bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging to predict lymphovascular invasion and survival outcome in breast cancer
Authors: Lai Tianfu , Chen Xiaofeng , Yang Zhiqi , Huang Ruibin , Liao Yuting , Chen Xiangguang , Dai Zhuozhi 
Published: October 2022

Abstract
Background
Lymphovascular invasion (LVI) predicts a poor outcome of breast cancer (BC), but LVI can only be postoperatively diagnosed by histopathology. We aimed to determine whether quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can preoperatively predict LVI and clinical outcome of BC patients.

Methods
A total of 189 consecutive BC patients who underwent multiparametric MRI scans were retrospectively evaluated. Quantitative (Ktrans, Ve, Kep) and semiquantitative DCE-MRI parameters (W− in, W− out, TTP), and clinicopathological features were compared between LVI-positive and LVI-negative groups. All variables were calculated by using univariate logistic regression analysis to determine the predictors for LVI. Multivariate logistic regression was used to build a combined-predicted model for LVI-positive status. Receiver operating characteristic (ROC) curves evaluated the diagnostic efficiency of the model and Kaplan-Meier curves showed the relationships with the clinical outcomes. Multivariate analyses with a Cox proportional hazard model were used to analyze the hazard ratio (HR) for recurrence-free survival (RFS) and overall survival (OS).

Results
LVI-positive patients had a higher Kep value than LVI-negative patients (0.92 ± 0.30 vs. 0.81 ± 0.23, P = 0.012). N2 stage [odds ratio (OR) = 3.75, P = 0.018], N3 stage (OR = 4.28, P = 0.044), and Kep value (OR = 5.52, P = 0.016) were associated with LVI positivity. The combined-predicted LVI model that incorporated the N stage and Kep yielded an accuracy of 0.735 and a specificity of 0.801. The median RFS was significantly different between the LVI-positive and LVI-negative groups (31.5 vs. 34.0 months, P = 0.010) and between the combined-predicted LVI-positive and LVI-negative groups (31.8 vs. 32.0 months, P = 0.007). The median OS was not significantly different between the LVI-positive and LVI-negative groups (41.5 vs. 44.0 months, P = 0.270) and between the combined-predicted LVI-positive and LVI-negative groups (42.8 vs. 43.5 months, P = 0.970). LVI status (HR = 2.40), N2 (HR = 3.35), and the combined-predicted LVI model (HR = 1.61) were independently associated with disease recurrence.

Conclusion
The quantitative parameter of Kep could predict LVI. LVI status, N stage, and the combined-predicted LVI model were predictors of a poor RFS but not OS.
Subpleural emphysema as a rare initial manifestation of an iatrogenic tracheal penetration: a case report
Authors: Nakamura Minori , Iizuka Shuhei , Nakamura Toru 
Published: October 2022

Abstract
Background
Iatrogenic tracheal injury is a rare but potentially morbid condition and often poses a diagnostic challenge due to its rarity and the lack of specific clinical findings. Because a delayed diagnosis is associated with a higher mortality, a prompt diagnosis is essential. We report a case of an iatrogenic tracheal injury detected by subpleural emphysema as a rare initial manifestation.

Case presentation
A 75-year-old woman was diagnosed with stage IA2 right lung cancer. During the surgery, visceral subpleural emphysema developed along the lung surface up to the interlobar fissure followed by subcutaneous emphysema in the anterior neck. Suspecting a tracheal injury, we aborted the surgery. Fiberoptic bronchoscopy revealed a longitudinal laceration on the membranous part of the distal trachea without esophageal involvement, consistent with a level II injury. Conservative management was chosen and she had a successful recovery.

