bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of lymphadenectomy extent on immunotherapy efficacy in post-resectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study
Authors: Deng Hongsheng , Zhou Juan , Chen Hualin , Cai Xiuyu , Zhong Ran , Li Feng , Cheng Bo , Li Caichen , Jia Qingzhu , Zhou Caicun , Petersen René Horsleben , Rocco Gaetano , Brunelli Alex , Ng Calvin S.H. , D’Amico Thomas A. , Su Chunxia , He Jianxing , Liang Wenhua , Zhu Bo ,   on behalf of the AME Thoracic Surgery Collaborative Group
Published: September 2023

Background:
Lymph node (LN) dissection is a common procedure for non-small cell lung cancer (NSCLC) to ascertain disease severity and treatment options. However, murine studies have indicated that excising tumor-draining LNs diminished immunotherapy effectiveness, though its applicability to clinical patients remains uncertain. Hence, we aim to illustrate the immunological implications of LN dissection by analyzing the impact of dissected LN (DLN) count on immunotherapy efficacy, and to propose a novel “immunotherapy-driven” LN dissection strategy.

Materials and Methods:
We conducted a retrospective analysis of NSCLC patients underwent anti-PD-1 immunotherapy for recurrence between 2018 and 2020, assessing outcomes based on DLN count stratification.

Results:
A total of 144 patients were included, of whom 59 had DLN count≤16 [median, IQR: 11, 7-13]; 66 had DLN count>16 [median, IQR: 23, 19-29]. With a median follow-up time of 14.3 months (95%CI: 11.0-17.6), the overall median PFS was 7.9 (95%CI: 4.1-11.7) months, 11.7 (95%CI: 7.9-15.6) months in the combination-therapy subgroup, and 4.8 (95%CI: 3.1-6.4) months in the immunotherapy alone subgroup, respectively. In multivariable Cox analysis, DLN count≤16 is associated with an improved PFS in all cohorts [Primary cohort: HR=0.26 (95%CI: 0.07-0.89), P=0.03; Validation cohort: HR=0.46 (95%CI: 0.22-0.96, P=0.04); Entire cohort: HR=0.53 (95%CI: 0.32-0.89), P=0.02]. The prognostic benefit of DLN count≤16 was more significant in immunotherapy alone, no adjuvant treatment, pN1, female, and squamous carcinoma subgroups. A higher level of CD8+ central memory T cell (Tcm) within LNs was associated with improved PFS (HR: 0.235, 95% CI: 0.065-0.845, P=0.027).

Conclusions:
An elevated DLN count (cutoff: 16) was associated with poorer immunotherapy efficacy in recurrent NSCLC, especially pronounced in immunotherapy alone subgroup. CD8+Tcm proportions in LNs may also impact immunotherapy efficacy. Therefore, for patients planned for adjuvant immunotherapy, a precise rather than expanded lymphadenectomy strategy to preserve immune-depending LNs is recommended.
Risk assessment of pneumothorax in colorectal lung metastases treated by percutaneous thermal ablation: A multicenter retrospective cohort study
Authors: Fan Hongjie , Xie Xuancheng , Pang Zhenzhu , Zhang Licai , Ding Rong , Wan Cheng , Li Xinghai , Yang Zebin , Sun Jihong , Kan Xuefeng , Tang Bufu , Zheng Chuansheng 
Published: September 2023

Purpose:
To evaluate the risk of pneumothorax in the percutaneous image-guided thermal ablation (IGTA) treatment of colorectal lung metastases (CRLM).

Methods:
Data regarding patients with CRLM treated with IGTA from five medical institutions in China from 2016 to 2023 were reviewed retrospectively. Pneumothorax and non-pneumothorax were compared using the Student’s t test、Chi-square test and Fisher’s exact test. Univariate logistic regression analysis was conducted to identify potential risk factors, followed by multivariate logistic regression (MLR) analysis to evaluate the predictors of pneumothorax. Interactions between variables were examined and used for model construction. Receiver operating characteristic (ROC) curves and nomograms were generated to assess the performance of the model.

