bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intestinal Malrotation in Chronic Form in Adults: A Diagnostic and Management Challenge
Authors: Kaleem Ahmad , Reza Ali , Abdalla Alaa 
Published: December 2024

Background:
Intestinal malrotation in adults is more common in chronic, insidious patterns, reported to be around 88% in the literature, with features ranging
from intermittent abdominal pain and vomiting to food intolerance, malabsorption, and motility disorders. This clinical spectrum can be
debilitating for the patient in terms of morbidity and mortality, especially in the context of acute presentation in the background of chronic features.

Case Presentation:
We present a 26-year-old male with a history of over 10 hospital admissions since childhood with intermittent abdominal pain and vomiting
labeled as cyclic vomiting syndrome. He was in distress regarding the chronicity of his symptoms and presented with an acute abdomen due to
acute small bowel intestinal obstruction. He underwent diagnostic laparoscopy and reduction of internal hernia followed by exploratory laparotomy
and division of Ladd’s band and realignment of bowel. Postoperatively, he recovered and recuperated well.

Conclusion:
Intestinal malrotation should be in the routine differential diagnosis of acute abdomen, especially with the history of nonspecific abdominal
symptomatology, so that diagnosis can be made early to prevent morbidity and mortality in this age group.
De novo Presentation of Systemic Lupus as Bullous Erythematosus: A Case Report
Authors: Mattoo Saima Majid , Iftikhar Sarah Mohammed , Gopal Rajesh Gupta , Hamad Imadeldin Ahmed , Bichu Shubhada Mandar 
Published: December 2024

Background::
Systemic Lupus Erythematosus (SLE) (C1) is a disease with multi-organ
involvement that can have a variety of cutaneous manifestations in 76% of cases during the disease.
Less than 1% of these patients are diagnosed with confirmed bullous systemic lupus erythematosus
(C1). Given the wide differential diagnosis of a bullous lesion, it is imperative to reach a
conclusive diagnosis as it can have a direct impact on the course of management of the disease.
Here, we present a case of SLE with a de novo presentation of bullous lesions. Throughout the
length of the report, we will go through the protracted clinical course of the patient, followed by a
clinically relevant discussion of the condition.

Case Presentation:
The case describes the presentation of a young African female of low socio-economic
status with first-ever eruption of bullous lesions on her trunk and groin. The lesions progressed
to involve the face. A biopsy was taken, and the patient was started on dapsone and hydroxychloroquine.
She initially responded well but soon developed Steven Johnson syndrome in
reaction to dapsone. In the meantime, a biopsy and hematological work-up confirmed a diagnosis
of Bullous SLE. The patient was started on methotrexate, to which she initially responded well but
developed methotrexate-induced cytopenia. This was followed by initiation of mycophenolate, to
which the patient responded very well and was subsequently discharged on the same. At the time
of discharge, all lesions healed, and the hematological workup remarkably improved.

Conclusion:
All patients with bullous lesions should be evaluated for bullous SLE. A definitive diagnosis
will chart the course of management. Multiple drug options are available, and there is no
single hierarchy of medicines that will suit all. Sometimes, multiple modalities need to be tried before
the patient achieves clinical remission and then can be continued on the same.
Atrial Fibrillation Ablation in Heart Failure and Preserved Ejection Fraction: An Observational Study of Risk Factors for Heart Failure Hospitalization
Authors: qi Rundi , Liu Hailei , Zhu Yue , Wu Nan , Wang Kexin , Ding Xiangwei , Gu Zhoushan , Li Mingfang , Chen Hongwu , Ju Weizhu , Li Xin , Chen Minglong 
Published: December 2024

Introduction:
Long-term heart failure hospitalization (HFH) after radiofrequency
catheter ablation (RFCA) in atrial fibrillation (AF) patients with heart failure and preserved
ejection fraction (HFpEF) and its risk factors remain to be investigated.

Methods:
AF patients with HFpEF who underwent RFCA from January, 2014 to December,
2018 from three centers were retrospectively included. Patients were assigned to the training and
testing cohorts, respectively. In the training cohort, logistic regression analyses were performed
to discriminate those with and without HFH. A scoring system was developed accordingly and
validated.