Conclusions
Iatrogenic tracheal injury could initially manifest as visceral subpleural emphysema. Once subpleural emphysema is observed during surgery, a prompt diagnostic workup of the tracheal injury should be performed.
Indirect cholecystoduodenal fistula via hepatoduodenal ligament secondary to gangrenous cholecystitis: a case report
Authors: Fukuda Yasunari , Michiura Toshiya , Ito Daisaku , Takahashi Tomohiro , Tokuyama Shinji , Morishita Hiromu , Nuta Junya , Miyazaki Yasuaki , Hayashi Nobuyasu , Yamabe Kazuo 
Published: October 2022

Abstract
Background
Cholecystoduodenal fistula is an infrequent complication of gallbladder diseases. In the majority of cases, the fistula is formed by direct communication between the gallbladder and duodenum due to gallstone impaction in the gallbladder neck. We herein report a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis.

Case presentation
An 80-year-old woman suspected of having emphysematous cholecystitis by a previous doctor was referred to our hospital for urgent surgery. The initial diagnosis based on additional examinations was gangrenous cholecystitis penetrating the hepatoduodenal ligament. Since she did not complain of signs of peritonitis and was taking an anticoagulant medicine, we avoided surgery and selected percutaneous gallbladder drainage (PTGBD) instead. Contrast imaging of the PTGBD tube and upper endoscopy identified the indirect cholecystoduodenal fistula via the hepatoduodenal ligament. Despite repeated attempts at endoscopic fistula closure using clips, the fistula did not close successfully. We therefore performed laparoscopic cholecystectomy and fistula closure. The postoperative clinical course was uneventful, and she left the hospital on postoperative day 15. The resected gallbladder contained small black stones, and a histological examination revealed gangrenous cholecystitis with no malignant signatures.

Conclusion
We encountered a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis that was successfully treated by laparoscopic cholecystectomy and fistula closure. It is important to recognize the possible formation of indirect cholecystoduodenal fistula in cases of gangrenous cholecystitis penetrating the hepatoduodenal ligament.
Laparoscopic hepatectomy for hepatocellular carcinoma in a patient with congenital factor V deficiency: a case report
Authors: Seki Takaomi , Tsukagoshi Mariko , Harimoto Norifumi , Araki Kenichiro , Watanabe Akira , Ishii Norihiro , Hagiwara Kei , Hoshino Kouki , Muranushi Ryo , Kakizaki Satoru , Ogawa Yoshiyuki , Handa Hiroshi , Shirabe Ken 
Published: October 2022

Abstract
Background
Factor V (FV) deficiency is an extremely rare disease, with an incidence of 1 in 1 million. The bleeding symptoms are mild, and the prognosis is good; however, the safety of surgical treatment is unclear, because there are few available reports. Herein, we report a case of hepatocellular carcinoma with congenital FV deficiency in a patient who safely underwent laparoscopic hepatectomy.

Case presentation
A 79-year-old man, diagnosed with hepatocellular carcinoma of liver segment 5, with type C cirrhosis and sustained virological response visited our hospital. He had congenital FV deficiency, and blood tests showed coagulation deficiencies with an FV activity of < 2.6%, prothrombin time activity of 11%, and activated partial thromboplastin time of 100.3 s. Surgery and radiofrequency ablation were considered for treatment. Since the tumor was in contact with the Glissonean pedicle 5 + 6, surgery was judged to be superior from the viewpoint of safety and curability. After discussing the safety of the surgery with a hematologist, it was determined that the operation could be performed safely by transfusing sufficient fresh frozen plasma (FFP). Laparoscopic hepatic segment 5 + 6 subsegmental resection was performed with FFP transfusion, fluid restriction, airway pressure control, and central venous pressure reduction to control the bleeding. Bleeding was minimized during the transection of the liver parenchyma and no bleeding tendency was observed. The operative time was 445 min, and the amount of intraoperative bleeding was 171 mL. No complications, such as postoperative bleeding, were observed, and the patient was discharged on the eighth postoperative day.

