bluuebunny/crossref_metadata_2025 huggingface dataset:
Infrastructure and Inequality in Washington, D.C.: Environmental Change and Federal Management of the District’s Forgotten River
Authors: Shapiro Justin
Published: November 2024

The District of Columbia has long served as a test case for federal planning priorities. Congress has jurisdiction over the District, and has historically delegated different agencies to administer the capital on its behalf. Those agencies have been given wide latitude to build the District according to their vision for a grand and monumental capital city, often to the exclusion of city residents. This article provides a detailed history of the Kenilworth neighborhood of Washington, D.C., which was home to the city’s main garbage dump and a nearby public housing complex. The history of infrastructure in Kenilworth shows how the District has balanced the desire for a clean, monumental capital against the interests of many low-income, Black communities. By doing so, it did not isolate Kenilworth from the rest of the city, but instead deeply intertwined its fate with those of the communities surrounding it.
Optimal control and zero-sum differential game for stochastic uncertain systems with randomness and uncertainty
Authors: Chen Xin , Lu Ziqiang , Shao Yu , Yuan Dongmei
Published: November 2024

This paper presents a stochastic uncertain system characterized by a differential equation involving multiple Wiener processes and uncertain matrices. Our study delves into the realm of chance theory to address problems related to optimal control and zero-sum differential games within this stochastic uncertain framework. Based on the properties of both the Wiener processes and the uncertain matrices, we present an equation of optimality tailored for solving stochastic uncertain optimal control problems. Leveraging this equation, we derive analytical optimal solutions for both bang–bang and linear quadratic control problems. Furthermore, we extend our results to encompass the domain of zero-sum differential games, proposing equilibrium equations to identify the saddle point equilibrium in stochastic uncertain zero-sum games. The practical applicability of our theoretical framework is demonstrated through the analysis of a counterterrorism game scenario.
Caregiver-Implemented Interventions to Improve Daily Living Skills for Individuals With Developmental Disabilities: A Systematic Review
Authors: Liu Renming , Gerow Stephanie , Lory Catharine , McGinnis Kristina , Cosottile David
Published: November 2024

Many individuals with intellectual and developmental disabilities (DD) encounter difficulties in performing daily living skills, which limits their self-sufficiency and autonomy. Caregivers, such as parents, are often the individuals who interact with individuals with DD the most during daily living skills routines. Therefore, it is critical to teach caregivers to implement daily living skills interventions with their children. A systematic review of the literature related to caregiver-implemented daily living skills interventions yielded 38 articles. Of those, 20 articles, with 21 experiments, were rated as high quality based on What Works Clearinghouse design standards. Behavior skill training was the most common strategy used to teach caregivers to implement interventions. Common daily living skills interventions included prompting, reinforcement, and task analysis. The most common form of prompting was verbal prompting, and the most common schedule of reinforcement was a continuous schedule of reinforcement. Of the 21 high-quality experiments, 86% demonstrated caregiver-implemented interventions yielded improvements in daily living skills. Several studies demonstrated generalization and maintenance of daily living skills. Implications for research and practice are discussed.
Early Childhood Teachers’ Perceptions, Experiences, and Needs Related to the Inclusion of Autistic Children in a Developing Country
Authors: Kim Casey K. , Hardy Jessica K. , Corr Catherine
Published: November 2024

We examined the experiences of early childhood teachers (ECTs) in the Philippines, a representative low-resource setting (LRS), focusing on the challenges and opportunities in providing inclusive education for autistic children. Using the socio-ecological model as a framework, we analyzed interview data from eight participants through inductive and deductive coding. The analysis revealed key themes across individual, interpersonal, organizational, community, and public policy levels. Our findings highlight significant disparities between the needs of ECTs in supporting autistic children and the available resources, emphasizing the need for targeted professional development and systemic support. Our results offer insights into the factors affecting inclusive education in LRS contexts and proposes strategies to address these challenges. The results contribute to a broader understanding of inclusive education in LRS and suggest directions for future research and policy development.
The Donnan equilibrium is still valid in high-volume HDF
Authors: Gross Malte , Gagel Alfred , Maierhofer Andreas
Published: November 2024

Clinical studies have shown that hemodiafiltration reduces morbidity and mortality of dialysis patients compared to hemodialysis alone. This is attributed to its superior middle molecule clearance compared to standard hemodialysis. However, doubts arose as to whether a high convective flux through the dialyzer membrane has an influence on the equilibrium concentration of small ions, especially that of sodium. Due to the presence of negatively charged impermeable proteins on the blood side, the Gibbs-Donnan effect leads to an asymmetric distribution of membrane permeable ions on both sides of the membrane. In thermodynamic equilibrium, the concentrations of those ions can easily be calculated. However, the convective fluid flow leads to deviations from thermodynamic equilibrium. In this article, the effect of a convective flow on the ion distribution across a semipermeable membrane is analyzed in a theoretical model. Starting from the extended Nernst-Planck equation, including diffusive, convective, and electrostatic effects, a set of differential equations is derived. An approximate solution for flow speeds up to 0.1 ms−1 as well as a numerical solution are given. The results show that in any practical dialysis setting the convective flow has negligible influence on the electrolyte concentrations.
Beyond the Badge: A Critical Commentary on B. Beyer's “Rethinking the False Confession Phenomenon”
Authors: Sorochinski Marina
Published: November 2024