Results:
A total of 417 AF patients with HFpEF receiving RFCA were enrolled. About 35 patients
(8.4%) had HFH for 6 years. In the training cohort, the use of diuretics, atrial tachycardia
(AT)/AF recurrence, prior HFH, and female sex were independent predictors of HFH in the
multivariable analysis. A DAPF score (ranging from 0 to 9.0) was developed. The area under
the receiver operating characteristic curve (AUC) of the DAPF score was 0.880 (95% CI, 0.830-
0.929). A DAPF score ≥3.5 could predict HFH with a sensitivity of 81.8% and a specificity of
74.6%. The performance in the testing cohort remained robust (AUC, 0.858; 95% CI, 0.749-
0.967).

Conclusion:
HFH in patients with AF and HFpEF after RFCA is not rare. The DAPF score
could predict the risk of HFH in AF patients with HFpEF after RFCA and guide our treatment
strategy.
Patent Review of Electric Spindle Bearing Lubrication
Authors: Bao Yudong , Yao Baitong 
Published: December 2024

Background:
Lubrication is essential in the working process of bearings. Lubrication can
reduce friction damage to the bearings, which is conducive to reducing the failure rate and prolonging
the service life.

Objective:
Some valuable conclusions are drawn by summarizing the research on bearing lubrication
in recent years. The future development of bearing lubrication is predicted to provide a reference for
researchers in related fields.

Methods:
This paper reviews representative patents related to bearing lubrication, discusses how
these bearings are lubricated and explains the impact of these lubrication methods on bearing life.

Results:
By retrospectively characterizing the influence of different influencing factors on the lubrication
of the electro spindle, the main problems existing in the current development, such as temperature,
sealing, lubrication method, etc., are analyzed and summarized. The future development of the
patent for electro spindle lubrication is discussed.

Conclusion:
The optimization and development of bearing lubrication are conducive to enhancing
equipment stability and safety. Bearing lubrication needs to be improved futher. More patents related
to spindle lubrication will be invented. Optimization and development of bearing lubrication are
conducive to enhancing equipment stability and safety.
Identification and Control of Transportation Units with Sequenced Learning Models Using Neural Networks
Authors: Selvarajan Shitharth , Manoharan Hariprasath , Saleem Farrukh , S Ramesh , T Manikandan 
Published: December 2024

Aim:
This study illustrates the significance of transport units in monitoring diverse
paths using a critical system model. The suggested method identifies proficiency and framework
patterns that evolve across different time intervals, utilising machine learning optimisation that incorporates
sequence learning with interconnected neural networks.

Background:
As an increasing number of cars are interconnected for data communication to illustrate
available routes, it is essential to have suitable connectivity for transportation units. This
study may facilitate intelligent connectivity across transportation units by employing essential
shifts without compromising the efficiency of connected units.

Objective:
This study aimed to integrate the parametric design representations with neural networks
to address the primary goal of min-max functions, hence enhancing the efficiency of transportation
units.

Method:
The method presented here has employed sequenced learning patterns to select the shortest
path while rapidly altering pathway representations.

Results:
The alterations in pathways influenced by emissions have been noted and excluded from
connectivity units to enhance the overall lifetime of transportation units in the projected model.

Conclusion:
The results have been examined through a simulation framework encompassing four
scenarios, wherein potential connectedness has enhanced both the proficiency rate and the structure
while minimising the shifts. Subsequently, a comparison of the proposed method with the existing
methodology, where total efficiency has been assessed, has revealed the proposed method to
maximise the efficiency to 95%. In contrast, the existing strategy has yielded a reduced efficiency
of 86%.
Coexisting with Nature: “A Mini-Review of Outdoor Robot Arm Studies”
Authors: Abdi Ali 
Published: December 2024

Abstract:
The use of robot arms has significantly increased due to their numerous advantages.
Initially confined to controlled environments such as factories, homes, operating rooms, and
laboratories, these robots have now expanded into open spaces. This expansion includes gardens,
farms, forests, job sites, urban areas, and even underwater settings, where they interact
with diverse elements including humans, animals, plants, and environmental factors. The integration
of outdoor robot arms into shared natural environments worldwide is crucial for the advancement
of the upcoming intelligent era. However, this integration presents new challenges
due to the dynamic and unpredictable nature of these environments, necessitating the development
of new rules and guidelines. One significant concern is the safety of both the robot arms
and the non-intelligent entities they interact with, alongside human safety considerations. This
paper reviews recent literature on outdoor robot arms in shared natural environments, analyzing
studies from multiple perspectives. It categorizes the distribution of publications by working
places, including gardens, job sites, farms, urban areas, forests, beaches and seas, and other
locations. The analysis also examines the primary targets and obstacles faced by these robots,
such as plants, elements, animals, and humans. Finally, the paper discusses critical considerations
for the successful coexistence of robot arms with the diverse elements of nature. These
considerations include sustainable integration, balancing technological advancement with environmental
preservation, ethical considerations, adaptability to dynamic environments, and ensuring
safety in diverse settings. Addressing these aspects is essential for the harmonious and
effective deployment of robotic arms in outdoor environments.
Distribution of Water Quality Parameters Using Equation Multiple Linear Regression
Authors: Wahyuningsih Sri , Andriyani Idah , Soekarno Siswoyo , Khoirulloh Deffa 
Published: December 2024