Conclusions
Liver surgery can be performed safely in FV-deficient patients with strict coagulation capacity monitoring and appropriate transfusion of FFP. Preoperative evaluation of cardiac function to determine tolerance to high doses of FFP and ingenuity of surgery and intraoperative management to minimize blood loss are important.
The influence of a virtual reality entertainment program on depressive symptoms and sedentary behaviour in inpatient stroke survivors: a research protocol for a pilot randomized controlled trial
Authors: Rash Isabelle , Helgason Megan , Jansons Donna , Mitchell Lindsay , Sakakibara Brodie M. 
Published: October 2022

Abstract

Background

Sedentary behaviour among stroke inpatients may be due to high rates of depressive symptoms after stroke. Thus, efforts to address depressive symptoms among stroke inpatients are warranted to in turn lessen sedentary behaviour. Despite evidence that virtual reality (VR) is emerging as a method to help with depression, the use of VR to improve depression among inpatient stroke survivors has yet to be studied. In this paper, we report on the protocol investigating the feasibility of a VR entertainment system at improving depressive symptoms among stroke survivors receiving inpatient rehabilitation.

Methods
In this single-blind randomized controlled trial, 30 inpatient stroke survivors from the rehabilitation unit at Kelowna General Hospital will be randomized to either (1) intervention: 3 times per week of VR entertainment for duration of inpatient rehabilitation or (2) control: usual care. Individuals will be included if they have a confirmed diagnosis of stroke, are 19 years of age or older, able to provide informed consent, have physician clearance to participate in the study (medically stable or fit), or are able to understand English. Outcome measures to address depressive symptoms (primary outcome), sedentary behaviour, motivation, anxiety, stress, and happiness (secondary outcome) will be administered at two timepoints: (1) baseline (T1) and (2) post-intervention (T2). Study analyses will consider study feasibility indicators and clinical (statistical) outcomes. Means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) will be used to summarize the variables. Feasibility indicators will be dichotomized into either ‘success’ if they meet the a priori criteria, or ‘revise’ if they do not meet the criteria. Intervention effects post-intervention (T2) for the primary and secondary clinical outcomes will be estimated using linear regression including baseline (T1) controlling for age and sex.

Discussion
The results of this trial will add to our understanding of depression and sedentary behaviour among individuals receiving inpatient stroke rehabilitation as well as the feasibility of a VR entertainment program to improve depressive symptoms, which will in turn may lessen sedentary behaviour in inpatient stroke survivors.

Trial registration
ClinicalTrials.gov Identifier: NCT04011202
. First posted July 8, 2019 (study postponed from March 2020 to July 2021 due to COVID-19).
Subaxial cervical spine ligamentous instability anterior versus posterior fixation: prospective nonrandomized study
Authors: Moawad Ahmed M. , El-Sawy Medhat M. 
Published: October 2022

Abstract
Background
The goals of cervical internal fixation are to provide immediate stability to control an unstable segment and to improve bony union. Early cervical fixation methods preferred a posterior approach and consisted of simple wire and cancellous bone graft. Later, anterior, and posterior fixation became recent additions to surgeon’s armamentarium.

Objectives
Comparing between anterior and posterior fixation in cervical subaxial ligamentous subluxation regarding the applicability, safety, and clinical efficacy in achieving stability and enhancing bony union. Also cost-related variables are studied.

Methods
This prospective clinical and radiographic analysis was performed on 40 patients with cervical subaxial ligamentous subluxation. Half of these patients were treated with anterior cervical fixation and interlocking screws with inter-body cage fusion. The other half was treated by posterior fixation with lateral mass fixation and inter-facet bone fusion.

