bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis: A prospective single-center study
Authors: Aggarwal Gaurav , Adhikary Samiran Das 
Published: November 2022

Abstract

Background
Noncontrast computed tomography (CT) scan of the kidneys, ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis. With each scan, a patient receives radiation of 18–34 mGy. Dose considerations become pertinent because of a 10% lifetime incidence rate and higher than 50% risk of recurrence, necessitating repeated imaging in the lifetime of a stone former. Hence, this study aimed to assess the sensitivity of “reduced-radiation” CT imaging by altering scan settings to lower than the “standard” norms.

Materials and methods
Altogether, 222 patients (255 “kidney-ureter” stone-bearing units or “renal units”) with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included. All patients were subjected to 3 sequential scans at tube current settings of 250 mA (CT-N/Standard), 100 mA (CT-100), and 50 mA (CT-50) at a constant voltage of 120 kV. Their clinicodemographic and radiological findings were recorded and assessed for significance.

Results
Of the 255 renal units, 117 were between 30 and 44 years of age, 75% were men. Of the 255 patients, 178 (70.1%) reported a first stone episode and 77 had recurrence. Lower ureteric calculi were predominant (40.4%). All calculi were identified on CT-N; CT-100 failed to detect calculi in 1 patient, and CT-50 failed in 3 patients, where all calculi were <3 mm in size. Meanwhile, none were undetected among patients with obesity. The sensitivity was 99.61% for the CT-100 and 98.82% for the CT-50, which indicated a 2.5 and 5 times lower radiation and dose/length, respectively, than CT-N.

Conclusions
The reduced-radiation CT scan is safe, sensitive, and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures. Our study lays the foundation to accept low-dose CT in general and CT-50 in particular, as the new “standard of care,” and attempt further dose reduction without loss of diagnostic efficacy.
The ongoing crisis of abortion care education and training in the United States
Authors: Cahill Erica P. , Meza Pamela K. 
Published: November 2022

Purpose of review
The Dobbs vs Jackson case (Dobbs) decided by the Supreme Court of the United States (SCOTUS) in 2022 rescinded the constitutional right to abortion care, resulting in immediate state bans and severe restrictions on abortion care in almost half of the states at the time of submission. This article reviews the current state of abortion education and training as well as available curricula and programmes to support continued training.

Recent findings
Prior to Dobbs, a national residency-level training programme, the Ryan Residency Training Program, has helped expand abortion care training in residency programs nationally, yet there remained many barriers to incorporating this training into practice, including practice and hospital restrictions. New state restrictions now additionally constrain almost half of all the Ob-Gyn residency programmes. Medical students benefit from education on options counselling and values exploration.

Summary
Abortion care education and training is in crisis. Almost half of the Ob-Gyn residents are training in states that have banned or severely restricted abortion care. This threatens to create a workforce without critical early pregnancy management knowledge and skills. Residents are more likely to provide abortion care when they have scheduled routine training. Medical students can apply options counselling and values exploration knowledge broadly. Online education resources provide some patchwork solutions to continue abortion care education and training in this heavily restrictive landscape.
New treatment options for hormone receptor positive breast cancer in 2023
Authors: Lüftner Diana 
Published: November 2022

Purpose of review
Hormone receptor positive, human epidermal growth factor receptor 2 negative (HR+/HER2-) breast cancer does respond to chemotherapy but can be addressed with a better therapeutic index by using biologically modified endocrine therapy. The most pronounced recent successes were reached by antibody drug conjugates (ADCs).

Recent findings
In early HR+/HER2- disease, adjuvant treatment escalations have taken place for high-risk patients using abemaciclib for the HR+ BRCA- subset and olaparib for HR+ BRCA+ patients. In metastatic spread, among all CDK (cyclin-dependent kinase) 4/6 inhibitors used for first-line therapy, only ribociclib improved overall survival in pre and postmenopausal patients. Palbociclib failed to demonstrate overall survival benefits. New options come up with oral selective oestrogen receptor degraders (SERDs) such as elacestrant, which will replace fulvestrant and is clinically important in combination therapies. ADCs, together with new patient categories such as HER2low or HER3+, enlarge the treatment portfolio and challenge the need of supportive care. The antitrophoblast antigen 2 (TROP2) ADC sacituzumab govitecan improves overall survival in heavily pretreated HR+/HER2- patients by 3.2 months. The best improvement of overall survival was shown bý trastuzumab deruxtecan in less pretreated HER2low (HER2 1+ or HER2 2+/no gene amplification) patients with a gained life span of 6 months.