This critical commentary thoroughly analyzes “Rethinking the False Confession Phenomenon” by Bradford Beyer, a book that purports to provide a law enforcement viewpoint on the contentious issue of false confessions. The review methodically analyzes Beyer's arguments, emphasizing the multiple factual errors, logical flaws, and misinterpretations of well-established research. The argument posits that Beyer's endeavor to challenge well-established, scientifically valid, and globally recognized research with personal stories, a solitary, limited qualitative study on polygrapher viewpoints, biased data presentation, and unsupported assertions regarding the flawless nature of police interrogation methods weakens the persuasiveness of his arguments and undermines both the credibility of his arguments and the potential utility of the book in contributing to informed discussions on criminal justice reforms.
Successful Adaptation to Type 2 Diabetes Mellitus (DM2): A Qualitative Study
Authors: Kumar Vipul , Kohli Neena
Published: November 2024

When diabetes unexpectedly enters someone’s life, it starts interfering with every aspect of life, requiring them to make adjustments, adapt and carefully manage their lifestyle. The objectives of this qualitative research were (a) understanding the patients’ perceptions about type 2 diabetes and (b) the process of successful adaptation. The study sample consisted of 47 individuals with type 2 diabetes mellitus, aged 37 to 65 years (mean = 55.44; standard deviation [SD] = 8.56). Among them, 23 (49%) were male and 24 (51%) were female. Data were collected through a semi-structured interview schedule, which tapped information regarding demographics such as age, gender, timeline, educational qualification, and socio-economic status. The semi-structured interview schedule also comprised open-ended questions related to the meaning of diabetes, cognitive and emotional reactions, and appropriate actions for adapting to diabetes. Thematic analysis was performed to analyse and summarise the data from a theoretical perspective. The findings revealed that themes of adaptation can be divided into four broad categories: layperson’s understanding of diabetes, mastery, survival competence, and successful adaptation. Patients with diabetes make many attempts to control their diabetes as advised by healthcare professionals, other diabetics and close friends. The results showed that, despite the fact that diabetes ruins their entire lives, patients attempt to cope with diabetes by trying to make sense of their condition.
Attentional Control: Institutions, Management, Organizations, and Algorithms
Authors: Ocasio William
Published: November 2024

This paper presents my development of an integrated, cross-level theory of attentional control in macro-organizational behavior. Viewing organizations as complex adaptive systems of joint and distributed attention, the paper highlights the importance of attention in facilitating joint attention, collective intentionality, coordinated action, and adaptation. The theory posits that intentional organizational behavior is shaped by top-down attentional control mechanisms: institutions and institutional logics, organizational structures and processes, managers and management, and, in the digital age, algorithms. I trace the theory's roots to my personal, educational, and professional experiences, emphasizing the need for integration across perspectives, interdisciplinary and multilevel research, and connecting research to practitioners’ needs. I conclude by calling for a more unified understanding of organizational phenomena through a theory of attentional control and encourage dialogue across scholarly communities to build a more integrative and impactful organizational science.
Work-related stress among sworn and non-sworn law enforcement personnel
Authors: Nam Yoon-Sung , Frazier Patricia A , Everson-Rose Susan , Kim Hyun , Ryan Andrew D , Ramirez Marizen R
Published: November 2024

Sworn law enforcement personnel in the United States face high rates of work-related stress. Yet, the well-being of more than 300,000 non-sworn personnel, particularly regarding work-related trauma and stress, remains underexplored. This study aims to test the hypothesis that non-sworn personnel experience lower levels of stress, comparing stress and probable post-traumatic stress disorder (PTSD) between sworn and non-sworn personnel. The study recruited 283 sworn and 85 non-sworn personnel from two large urban law enforcement agencies in the Twin Cities, Minnesota, between May and October 2021, coinciding with the COVID-19 pandemic and the civil unrest following the murder of George Floyd. Participants completed an online survey measuring perceived work-related stress (organizational and operational) and PTSD validated by PTSD Checklist for DSM-5 (PCL-5) questionnaire. The study considered different intensities of exposure to COVID and civil unrest, demographics, and worker characteristics as covariates in linear regression models, comparing stress outcomes among sworn and non-sworn personnel. The results showed no significant difference in operational and organizational stress levels between groups, except regarding pension eligibility (non-sworn < 5 years, sworn < 10 years). Non-sworn personnel not yet pension-eligible reported lower organizational stress (β = −10.1, CI = −18.84, −1.36). PCL-5 scores averaged 20.2 ± 17.4 for sworn and 23.6 ± 19.1 for non-sworn personnel, indicating no significant difference in probable PTSD (β = 3.24, CI = −4.19, 10.67). Both groups experienced similar stress levels, though non-sworn personnel ineligible for pension benefits showed lower organizational stress. These findings underscore the importance of targeted interventions and enhanced mental health services for all law enforcement personnel, regardless of classification.
Machine learning-driven discovery of novel therapeutic targets in diabetic foot ulcers
Authors: Yu Xin , Wu Zhuo , Zhang Nan
Published: November 2024

Background

To utilize machine learning for identifying treatment response genes in diabetic foot ulcers (DFU).