Results:
A total of 254 patients with 376 CRLM underwent 299 ablation sessions. The incidence of pneumothorax was 45.5%. The adjusted MLR model, incorporating interaction terms, revealed that tumor number (odds ratio [OR]=8.34 [95% confidence interval [CI]: 1.37-50.64]), puncture depth (OR=0.53 [95%CI: 0.31-0.91]), pre-procedure radiotherapy (OR=3.66 [95%CI: 1.17-11.40]), peri-bronchial tumor (OR=2.32 [95%CI: 1.04-5.15]), and emphysema (OR=56.83 [95%CI: 8.42-383.57]) were significant predictive factors of pneumothorax (all P<0.05). The generated nomogram model demonstrated a significant prediction performance, with an area under the ROC curve of 0.800 (95%CI: 0.751-0.850).

Conclusions:
Pre-procedure radiotherapy, tumor number, peri-bronchial tumor, and emphysema were identified as risk factors for pneumothorax in the treatment of CRLM using percutaneous IGTA. Puncture depth was found to be a protective factor against pneumothorax.
Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients
Authors: Jing Wei , Wu Shengyong , Gao Suizhi , Shi Xiaohan , Liu Wuchao , Ren Yiwei , Ouyang Liu , Zheng Kailian , Guo Shiwei , Wu Cheng , Jin Gang 
Published: September 2023

Background:
Notwithstanding that significant medical progress has been achieved in recent years, the optimal nutritional support method following pancreaticoduodenectomy (PD) remains uncertain. This study compared the safety and feasibility of early oral feeding (EOF) with nasojejunal early enteral nutrition (NJEEN) after PD.

Methods:
A retrospective cohort study was conducted on 428 consecutive patients who underwent PD between August 2018 and December 2020. During the first study phase, the routine postoperative feeding strategy was NJEEN, later replaced by EOF during the second study phase. The primary outcome was the incidence of delayed gastric emptying (DGE) following PD. Propensity score weighting (PSW) was used to control for confounding factors.

Results:
440 patients underwent PD during the overall study period, with 438 patients aged 18 years and older. Ten patients experienced accidental tube dislodgement or migration and were excluded from the study based on the exclusion criteria. Finally, 211 patients and 217 patients underwent EOF and NJEEN, respectively. After PSW, it was observed that patients who underwent postoperative EOF experienced a significantly lower DGE (B/C) rate compared to those who underwent postoperative NJEEN (7.38% (31/424) vs. 14.97% (62/413), P=0.0005). Subgroup analyses according to the presence of soft pancreatic texture yielded consistent results. The EOF group exhibited lower DGE grade, DGE (B/C) rate (5.90% (11/194) vs. 22.07% (43/193), P<0.0001), postoperative gastrointestinal endoscopic intervention rate, and Clavien-Dindo Grade III or higher rate.

Conclusions:
EOF is superior to NJEEN in reducing the incidence of grade B/C DGE after PD. The EOF procedure is safe and feasible and should be recommended as the optimal postoperative feeding method following PD.
Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database
Authors: Park Shin-Hoo , Hur Hoon , Park Jong-Hyun , Lee Chang-Min , Son Young-Gil , Jung Mi Ran , Lee Han Hong , Hwang Sun-Hwi , Lee Moon-Soo , Seo Sang Hyuk , Jeong In Ho , Son Myoung Won , Kim Chang Hyun , Yoo Moon-Won , Oh Sung Jin , Hwang Seong Ho , Il Choi Sung , Choi Hyuk Soon , Keum Bo-Ra , Yang Kyung Sook , Park Sungsoo 
Published: September 2023

Backgrounds:
This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG).

Material and methods:
We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups.

Results:
In endoscopic findings, bile reflux was the lowest in the RY group (n=67), followed by the BII-B (n=183) and BII groups (n=147) at 1 year (3.0% vs. 67.8% vs. 84.4%, all P<0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups.

