bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic role of early tumor shrinkage in patients with hepatocellular carcinoma undergoing immunotherapy
Authors: Müller Lukas , Gairing Simon Johannes , Kloeckner Roman , Foerster Friedrich , Schleicher Eva Maria , Weinmann Arndt , Mittler Jens , Stoehr Fabian , Halfmann Moritz Christian , Düber Christoph , Galle Peter Robert , Hahn Felix 
Published: September 2022

Abstract
Background
Early tumor shrinkage (ETS) has been identified as a promising imaging biomarker for patients undergoing immunotherapy for several cancer entities. This study aimed to validate the potential of ETS as an imaging biomarker for patients undergoing immunotherapy for hepatocellular carcinoma (HCC).

Methods
We screened all patients with HCC that received immunotherapy as the first or subsequent line of treatment at our tertiary care center between 2016 and 2021. ETS was defined as the reduction in the sum of the sizes of target lesions, between the initial imaging and the first follow-up. The ETS was compared to the radiologic response, according to the modified response evaluation criteria in solid tumors (mRECIST). Furthermore, we evaluated the influence of ETS on overall survival (OS), progression-free survival (PFS), and the alpha-fetoprotein (AFP) response.

Results
The final analysis included 39 patients with available cross-sectional imaging acquired at the initiation of immunotherapy (baseline) and after 8–14 weeks. The median ETS was 5.4%. ETS was significantly correlated with the response according to mRECIST and with the AFP response. Patients with an ETS ≥10% had significantly longer survival times after the first follow-up, compared to patients with < 10% ETS (15.1 months vs. 4.0 months, p = 0.008). Additionally, patients with both an ETS ≥10% and disease control, according to mRECIST, also had significantly prolonged PFS times after the initial follow-up (23.6 months vs. 2.4 months, p < 0.001).

Conclusion
ETS was strongly associated with survival outcomes in patients with HCC undergoing immunotherapy. Thus, ETS is a readily assessable imaging biomarker that showed potential for facilitating a timely identification of patients with HCC that might benefit from immunotherapy.
Development of cellulosic-based hemostatic dressing with antibacterial activity
Authors: Goodarz Mostafa , Behzadnia Amir , Mohammadi Hassan 
Published: September 2022

AbstractA cotton-based hemostatic dressing featuring antibacterial properties was developed with the potential of being used in traffic accidents to control hemorrhage. Cotton gauze was oxidized initially in an acidic medium and then coated by PVA nanofibers and/or PVA nanofibers loaded with Ciprofloxacin. Fabricated dressings were characterized by FTIR analysis and SEM images. The FTIR spectrum showed the existence of carboxyl groups on the oxidized cotton gauze's surface. The carboxyl groups content was estimated to be 17.3 ± 0.3 for the oxidized sample with a mixture of nitric acid and phosphoric acid for 24 h (OCF-Mixed acid24). Moreover, the effect of the exposure duration of cotton gauze in the acidic medium on the blood coagulation activity was assessed. It was observed that the OCF-Mixed acid24 sample exhibited an agreeable hemostatic activity (BCIs = 10). The antibacterial activity against E. coli and S. aureus bacteria was also captured for the coated cotton gauze by the PVA nanofibers loaded with Ciprofloxacin.
Triangulation proves Geum brocade with the horizontal loom of Gojoseon
Authors: Kim Jisu , Na Young-Joo 
Published: September 2022

AbstractGeum (錦, Jin) is a jacquard brocade silk fabric (or doubled~tripled woven) with multi-colored warps. Because patterns are shown by colored yarns of overlapping warp layers, it is dense and stiff, making bulky silhouette of layerlook suitable in cool or dry weather. This fabric is completely different from the drape and lightweight low-density plain weave of ‘China silk’. KyungGeum (經錦, warp direction color yarns) requires a high level of weaving technology, different from WiGeum(緯錦, weft direction color yarns). Geums excavated in Louran and Niya of Xinjiang Autonomous Region, Astana, Pazyrik and Noin-Ula have the pattern of animal flock style of Northern people. The purpose of this study is to find out who wove these Geum fabrics by the triangulation of literatures, relics and loom technology. The pattern was quite complex, so a horizontal and rectangular type of loom or a special loom ‘JeHwa-Ru(製華樓)’ were required. Since the ‘Warring States Period(戰國時代)’ of China, all Han (漢) looms were oblique looms with one heald and KyungGeum production was impossible with these looms. The same is true for vertical looms in Central Asia. Also, the Odes(詩經) and the Shujing(書經) told that barbarian and bandits had weaved KyungGeum. Geum as the special products of Goguryeo and Silla it was exported to China and Japan. Therefore it is reasonable to regard the KyungGeum relics of Niya and of Louran as those from Gojoseon, Goguryeo, Silla(Seres) of Korea, as a result of comprehensive examining the year of production, historical documents, pattern symbolism and loom types.
Choroidal ischemia as one cardinal sign in giant cell arteritis
Authors: Casella Antonio M. B. , Mansour Ahmad M. , EC Souza , do Prado Rodrigo B. , Meirelles Rodrigo , Wong Keye , Yassine Salma , Monteiro Mário Luiz R. 
Published: September 2022

Abstract
Purpose
To describe chorioretinal signs in a case series of Giant Cell Arteritis (GCA).