Summary
Real-world data on the sequence of different ADCs with similar payloads are needed to establish best possible treatment algorithms. All these new agents will find their place after CDK4/6 inhibitor-based endocrine combination therapy.
Assessment of Atherosclerotic Cardiovascular Disease Risk in Primary Prevention
Authors: Rikhi Rishi , Shapiro Michael D. 
Published: November 2022

Purpose:
The objective of this report was to review the application of the pooled cohort equations in primary prevention and the assessment of cardiovascular health.

Review Methods:
Literature review was conducted using the PubMed database. In addition, the 2018 Multi-Society Guidelines on Management of Blood Cholesterol and the 2019 American College of Cardiology/American Heart Association Guidelines on the Primary Prevention of Cardiovascular Disease were reviewed.

Summary:
Primary prevention refers to individuals with no history of atherosclerotic cardiovascular disease, severe hypercholesterolemia, or diabetes. For these adults, aged 40-75 yr, who have a low-density lipoprotein-cholesterol of ≥70 mg/dL and <190 mg/dL, the pooled cohort equations should be used to provide a quantitative assessment of 10-yr atherosclerotic cardiovascular disease risk. From here, individuals are grouped as low risk (<5%), borderline risk (5 to <7.5%), intermediate risk (7.5 to <20%), or high risk (≥20%). Statin therapy should be strongly advised in those with an atherosclerotic cardiovascular disease risk of ≥20%, while statin therapy can be considered in those with a risk between 5% and <20%, especially if risk enhancing factors are present. If uncertainty still exists regarding treatment, a coronary artery calcium score can help further refine risk. All individuals, regardless of atherosclerotic cardiovascular disease risk, should have a cardiovascular health assessment using Life's Essential 8, which includes diet, physical activity, nicotine exposure, body mass index, blood glucose, blood lipids, blood pressure, and sleep.
Screening for Psychological Distress and Risk of Cardiovascular Disease and Related Mortality
Authors: Gaffey Allison E. , Gathright Emily C. , Fletcher Lauren M. , Goldstein Carly M. 
Published: November 2022

Background:
Psychological distress—elevated symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), or psychosocial stress—has been associated with risk for cardiovascular disease (CVD). Despite increasing attention to the importance of these factors for CVD prevention, the state of this science requires updated synthesis to enable practice recommendations. Moreover, it is unknown whether psychological distress based on screeners, validated self-report instruments that efficiently identify those who may require mental health services or additional support, is associated with incident CVD.

Methods:
MEDLINE, Embase, and PsycInfo were searched for studies published 2017-2022, including adults without a past psychiatric diagnosis, who were screened at baseline for depression, anxiety, PTSD, stress, or general mental health symptoms, and followed for >6 mo to determine their risk for incident CVD (ie, atrial fibrillation, acute coronary syndrome, coronary heart disease, peripheral vascular disease, heart failure, or a composite). A meta-analysis was used to aggregate results to determine whether clinically significant levels of psychological distress were associated with CVD onset.

Results:
The search identified 28 investigations that represented 658 331 participants (58% women). Fifteen studies had adequate data for the primary meta-analysis, which indicated that those reporting high psychological distress showed a 28% greater risk of incident CVD compared with those with low or no distress.

Conclusions:
Rapid screening for psychological distress is a helpful and efficient approach to understanding the CVD risk profile of an individual. Additional investigations are needed to improve prospective evidence concerning psychosocial stress. Conducting analyses by sex may better elucidate the benefits of psychological distress screening for men and women, respectively, and encourage more widespread adoption in CVD prevention.
A Randomized Controlled Trial Comparing Microthin Descemet Stripping Automated Endothelial Keratoplasty With Descemet Membrane Endothelial Keratoplasty: Two-Year Report
Authors: Pujari Rathin , Matsou Artemis , Kean Jane , Zhang Jufen , Rajan Madhavan S. 
Published: November 2022

Purpose:
The purpose of this study was to report the 2-year outcomes of a double-blinded randomized controlled trial comparing Descemet membrane endothelial keratoplasty (DMEK) and microthin Descemet stripping automated endothelial keratoplasty (MT-DSAEK).

