Obtained transfer factors, fA, for the powder preparation and pelletizing workshops where UO2 and U3O8 are handled are lower for inhalation and much lower for ingestion than those recommended by the ICRP for Type M/S materials fA = 0.00029 and 0.00016 vs. 0.0006 and 0.002, respectively. The results for ingestion and inhalation fA indicate that ICRP’s conservative recommendation of fA for inhalation exposure is applicable to both ingestion and inhalation of insoluble material in this study. The dissolution- and subsequent absorption-dependence on particle size showed correlation only for one of the workshops (pelletizing). The absence of correlation at the other workshops may be an effect of multiple chemical compounds with different size distribution and/or the reported presence of agglomerated particles at higher cut points having more impact on the dissolution than particle size. The impact on dose coefficients [committed effective dose (CED) per Bq] of using experimental fA vs. using default fA recommended by the ICRP for the uranium compounds of interest for inhalation exposure was not significant for any of the workshops. However, a significant impact on CED for ingestion exposure was observed for all workshops when comparing with CED estimated for insoluble material using ICRP default fA. This indicates that the use of experimentally derived site-specific fA can improve dose assessments. It is essential to acquire site-specific estimates of the dissolution and absorption of uranium aerosols as this provides more realistic and accurate dose- and risk-estimates of worker exposure. In this study, the results indicate that ICRP’s recommendations for ingestion of insoluble material might overestimate absorption and that the lower fA found for inhalation could be more realistic for both inhalation and ingestion of insoluble material.
DynamicMC: An Open-source GUI Program Coupled with MCNP for Modeling Relative Dynamic Movement of Radioactive Source and ORNL Phantom in a 3-dimensional Radiation Field
Authors: Yu Kwan Ngok , Watabe Hiroshi , Zivkovic Milena , Krstic Dragana , Nikezic Dragoslav , Kim Kyeong Min , Yamaya Taiga , Kawachi Naoki , Tanaka Hiroki , Haque A.K.F. , Shahmohammadi Beni Mehrdad 
Published: February 2023

Abstract
The present work introduces an open-source graphical user interface (GUI) computer program called DynamicMC. The present program has the ability to generate ORNL phantom input script for the Monte Carlo N-Particle (MCNP) package. The relative dynamic movement of the radiation source with respect to the ORNL phantom can be modeled, which essentially resembles the dynamic movement of source-to-target (i.e., human phantom) distance in a 3-dimensional radiation field. The present program makes the organ-based dosimetry of the human body much easier, as users are not required to write lengthy scripts or deal with any programming that many may find tedious, time consuming, and error prone. In this paper, we have demonstrated that the present program can successfully model simple and complex relative dynamic movements (i.e., those involving rotation of source and human phantom in a 3-dimensional field). The present program would be useful for organ-based dosimetry and could also be used as a tool for teaching nuclear radiation physics and its interaction with the human body.