bluuebunny/crossref_metadata_2025_split huggingface dataset:
Degenerative mitral regurgitation
Authors: Soulat-Dufour Laurie , Addetia Karima 
Published: July 2020

Purpose of review
Degenerative mitral regurgitation (DMR) continues to be an important cause of morbidity and mortality with surgical mitral valve repair remaining the gold standard for the treatment of severe disease. The purpose of this review is to summarize recent advances in the understanding of DMR as well as the progress made in its assessment with a focus on imaging techniques.

Recent findings
Recent insights into the anatomy and physiology of DMR challenge the assumption that fibroelastic deficiency and Barlow disease are part of a single DMR spectrum. Advances in echocardiography and cardiovascular MRI have the potential to improve quantification of mitral regurgitation, provide unique information on prognosis and impact of DMR, further the association between DMR and arrhythmic risk and aide in decision-making for DMR treatment.

Summary
With growing interest in the use of noninvasive transcatheter therapies in the mitral valve space, comprehensive assessment of the mitral valve is critical to instruct decision-making and guide therapeutic strategy.
Functional mitral regurgitation
Authors: Asch Federico M. , Medvedofsky Diego 
Published: July 2020

Purpose of review
Functional mitral regurgitation (FMR) is a complex condition in which significant mitral regurgitation coexist with cardiomyopathy and heart failure and carries an increased risk for associated morbidity and mortality. In addition to guideline-directed medical therapy and cardiac resynchronization therapy, percutaneous transcatheter mitral valve repair (TMVr) is a new therapeutic option but requires careful selection of the proper candidates. We describe the different mechanisms of functional mitral regurgitation, review echocardiographic parameters to assess its severity, and discuss recently published relevant studies including TMVr.

Recent findings
Two randomized controlled trials assessing the efficacy and safety of TMVr using the MitraClip in patients with heart failure and severe functional mitral regurgitation were published: MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) and COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation). The results of these trials were opposite: although MITRA-FR failed to show clinical benefit, COAPT showed a dramatic clinical and echocardiographic benefit from transcatheter mitral valve repair using the MitraClip device. We discuss these two important trials and how differences in patient enrollment could explain the discrepant results and the manner they may influence future studies and clinical practice.

Summary
Patients with FMR receiving optimal guideline-directed medical therapy and cardiac resynchronization therapy who meet specific clinical and echocardiographic criteria can benefit from transcatheter mitral valve repair.
Subclinical left atrial dysfunction profiles for prediction of cardiac outcome in the general population
Authors: Cauwenberghs Nicholas , Haddad Francois , Sabovčik František , Kobayashi Yukari , Amsallem Myriam , Morris Daniel Armando , Voigt Jens-Uwe , Kuznetsova Tatiana 
Published: July 2020

Objective:
Echocardiographic definitions of subclinical left atrial dysfunction based on epidemiological data remain scarce. In this population study, we derived outcome-driven thresholds for echocardiographic left atrial function parameters discriminating between normal and abnormal values.

Methods:
In 1306 individuals (mean age, 50.7 years; 51.6% women), we echocardiographically assessed left atrial function and LV global longitudinal strain. We derived cut-off values for left atrial emptying fraction (LAEF), left atrial function index (LAFI) and left atrial reservoir strain (LARS) to define left atrial dysfunction using receiver-operating curve threshold analysis. Main outcome was the incidence of cardiac events and atrial fibrillation (AFib) on average 8.5 years later.

Results:
For prediction of new-onset AFib, left atrial cut-offs yielding the best balance between sensitivity and specificity (highest Youden index) were: LAEF less than 55%, LAFI less than 40.5 and LARS less than 23%. Applying these cut-offs, abnormal LAEF, LAFI and LARS were, respectively, present in 27, 37.1 and 18.1% of the cohort. Abnormal LARS (<23%) was independently associated with higher risk for cardiac events and new-onset AFib (P ≤ 0.012). Participants with both abnormal LAEF and LARS presented a significantly higher risk to develop cardiac events (hazard ratio: 2.10; P = 0.014) and AFib (hazard ratio: 6.45; P = 0.0036) than normal counterparts. The concomitant presence of an impaired LARS and LV global longitudinal strain improved prognostic accuracy beyond a clinical risk model for cardiac events and the CHARGE-AF Risk Score for AFib.