Methods

Transcriptome data from patients with DFU were collected and subjected to comprehensive analysis. Initially, differential expression analysis was conducted to identify genes with significant changes in expression levels between DFU patients and healthy controls. Following this, enrichment analyses were performed to uncover biological pathways and processes associated with these differentially expressed genes. Machine learning algorithms, including feature selection and classification techniques, were then applied to the data to pinpoint key genes that play crucial roles in the pathogenesis of DFU. An independent transcriptome dataset was used to validate the key genes identified in our study. Further analysis of single-cell datasets was conducted to investigate changes in key genes at the single-cell level.

Results

Through this integrated approach, SCUBE1 and RNF103-CHMP3 were identified as key genes significantly associated with DFU. SCUBE1 was found to be involved in immune regulation, playing a role in the body’s response to inflammation and infection, which are common in DFU. RNF103-CHMP3 was linked to extracellular interactions, suggesting its involvement in cellular communication and tissue repair mechanisms essential for wound healing. The reliability of our analysis results was confirmed in the independent transcriptome dataset. Additionally, the expression of SCUBE1 and RNF103-CHMP3 was examined in single-cell transcriptome data, showing that these genes were significantly downregulated in the cured DFU patient group, particularly in NK cells and macrophages.

Conclusion

The identification of SCUBE1 and RNF103-CHMP3 as potential biomarkers for DFU marks a significant step forward in understanding the molecular basis of the disease. These genes offer new directions for both diagnosis and treatment, with the potential for developing targeted therapies that could enhance patient outcomes. This study underscores the value of integrating computational methods with biological data to uncover novel insights into complex diseases like DFU. Future research should focus on validating these findings in larger cohorts and exploring the therapeutic potential of targeting SCUBE1 and RNF103-CHMP3 in clinical settings.
The use of bedside case-based learning in the clinical practice of midwifery education in China
Authors: Zhang Yao , Xu Xinfen , Wang Fang , Tu Lewei , Deng Qinqi , Xu Mengyan , He Guijuan , Johnston Linda
Published: November 2024

Aim

This study aimed to investigate the impact of bedside case-based learning on critical thinking and capacity for self-directed learning in a group of midwifery students in China.

Background

Bedside teaching is a well-established educational tool to improve the clinical practice of medical, nursing, and midwifery students. A new pedagogical approach; bedside case-based learning (BCBL) is an interactive teaching approach involving small-group, student-educator discussion to describe the etiology and management of a patient case. This new approach has been gradually integrated into Chinese midwifery education programs to promote clinical problem-solving skills, knowledge application, teamwork, and collaboration.

Design

A quasi-experimental pre-test-post-test group design.

Methods

This study used a quasi-experimental pre-test-post-test group design. A convenience sample of 67 third-year students majoring in midwifery at the university were prospectively enrolled in this study. Pre- and post-BCBL class surveys were conducted using the Self-Rating Scale of Self-Directed Learning (SRSSDL) and the Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) to assess changes in self-learning and critical thinking abilities before and after the intervention.

Results

Following bedside case-based learning, the total scores for self-directed learning capacity and critical thinking increased, although there were no statistically significant differences (P > 0.05).

Conclusions

Although there were no statistically significant differences between pre- and post-test results, students’ self-assessed scores in self-directed learning and critical thinking improved between pre- and post-test.
Septic shock in the prehospital setting: a scoping review
Authors: Pinto-Villalba Ricardo Sebastian , Balseca-Arellano Daniela , Leon-Rojas Jose E.
Published: November 2024

Septic shock (SS) is a potential life-threatening condition in which an early identification and immediate therapy stand out as the main cornerstones to improve survival chance; in this context, emergency medical services (EMS) become key to reduce the time between diagnosis and management in the ICU or emergency department. However, guidelines for the prehospital management of SS patients remains unclear, and literature around this topic is scant. Our scoping review was conducted following the PICO framework and a search strategy related to septic shock management and diagnosis in prehospital settings was executed in PubMed, Scopus and Virtual Health Library; articles in English and Spanish from 2015, onwards, were screened by the authors and selected by mutual consensus. Our aim is to analyze the prehospital management strategies of SS reported in the literature, and to showcase and summarize the screening tools, demographic factors, clinical manifestations and prognostic factors of SS in the prehospital setting.
Hypothermic cardiac arrest: prognostic factors for successful resuscitation before rewarming
Authors: Podsiadło Paweł , Mendrala Konrad , Hymczak Hubert , Nowak Ewelina , Witt-Majchrzak Anna , Dąbrowski Wojciech , Miazgowski Bartosz , Dudek Michał , Darocha Tomasz
Published: November 2024

Objective

To indicate factors predicting return of spontaneous circulation in patients with hypothermic cardiac arrest in the pre-rewarming period.