Results
There were 27 male and 13 female patients with mean age 37.4 years. The level of cervical dislocation was C4–5 in four, C5–6 in 14, C6–7 in 20 and more than one level in two patients. Closed reduction was achieved in 33 patients while open reduction through the posterior approach was done in four cases and through anterior approach in other three cases. Statistically significant difference between the two groups was found for estimated blood loss and operating room time with better results in the anterior group. There were no perioperative deaths in both groups. Regarding surgery-related complications, there was injury to a cervical root during posterior fixation in two cases. There was no statistical difference between the two groups regarding the length of the hospital stay. The mean hospital stay was 7 days. Positioning of the plate and screws in all cases was satisfactory. All patients were followed up for at least 6 months. Mean follow-up period was 13 months. Vertebral body alignment (radiological stability) was achieved in all cases with anterior fixation while one case with posterior fixation showed delayed subluxation. Solid bony cage fusion was found in 85% with anterior fixation and solid bony fusion in 70% with lateral mass fixation.

Conclusions
Although some of the literature have indicated that posterior fixation in ligamentous cervical subaxial injury is more solid than anterior fixation, yet most of these studies were done on cadaver subjects so eliminating any bony fusion, long-term stability, and hardware failure. This study proved that anterior cervical fixation is not only safer and simple procedure than posterior fixation, but also it restores the cervical stability better than the posterior fixation.
THC degradation does not impair the accuracy of THC doses aerosolized by the metered-dose SyqeAir inhaler: a 24-month stability trial
Authors: Aviram Joshua , Atzmony Daniella , Frenklakh Anna , Kroll Asaf , Zaks Ilana , Hazekamp Arno 
Published: October 2022

Abstract
Background
Although the worldwide use of medical cannabis (MC) is on the rise, there is insufficient data regarding the long-term stability of phytocannabinoids in the plant material under different storage conditions. Specifically, there is insufficient data on the effect of storage conditions on the availability of (-)-∆9-trans-tetrahydrocannabinol (THC) in vaporized cannabis. The Syqe inhaler delivers metered doses of phytocannabinoids by inhalation and utilizes accurate quantities of ground cannabis inflorescence packaged in tamper-proof cartridges. We aimed to assess the stability of phytocannabinoids in ground cannabis before and after packaging in Syqe cartridges as well as the reproducibility of THC delivery in the aerosolized dose.

Methods
Ground MC inflorescence was stored under different temperature and humidity conditions, before or after being packaged in Syqe cartridges. Concentrations of the major phytocannabinoids therein were analyzed at different time points using ultra-high performance liquid chromatography (U-HPLC). THC doses aerosolized via the Syqe inhaler were evaluated using cartridges stored for up to 2 years at 25°C. Every vapor chip contains 13.5±0.9 mg of ground MC powder.

Results
No significant changes were observed in phytocannabinoid concentrations in ground cannabis inflorescence after 3 months of bulk storage in a polypropylene container and sealed in an aluminum foil pouch at 5°C. In contrast, significant changes in phytocannabinoid concentrations were found when ground inflorescence was stored in the cartridges at 25°C for 2 years. Specifically, CBGA, THCA, and total THC concentrations decreased from 0.097±0.023, 2.7±0.3, and 2.80±0.16 mg/chip at baseline to 0.044±0.007 (55% decrease), 1.50±0.27 (44% decrease), and 2.20±0.083 (21% decrease) mg/chip following 2 years, respectively, while CBN and THC concentrations increased from 0.005±0.005 and 0.44±0.11 mg/chip at baseline to 0.14±0.006 (2700% increase) and 0.88±0.22 (100% increase) mg/chip following 2 years, respectively. Storage at 30°C revealed a steeper change in phytocannabinoid concentrations within an even shorter period. Despite the significant change of relative cannabinoid composition within the cartridge, the actual THC dose present in the aerosol remained relatively stable throughout this period and within the dosage range of 500mcg±25% required for pharmaceutical-grade inhalers.

