bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Midterm Outcomes of Endovascular Aneurysm Repair in Octogenarians From the ENGAGE Registry
Authors: Mwipatayi Bibombe P. , Oshin Olufemi A. , Faraj Joseph , Varcoe Ramon L. , Wong Jackie , Becquemin Jean-Pierre , Riambau Vincente , Böckler Dittmar , Verhagen Hence J. 
Published: May 2020

Purpose: To assess periprocedural results and secondary endovascular procedure outcomes over 5 years in patients aged ≥80 vs <80 years undergoing endovascular aneurysm repair (EVAR). Materials and Methods: Data from the Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE) were used for the analyses. A total of 1263 consecutive patients were enrolled in the prospective, observational, single-arm registry and divided into 2 groups according to age: ≥80 years (290, 22.9%) and <80 years (973, 77.1%). Baseline patient characteristics, risk scores according to the Society for Vascular Surgery (SVS) reporting standards, American Society of Anesthesiologists (ASA) classification, quality of life assessments [EuroQol 5 (EQ5D) index], and treatment outcomes, including all-cause mortality, aneurysm-related mortality, major adverse events, secondary endovascular procedures, and endoleaks were compared between groups. Results: Octogenarians were classified into the highest category of the SVS risk stratification system; however, this did not result in a significant difference in the 30-day mortality [1.4% (4/290) vs 1.2% (12/973) for controls; p=0.85] or major adverse event rates [5.2% (15/290) vs 3.6% (35/973), p=0.23]. Multivariable analysis confirmed that age ≥80 years, pulmonary disease, large aneurysm diameter, and renal insufficiency were significantly associated with all-cause mortality, whereas diameter was the only parameter associated with increased aneurysm-related mortality. The differences in freedom from secondary endovascular procedures over 5 years between octogenarians and controls did not reach statistical significance (88.5% vs 83.2%, p=0.07). Conclusion: EVAR can be performed in individuals aged ≥80 years with no statistically significant difference in midterm aneurysm-related deaths compared with younger patients. The findings in this elderly patient cohort show that EVAR can be safely performed with acceptable morbidity rates in octogenarians.
Evidence From Meta-Analysis Supports Ictal Magnetoencephalographic Source Imaging as an Accurate Method in Presurgery Evaluation of Patients With Drug-Resistant Epilepsy
Authors: Brændholt Malthe , Jensen Mads 
Published: May 2020

Background. Successful epilepsy surgery relies on localization and removal of the brain area responsible for initializing the seizures called the epileptogenic zone (EZ). Intracranial EEG (icEEG) is gold standard of this localization but has several limitations like invasiveness and limited covered area. A noninvasive method with accurate localization precision is therefore desirable. The aim of this article is to investigate the following hypotheses: (1) Ictal onset zone as localized by magnetic source imaging (iMSI) can reliably localize the EZ in focal epilepsy and (2) this localization is as good as that of icEEG. Methods. Six original studies and a total of 59 unique patients were included in a meta-analysis. Results. Sensitivity and specificity of iMSI based on surgery outcome were 77% (95% CI 60%-90%) and 75% (95% CI 53%-90%), respectively. Specificity of iMSI was statistically higher than that of icEEG. There was no significant difference between sensitivity of iMSI and icEEG. Conclusion. The meta-analysis supports that iMSI is an accurate method, achieving similar sensitivity and higher specificity than icEEG. However, at present the use of the method is limited by short recording times. A limitation that might be overcome in the future using technical advances.
Cannulation Strategies for Minimally Invasive Cardiac Surgery
Authors: Lamelas Joseph , Aberle Corinne , Macias Alejandro E. , Alnajar Ahmed 
Published: May 2020