Mayang River in Jember Regency has a strategic role in fulfilling people's lives and is a source of water for 79 irrigation areas with a total area of 16,471 hectares. Community use of the Mayang River has the potential to provide input of organic material from waste which can reduce river water quality. The aim of this research is to analyze the spatial distribution of water quality parameters, namely TSS, TDS, pH, DO and BOD. This research uses multiple linear regression techniques to determine the value of the distribution or spatial distribution of Mayang River pollution, as well as identifying water quality variables that are correlated in each region. The research results show that water quality parameters that have a strong correlation are pH (r = 0.74), DO (r = 0.72) and TSS (r = 0.65), moderate correlation with BOD parameters (r = 0.48) and low correlation with BOD parameters. TDS parameters (r = 0.25). Based on the analysis results, it is known that water quality parameters are correlated with different activities in each region. The results of this research can be used as a strategy for monitoring water quality in the Mayang River to control the impact of human activities in the surrounding area. Keywords: Multiple Linear Regression, Spatial Distribution, Water Quality.
TRANSCATHETER MITRAL VALVE REPAIR IN A SURGICAL UNIT: UPDATED RESULTS
Authors: Russo M. , Cammardella A. G. , Ciuffreda A. , Pergolini A. , Sbaraglia F. , Ranocchi F. 
Published: December 2024

Background and Aim:
Transcatheter edge-to-edge repair (TEER) has been introduced as a valuable tool for the treatment of high-risk patients affected by mitral valve regurgitation. We present the results of a dedicated surgical team.

Methods:
From November 2020 to August 2024, Fifty-four patients (median age 81 y.o, range 39-90, 55% male, 1 urgent procedure) with severe mitral valve regurgitation underwent TEER. A dedicated structural valve team has been established. All cases have been approved by the local weekly heart team according risk profile or specific contra-indication to conventional surgery. Data were collected prospectively.

Results:
Twenty-two patients (40%) were affected by functional MR of whom two cases were performed as bridge to heart transplantation. In the remaining cases, P2 prolapse was present in (50%) patients, leaflet retraction and commissural disease in 10%. Procedural success (MR<2) was achieved in 92% of cases. In the elective cases, 30-day survival was 98%. Kaplan Meier Freedom from cardiac death was 85±5% and 77±3% at 12 and 24 months. Freedom from MR recurrence (>2+) at 12 months was 90±3%%. At mean follow up of 11±2 months, functional status significantly improved (NYHA class 3±0.8 vs 1.25±0.25).

Conclusions:
Surgeon’s headed transcatheter mitral valve repair program is a feasible concept that can should expanded in dedicated centers. TEER is a safe and reproducible procedure that represents a useful tool in armamentarium of the contemporary cardiac surgeon. Late results have to be balanced with the preoperative patient’s characteristics
MID-TERM OUTCOMES OF MODIFIED BENTALL USING A SELF- ASSEMBLED BIOLOGICAL COMPOSITE GRAFT WITH INSPIRIS RESILIA VALVE
Authors: Fiore A. , D’Alonzo M. , Leprince P. , Achouh P. , Poitier B. , Demondion P. , Folliguet T. 
Published: December 2024

Background:
The modified Bentall procedure is a standard surgical approach for aortic root pathologies, including aneurysms, endocarditis with abscess, and aortic dissections. Despite requiring aortic valve replacement, this procedure yields excellent results. Prosthesis selection should be individualized based on patient characteristics, contraindications to anticoagulation, and patient preference. This study aims to assess early and mid-term outcomes of the modified Bentall procedure using a 4th generation pericardial valve.