Methods

A multicenter retrospective study was conducted. We included patients who had suffered cardiac arrest caused by severe accidental hypothermia with a core body temperature of ≤ 28 °C. Patients who had achieved return of spontaneous circulation before commencement of active rewarming at the hospital were compared to those who remained in cardiac arrest.

Results

A total of 156 patients suffering hypothermic cardiac arrest were included in the study. In 14 of them (9%) resuscitation was successful before rewarming. Factors associated with return of spontaneous circulation were as follows: witnessed onset of cardiac arrest (p = 0.04); a higher core body temperature (p = 0.005) with a prognostic threshold of 24.6 °C; and a higher arterial oxygen partial pressure (p = 0.04) with a prognostic threshold of 81 mmHg. One patient after successful resuscitation sustained recurrence of cardiac arrest during rewarming.

Conclusions

Patients with core body temperature < 25 °C, hypoxemia, and those who sustained unwitnessed hypothermic cardiac arrest have weak chances for successful resuscitation before rewarming. They can benefit from immediate transportation to an extracorporeal life support facility under continuous cardiopulmonary resuscitation. Effective rewarming and oxygenation during the prehospital period can increase the chances for return of spontaneous circulation. Recurrence of cardiac arrest during rewarming is uncommon.
A genome-wide association study in Swedish colorectal cancer patients with gastric- and prostate cancer in relatives
Authors: Samola Winnberg Johanna , Vermani Litika , Liu Wen , Soller Veronika , Thutkawkorapin Jessada , Lindblad Mats , Lindblom Annika
Published: November 2024

Background

A complex inheritance has been suggested in families with colorectal-, gastric- and prostate cancer. Therefore, we conducted a genome-wide association study (GWAS) in colorectal cancer patients, who’s relatives had prostate-, and/or gastric cancer.

Methods

The GWAS analysis consisted of 685 cases of colorectal cancer and 4780 healthy controls from Sweden. A sliding window haplotype analysis was conducted using a logistic regression model. Thereafter, we performed sequencing to find candidate variants, finally to be tested in a nested case–control study.

Results

Candidate loci/genes on ten chromosomal regions were suggested with odds ratios between 1.71–3.62 and p-values < 5 × 10–8 in the analysis. The regions suggested were 1q32.2, 3q29, 4q35.1, 4p15.31, 4q26, 8p23.1, 13q33.3, 13q13.3, 16q23.3 and 22q11.21. All regions, except one on 1q32.2, had protein coding genes, many already shown to be involved in cancer, such as ZDHHC19, SYNPO2, PCYT1A, MYO16, TXNRD2, COMT, and CDH13. Sequencing of DNA from 122 colorectal cancer patients with gastric- and/or prostate cancer in their families was performed to search for candidate variants in the haplotype regions. The identified candidate variants were tested in a nested case–control study of similar colorectal cancer cases and controls. There was some support for an increased risk of colorectal-, gastric-, and/or prostate cancer in all the six loci tested.

Conclusions

This study demonstrated a proof of principle strategy to identify risk variants found by GWAS, and identified ten candidate loci that could be associated with colorectal, gastric- and prostate cancer.

Graphical Abstract
Metformin plus lifestyle interventions versus lifestyle interventions alone for the delay or prevention of type 2 diabetes in individuals with prediabetes: a meta-analysis of randomized controlled trials
Authors: Amer Basma Ehab , Abdelgalil Mahmoud Shaaban , Hamad Abdullah Ashraf , Abdelsayed Kerollos , Elaraby Ahmed , Abozaid Ahmed Mohamed , Abd-ElGawad Mohamed
Published: November 2024

Objectives

We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes.

Materials and methods

We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the “meta” package of RStudio software.

Results

We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes.

Conclusions

Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.
Immortalized mammosphere-derived epithelial cells retain a bioactive secretome with antimicrobial, regenerative, and immunomodulatory properties
Authors: Danev Nikola , Poggi Julia M. , Dewever Emilie A. , Bartlett Arianna P. , Oliveira Leane , Huntimer Lucas , Harman Rebecca M. , Van de Walle Gerlinde R.
Published: November 2024

Background

The secretome of primary bovine mammosphere-derived epithelial cells (MDECs) has been shown to exert antimicrobial, regenerative, and immunomodulatory properties in vitro, which warrants its study as a potential biologic treatment with the potential to be translated to human medicine. Currently, the use of the MDEC secretome as a therapy is constrained by the limited life span of primary cell cultures and the decrease of secretome potency over cell passages.

Methods

To address these limitations, early-passage bovine MDECs were immortalized using hTERT, a human telomerase reverse transcriptase. The primary and immortal MDECs were compared morphologically, transcriptomically, and phenotypically. The functional properties and proteomic profiles of the secretome of both cell lines were evaluated and compared. All experiments were performed with both low and high passage cell cultures.