Conclusions:
BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms, but failed to reduce C30 nausea symptoms, postoperatively.
Change in Health-Related Quality of Life in Youth with Chronic Hepatitis B Living in North America: A 5-Year Cohort Study
Authors: Schwarzenberg Sarah Jane , King Wendy C. , Ling Simon C. , Murray Karen F. , Mogul Douglas , Rosenthal Philip , Rodriguez-Baez Norberto , Teckman Jeffrey , Schwarz Kathleen B. ,   for the Hepatitis B Research Network (HBRN)
Published: September 2023

Background:
Greater hepatitis-related symptomology is associated with lower health-related quality-of-life (HRQoL) among untreated youth with chronic hepatitis B (CHB). How HRQoL changes over time in this population is unknown.

Methods:
Children from 7 hepatology centers in North America positive for hepatitis B surface antigen, not taking anti-viral therapy, were enrolled in the Hepatitis B Research Network. A validated self-report HRQoL measure, the Child Health Questionnaire Child Report (CHQ-CF87), was completed annually by participants 10–17 years, with demographic variables, liver disease symptoms, and laboratory tests. Linear mixed-effects models were used to evaluate the 10 CHQ-CF87 subscale scores over 5 years among participants who completed the CHQ-CF87 at least twice.

Results:
Participants (N = 174) completed the CHQ-CF87 a median of 4 times. Median age was 12 years (interquartile range: 10–14) at baseline; 60% were female, 79% Asian, and 47% adopted. The CHQ-CF87 subscale scores were high at baseline (median range: 75.4–100) and did not differ by time point, except for the Family Activities subscale (mean [95% CI]: 82.3 [79.8–84.8] at baseline; 90.8 [86.1–94.6] week 240). Most subscale scores lacked sufficient individual-level variability in change over time to evaluate predictors. Being White versus Asian predicted a more favorable change in Behavior (6.5 [95% CI: 2.0–11.0]). Older age predicted less favorable change in Mental Health (−0.8 [95% CI: −1.36 to −0.23] per year). Changes in liver enzymes and hepatitis B antigens, DNA, or symptom count were not related to changes in these subscale scores.

Conclusion:
HRQoL was generally good and consistent across 5 years in youth with CHB.
Success rates of endotracheal intubation using the standard method versus the modified-ramped position
Authors: Lotfi Sarah , Mohamadi Mohamad sepehr , Ahmadi Abbas , Rezvani Sourena , Sehat Malihe , Tabaraii Reihane 
Published: September 2023

Background:
The sniffing position used in intubation has disadvantages, including suboptimal glottic view, respiratory problems, increased risk of aspiration, and pain. In this regard, we have proposed new conditions to facilitate intubation and tube placement in patients with a Mallampati score higher than 2, by introducing a new position called the modified rapid airway management positioner (RAMP) position. The authors compared various parameters to improve intubation conditions between these two positions.

Methods:
This intervention is a randomized clinical trial study, with a random sampling method that divides the patients into two groups: a control group placed in the standard position (S) and an intervention group placed in the modified (M) RAMP position. An anesthesiologist performed intubation. In group (S), patients were placed in the supine position as usual, and a pillow with a height of 10 cm was placed under their heads. In group (M), the patients were placed in the supine position on a modified RAMP with a triangular shape, 15 cm in height, and 80 cm in length, at a 30° angle. The pillow had lengths of 20 and 80 cm.

Results:
In the present study, 112 patients were investigated, consisting of 58 women (51.8%) and 54 men (48.2%). The intubation time in the intervention group using the modified RAMP roll technique was significantly shorter (51.25 s) compared to the control group using the standard method (88.39 s) (P=0.019).

Conclusion:
The results of the study showed that the modified RAMP roll improved the general conditions of intubation and led to a better view of the glottis in direct laryngoscopy. This is a very important aspect of intubation, and with a better view of the pharynx and glottis, the intubation procedure can be performed with higher quality, reducing the number of intubation attempts and the duration of the procedure.
Recent advances in three-dimensional ultrasound virtual cystoscopy in modeling and local staging for urothelial carcinoma with histopathological correlation: a cohort prospective study
Authors: Mohamed Hassan Ismail , Aly Mahmoud , Badran Yasser , Fawzy Mohamed , El-damanhory Hany , Gomma Aly , Ghoneimy Osama M. , Abdelaleem Mohamed F. , Elsharkawy Moataz , Fayad Sherif , Zidan Ahmed M. , Soltan Hassan A. , Samih Tamer A.A. , Aboelsaad Ahmed Y. , Abdel Gawad Ahmed M. , Moustafa Bahaa-Eldin Ahmed , Abbas Hesham , Aly Noha M. , Elhawary Reda , Hasan Abdulkarim 
Published: September 2023