Conclusions
MC powder in Syqe cartridges may be stored at room temperature for at least 2 years after production without affecting the aerosolized THC dose delivered to patients by more than ±25%. Future studies should analyze additional phytocannabinoids and terpenes in the cannabis inflorescence and assess the stability of different cannabis cultivars following storage in Syqe cartridges.
CD44+/CD24- Expression as predictors of ovarian cancer chemoresistance: immunohistochemistry and flow cytometry study
Authors: Sihombing Unedo Hence Markus , Andrijono Andrijono , Purwoto Gatot , Gandamihardja Supriadi , Harahap Alida R. , Rustamadji Primariadewi , Kekalih Aria , Widyawati Retno , Fuady Dzicky Rifqi 
Published: October 2022

Abstract
Background
The conventional standard treatment for ovarian cancer is not very effective, and the disease is fatal for women. Cancer Stem Cells (CSCs) that express CD44+/CD24- can contribute to chemoresistance and a poor prognosis. We seek to investigate the expression of CSCs (CD44+/CD24-) in ovarian cancer and their predictive significance.

Methods
The ambispective cohort was performed on 64 patients (32 patients in each group) at four hospitals (Cipto Mangunkusumo, Tarakan, Fatmawati, and Dharmais Hospital). Debulking surgery was performed on the patients, followed by histopathological analysis. The patients had six rounds of chemotherapy and were under monitoring for six months. The therapeutic responses were evaluated using the RECIST criteria (Response Criteria in Solid Tumors) and categorized as chemoresistant or chemosensitive. Using immunohistochemistry, we directly assess the CSCs from ovarian cancer tissue and using flow cytometry to assess the CSCs from the blood.

Results
High CSCs expression and ovarian cancer chemoresistance were significantly related in both trials (p 0.05). A better outcome was obtained using CD44+/CD24- immunohistochemistry.

Conclusions
We conclude that there is a substantial association between high CSCs expression and chemoresistance in ovarian cancer and that CSCs immunohistochemistry has a higher predictive value.
The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms
Authors: Lewis Cara C. , Klasnja Predrag , Lyon Aaron R. , Powell Byron J. , Lengnick-Hall Rebecca , Buchanan Gretchen , Meza Rosemary D. , Chan Michelle C. , Boynton Marcella H. , Weiner Bryan J. 
Published: October 2022

Abstract
Background
There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. This research project aims to identify plausible strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The specific aims are as follows: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams, (2) develop psychometrically strong, pragmatic measures of mechanisms, and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders.

Methods
For the first aim, a combination of qualitative inquiry, expert panel methods, and causal pathway diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid-cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms of common strategies for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database that incorporates user-centered design, disseminating the final product using social marketing principles.

Discussion
Once strategy-mechanism linkages are identified using this multi-method approach, implementation scientists can use the searchable database to develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be more attainable as a result of this research, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.
Correlation of hearing outcome in otic capsule sparing temporal bone fractures using temporal bone sub-site classification: a cross-sectional descriptive study
Authors: Keshavamurthy Venkatesha Belur , Ajith K. M. , Maradi Nagaraj , Gupta Richa , Jain Suhani 
Published: October 2022

Abstract
Background
Head injury most commonly occur following road traffic accidents. Often hearing loss and other otological injuries are missed in view of serious head injury or other visible bodily injuries, leading to delayed recognition of problems. There is a need for early clinical and radiological indicators which can predict adverse outcome. Early diagnosis of otological injury during initial evaluation of the head injury has given some clues regarding the severity of hearing outcomes and such correlation has been attempted in this study. Two-year cross-sectional study involving head injury patients with radiological evidence of temporal bone fracture were assessed for hearing impairment.

Results
Thirty-seven patients who satisfied the inclusion criteria were assessed. Fifty-one percent patients had conductive hearing loss. 35.14% of the patients had involvement of mastoid, external auditory canal, and middle ear involvement. A weakly positive correlation was noted between otic capsule sparing fracture and hearing loss. (R value + 0.2064).

Conclusion
Weak correlation was observed between temporal bone sub-site classification and severity of hearing loss in otic capsule sparing temporal bone fractures.