Objective Operative techniques for minimally invasive cardiac surgery (MICS) have evolved dramatically over the past decade to include a wide demographic of patients. Mastering a variety of cannulation techniques is of paramount importance in performing a safe perfusion strategy and operation. Our aim is to describe cannulation strategies utilized in various MICS procedures. Methods We review numerous cannulation strategies and their application in different minimally invasive procedures. Results Cannulation strategies will vary depending on the MICS procedure and other anatomical variations and obstacles. Utilizing the appropriate cannulation strategy will allow for a safe and effective operation. Conclusions Mastering the art of cannulation will provide surgeons with a toolbox to choose from when performing MICS in a wide variety of procedures.
Off-label use of Proglide percutaneous closure device in iatrogenic arterial catheterizations: Our experience
Authors: Lorenzo Javier Fernández , Rey Jorge Vidal , Arquillo Irene López , Encisa de Sá Jose Manuel 
Published: May 2020

Introduction Incidental arterial puncture is one of the main complications associated with central venous catheter placement. Manual compression to achieve hemostasis in subclavian and carotid artery punctures is often ineffective because of the anatomical arterial position. Accidental cannulation has traditionally been treated with open surgery or endovascular treatment, but such procedures are not exempt from complications. Objectives Report our experience with ultrasound-guided off-label use of Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) in patients with iatrogenic arterial cannulation. Methods Six unstable patients with accidental arterial catheterization during placement of a central venous catheter: five of them in the subclavian artery and one in the right common carotid artery. Ultrasound-guided percutaneous closure was performed at bedside using a Perclose ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA). Results All patients underwent duplex ultrasound 6, 12, 24, and 48 h postprocedure, and no complications associated with percutaneous closure (embolism, ischemia, stenosis, or arterial occlusion, bleeding, pseudoaneurysm, etc.) were described. Conclusions Accidental artery puncture during central venous catheterization is an uncommon situation but can be effectively managed by using percutaneous vascular closure device. It is a reliable alternative that should be considered as a first-line approach before endovascular or open surgery, specially in patients with unstable conditions in which it is possible to be performed without transfer to an operation room.
Magnetic resonance imaging in the assessment of pancreatic cancer with quantitative parameter extraction by means of dynamic contrast-enhanced magnetic resonance imaging, diffusion kurtosis imaging and intravoxel incoherent motion diffusion-weighted imaging
Authors: Granata Vincenza , Fusco Roberta , Sansone Mario , Grassi Roberto , Maio Francesca , Palaia Raffaele , Tatangelo Fabiana , Botti Gerardo , Grimm Robert , Curley Steven , Avallone Antonio , Izzo Francesco , Petrillo Antonella 
Published: May 2020

Background: Despite great technical advances in imaging, such as multidetector computed tomography and magnetic resonance imaging (MRI), diagnosing pancreatic solid lesions correctly remains challenging, due to overlapping imaging features with benign lesions. We wanted to evaluate functional MRI to differentiate pancreatic tumors, peritumoral inflammatory tissue, and normal pancreatic parenchyma by means of dynamic contrast-enhanced MRI (DCE-MRI)-, diffusion kurtosis imaging (DKI)-, and intravoxel incoherent motion model (IVIM) diffusion-weighted imaging (DWI)-derived parameters. Methods: We retrospectively analyzed 24 patients, each with histopathological diagnosis of pancreatic tumor, and 24 patients without pancreatic lesions. Functional MRI was acquired using a 1.5 MR scanner. Peritumoral inflammatory tissue was assessed by drawing regions of interest on the tumor contours. DCE-MRI, IVIM and DKI parameters were extracted. Nonparametric tests and receiver operating characteristic (ROC) curves were calculated. Results: There were statistically significant differences in median values among the three groups observed by Kruskal–Wallis test for the DKI mean diffusivity (MD), IVIM perfusion fraction (fp) and IVIM tissue pure diffusivity (Dt). MD had the best results to discriminate normal pancreas plus peritumoral inflammatory tissue versus pancreatic tumor, to separate normal pancreatic parenchyma versus pancreatic tumor and to differentiate peritumoral inflammatory tissue versus pancreatic tumor, respectively, with an accuracy of 84%, 78%, 83% and area under ROC curve (AUC) of 0.85, 0.82, 0.89. The findings were statistically significant compared with those of other parameters ( p value < 0.05 using McNemar’s test). Instead, to discriminate normal pancreas versus peritumoral inflammatory tissue or pancreatic tumor and to differentiate normal pancreatic parenchyma versus peritumoral inflammatory tissue, there were no statistically significant differences between parameters’ accuracy ( p > 0.05 at McNemar’s test). Conclusions: Diffusion parameters, mainly MD by DKI, could be helpful for the differentiation of normal pancreatic parenchyma, perilesional inflammation, and pancreatic tumor.
Prediction of motor recovery using indirect connectivity in a lesion network after ischemic stroke
Authors: Lee Jungsoo , Park Eunhee , Lee Ahee , Chang Won Hyuk , Kim Dae-Shik , Kim Yun-Hee 
Published: May 2020