Results

We confirmed through in vitro experiments that the secretome of immortalized MDECs, unlike that of primary cells, maintained antimicrobial and pro-migratory properties over passages, while pro-angiogenic effects of the secretome from both primary and immortalized MDECs were lost when the cells reached high passage. The secretome from primary and immortalized MDECs, at low and high passages exerted immunomodulatory effects on neutrophils in vitro.

Conclusions

High passage immortalized MDECs retain a bioactive secretome with antimicrobial, regenerative, and immunomodulatory properties, suggesting they may serve as a consistent cell source for therapeutic use.
Enrichment of trimethyl histone 3 lysine 4 in the Dlk1 and Grb10 genes affects pregnancy outcomes due to dietary manipulation of excess folic acid and low vitamin B12
Authors: Sapehia Divika , Mahajan Aatish , Singh Parampal , Kaur Jyotdeep
Published: November 2024

The aberrant expression of placental imprinted genes due to epigenetic alterations during pregnancy can impact fetal development. We investigated the impact of dietary modification of low vitamin B12 with varying doses of folic acid on the epigenetic control of imprinted genes and fetal development using a transgenerational model of C57BL/6J mice. The animals were kept on four distinct dietary combinations based on low vitamin B12 levels and modulated folic acid, mated in the F0 generation within each group. In the F1 generation, each group of mice is split into two subgroups; the sustained group was kept on the same diet, while the transient group was fed a regular control diet. After mating, maternal placenta (F1) and fetal tissues (F2) were isolated on day 20 of gestation. We observed a generation-wise opposite promoter CpG methylation and gene expression trend of the two developmental genes Dlk1 and Grb10, with enhanced gene expression in both the sustained and transient experimental groups in F1 placentae. When fetal development characteristics and gene expression were correlated, there was a substantial negative association between placental weight and Dlk1 expression (r = − 0.49, p < 0.05) and between crown-rump length and Grb10 expression (r = − 0.501, p < 0.05) in fetuses of the F2 generation. Consistent with these results, we also found that H3K4me3 at the promoter level of these genes is negatively associated with all fetal growth parameters. Overall, our findings suggest that balancing vitamin B12 and folic acid levels is important for maintaining the transcriptional status of imprinted genes and fetal development.
Stature estimation using scapula measurements by postmortem computed tomography in the southern Thai population
Authors: Monum Tawachai , Opaburanakul Thutchai , Samai Wirachai , Kosawiwat Komet , Kawin Chanathip
Published: November 2024

Background

Estimating stature is crucial information of biological profile analysis, especially for identifying skeletal remains. Measuring long bones is the most accurate method for estimating stature. However, when it is not possible to obtain long bones, alternative non-long bone components such as scapula may need to be used. This study developed the stature estimation model utilizing postmortem computed tomography (PMCT) based on scapular dimensions in the southern Thai population.

Result

Regression equations for stature estimation were developed using 13 scapular measurements obtained from PMCT scans of 201 cadavers (151 males, 50 females). For single linear regression, the combination of transverse and longitudinal scapular length (CTLSL) produced the lowest standard error of estimation (SEE) for males (5.688 cm) and the combined group (5.971 cm), while the combination of longitudinal maximum and longitudinal scapular length (CLMLSL) was best for females (6.333 cm SEE). Stepwise multiple regression analysis improved the accuracy of the combined and male equations, with SEE of 5.645 cm and 5.266 cm, respectively, using longitudinal maximum length (LML), length of axillary margin (LAM), and transverse scapular length (TSL) for the combined group, and LML, LAM, and the combination of all horizontal parameters (CAHP) for males. The female equation did not improve with multiple regression analysis.

Conclusion

The result of this study indicated that scapular measurements can be used to estimate stature in the southern Thai population, particularly when long bone measurements are not available.
Echocardiographic evaluation in patient candidate for liver transplant: from pathophysiology to hemodynamic optimization
Authors: Iaconi Marta , Maritti Micaela , Ettorre Giuseppe Maria , Tritapepe Luigi
Published: November 2024

Cardiovascular complications are common in patients with severe liver disease and are an important cause of peri-operative and post-transplant morbidity and mortality. Cirrhotic cardiomyopathy (CCM), often found in advanced liver disease, is characterized by diastolic dysfunction, systolic dysfunction, and electrophysiological abnormalities. While CCM may not cause symptoms at rest, it can become evident during stressful activities, such as surgery. Liver transplantation, while being the definitive treatment for end-stage liver disease (ESLD), carries significant cardiovascular risks. Preoperative cardiac evaluation is essential for assessing these risks and planning appropriate management. Cardiac imaging, particularly echocardiography, plays a crucial role in evaluating liver transplant candidates, helping to identify conditions such as CCM, pulmonary hypertension, hepatopulmonary syndrome, and others. Currently, liver transplant anesthetists must acquire echocardiographic knowledge and skills to evaluate the cardiocirculatory conditions of the transplanted patient, especially in the pre-operative phase, but also intra-operatively and post-operatively.
Predictive Factors of Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer: A Decision Tree Model Approach
Authors: Wiranata Juan Adrian , Astari Yufi Kartika , Ucche Meita , Hutajulu Susanna Hilda , Paramita Dewi Kartikawati , Sulistyoningrum Dian Caturini , Siswohadiswasana Yudiyanta , Asmedi Ahmad , Hardianti Mardiah Suci , Taroeno-Hariadi Kartika Widayati , Kurnianda Johan , Purwanto Ibnu
Published: November 2024

PURPOSE

Chemotherapy-induced peripheral neuropathy (CIPN) poses a substantial challenge in breast cancer (BC) chemotherapy, affecting the patient's quality of life. Recent studies have focused on exploring predictors and patterns of CIPN occurrence. We aimed to develop a prediction model for CIPN occurrence using a classification and regression tree (CART) algorithm.