Conclusion:
Left atrial dysfunction based on outcome-driven thresholds predicted cardiac events and AFib independent of conventional risk factors. Screening for subclinical left atrial and LV systolic dysfunction may enhance cardiac disease prediction in the community.
Efficacy of Azithromycin Eyedrops for Individuals With Meibomian Gland Dysfunction–Associated Posterior Blepharitis
Authors: Arita Reiko , Fukuoka Shima 
Published: July 2020

Purpose:
To examine the safety and efficacy of azithromycin eyedrops in Japanese individuals with meibomian gland dysfunction (MGD)-associated posterior blepharitis.

Methods:
Individuals with MGD-associated posterior blepharitis who visited the Itoh Clinic, Saitama, Japan, were randomly assigned to receive azithromycin (1%) eyedrops (AZM group, 16 eyes of 16 patients) or preservative-free artificial tears (control group, 20 eyes of 20 patients) for 2 weeks. All subjects also applied a warming eyelid compress twice per day. Subjective symptoms (Standardized Patient Evaluation of Eye Dryness [SPEED] score), lipid layer thickness (LLT) and interferometric pattern of the tear film, plugging and vascularity of the lid margin, noninvasive break-up time of the tear film (NIBUT) and fluorescein-based break-up time of the tear film (TBUT), corneal–conjunctival fluorescein staining score, tear meniscus height, meibum grade, meiboscore, tear osmolarity, and Schirmer test value were determined before and after treatment. Side effects of treatment were also recorded.

Results:
In the AZM group, SPEED score, LLT, interferometric pattern, plugging and vascularity of the lid margin, NIBUT, TBUT, meibum grade, and tear osmolarity were significantly improved after treatment compared with baseline. The SPEED score, interferometric pattern, plugging, vascularity, meibum grade, and tear osmolarity were also significantly improved after treatment in the AZM group compared with the control group. Common side effects in the AZM group were transient eye irritation and blurred vision.

Conclusion:
Azithromycin eyedrops improved eyelid inflammation, the quality and quantity of the lipid layer of the tear film, and tear film stability. Such eyedrops thus seem to be a safe and effective treatment for MGD-associated posterior blepharitis.
Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture
Authors: Bhojwani Deepak , Vasavada Abhay R. , Vasavada Vaishali , Vasavada Shail , Praveen Mamidipudi R. , Srivastava Samaresh 
Published: July 2020

Purpose:
To report intraoperative performance and long-term postoperative outcomes after scleral fixation of intraocular lenses (IOLs) with polytetrafluoroethylene suture (PTFE).

Setting:
Raghudeep Eye Hospital, Ahmedabad, India.

Design:
Prospective, interventional case series.

Methods:
One hundred eyes undergoing scleral fixation of IOLs using PTFE suture (Gore-Tex) with 12 months or more postoperative follow-up were included. The primary outcome measures were occurrence of intraoperative and postoperative complications such as glaucoma, suture-related complications, and inflammation within the follow-up period. The secondary outcome measure was improvement in visual acuity (VA).

Results:
Of the 100 eyes, posteriorly dislocated IOLs (53 eyes) followed by dropped nuclei (33 eyes) were the most common surgical indications. Mean follow-up was 23 months (range 12 months to 5 years). Seventy-one patients (77.17%) had 18 months or more follow-up; 21 eyes had a rise in intraocular pressure in the early postoperative period; 12 of them required glaucoma surgery. Early complications were vitreous hemorrhage in 13 eyes, retinal detachment in 6 eyes, and transient hyphema in 1 eye. Late postoperative complications were cystoid macular edema (9 eyes), epiretinal membrane (3 eyes), and bullous keratopathy (3 eyes). Mean VA improved from 0.92 ± 0.16 (SD) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.41 ± 0.27 logMAR. LogMAR at final follow-up was 0.41 ± 0.28 (P < .01). There were no cases of suture-related complications (erosion/breakage/granuloma) or IOL decentration throughout the follow-up period.

Conclusions:
Scleral fixation of IOLs with PTFE suture was found to be safe and well tolerated. All eyes had well-centered IOLs, with no suture-related complications during long-term follow-up. VA improved significantly with acceptable postoperative complications.
Liver fibrosis regression correlates with downregulation in liver angiogenesis in chronic hepatitis C through viral eradication
Authors: Chen Sheng-Hung , Huang Chia-Lin , Chiang I-Ping , Chang Tzu-Ching , Wang Hung-Wei , Hsu Wei-Fan , Tsai Tsung-Yu , Peng Cheng-Yuan 
Published: July 2020

Objectives
The impact of viral eradication on hepatic angiogenesis is unknown. This study aimed to analyze the correlations of liver angiogenesis with liver fibrosis progression or regression in chronic hepatitis C (CHC) after viral eradication.