Background:
Bladder urothelial carcinoma is an alarming urologic malignancy. Complex factors like modelling and local staging can affect treatment strategy. However, local staging, particularly the muscle invasion status, significantly influences decisions regarding treatment strategies. Therefore, this study aims to evaluate the novel advances of three-dimensional (3D) ultrasound (US) imaging to assess local staging in comparison with conventional cystoscopy.

Methods:
Forty-three patients with painless haematuria and conventional cystoscopy findings of bladder mass underwent 3D US virtual cystoscopy. All specimens from conventional cystoscopy were processed histologically.

Results:
Out of 43 participants, 18 (41.9%) patients proved to have invasive urothelial carcinoma by histopathology. The 3D US had a sensitivity of 97.5% and a specificity of 100%; however conventional cystoscopy was accurate in only 53.5% of the studied cases. Furthermore, in the case of malignant ulcers, mural extension into both the submucosal and the muscle layers was more readily appreciated in multiplanar images.

Conclusion:
3D US updates are promising for use in bladder tumour modelling and local staging; however, they can be of value in evaluating mural and extramural tumour extent and have proven accuracy.
The Research Accelerator Program: A strategic initiative to facilitate interdisciplinary collaboration that advances translational research
Authors: Briody Melissa A. , Rafferty Miriam R. , Fahey Meghan , Sliwa James A. , Lieber Richard L. 
Published: September 2023

ABSTRACT
Developing a culture of innovative thinking and one that emphasizes clinician-researcher interaction is critical for the future of rehabilitation. We designed and implemented a strategy to build a culture of interdisciplinary communication and collaboration that facilitates translational research across several disciplines in our inpatient rehabilitation hospital. We co-located clinicians and researchers in workspaces within a new hospital and created the Research Accelerator Program— a collection of team-focused initiatives that promote communication and collaboration among researchers, clinicians, and other staff. The purpose of this article is to disseminate this strategy, which has increased staff participation in research activities and increased scientific productivity of interdisciplinary research teams over the past eight years.
Examining diversity recruitment efforts in US-Based Physical Medicine and Rehabilitation residencies: A survey of program directors on gender, ethnic and racial diversity and Implications for Recruitment efforts
Authors: Barylski Nicole , Henson Philip , Verduzco-Gutierrez Monica , Escalon Miguel X. 
Published: September 2023

Abstract
As the population of the United States (US) continues to grow and diversify, it is critical that the medical profession follows. This study aimed to evaluate aspects of the current landscape of diversity within physical medicine and rehabilitation (PM&R) by surveying program directors (PDs) of US-based PM&R residencies. The secondary aim was to identify program characteristics that correlate with more diverse residency classes. An online, cross-sectional 17-question survey was distributed to PDs of all US-based PM&R residencies with known contact information (95/100), with a completed survey response rate of 53% (50/95). Race and ethnicity categories of the survey were based on those used by the US Census. The percentages of individuals identifying as women or those underrepresented in medicine (URiM) in this survey were below those of the general US population, a trend also seen within the field of PM&R overall. Linear regression revealed no statistically significant association between the percentage of URiM residents and commonly used diversity recruitment initiatives. There was a significant association between the presence of a departmental role for DEI and the percentage of women residents (OR 1.13; p = 0.017). Continued research is required to identify additional strategies with demonstrated efficacy in recruiting diverse residency applicants.
Doravirine Plus Integrase Strand Transfer Inhibitors as a 2-Drug Treatment–Switch Strategy in People Living with HIV: The Real-Life DORINI Multicentric Cohort Study
Authors: Poliseno Mariacristina , Mazzitelli Maria , Narducci Arianna , Ferrara Sergio Maria , Resnati Chiara , Gervasoni Cristina , Cattelan Anna Maria , Lo Caputo Sergio 
Published: September 2023

Background:
Few data are available about the efficacy, durability, and tolerability of doravirine (DOR) + integrase strand inhibitors (INI) as a switching strategy among antiretroviral therapy (ART)–experienced people living with HIV (PLWH).