Methods:
Fifty-six eyes of 56 patients were randomized to DMEK or microthin DSAEK (MT-DSAEK). The main outcome measure was best spectacle-corrected visual acuity (BSCVA) at 24 months. Other secondary outcomes included complications, endothelial cell density, and vision-related quality-of-life (vQoL) scores.

Results:
There was no statistically significant difference in BSCVA between the DMEK and MT-DSAEK groups at the 2-year time point (mean ± SD; 0.04 ± 0.14 vs. 0.12± 0.19, P = 0.061) in contrast to the 1-year results (mean ± SD; 0.04 ± 0.13 vs. 0.11 ± 0.09, P = 0.002) previously reported. Endothelial cell density did not show a statistically significant difference at 24 months between the DMEK and MT-DSAEK groups (1522 ± 293 cell/mm2 vs. 1432 ± 327 cells/mm2, P = 0.27). There were 2 additional graft rejection episodes in the MT-DSAEK group between the 1- and 2-year follow-up periods, but this did not result in graft failure. The mean vQoL scores between DMEK and MT-DSAEK indicated similar patient satisfaction between the groups (97.1 ± 4.0 vs. 92.6 ± 10.2, P = 0.13).

Conclusions:
In summary, the trial showed no significant difference in BSCVA at 24 months between the DMEK and MT-DSAEK groups. Both techniques continued to demonstrate comparable outcomes for complication rates, endothelial cell loss, and patient-reported vQoL scores.

Trial Registration:
ISRCTN10578843.
Temporal fluctuations of cardiovascular parameters after intravitreal injections
Authors: Chiu Hsun-I , Chou Yu-Bai , Lin Tai-Chi , Chiou Shih-Hwa , Chen Shih-Jen , Hwang De-Kuang 
Published: November 2022

Background:
Despite the effectiveness of intravitreal injection (IVI) of anti–vascular endothelial growth factor in treating retinal diseases, there remains a paucity of evidence on potential systemic risks associated with this procedure. This study aims to investigate cardiovascular parameters and the risk of hypertensive urgency after IVIs.

Methods:
Patients who received IVIs for retinal/macular diseases were enrolled retrospectively. Patients who received cataract surgeries were enrolled as controls. Systolic and diastolic blood pressure (BP) and heart rate were measured 10 minutes before, immediately after, and more than 30 minutes after IVIs and cataract surgery. Multivariate analysis was performed to evaluate risk factors for hypertensive urgency.

Results:
Seventy patients who received IVIs and 95 patients who received cataract surgeries were enrolled. A higher preoperative systolic BP was found in the IVI groups than in the control group (147.0 ± 22.9 vs 136.3 ± 21.8 mmHg, respectively). The patients who received IVIs had a higher increase in perioperative systolic BP immediately after the procedure than the controls (17.43 ± 20.53 mmHg vs 9.11 ± 18.92 mmHg, p = 0.009). The IVI procedure (odds ratio [OR] 4.84, p = 0.008), preoperative systolic BP ≥160 mmHg (OR 17.891, p = 0.001, compared to preoperative systolic BP <140 mmHg), and underlying hypertension (OR 3.305, p = 0.041) were risk factors for hypertensive urgency immediately after the IVIs.

Conclusion:
We found a transient increase in BP after IVIs, which may have been associated with hypertensive urgency and related cardiovascular disorders in older patients and in those with relevant comorbidities. Clinicians should pay more attention to these patients before performing IVIs.
Indwelling pleural catheters for benign pleural effusions: a concise review
Authors: Matta Atul 
Published: November 2022