Methods
This is a multicenter retrospective observational case series with GCA that presented with a headache and an abrupt, unilateral loss in vision. Workup included temporal artery biopsies, intravenous fluorescein angiography, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), blood levels of erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).

Results
There are a total of 8 GCA instances presented. Average age was 74.5. (Range 68–83 years). The patients reported that one eye's visual loss had suddenly started, along with a fresh headache and other systemic symptoms. Eight patients exhibited choroidal ischemia, five paracentral acute middle maculopathy (PAMM) lesions, five cotton wool spots, four anterior ischemic optic neuropathy, and one central retinal arterial occlusion at the time of presentation. The average ESR at presentation was 68 mm/hr (range 4–110), and 4/6 individuals had a significant increase. The mean CRP level was 6.2 mg/dL (range 2.0–15.4), and the level was always over the normal range. All patients' temporal artery biopsies were positive.

Conclusion
Alongside PAMM lesions, cotton wool spots, anterior ischemic optic neuropathy, and central retinal artery occlusion, choroidal ischemia is a key angiographic indicator in the diagnosis of GCA. It may be crucial to recognize these typical ischemic chorioretinal signs while diagnosing GCA.
Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report
Authors: Yanes Ryan R. , Malijan Greco Mark B. , Escora-Garcia Lyka Kymm , Ricafrente Stephanie Angel M. , Salazar Mary Jane , Suzuki Shuichi , Smith Chris , Ariyoshi Koya , Solante Rontgene M. , Edrada Edna M. , Takahashi Kensuke 
Published: September 2022

Abstract
Background
Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid.

Case presentation
We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death.

Conclusion
Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.
The remarkable history of pneumococcal vaccination: an ongoing challenge
Authors: Musher Daniel M. , Anderson Ronald , Feldman Charles 
Published: September 2022

AbstractAlthough it varies with age and geographical distribution, the global burden of infection withStreptococcus pneumoniae(pneumococcus) remains considerable. The elderly, and younger adults with comorbid conditions, are at particularly high risk of pneumococcal infection, and this risk will increase as the population ages. Vaccination should be the backbone of our current strategies to deal with this infection.Main body: This manuscript reviews the history of the development of pneumococcal vaccines, and the impact of different vaccines and vaccination strategies over the past 111 years. It documents the early years of vaccine development in the gold mines of South Africa, when vaccination with killed pneumococci was shown to be effective, even before the recognition that different pneumococci were antigenically distinct. The development of type-specific vaccines, still with whole killed pneumococci, showed a high degree of efficacy. The identification of the importance of the pneumococcal capsule heralded the era of vaccination with capsular polysaccharides, although with the advent of penicillin, interest in pneumococcal vaccine development waned. The efforts of Austrian and his colleagues, who documented that despite penicillin therapy, patients still died from pneumococcal infection in the first 96 h, ultimately led to the licensing first of a 14-valent pneumococcal polysaccharide in 1977 followed by the 23-valent pneumococcal polysaccharide in 1983. The principal problem with these,as with other polysaccharide vaccines, was that that they failed to immunize infants and toddlers, who were at highest risk for pneumococcal disease. This was overcome by chemical linking or conjugation of the polysaccharide molecules to an immunogenic carrier protein. Thus began the era of pneumococcal conjugate vaccine (PCV), starting with PCV7, progressing to PCV10 and PCV13, and, most recently, PCV15 and PCV20. However, these vaccines remain serotype specific, posing the challenge of new serotypes replacing vaccine types. Current research addresses serotype-independent vaccines which, so far, has been a challenging and elusive endeavor.Conclusion: While there has been enormous progress in the development of pneumococcal vaccines during the past century, attempts to develop a vaccine that will retain its efficacy for most pneumococcal serotypes are ongoing.
Vertebroplasty in geriatric patients with osteoporotic vertebral fractures: single-center cohort study at a level 1 center for spinal surgery
Authors: Banat Mohammed , Bara Gregor , Salemdawod Abdallah , Rana Shaleen , Hamed Motaz , Scorzin Jasmin , Vatter Hartmut 
Published: September 2022

Abstract
Study design
Retrospective single-center cohort study.