Methods
From 2003 to 2020, a cohort of 130 eligible participants underwent paired percutaneous liver biopsies (median = 48 months apart; range = 46–62) at the treatment baseline and after sustained virological response to CHC treatment at the tertiary referral center. The collagen proportionate area (CPA) of liver tissue sections was determined using picrosirius red staining through digital image analysis. CD34 and α-smooth muscle actin (α-SMA) phenotypically quantitated liver angiogenesis and myofibroblasts, respectively, through immunohistochemistry staining, to correlate the total, portal, and extraportal liver angiogenesis with fibrogenesis.

Results
Paired histology manifested significant regressions in fibrosis stages, and necroinflammatory grades (both P
< 0.001). The median of changes in CPAs (follow-up minus baseline) was −6.12% (interquartile range = −12.35 to −2.05%). The median of CPA changes per year was −1.38%/year (interquartile range = −2.98 to −0.51%/year). The significance of declines in total CD34 [coefficient (95% confidence interval), 5.577 (3.286–7.868); P
< 0.001] outweighed α-SMA declines, when explaining (R
2 = 0.522; adjusted R
2 = 0.502) the CPA declines through multiple regression analysis adjusting for other histological variables.

Conclusion
Through viral eradication in CHC, the downregulated liver angiogenesis significantly explains the CPA regression.
Isolated Right Atrial Rupture From Blunt Chest Trauma in Motor Vehicle Collisions
Authors: Feola Alessandro , Mastroianni Valerio , Scamardella Irene Adelaide , Zangani Pierluca , Della Pietra Bruno , Campobasso Carlo Pietro 
Published: July 2020

Abstract
Isolated right atrial rupture after nonpenetrating blunt chest trauma is rare, and very few cases have been reported in the literature. Isolated right atrial rupture is a diagnostic challenge in these patients, who are mostly victims of motor vehicle collisions. The clinical presentation is heterogeneous and can vary depending on rupture location and size. The anatomical sites mostly involved are the appendage and the free wall followed by the superior and inferior vena cava junctions. The present case study shows a fatal isolated rupture of the right atrial appendage in a victim of a motor vehicle collision. At the emergency room, a computed tomography scan revealed a severe pericardial blood effusion, and pericardiocentesis was promptly performed. Unfortunately, the patient suddenly worsened just before cardiac surgery. Autopsy findings showed a cardiac tamponade due to a linear laceration 1.8 cm in length on the right atrial appendage. No other relevant injuries were observed. A prompt diagnosis of isolated right atrial rupture can be crucial for victims of blunt chest trauma with unexplained hypotension or hemodynamic instability to improve their chances of survival. Medicolegal issues can be raised mainly related to delayed diagnosis. Once a cardiac rupture is suspected, the injury repair is essential to achieve the best outcome.
Split Calvarial Bone Graft for Reconstruction of Skull Defect in Langerhans Cell Histiocytosis
Authors: Baek Sang Oon , Kim Jaewon , Lee Jun Yong 
Published: July 2020

Abstract
Langerhans cell histiocytosis (LCH) is a rare disease in which histiocytes proliferates in several tissues. It mainly occurs in children between 1 and 15 years of age, and affects bone especially the skull being the most common site of invasion. It is desirable to reconstruct the skull defect after surgical removal of the lesion with autologous bone considering the fact that this disease affects children who continuously experience the deformation and growth of the frontal head. We introduce a case report who reconstructs the skull defect using split calvarial bone graft in LCH. A 3-year-old male visited the hospital with a painful, palpable protruding mass in the frontal area lasting 1 month. Craniectomy with skull tumor removal was performed by neurosurgeon, after that we harvested a calvarial bone graft and carefully separated the outer cortex from the inner cortex. Then, we covered the donor site with the inner cortex while covered the bone defect with the outer cortex and fixed with absorbable plates. The patient showed palpable mass at 1-year follow-up but it disappeared. After 5 years, there was no recurrence, the lytic lesion of the skull was resolved, and showed cosmetically good result. We conclude that the palpable lesion was more likely to be the result of postoperative swelling of the plate. We propose split calvarial bone graft as a good treatment option for reconstruction of the skull defect in LCH.
Flow Chart for Reconstructive Head and Neck Surgery in Composite Soft and Hard Tissue Defects
Authors: Lethaus Bernd , Kamal Mohammad , Kettner Franziska , Kloss-Brandstätter Anita , Halama Dirk , Hölzle Frank , Bartella Alexander K. 
Published: July 2020