Setting:
Retrospective, multicenter cohort study investigating the durability, efficacy, and tolerability of 2 off-label drug associations of DOR + INI among ART-experienced PLWH.

Methods:
The study included PLWH who switched to DOR combined with either raltegravir (RAL) or dolutegravir (DTG) between June 1, 2020, and December 31, 2021, with at least 1 follow-up (FU) visit. Virologic, biometric, and metabolic parameters were evaluated at baseline (T0) and at 1–3 (T1), 6 (T2), and 12 (T3) months. Univariate and multivariate survival analyses assessed the 28-week probability of persistence on the regimens. Patient satisfaction was measured using the HIV Treatment Satisfaction Questionnaire.

Results:
Ninety-five PLWH were included, 52 in DOR + RAL and 43 in DOR + DTG. Six treatment discontinuations were reported during a mean of 37 (±17) weeks of FU (incidence of 2.7 × 1000 person-weeks FU). Only 2 were the result of virological failure without resistance mutations. DOR + DTG demonstrated significantly higher 28-week persistence than DOR + RAL (HR 1.90, 95% CI: 1.24–2.90, log-rank: P = 0.003). Weight, waist circumference, and fasting lipids reduced considerably at T3 vs T0. Overall, high satisfaction with the new treatment was reported, particularly in the DOR + RAL (68 (64–72)/72), compared with the DOR + DTG group (58 (50–65)/72, P< 0.001).

Conclusions:
Our experience revealed few treatment discontinuations, improved metabolic parameters, and high patient satisfaction among ART-experienced PLWH switching to DOR combined with INI, irrespective of the specific INI used.
Effectiveness of an Integrated Ambulatory Care Program in Health Care and Medication Use in Patients With Multimorbidity and Polypharmacy
Authors: Lo Yu-Tai , Chen Mei-Hua , Chen Pin-Hao , Lu Feng-Hwa , Chang Chia-Ming , Yang Yi-Ching 
Published: September 2023

Background and Objectives:
Multimorbidity increases risks, such as polypharmacy, inappropriate prescription, and functional decline. It also increases medical care utilization by older adults, placing a burden on health care systems. This study evaluated the effectiveness of an integrated ambulatory care program for health care and medication use in patients with multimorbidity and polypharmacy.

Methods:
We conducted a retrospective clinical review of adults with multimorbidity and polypharmacy who attended an integrated ambulatory care program at a 1193-bed university hospital between July 1 and September 30, 2019. This program involves multidisciplinary teamwork, comprehensive assessments, medication reviews, and case management. Outcomes, including the frequency of outpatient visits, emergency department visits, hospitalizations, chronic prescription medications, potentially inappropriate medications (PIMs), health care costs, and total medical expenditure, were compared before and after the program.

Results:
The mean age of participants (n = 134) at baseline was 74.22 ± 9.75 years. The mean number of chronic diagnoses was 9.45 ± 3.38. Participants included 72 (53.7%) women. At the 1-year follow-up, participants showed a significant decrease in the annual frequency of outpatient visits (19.78 ± 9.98 to 13.90 ± 10.22, P < .001), emergency department visits (1.04 ± 1.70 to 0.73 ± 1.40, P = .029), and chronic disease medications (10.71 ± 3.96 to 9.57 ± 3.67, P < .001) across all age groups. There was also a reduction in the annual number of PIMs (from 1.31 ± 1.01 to 1.12 ± 0.93, P = .002) among patients aged 65 years. However, no effects were observed on annual hospitalization, duration of hospital stay, or total health care expenditure, possibly due to the high disease-related treatment cost for certain participants.

Conclusions:
Expanding integrated ambulatory care programs in Taiwan may help patients with multimorbidity reduce their use of outpatient and emergency services, chronic prescriptions, and PIMs.