Background
The spine is the most common anatomic site for osteoporotic fractures. Osteoporotic vertebral fractures play an increasingly important role in geriatric patients and percutaneous vertebroplasty (PVP) constitutes a common treatment option. The aim of this study was to evaluate the safety and efficacy of PVP in geriatric patients with cardiovascular comorbidities at our center.

Methods
In this retrospective single-center study, 49 patients aged ≥ 65 with a total of 88 vertebral fractures underwent vertebroplasty. MRI and CT scans of the spine were performed in all patients prior to surgery. All patients were evaluated 4 weeks after surgery as part of their clinical follow-up. VAS scores were recorded before and after the operation. Postoperative complications within 30 days of the initial surgery were analyzed.

Results
The mean age of patients was 77 years (± 6.4). Of the 49 patients, 39 (80%) were female, and 36 (76%) had cardiovascular comorbidities. The most frequent postoperative complications were cement leakage with no new neurological postoperative deficits (14.3%). The in-hospital mortality rate was 1 out of 49 patients (2%). VAS scores revealed an overall pain reduction of > 97%. None of the following affected patient safety: ASA, BMI, duration of surgery, or the level or localization of vertebroplasty.

Conclusions
Our data demonstrate that vertebroplasty was a feasible and effective treatment for pain reduction in geriatric patients with osteoporotic fractures despite cardiovascular comorbidities.

Level of evidence
3.
Quadratus lumborum (QL1) block in a morbidly obese patient posted for laparoscopic mesh hernia repair: a case report
Authors: Malviya Amit Kumar , Bhoi Debesh , Mohan Virender Kumar , Gupta Anju 
Published: September 2022

Abstract
Background
Quadratus lumborum block has been claimed to provide effective analgesia in abdominal surgeries by covering both somatic as well as visceral pain. However, its utility in morbidly obese patients has not been reported or evaluated.

Case presentation
In this case report, of laparoscopic hernia repair in a morbidly obese patient (weight 110 kg, height 1.53 m, BMI 46.9 kg/m2), there was excellent perioperative analgesia with no rescue opioid consumption in intraoperative period and average VAS score of 3 in 24 h postoperatively. The first recue analgesic was administered in the form of intravenous (IV) diclofenac 75 mg (diluted in 100 ml normal saline) 12 h after surgery when the patient reported a VAS of 5.

Conclusions
QL block is an effective, feasible, and safe option for providing analgesia for laparoscopic hernia repair in morbidly obese patients.
Pathway analysis of sepsis-induced changes gene expression
Authors: Elbakkoush Abdallah Ahmed , Khaleel Anas , Mohamed Albakush Nura Ahmed , Alathamneh Ahmad 
Published: September 2022

Abstract
Background
Sepsis reaction is a response to an infection composed of genetic elements. This research aims to better understand how sepsis affects the molecular pathways in whole blood samples.

Methods
Whole blood samples from healthy controls (n = 18), sepsis nonsurvivors (n = 9), and sepsis survivors (n = 26) were retrieved from the gene expression omnibus (GEO) collection of the national center for biotechnology information (NCBI) (accession number GSE54514). The NCBI's GEO2R program was used to determine differential expression, and the ingenuity pathway analysis (IPA) software was utilized to do a pathway analysis.

Results
In sepsis patients, 2672 genes were substantially differently expressed (p value 0.05). One thousand three hundred four genes were overexpressed, and one thousand three hundred sixty-eight were under-expressed. The inhibition of ARE-mediated mRNA degradation pathway and the Pl3K/AKT signaling spliceosomal cycle were the most significant canonical pathways identified by ingenuity pathway analysis (IPA). The IPA upstream analysis predicted the ESR1, SIRT1, and PTPRR proteins, and the drugs filgrastim and fluticasone were top transcriptional regulators.