Introduction:
Virtual planning of reconstructive surgical procedures in patients with osseous and composite defects in the head and neck region is becoming increasingly a state of the art modality. However, computational algorithms lack the capability of planning the involved soft tissue and vascular pedicle position. The authors present a flow-chart to solve this problem in the reconstruction of defects of the upper and lower jaw.

Material and Methods:
Clinical records from 2013 to 2018 from a tertiary care center were screened for patients undergoing osseous reconstruction in the head and neck region. A flow-chart considering soft tissue positioning and the anatomical course of the vascular pedicle was assessed in consideration of the defect and donor-site.

Results:
A total of 81 osseous and composite microvascular reconstructive procedures have been conducted. Defects of the lower jaw were the most common (n = 61). The free fibula flap was the most common reconstructive measure and showed a wide versatility of surgical options to reconstruct these defects. The flow charts were assessed accordingly in these procedures.

Conclusion:
Soft tissue and vascular pedicle positioning can be planned pre-operatively by the use of virtual planning and should be considered as an enhancement tool to the already existing computational algorithms of planning hard tissue reconstruction.
Intradiploic Hematoma Associated With Synostosis in an Infant
Authors: Solaja Ogi , McAuley David , Peters Daniel A. 
Published: July 2020

Abstract
Intradiploic hematomas are extremely rare, particularly in newborns. Caused by bleeding between the inner and outer tables of the calvarium, they manifest with bony swelling of the skull. The authors present the first case of an intraosseous hematoma associated with synostosis, and the first report in a female patient. The clinical, radiological, surgical, and pathological characteristics of this lesion are discussed.
Modulation of Brain Transcriptome by Combined Histone Deacetylase Inhibition and Plasma Treatment Following Traumatic Brain Injury and Hemorrhagic Shock
Authors: Dekker Simone E. , Biesterveld Ben E. , Bambakidis Ted , Williams Aaron M. , Tagett Rebecca , Johnson Craig N. , Sillesen Martin , Liu Baoling , Li Yongqing , Alam Hasan B. 
Published: July 2020

ABSTRACT

Introduction:
We previously showed that the addition of valproic acid (VPA), a histone deacetylase inhibitor, to fresh frozen plasma (FFP) resuscitation attenuates brain lesion size and swelling following traumatic brain injury (TBI) and hemorrhagic shock (HS). The goal of this study was to use computational biology tools to investigate the effects of FFP+VPA on the brain transcriptome following TBI+HS.

Methods:
Swine underwent TBI+HS, kept in shock for 2 h, and resuscitated with FFP or FFP + VPA (n = 5/group). After 6 h of observation, brain RNA was isolated and gene expression was analyzed using a microarray. iPathwayGuide, Gene Ontology (GO), Gene-Set Enrichment Analysis, and Enrichment Mapping were used to identify significantly impacted genes and transcriptomic networks.

Results:
Eight hundred differentially expressed (DE) genes were identified out of a total of 9,118 genes. Upregulated genes were involved in promotion of cell division, proliferation, and survival, while downregulated genes were involved in autophagy, cell motility, neurodegenerative diseases, tumor suppression, and cell cycle arrest. Seven hundred ninety-one GO terms were significantly enriched. A few major transcription factors, such as TP53, NFKB3, and NEUROD1, were responsible for modulating hundreds of other DE genes. Network analysis revealed attenuation of interconnected genes involved in inflammation and tumor suppression, and an upregulation of those involved in cell proliferation and differentiation.