METHODS

In this prospective study of 170 patients with BC undergoing chemotherapy, patient-reported adaptation of the Common Terminology Criteria for Adverse Events version 4.0 was used to assess CIPN occurrence. Multivariable analysis using the CART model was tuned using 10-fold cross-validation to identify baseline predictors for CIPN throughout chemotherapy. A receiver operating characteristic curve analysis was conducted for the CART model. A multivariable logistic regression was conducted from the variables included in the CART model to assess the strength and direction of the association.

RESULTS

The prevalence of CIPN was 64.7% (n = 110). The most decisive predictor of CIPN occurrence in the CART model was the subject's C-reactive protein (CRP) level. CRP level >3.91 mg/dL, BMI >21.85 kg/m
2
, and a marital status of unmarried have predicted a probability of 100% in CIPN occurrence. The CART model showed an accuracy of 65.9%, sensitivity of 51.7%, specificity of 73.2%, and an area under the curve of 0.705. A CRP level of >3.91 mg/dL and a neutrophil-to-lymphocyte ratio (NLR) of >2.82 are significantly associated with the occurrence of CIPN (odds ratio [OR], 2.01 [95% CI, 1.01 to 4.01];
P
= .046, OR, 2.09 [95%, CI, 1.02 to 4.24];
P
= .042, respectively).

CONCLUSION

Baseline CRP, NLR, BMI level, and marital status are significant predictors of CIPN occurrence throughout chemotherapy. Our CART model was better at ruling out individuals who would not experience CIPN. The CART model may provide insight into the future development of individualized patient care and prevention strategies.
Endovascular Flow Diversion for Hemifacial Spasm Due to an Unruptured Fusiform Vertebral Artery Aneurysm: A Case Report
Authors: Aonuma Yuki , Yoshioka Hideyuki , Kanemaru Kazuya , Hashimoto Koji , Saito So , Wakai Takuma , Fukuda Norito , Kinouchi Hiroyuki
Published: November 2024

BACKGROUND AND IMPORTANCE:

Hemifacial spasm (HFS) caused by a fusiform aneurysm is rare and difficult to treat. We present the first case of successful endovascular flow diversion treatment for HFS due to a fusiform aneurysm.

CLINICAL PRESENTATION:

A 46-year-old man suffered from right HFS for 6 months because of a fusiform right vertebral artery aneurysm compressing the root exit zone of cranial nerve VII. He successfully underwent flow diversion, with immediate disappearance of his HFS. Follow-up digital subtraction angiography 3 months after treatment showed complete resolution of the aneurysm.

CONCLUSION:

Flow diversion might be a promising treatment option for HFS due to a fusiform vertebral artery aneurysm.
Stereotactic DOTATATE Positron Emission Tomography/Computed Tomography–Guided Resection of a Multiply Recurrent World Health Organization Grade 2 Parasagittal Meningioma: A Technical Case Report
Authors: Nandoliya Khizar R. , Jamshidi Pouya , Castellani Rudolph J. , Tate Matthew C. , Avery Ryan J. , Magill Stephen T.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Resection of parasagittal meningiomas is challenging due to venous and superior sagittal sinus involvement. Recurrent tumors can be particularly challenging given scar tissue from prior surgery and radiation, which can be difficult to differentiate from active tumor on preoperative MRI. Cu-64-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE) is a somatostatin receptor (SSTR) ligand detectable on positron emission tomography (PET) imaging. SSTR is expressed by most meningiomas. While DOTATATE-PET has been investigated for radiotherapy planning, its use in guiding oncological meningioma resection is understudied. Here, we present a case example demonstrating its use in guiding surgical planning and maximizing the extent of resection.

CLINICAL PRESENTATION:

A 45-year-old man with a World Health Organization grade 2 bilateral parasagittal meningioma presented with recurrence after 2 prior resections, wound infection and washout, and fractionated radiotherapy with boost to residual disease. Preoperative angiography demonstrated an occluded sagittal sinus beyond the extent of the residual tumor. Stereotactic DOTATATE PET-computed tomography (CT) imaging was integrated with the neuro-navigation and used intraoperatively to identify extent of active tumor, differentiating it from scar tissue and gliosis. This was used to facilitate oncological tumor resection with negative pathological margins that correlated with the absence of DOTATATE signal.