Conclusions
The inhibition of ARE-mediated mRNA degradation pathway and the Pl3K/AKT signaling spliceosomal cycle were highlighted as essential pathways of inflammation by IPA, indicating widespread cancer owing to sepsis. Our data imply that sepsis considerably influences gene pathways in whole blood samples, pointing to possible targets for sepsis treatment.
The economics of adaptations to evidence-based practices
Authors: Salloum Ramzi G. , Wagner Todd H. , Midboe Amanda M. , Daniels Sarah I. , Quanbeck Andrew , Chambers David A. 
Published: September 2022

AbstractBackgroundEvidence-based practices (EBPs) are frequently adapted in response to the dynamic contexts in which they are implemented. Adaptation is defined as the degree to which an EBP is altered to fit the setting or to improve fit to local context and can be planned or unplanned. Although adaptations are common and necessary to maximizing the marginal impact of EBPs, little attention has been given to the economic consequences and how adaptations affect marginal costs.DiscussionIn assessing the economic consequences of adaptation, one should consider its impact on core components, the planned adaptive periphery, and the unplanned adaptive periphery. Guided by implementation science frameworks, we examine how various economic evaluation approaches accommodate the influence of adaptations and discuss the pros and cons of these approaches. Using the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME), mixed methods can elucidate the economic reasons driving the adaptations. Micro-costing approaches are applied in research that integrates the adaptation of EBPs at the planning stage using innovative, adaptive study designs. In contrast, evaluation of unplanned adaptation is subject to confounding and requires sensitivity analysis to address unobservable measures and other uncertainties. A case study is presented using the RE-AIM framework to illustrate the costing of adaptations. In addition to empirical approaches to evaluating adaptation, simulation modeling approaches can be used to overcome limited follow-up in implementation studies.ConclusionsAs implementation science evolves to improve our understanding of the mechanisms and implications of adaptations, it is increasingly important to understand the economic implications of such adaptations, in addition to their impact on clinical effectiveness. Therefore, explicit consideration is warranted of how costs can be evaluated as outcomes of adaptations to the delivery of EBPs.
A rare case report of combined metformin-associated lactic acidosis and diabetic ketoacidosis
Authors: Kularathne Yudara , Goh Shaun , Pothiawala Sohil 
Published: September 2022

Abstract
Background
Triad of diabetic ketoacidosis (DKA) comprises of hyperglycemia with serum glucose > 11 mmol/L, high anion gap metabolic acidosis and ketonemia. Hyperlactemia is often noted in patients with DKA. Metformin use is one of the risk factors of hyperlactemia, resulting in high anion gap metabolic acidosis, known as metformin associated lactic acidosis (MALA). This report is of a 60-year-old woman with type 2 diabetes mellitus who presented with combined metformin-associated lactic acidosis MALA and DKA.

Case presentation
A 60-year-old diabetic female presented to the emergency department with complaints of abdominal pain, vomiting and diarrhea. She was on metformin for the last 10 years, but despite compliance to medications, her HbA1c was 14.1. With an aim to improve her glycemic control, linagliptin 5 mg once a day was added 1 month ago. Initial investigations in ED including arterial blood gas analysis revealed metabolic acidosis, ketosis, hyperlactemia, and acute kidney injury. In view of metabolic acidosis and ketosis with elevated blood glucose level, she was diagnosed to have DKA. Compared to isolated DKA, patients with combined MALA and DKA have severe metabolic acidosis, a greater degree of hyperlactatemia but less extensive ketoacidosis. Hence, she was diagnosed to have combined MALA and DKA. She was admitted to intensive care unit and treated with intravenous fluids, insulin infusion, and continuous renal replacement therapy. Her metabolic acidosis, hyperlactemia, and kidney injury resolved and she was discharged well.

Conclusion
This report has shown the importance of rapid diagnosis and management of the rare and challenging diagnosis of combined MALA and DKA. The main goal of therapy is preventing hyperglycemia and ketosis, resolution of metabolic acidosis, and removal of accumulated metformin using intensive therapies like aggressive fluid resuscitation and early initiation of renal replacement therapy. Adjustment of dose of medications is needed to avoid this complication.
Experimental investigation of small-scale shear walls under lateral loads
Authors: Fadallah Reda , Elbayomy Mohamed , Ghith Hatem , Salem Hamed 
Published: September 2022

AbstractShear walls are critical in designing of reinforced concrete structures against lateral loads. Although various research studies have been conducted on the design of reinforced concrete shear walls, these studies were limited by the laboratory capacity. This led to inability of testing walls with their full height for high to mid-rise shear walls. Fortunately, progress in specimen modeling techniques permitted performing scaled experimental studies. This paper presents 11 scaled down reinforced concrete shear walls—with 1/10 scale. The shear walls were cast to investigate various number of parameters. Shear walls have been tested under both monotonic and cyclic lateral loads. The scaled down tested specimens showed a behavior close to that of large-scale shear wall structural elements, not only in monotonic lateral loading, but also, in cyclic loading stiffness degradation and energy dissipation behavior. Experimental results were compared to that estimated by ACI sectional analysis as well as the ACI SP-36 and showed great similitude. The applicability to use the presented methodology is tested, in order to construct and test small-scale models of full-scale shear walls to allow for better understanding shear wall behavior under various loading conditions.