Background: Recovery prediction can assist in the planning for impairment-focused rehabilitation after a stroke. This study investigated a new prediction model based on a lesion network analysis. To predict the potential for recovery, we focused on the next link-step connectivity of the direct neighbors of a lesion. Methods: We hypothesized that this connectivity would contribute to recovery after stroke onset. Each lesion in a patient who had suffered a stroke was transferred to a healthy subject. First link-step connectivity was identified by observing voxels functionally connected to each lesion. Next (second) link-step connectivity of the first link-step connectivity was extracted by calculating statistical dependencies between time courses of regions not directly connected to a lesion and regions identified as first link-step connectivity. Lesion impact on second link-step connectivity was quantified by comparing the lesion network and reference network. Results: The lower the impact of a lesion was on second link-step connectivity in the brain network, the better the improvement in motor function during recovery. A prediction model containing a proposed predictor, initial motor function, age, and lesion volume was established. A multivariate analysis revealed that this model accurately predicted recovery at 3 months poststroke ( R 2 = 0.788; cross-validation, R 2 = 0.746, RMSE = 13.15). Conclusion: This model can potentially be used in clinical practice to develop individually tailored rehabilitation programs for patients suffering from motor impairments after stroke.
The risk of early infection following intra-articular corticosteroid injection following shoulder arthroplasty
Authors: Cancienne Jourdan M , Werner Brian C 
Published: May 2020

Background There is little literature examining the association of corticosteroid injections into shoulders with a pre-existing arthroplasty. The aim of the current study was to determine the risk of early infection following intra-articular corticosteroid injection into a pre-existing shoulder arthroplasty. Methods The PearlDiver database was retrospectively reviewed to identify patients with a pre-existing shoulder arthroplasty from 2007 to 2017. Patients with an ipsilateral shoulder corticosteroid injection in the postoperative period were identified. A control group of patients without an injection was matched 4:1 by age, gender, and postoperative timepoint. Periprosthetic infection within six months after the injection was then assessed and compared using a logistic regression analysis. Results Nine hundred and fifty-eight patients were identified who underwent a postoperative corticosteroid injection into a pre-existing shoulder arthroplasty and compared to 3832 control patients. After controlling for demographics, comorbidities, and procedure type, the rate of infection in patients who received a postoperative corticosteroid injection (1.77%) was significantly higher than control patients who did not receive an injection (0.91%) (OR 1.98 (95% CI 1.31–2.98), p = 0.0253). Conclusions There is a significant association between intra-articular shoulder corticosteroid injections in patients with pre-existing shoulder arthroplasties and prosthetic joint infection compared to matched controls without postoperative injections. Study Design Level III, retrospective cohort study.
The role of the renin–angiotensin system in regulating endometrial neovascularization during the peri-implantation period: literature review and preliminary data
Authors: Qi Ruofan , Li Tin Chiu , Chen Xiaoyan 
Published: May 2020