CONCLUSION:

Stereotactic DOTATATE PET-CT is a valuable addition to the neurosurgeon's toolkit, particularly when integrated into the neuro-navigation, for achieving complete resections of recurrent meningiomas, or meningiomas where the extent of tumor invasion can be challenging to define on preoperative MRI.
Rupture of a Spinal Dural Arteriovenous Fistula as a Differential Diagnosis of a Coronary Syndrome: Case Report
Authors: Ramón Juan Fernando , Garcia Rairan Luis , Araque Yessid , Fuentes Santiago , Useche Nicolas
Published: November 2024

BACKGROUND AND IMPORTANCE:

Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment.

CLINICAL PRESENTATION:

A case of a 73-year-old female with a history of acute coronary syndrome who presented to the emergency department with sudden onset chest pain suggestive of an acute myocardial infarction is presented. Further evaluation revealed a subdural hematoma at T2-T5 and T8-L5, caused by a ruptured SDAVF at the T12-L1 level. The patient required emergency decompression surgery, but because of late diagnosis, she suffered a spinal cord injury with an ASIA-A classification.

CONCLUSION:

SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.
Late Removal of Brain-Penetrating Nails Adherent to Intracranial Arteries: A Case Report
Authors: Qian Cheng , Isokangas Juha-Matti , Lahtinen Maija , Suutari Angelica , von und zu Fraunberg Mikael , Knuutinen Oula
Published: November 2024

BACKGROUND AND IMPORTANCE:

Pneumatic nail guns are a rare cause of penetrating brain injury, and subsequent nail removal in the acute setting is well reported. However, reports of late removal or removal of nails adjacent to intracranial vessels are rare. In the delayed setting, scar formation around the nails and surrounding brain structures may complicate surgical removal. Here, we report a case of late removal of brain-penetrating nails adherent to the middle cerebral artery branches.

CLINICAL PRESENTATION:

A 70-year-old left-handed male presented with mild aphasia, vertigo, and facial nerve palsy. Imaging studies demonstrated two nails fired 2 months before in the right temporal lobe adjacent to the middle cerebral artery branches. The nails were surgically removed through a modified pterional approach after meticulous dissection of scar tissue adherent to the nails. Before removal, proximal vessel control was achieved.

CONCLUSION:

Brain-penetrating nail removal weeks after the original incident may be complicated by extensive scarring. This can be dealt with a generous craniotomy, proximal vessel control through microsurgical or endovascular means, and careful dissection of scar tissue around the nails.
Stereotactic Radiosurgery and Highly Active Antiretroviral Therapy for HIV-Related Primary Central Nervous System Lymphomas: A Prospective Study Analyzing the Efficacy and Safety
Authors: Alvarez Pinzon Andres M. , Ramon Alonso Jose , Wolf Aizik , Ramirez-Velandia Felipe , Valerio Jose E.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Stereotactic radiosurgery (SRS) has been well established and considered a safe alternative for primary central nervous system lymphomas (PCNSLs). However, in HIV-related PCNSL, the use of SRS remains controversial. The purpose of this study was to evaluate the efficacy and safety of SRS in HIV-related PCNSL.

METHODS:

Forty-two adult patients with confirmed PCNSL and no previous radiotherapy or chemotherapy were selected, with 16 receiving Gamma Knife Radiosurgery (GKRS) alone and 26 receiving Highly Active Antiretroviral Therapy (HAART) before GKRS. Follow-up evaluations were conducted at 3, 6, 12, and 24 months post-treatment using clinical and imaging techniques. Statistical analyses were performed using SPSS v22, assessing for new lesions, changes in lesion size, progression-free survival, and overall survival.

RESULTS:

HAART/GKRS showed a significantly higher rate of complete response compared with the GKRS group, with 53.8% vs 18.8% (P = .048). The mean progression-free survival for the HAART/GKRS group and the GKRS group was 39.7 months and 31.2 months, respectively (P = .0051). Patients with a delayed HAART initiation (>6 months) exhibited an increased burden of T2 white matter lesions and a higher number of large lesions (odds ratio = 1.9, 95% CI = 1.44-2.42, P = .001). However, no significant difference was observed between the two groups regarding radionecrosis.

CONCLUSION:

The study highlights the potential benefits of adding HAART to GKRS for patients with PCNSL, leading to improved survival outcomes. An early initiation of HAART was associated with less tumor progression, underscoring the importance of timely administration of HAART in patients with AIDS-related PCNSL.
Clinical and Radiological Outcomes of Full-Endoscopic Decompression for Lumbar Spinal Stenosis With Grade I Degenerative Spondylolisthesis: A Retrospective Study With a Minimum 1-Year Follow-up
Authors: Choi Sang-Soo , Ahn Geon , Jang Il-Tae , Kim Hyeun Sung
Published: November 2024

BACKGROUND AND OBJECTIVES:

Decompression without fusion is a surgical option for the treatment of lumbar spinal stenosis (LSS) with grade I degenerative spondylolisthesis (DS). However, the outcomes of full-endoscopic decompression remain unknown. This study aimed to investigate the clinical and radiological outcomes of lumbar full-endoscopic decompression for spinal stenosis with grade I DS.