Purpose of reviewBenign pleural effusions (BPEs) are more common than malignant effusions and their treatment involves treating the underlying disease process. However, in cases refractory to medical management, pleural interventions might be necessary. Use of indwelling pleural catheters (IPCs) has been gaining popularity for patients with refractory effusion. In this review, we will focus on reviewing the data assessing safety and efficacy of IPC in patients with BPE related to congestive heart failure (CHF), hepatic hydrothorax, end-stage renal disease (ESRD) and chylothorax.Recent findingsSeveral small studies including the most recent randomized control trial have looked into the efficacy and safety of IPC in BPE. Majority of data come from patients having CHF and hepatic hydrothorax as the underlying cause of the effusion. Limited data are available in patients with ESRD and chylothorax. Time to pleurodesis varies but is relatively higher in this patient population. Caution must be addressed in patients with immunocompromised status given a high risk of infection.SummaryIPCs are increasingly being used in patients with BPE refractory to medical management. They can be used both for palliation and to achieve pleurodesis in some cases. Further data in the form of randomized control trials are still needed to evaluate the efficacy and safety of its use in this patient population.
Evaluation of intravascular irradiation of blood in children with sleep bruxism: Study protocol for a randomized controlled clinical trial
Authors: Viarengo Natalia Osorio , Gonçalves Marcela Leticia Leal , Bruno Laura Hermida , Fossati Ana Laura , Sertaje María Roxana Ferreira , Santos Elaine Marcilio , Sobral Ana Paula Taboada , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Bussadori Sandra Kalil 
Published: November 2022

Background:
The objective of this study will be to evaluate the effect of intravascular irradiation of blood (ILIB) combined with myofunctional exercises for sleep bruxism in pediatrics.

Methods:
This study will be a randomized controlled clinical trial. A triage of individuals between 4 and 17 years old with a diagnosis of sleep bruxism will be carried out at the clinic of the Catholic University of Uruguay, and in a private office referred by different private care centers. The selected participants will be evaluated before and after treatment by means of questionnaires on bruxism, sleep quality and nocturnal oxygen saturation measurement. For this, 46 patients with sleep bruxism will be recruited, who will be divided into 2 groups: control group (CG), which will undergo an application of placebo ILIB and an orofacial myofunctional therapy (MFT) exercise protocol; and na ILIB group, which will carry out an active application of ILIB and an exercise protocol, this being once a week for 8 weeks. The laser treatment (808 nm) will be performed twice a week for 8 weeks. The values will be tested for normality by the Kolmogorov–Smirnov test. For the comparison between the groups, t test will be carried out, considering a level of significance of 0.5% (P < .05).

Discussion:
Although local photobiomodulation (PBM), acupuncture PBM and physiotherapy have been studied in the treatment of bruxism, this is the first study to evaluate the effect of ILIB combined with myofunctional exercises for sleep bruxism in pediatrics.
Inherited antithrombin deficiency caused by a mutation in the SERPINC1 gene: A case report
Authors: Hou Xinwei , Zhang Kairu , Wu Qian , Zhang Mingyuan , Li Li , Li Hongwei 
Published: November 2022

Rationale:
Inherited antithrombin deficiency (ATD) is a major cause of thrombotic deficiency. Genetic testing is of great value in the diagnosis of hereditary thrombophilia. Herein, we report a case of inherited ATD admitted to our hospital. We include the results of genealogy and discuss the significance of genetic testing in high-risk groups of hereditary thrombophilia.

Patient concerns:
A 16-year-old male patient presented with chest tightness, shortness of breath, wheezing, and intermittent fever (up to 39 °C) after strenuous exercise for 2 weeks. He also had a cough with white sputum with a small amount of bright red blood in the sputum and occasional back pain.

Diagnoses:
The blood tests showed that the patient’s antithrombin III concentration and activity were both significantly reduced to 41% and 43.2%, respectively. Enhanced chest computed tomography scans showed pulmonary infarction in the lower lobe of the right lung with multiple embolisms in the bilateral pulmonary arteries and branches. Lower vein angiography revealed a contrast-filling defect of the inferior vena cava and left common iliac vein. Thrombosis was considered as a differential diagnosis. His father and his uncle also had a history of thrombosis. The patient was diagnosed with inherited ATD. Further, peripheral venous blood samples of the family members were collected for whole-exome gene sequencing, and Sanger sequencing was used to verify the gene mutation site in the family. The patient and his father had a SERPINC1 gene duplication mutation: c.1315_1345dupCCTTTCCTGGTTTTTAAGAGAAGTTCCTC (NM000488.4).