Methods:
This multicentric observational prospective registry includes patients from three French centers, enrolled from 2019 to 2023. Inclusion criteria involved all consecutive patients undergoing modified Bentall with the Inspiris Resilia aortic valve bioprosthesis. Patients under 18 were excluded. Of the 1208 patients, 151 met the inclusion criteria (mean age: 61.9 ± 9.8 years, 11.3% female, mean EuroSCORE II: 5.3%).

Results:
In-hospital mortality was 2.6%. At 30 days, mortality was 6.0% for aortic aneurysm, 16.4% for aortic dissection, and 20% for endocarditis. Severe patient-prosthesis mismatch was observed in 1.7% at discharge. Four-year follow-up (median 25 months) showed 2.6% endocarditis, 0% severe structural deterioration, 12.6% overall mortality, and 9.3% cardiac- related death.

Conclusions:
The modified Bentall with a biological composite graft is safe and effective for various aortic root pathologies. Incorporating the 4th generation Inspiris Resilia valve into the Valsalva graft does not complicate the procedure. Aortic root aneurysm patients show excellent early and mid-term outcomes, with a 90.2±5.5% survival rate at 4-year. Longer follow-up is needed to evaluate long-term outcomes.
LONG-TERM IMPACT OF CHRONIC KIDNEY DISEASE ON CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING
Authors: Gastino E. , Garatti A. , Scarpanti M. , Buttiglione G. , D’Ovidio M. , Canziani A. , Daprati A. , de Vincentiis C. , Parolari A. , Menicanti L. 
Published: December 2024

Background and Aim:
Chronic kidney disease (CKD) is one of the major comorbidities in patients undergoing coronary artery bypass grafting (CABG). Its effect on adverse events after surgery is well established, however, the impact of CKD even at early stages on long-term outcomes after CABG is unclear.

Methods:
We analyze 4493 patients who underwent isolated CABG between 2005 and 2018. They were divided into five classes according to the KDIGO definition based on eGFR. Record linkage with the NHIS codes allowed identification of long-term outcomes.

Results:
There was a clear trend of worsening risk profile in patients from Class 1 to 4, while Class 5 showed a reverse pattern, most likely reflecting a prevalent primary end-stage renal disease (ESRD). There was no significant difference in intra-operative variables from classes 1 to 5. Short-term postoperative outcomes progressively declined from class 1 to 4, with class 5 presenting less overall complications. On the other hand, patients in class 5 had a significantly higher 30-day mortality. At 5 and 10 years follow-up, we observed an overall survival decreasing from Class 1 to 3 (p<0.001). Accordingly, Classes 4 and 5 showed dramatically worse long-term survival (49%-21% and 41%-18% respectively, p=n.s.). Classes 4 and 5 did not show a statistically significant difference in the rate of MACCE when compared to Classes 1-3.

Conclusion:
In our experience, The dramatic decrease in survival for ESRD patients can be attributed to the natural history the disease. Further studies are warranted to better clarify the topic.
A HUGE IMPELLA-RELATED AORTIC THROMBUS IN A D-LVAD PATIENT SUCCESSFULLY TREATED WITH THE INARI FLOWTRIEVER SYSTEM
Authors: Loforte A. , Spitaleri A. , Monteleone G. , Abbà P. , Galanti G. A. , Aloi V. , Sandoval A. , Gallone G. , Di Scalzi A. , Trompeo A. C. , Boffini M. , Rinaldi M. 
Published: December 2024

Micro-axial flow pumps (mAFPs), eventually associated with ECLS, have emerged as a valid option to treat cardiogenic shock as a bridge to durable LVAD (d-LVAD) therapy.
We describe the case of a 55-year-old man with acute myocardial infarction-related cardiogenic shock (AMI-CS) who was bridged from ECMELLA to d-LVAD. He subsequently developed early right heart failure and required a temporary right ventricular assist device (t-RVAD). Four days later the RV function recovered, and TEE showed an incidental huge floating thrombus in the descending aorta. Despite anticoagulation, the thrombus remained stable. However, fibrinolysis wasn’t a suitable option due to high bleeding risk of pre-existing cerebral lesions thus, after a multidisciplinary team discussion (cardiac surgeons, anesthesiologists, interventional radiologists), we decided for mechanical thrombectomy using the FlowTriever System (Inari Medical, Irvine, CA).
EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT AS TREATMENT FOR CARDIOGENIC SHOCK: TREATMENT STRATEGIES AND ANALYSIS OF RISK FACTORS
Authors: Loforte A. , Parrella B. , Spitaleri A. , Aloi V. , Abbà P. , De Laurentis A. , Cura Stura E. , Costamagna A. , Zanierato M. , Trompeo A. C. , La Torre M. W. , Boffini M. , Rinaldi M. 
Published: December 2024

Background and Aim:
RotaFlow and CardioHelp (Getinge), used in central (c-) or peripheral (p-) veno-arterial (VA) extra-corporeal membrane oxygenation (ECMO) support systems have been investigated as treatment for patients with cardiogenic shock (CS).