METHODS:

A total 43 patients with LSS with grade I DS who underwent lumbar full-endoscopic unilateral laminotomy for bilateral decompression and were followed up for a minimum of 1 year were retrospectively reviewed. Data on demographic characteristics, operative details, radiological images, clinical outcomes, and complications were analyzed.

RESULTS:

Pain, evaluated using the visual analog scale, was significantly reduced in patients undergoing full-endoscopic decompression in both the leg and back; the Oswestry Disability Index scores also improved (P < .001). MacNab's outcome classification was excellent or good in 95% of patients. One patient eventually needed the fusion surgery, and two patients required further diskectomy surgery because of recurrent symptoms. During follow-up, an increase in the vertebral slip was observed in 46.5% of the patients, but it was not statistically significant (P = .46). The progression of DS, defined as percentage of slip >5%, was observed only in 7% of the patients. An increase in vertebral slip was not associated with the clinical outcomes. There was no difference in radiological outcomes, such as angular motion (P = .36) and translation (P = .13), compared with the preoperative state. The operation did not exacerbate spinal instability. Rather, fewer patients had spinal instability postoperatively.

CONCLUSION:

Endoscopic decompression alone has comparably good clinical outcomes with those of other surgical techniques in patients with LSS and DS. Few postoperative spinal instability occurred. Rather, the number of patients with instability decreased postoperatively. Full-endoscopic decompression may be a treatment option for patients with grade 1 DS.
Study Protocol for a Randomized Controlled Clinical Trial on the Outcome of Surgical Versus Primary Nonsurgical Treatment of Traumatic Thoracolumbar Spine Burst Fractures in Patients Without Neurological Symptoms—A34RCT
Authors: Häckel Sonja , Stienen Martin N. , Martens Benjamin , Neuhaus Valentin , Albers Christoph E.
Published: November 2024

BACKGROUND AND OBJECTIVES:

There are still major global differences in the treatment of acute traumatic thoracolumbar burst fractures in patients without neurological deficits and without posterior column injury. Treatment strategies range from conservative treatment with orthosis or early functional mobilization to various surgical stabilization techniques. The study's objectives are to evaluate the clinical (Oswestry Disability Index [ODI]) and radiographical outcomes (restoration and maintenance of spinal alignment; injury of the affected intervertebral disk) and determine the prevalence of complications until 24 months of follow-up.

METHODS:

The study is designed as a randomized, controlled, noninferiority clinical trial. All patients with a thoracolumbar burst fracture (Arbeitsgemeinschaft für Osteosynthesefragen spine type A3 or A4) age 18 to 70 years without neurological deficit and without posterior ligament injury can be enrolled. We will randomly assign 52 patients for either surgical or nonsurgical treatment. The surgical group will receive combined anterior–posterior (360°) spinal stabilization therapy. Participants in the nonsurgical group will be treated with a 3-point hyperextension orthosis for 6 weeks. The primary outcome is the difference in ODI at 2 years after injury.

EXPECTED OUTCOMES:

We expect to find that conservative treatment of burst fractures in the thoracolumbar spine will be noninferior to the surgical treatment.

DISCUSSION:

This study will provide high-quality data comparing a modern surgical treatment regime with a standardized conservative treatment in patients with thoracolumbar burst fractures.
Resident Opinions on Image Guidance for External Ventricular Drain Placement: A National Survey
Authors: Noh Thomas , Juvekar Parikshit , Watanabe Gina , Golby Alexandra J.
Published: November 2024

BACKGROUND AND OBJECTIVES:

Low-quality data on image-guided external ventricular drain (EVD) accuracy are in large part due to a lack of widespread usage of this system for EVD placement. The potential disconnect between user preferences and existing technologies should be explored to guide future developments. The goal of this study was to survey neurosurgical residents regarding their EVD practices and determine the acceptable amount of setup time for an ideal neuronavigation system.

METHODS:

A 4-question survey was sent to approximately 1512 residents at 108 Acreditation Council for Graduate Medical Education–approved medical doctor neurosurgical training programs in the United States. The responses were received electronically, tabulated, and analyzed using descriptive statistics.

RESULTS:

A total of 130 respondents (9%) completed the survey, reflecting the highest number of neurosurgical resident respondents in an electronic qualitative survey of EVD practices thus far. Residents were willing to accept 6.39 min (SD = 3.73 min) on average for the setup of a bedside EVD image guidance system. The majority chose to use image guidance during EVD placement for cases of narrow slit-like ventricles (86.92%) over intraventricular hemorrhage (13.08%) and hydrocephalus (0%). A total of 90% of all resident respondents misplaced at least 1 EVD with 74% of post-graduate year–7 respondents misplacing more than 3 EVDs in their career. A total of 88.46% of respondents deemed more than a single pass as acceptable.

CONCLUSION:

Future EVD neuronavigation technologies should focus on achieving rapid registration times. These systems may be prioritized for patients with anatomic distortions. Current resident attitudes are accepting multiple EVD passes, likely because of the inherent limitations of the traditional freehand approach. Efforts should be made to encourage the best course for the patient.