Interventions:
An inferior vena cava filter was inserted to avoid thrombus shedding from the lower limbs. Urokinase was injected intermittently through the femoral vein cannula for thrombolysis. Heparin combined with warfarin anticoagulant therapy was sequentially administered. After reaching the international normalized ratio, heparin was discontinued, and oral warfarin anticoagulant therapy was continued. After discharge, the patient was switched to rivaroxaban as oral anticoagulation therapy.

Outcomes:
The patient’s clinical symptoms disappeared. reexamination showed that the thrombotic load was less than before, and the inferior vena cava filter was then removed.

Lessons:
By this report we highlight that gene detection and phenotypic analysis are important means to study inherited ATD.
Pegylated liposomal doxorubicin (PLD)-containing regimen as a novel treatment of monomorphic epithelial intestinal T-cell lymphoma (MEITL): A case report and review of literature
Authors: Chen Yue , Xu Hongzhi , Shan Ningning , Qu Huiting 
Published: November 2022

Introduction:
Monomorphic intestinal T-cell lymphoma (MEITL) is a rare, aggressive peripheral T-cell lymphoma that arises from intestinal epithelial lymphocytes. Currently, MEITL lacks standard treatment options. Under the current treatment regimen, the median survival time for patients is only 7 months. Chemotherapy followed by hematopoietic stem cell transplantation may improve patient outcomes. New anti-lymphoma drugs, including chidamide and PEG-asparaginase, are being tested against MEITL. To our knowledge, there are currently no data on the pegylated liposomal doxorubicin (PLD) regimen for MEITL therapy.
Patient concerns, diagnosis and interventions: We report the case of a 54-year-old patient diagnosed with MEITL who presented with abdominal pain and was treated with a cyclophosphamide, doxorubicin, vincristine, prednisone, etoposide regimen containing PLD.

Outcomes:
After 15 months of follow-up, the patient is currently alive and disease free. The application of doxorubicin liposomes in chemotherapy regimens may be a new way to treat MEITL.

Review:
We searched the literature on MEITL and selected 52 case reports. We summarized the clinical characteristics and treatment of 53 patients (including the current patient).

Conclusion:
It highlights 2 important clinical findings. First, for patients with MEITL treated with the cyclophosphamide, doxorubicin, vincristine, prednisone, etoposide regimen, PLD has fewer adverse reactions and better long-term survival than doxorubicin. Second, an early diagnosis is necessary for prompt treatment. We believe that this manuscript will be valuable to all the researchers who are interested in.
Prognostic study of acute-on-chronic liver failure patients: Usefulness of the fibrosis-4 index
Authors: Watanabe Yusuke , Osaki Akihiko , Waguri Nobuo , Tsuchiya Atsunori , Terai Shuji 
Published: November 2022

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by an acute deterioration of liver function in cirrhotic patients. Since treatment of this condition is difficult, its prevention is of paramount importance. The predictors of ACLF are yet to be identified. To determine the prognosis of cirrhotic and ACLF patients, we conducted a retrospective study to analyze each parameter in ACLF patients.
Cirrhotic patients with serum total-bilirubin level ≥5.0 mg/dL and prothrombin time (PT) value ≤40% after acute insults were diagnosed with ACLF, whereas patients who met one of the above criteria were diagnosed with extended type of ACLF (EX-ACLF). Overall, in this study, 18 ACLF and 16 EX-ACLF patients retrospectively investigated between 2008 and 2020, and each data was analyzed during and before acute insults.
In the analysis during acute insults, renal and coagulation functions showed significant differences between the ACLF and EX-ACLF groups. Furthermore, the mortality rate in the ACLF group was higher than that in the EX-ACLF group. In the analysis before acute insults, aspartate aminotransferase (AST), Fibrosis-4 (FIB-4) index score, and AST to platelet ratio index (APRI) showed significant differences between the two groups. Among these, the FIB-4 index score correlated best with ACLF severity for identifying cirrhotic patients with poor prognosis.
The FIB-4 index is the most useful predictor of ACLF severity. Careful management of cirrhotic patients with a high FIB-4 index score is considered beneficial to prevent ACLF occurrence.