Methods:
Between 2005 and 2024, 359 consecutive adult patients were supported on VA ECMO, at our institution (239 men; age 55.1±14.2 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of post-cardiotomy (n=134) and primary donor graft failure (n=39); post-acute myocardial infarction CS (n=79); acute myocarditis (n=34); and acute decompensation on chronic heart failure (n=27).

Results:
A p-ECMO setting was established in 241(67.13%) patients while c-ECMO in 118 (32.9%). Overall mean support time was 5.1±4.8 days. 187(52,1%) patients died on ECMO. Overall success rate was 48%, in terms of survival on ECMO (n = 241), weaning from mechanical support (n=132;54.8%), bridge to ventricular assist device (n=13;5.47%), and heart transplantation (n=26;10.7%). Stepwise Cox regression multivariate identified age, blood lactate level and SAPS II score value as significant predictors of mortality on ECMO (P=0.040, hazard ratio [HR]=2.01; 95% confidence interval [CI]=1.00–3.03; P<0.0001, HR=3.63; 95% CI=1.03-5.12 and P=0.017, HR=2.4; 95% CI=1.00–3.04, respectively), while “awake-on- ECMO condition” was a significant predictor of survival (P=0.023, HR=0.48; 95% CI=0.26- 1.90). c-ECMO population had significantly higher rate of rethoracotomy for bleeding (50%). Significant differences at 30-days were seen by comparing Kaplan-Meier survival estimates of left ventricular (LV) venting vs. no-LV venting cohorts (p=0.0073).

Conclusions:
A proper weight of pre-operative patients’ characteristics and a proactive LV venting set may contribute to improve the outcomes on ECMO support.
SAFETY AND EFFICACY OF TRANSCATHETER AORTIC VALVE REPLACEMENT FOR NATIVE PURE AORTIC VALVE REGURGITATION: SINGLE–CENTER EXPERIENCE
Authors: Cavalli G. G. , Vallabini A. , Braccio M. , Palladino M. , Gallo N. , Arcudi G. , Alemanni R. , Spatuzza P. , Di Marco L. , Leone A. , Greco F. , Pacini D. , Cassese M. 
Published: December 2024

Background:
Considering unique procedural challenges posed by native pure aortic regurgitation (NPAR), our aim was to evaluate off–label transcatheter treatment with new generation devices.

Materials and Methods:
We retrospectively enrolled 65 consecutive patients, the largest single-centre cohort to the best of our knowledge, who underwent TAVR for NPAR between 2017 and 2024, because deemed ineligible for surgery. Mean logistic and Euroscore II were 18,01±11,42% and 5,66±5,71%, though they did not accurately reflect surgical ineligibility: 8 patients (12,3%) had active cancer and 5(7,7%) end–stage liver failure. Patients with valve calcifications or stenosis were excluded. Primary endpoints were technical and device success.

Results:
We adopted local anesthesia in 60 patients (92,3%), reducing ICU admission and stay (26,2% and 1,86±6,32days). Most frequently implanted prostheses were Evolut R/Pro 34(41,5%), Sapien 3/Ultra 29(26,2%) and Accurate Neo M (10,8%). Approximately half of the population was shortly supported(23,53±24,13 minutes) with percutaneous fem–fem VA- ECMO, reducing hemodynamic instability. However, no increase in neither minor nor major vascular complication was observed (p=0,11 and p=0,27). One intraprocedural death was recorded (1,5%). Although 30–day mortality was 7,7%, primary outcomes were significantly better in the second half of the population (p=0,023 and p=0,026), reflecting the role of a standardized approach and surgeons’ higher expertise. Only 1 moderate paravalvular leaks was detected at 1–month follow–up.

Conclusions:
TAVR is still considered an off–label approach for NPAR because of increased stroke volume and absence of annular and leaflets calcification. Nonetheless a standardized approach, with the aid of brief VA ECMO support for complex cases, should be considered a safe and valid option for inoperable patients.