Conclusion:
Overall, these results suggest that VPA treatment creates an environment that favors production of new neurons, removal of damaged cells, and attenuation of inflammation, which could explain its previously observed neuroprotective effects.
Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience
Authors: Chan Albert C. Y. , Chok Kenneth S. H. , Dai Jeff , Tsang Simon H. Y. , Cheung Tan To , Poon Ronnie , Fan S. T. , Lo C. M. 
Published: July 2020

Objective:
To study the impact of LT experience on the outcome of CLR for locally advanced hepatobiliary malignancy

Summary of Background data:
Despite evolution in LT knowledge and surgical techniques in the past decades, there is yet data to evaluate the significance of LT experience in performing CLR.

Methods:
Postoperative outcome after CLR between 1995 and 2019 were reviewed and correlated with LT experience in a single center with both LT and CLR service. CLR was defined as hepatectomy with vasculobiliary reconstruction, or multivisceral resection, central bisectionectomy (S4/5/8), or associating liver partition and portal vein ligation for staged hepatectomy. Spearman rank correlation and receiver operating characteristic analysis were used to define the association between CLR-related outcomes and LT experience.

Results:
With cumulative single-center experience of 1452 LT, 222 CLR were performed during the study period [hepatectomy with biliary (27.0%), or vascular (21.2%) reconstruction, with multivisceral resections (9.9%), with associating liver partition and portal vein ligation for staged hepatectomy (18.5%)] mainly for hepatocellular carcinoma (53.2%), and hilar cholangiocarcinoma (14%). Median tumor size was 7.0 cm. Other features include macrovascular invasion (23.4%), and juxta-visceral invasion (14%). Major postoperative complication rate was 25.2% and mortality rate was 6.3%. CLR-complication rate was inversely associated with LT experience (R = −0.88, P < 0.005). Receiver operator characteristic analysis revealed the cutoff for LT experience to have the greatest influence on CLR was 95 with a sensitivity of 100% and Youden index of 1. Multivariable analysis showed that blood transfusion, prolonged operating time, LT experience < /=95 were associated with major postoperative complications.

Conclusion:
LT experience was complimentary to CLR for locally advanced hepatobiliary malignancy with improved postoperative outcome.
Myosin Va Brain-Specific Mutation Alters Mouse Behavior and Disrupts Hippocampal Synapses
Authors: Pandian Swarna , Zhao Jian-Ping , Murata Yasunobu , Bustos Fernando J. , Tunca Cansu , Almeida Ramiro D. , Constantine-Paton Martha 
Published: July 2020

ABSTRACTMyosin Va (MyoVa) is a plus-end filamentous-actin motor protein that is highly and broadly expressed in the vertebrate body, including in the nervous system. In excitatory neurons MyoVa transports cargo toward the tip of the dendritic spine, where the post-synaptic density (PSD) is formed and maintained. MyoVa mutations in humans cause neurological dysfunction, mental retardation, hypomelanation and death in infancy or childhood. Here we characterize the Flailer (Flr) mutant mouse, which is homozygous for amyo5amutation that drives high levels of mutant MyoVa (Flr protein) specifically in the CNS. Flr protein functions as a dominant-negative MyoVa, sequestering cargo and blocking its transport to the PSD. Flr mice have early seizures and mild ataxia, but mature and breed normally. Flr mice display several abnormal behaviors known to be associated with brain regions that show high expression of Flr protein. Flr mice are defective in the transport of synaptic components to the PSD and in mGluR-dependent LTD and have a reduced number of mature dendritic spines. The synaptic and behavioral abnormalities of Flr mice result in an anxiety/autism spectrum disorder (ASD)/obsessive compulsive-like phenotype similar to that of other mouse mutants with similar abnormalities. Because of the dominant-negative nature of the Flr protein, the Flr mouse offers a powerful system for the analysis of how the disruption of synaptic transport and lack of LTD can alter synaptic function, development and wiring of the brain and result in symptoms that characterize many neuropsychiatric disorders.SIGNIFICANCE STATEMENTHere we characterize a mutant mouse homozygous for a Myosin Va mutation named Flailer. The Flailer mutation generates a dominant-negative MyoVa transport motor protein that sequesters synaptic cargo and blocks synaptic transport, thereby resulting in an absence of LTD and in abnormal behaviors similar to those seen anxiety/Autism Spectrum disorders. We propose that the Flailer mutant can be used as a model to study how the absence of LTD disrupts brain connectivity and behavior. Moreover, by using the Flailer mutation together with gene editing technologies it should be possible to target specific brain areas to remove the mutation and recover MyoVa function, thereby interrogating the role of a specific brain region in the control of a particular behavior.