Background: Implantation is initiated when the blastocyst attaches to the endometrium during the peri-implantation period, and appropriate neovascularization is a prerequisite for the success of the subsequent process. The role of the renin–angiotensin system (RAS) in regulation of blood pressure and hydro-electrolyte balance has long been recognized, while its role in the peri-implantation endometrium remains unclear. This manuscript discusses endometrial RAS and its possible pathways in regulating endometrial angiogenesis and its influence on subsequent pregnancy outcomes. Methods: A comprehensive search of electronic databases was carried out to identify relevant published articles, and a literature review was then performed. Using immunohistochemistry, we also performed a pilot study to examine expression of angiotensin II receptors, including angiotensin II type 1 (AT1) receptor (AT1-R) and angiotensin II type 2 (AT2) receptor (AT2-R) in the human endometrium around the time of implantation. Results: The results of the pilot study showed expression of AT1-R and AT2-R in all endometrial compartments (luminal epithelium, glandular epithelium, stroma cells, and blood vessels), and altered expression was witnessed in women with recurrent miscarriage when compared with fertile control women from our preliminary result. Conclusion: Altered vasculature of the endometrium in the peri-implantation period is detrimental to implantation and may lead to recurrent miscarriage. Being an angiogenic mediators, endometrial RAS may play a role around the time of embryo implantation, affecting subsequent pregnancy outcomes.
Plasma adrenomedullin peptides and precursor levels in pulmonary arterial hypertension disease severity and risk stratification
Authors: Bouzina Habib , Rådegran Göran 
Published: May 2020

Adrenomedullin is a potent vasodilatory peptide, linked to pulmonary arterial hypertension pathology. Proximity extension assays were utilized to study plasma biomarkers related to vasoregulation, with focus on adrenomedullin peptides and precursor levels, collectively referred to as ADM. ADM was measured in 48 treatment‐naïve pulmonary arterial hypertension patients at diagnosis, and in 31 of them at an early treatment follow‐up. Plasma ADM was additionally assessed in patients with chronic thromboembolic pulmonary hypertension (n = 20) and pulmonary hypertension due to heart failure with preserved (HFpEF(PH)) (n = 33) or reduced (HFrEF(PH)) (n = 36) ejection fraction, as well as healthy controls (n = 16). ADM was studied in relation to pulmonary arterial hypertension hemodynamics, risk assessment, prognosis, treatment response, and differentiation. Plasma ADM levels in pulmonary arterial hypertension patients at diagnosis were higher than in healthy controls (p < 0.001), similar as in chronic thromboembolic pulmonary hypertension patients (p = ns), but lower compared to HFpEF(PH) (p < 0.03) and HFrEF(PH) (p < 0.001). In pulmonary arterial hypertension, specifically, plasma ADM at diagnosis correlated mainly to mean right atrial pressure (r = 0.73, p < 0.001), N‐terminal prohormone of brain natriuretic peptide (r = 0.75, p < 0.001), six‐minute walking distance (r = –0.57, p < 0.001), and venous oxygen saturation (r = –0.57, p < 0.001). ADM also correlated to the ECS/ERS‐ (r = 0.74, p < 0.001) and REVEAL risk scores (r = 0.54, p < 0.001) at pulmonary arterial hypertension diagnosis. Plasma ADM in pulmonary arterial hypertension patients was unaltered at early treatment follow‐up compared to baseline (p = ns). Pulmonary arterial hypertension patients with supra‐median ADM at diagnosis showed worse overall survival than those with infra‐median levels (median survival 34 versus 66 months, p = 0.0077). In conclusion, the present results suggest that baseline plasma ADM levels mirror disease severity, correlating to both ECS/ERS‐ and the REVEAL risk scores.
Study on drug use pattern in primary healthcare centers of Kathmandu valley
Authors: Aryal Amrita , Dahal Asmita , Shrestha Rajeev 
Published: May 2020

Background: The basic health service is a fundamental right of every citizen. Appropriate use of medicine is an essential component for the quality of health. Drug use evaluation is a systematic and criteria-based drug evaluation, which ensures the appropriate use of the drug. The purpose of this study was to analyze the drug use situation in primary healthcare centers of Kathmandu valley. Methodology: A cross-sectional descriptive study was performed in all primary healthcare centers of Kathmandu valley. Six hundred prescriptions were analyzed retrospectively, choosing a simple random sampling method for prescribing indicators. One hundred twenty patients were interviewed for patient-care indicators, and health facility representatives were interviewed for health facility indicators. Drug use indicators developed by World Health Organization/International Network for Rational Use of Drugs were used with slight modification. Result: The average number of drugs per encounter was 2.6. The percentage of drugs prescribed by generic names and from the essential medicine list was 60% and 80.9%, respectively. The prescriptions encounters with antibiotics and injections were 58% and 4.2%, respectively. The average consultation and dispensing time were 3.6 min and 54.4 s, respectively. The percentage of drugs actually dispensed was 76.6%. Only half of the patients knew the correct dose of the dispensed drug and no adequate labeling at all. The majority of dispensers were intern nursing students (42%), and all prescribers were medical officers. Ten out of 12 primary healthcare centers had a copy of EML. The availability of key drugs in primary healthcare centers was incomplete (64.7%). Conclusion: The observed values for all World Health Organization indicators deviated from the optimal range. Patient care provided by health facilities was insufficient and thus an effective intervention program for the promotion of rational drug use practice is recommended.
Promoting Resilience in Medicine: The Effects of a Mind–Body Medicine Elective to Improve Medical Student Well-being
Authors: Williams Michelle K , Estores Irene M , Merlo Lisa J 
Published: May 2020

Background Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting. Methods First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board. Results Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 ( SD =  6.17, range = 3–26) and at posttest was 14.2 ( SD =  4.17, range = 8–22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 ( SD =  6.10, range = 24–47) at pretest to 41.8 ( SD =  4.81, range = 33–49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being. Conclusion A mind–body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost–benefit of providing instruction in mind–body medicine techniques to all medical students.
Efficacy and Safety of Tranexamic Acid in Bimaxillary Orthognathic Surgery
Authors: Sun Liang , Guo Rui , Feng Yi 
Published: May 2020

Background: Tranexamic acid (TXA) has been widely used during craniofacial and orthognathic surgery (OS). However, results of the literature are inconsistent due to specific type of surgery and a small sample of studies. The purpose of this study was to evaluate the role of TXA in bimaxillary OS. Methods: We performed a comprehensive literature search of PubMed, Cochrane Central Register of Controlled Trials, and EMBASE to identify randomized controlled trials (RCTs) that compared effect of TXA on bimaxillary OS with placebo. Outcomes of interests included intraoperative blood loss, allogenic transfusion, operation time, and volume of irrigation fluid. Random effects models were chosen considering that heterogeneity between studies was anticipated, and I 2 statistics were used to test for the presence of heterogeneity. Results: Totally 6 RCTs were identified. Tranexamic acid resulted in significantly reduced intraoperative blood loss (weighted mean difference [WMD] = −264.82 mL; 95% CI: −380.60 to −149.04 mL) and decreased amounts of irrigation fluid (WMD = −229.23 mL; 95% CI: −399.63 to −58.83 mL). However, TXA had no remarkable impact on risk of allogenic blood transfusion (pooled risk ratio = 0.50; 95% CI: 0.20-1.23), operation time (WMD = −8.71 min; 95% CI: −20.98 to 3.57 min), and length of hospital stay (WMD = −0.24 day; 95% CI: −0.62 to 0.14 day). No TXA-associated severe adverse reactions or complications were observed. Conclusions: Currently available meta-analysis reveals that TXA is effective in decreasing intraoperative blood loss; however, it does not reduce the risk of allogenic blood transfusion in bimaxillary OS.