bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis
Authors: Wu Wen-Jie , Zhang Fu-Yu , Xiao Qin , Li Xiao-Kun 
Published: April 2021

Abstract

OBJECTIVES
A thymic epithelial tumour is the most common primary tumour in the anterior mediastinum of adults. A few retrospective studies compared the short-term outcomes between robotic-assisted thymectomy (RAT) and video-assisted thymectomy (VAT). So, it is necessary to conduct a meta-analysis to further compare these 2 surgical techniques.

METHODS
EMBASE, Medline and Web of Science were used. Thesaurus terms and medical subject headings were used in Medline and EMBASE, respectively. The Newcastle-Ottawa scale was used for grading because the included studies were all case-control studies.

RESULTS
Nine studies were included in the meta-analysis with a total of 723 patients, including 315 patients in the RAT group and 408 patients in the VAT group. The meta-analysis [odds ratio (OR) 0.24, 95% confidence interval (CI) 0.06–0.94; P = 0.041], indicating that RAT yielded a significantly lower rate of conversion compared with VAT. Duration of drainage with RAT was significantly less than that with VAT (weighted mean difference = −1.10; 95% CI −1.98 to −0.22; P = 0.014). The pooled analysis (weighted mean difference = −103.6; 95% CI −199.21 to −7.98; P = 0.034) suggested that patients in the RAT group had less drainage than those in the VAT group. The recurrence rates in both groups were comparable (OR 0.19, 95% CI 0.03–1.20; P = 0.078).

CONCLUSIONS
RAT has advantages over VAT in terms of short-term outcomes such as shorter duration of drainage, less total drainage and a lower rate of conversion. The recurrence rate was comparable between the 2 techniques. Therefore, RAT could be considered as an alternative treatment for diseases of the thymus.
Paediatric subaortic stenosis: long-term outcome and risk factors for reoperation
Authors: De Wolf Rik , François Katrien , Bové Thierry , Coomans Ilse , De Groote Katya , De Wilde Hans , Panzer Joseph , Vandekerckhove Kristof , De Wolf Daniël 
Published: April 2021

Abstract

OBJECTIVES
Surgical repair of subaortic stenosis (SAS) is associated with a substantial reoperation risk. We aimed to identify risk factors for reintervention in relation to discrete and tunnel-type SAS morphology.

METHODS
Single-centre retrospective study of paediatric SAS diagnosed between 1992 and 2017. Multivariable Cox regression analysis was performed to identify reintervention risk factors.

RESULTS
Eighty-five children [median age 2.5 (0.7–6.5) years at diagnosis] with a median follow-up of 10.1 (5.5–16.4) years were included. Surgery was executed in 83% (n = 71). Freedom from reoperation was 88 ± 5% at 5 years and 82 ± 6% at 10 years for discrete SAS, compared to, respectively, 33 ± 16% and 17 ± 14% for tunnel-type SAS (log-rank P &lt; 0.001). Independent risk factors for reintervention were a postoperative gradient &gt;20 mmHg [hazard ratio (HR) 6.56, 95% confidence interval (CI) 1.41–24.1; P = 0.005], tunnel-type SAS (HR 7.46, 95% CI 2.48–22.49; P &lt; 0.001), aortic annulus z-score &lt;−2 (HR 11.07, 95% CI 3.03–40.47; P &lt; 0.001) and age at intervention &lt;2 years (HR 3.24, 95% CI 1.09–9.86; P = 0.035). Addition of septal myectomy at initial intervention was not associated with lesser reintervention. Fourteen children with a lower left ventricular outflow tract (LVOT) gradient (P &lt; 0.001) and older age at diagnosis (P = 0.024) were followed expectatively.

CONCLUSIONS
Children with SAS remain at risk for reintervention, despite initially effective LVOT relief. Regardless of SAS morphology, age &lt;2 years at first intervention, a postoperative gradient &gt;20 mmHg and presence of a hypoplastic aortic annulus are independent risk factors for reintervention. More extensive LVOT surgery might be considered at an earlier stage in these children. SAS presenting in older children with a low LVOT gradient at diagnosis shows little progression, justifying an expectative approach.
Connected cars, SEP and FRAND—CJEU referral with a focus on multi-tier supply chains
Authors: Stief Marco , Röder-Hitschke Heike 
Published: April 2021

Abstract
Düsseldorf Regional Court, referral to the Court of Justice of the European Union, case 4c O 17/19, 26 November 2020
A recent referral of the Düsseldorf Regional Court to the Court of Justice of the European Union raises important questions on the interpretation of fair, reasonable and non-discriminatory licensing obligations in the context of supply chains.
Environmental Correlates of Lyme Disease Emergence in Southwest Virginia, 2005–2014
Authors: Lantos Paul M , Tsao Jean , Janko Mark , Arab Ali , von Fricken Michael E , Auwaerter Paul G , Nigrovic Lise E , Fowler Vance , Ruffin Felicia , Gaines David , Broyhill James , Swenson Jennifer 
Published: April 2021

AbstractLyme disease is the most common tick-borne disease in North America. Though human infection is mostly transmitted in a limited geography, the range has expanded in recent years. One notable area of recent expansion is in the mountainous region of southwestern Virginia. The ecological factors that facilitate or constrain the range of human Lyme disease in this region remain uncertain. To evaluate this further, we obtained ecological data, including remotely sensed data on forest structure and vegetation, weather data, and elevation. These data were aggregated within the census block groups of a 9,153 km2 area around the cities of Blacksburg and Roanoke, VA, an area with heterogeneous Lyme disease transmission. In this geographic area, 755 individuals were reported to have Lyme disease in the 10 yr from 2006 to 2015, and these cases were aggregated by block group. A zero-inflated negative binomial model was used to evaluate which environmental variables influenced the abundance of Lyme disease cases. Higher elevation and higher vegetation density had the greatest effect size on the abundance of Lyme disease. Measures of forest edge, forest integrity, temperature, and humidity were not associated with Lyme disease cases. Future southward expansion of Lyme disease into the southeastern states may be most likely in ecologically similar mountainous areas.
Fucoxanthin alters the apelin-13/APJ pathway in certain organs of γ-irradiated mice
Authors: El Bakary Nermeen M , Thabet Noura Magdy , El Fatih Neama M , Abdel-Rafei Mohamed Khairy , El Tawill Ghada , Azab Khaled Shaaban 
Published: April 2021

AbstractApelin-13 and APJ are implicated in different key physiological processes. This work aims at exploring the radioprotective effect of fucoxanthin (FX) on γ-radiation (RAD)-induced changes in the apelin-13/APJ pathway, which causes damage in the liver, kidney, lung and spleen of mice. Mice were administered FX (10 mg kg–1 day–1, i.p) and exposed to γ-radiation (2.5 Gy week–1) for four consecutive weeks. The treatment of irradiated mice by FX resulted in a significant amendment in protein expression of the apelin-13/APJ/NF-κB signalling pathway concurrently with reduced hypoxia (hypoxia-inducible factor-1α), suppressed oxidative stress marker (malondialdehyde), enhanced antioxidant defence mechanisms (reduced glutathione and glutathione peroxidase), a modulated inflammatory response [interleukin-6 (IL-6), monocyte chemoattractant protein-1, IL-10 and α-7-nicotinic acetylcholine receptor) and ameliorated angiogenic regulators [matrix metalloproteinase (MMP-2), MMP-9 and tissue inhibitor of metalloproteinase-1), as well as the tissue damage indicator (lactate dehydrogenase) in organ tissues. In addition, there were significant improvement in serum inflammatory markers tumour necrosis factor-α, IL-10, IL-1β and C-reactive protein compared with irradiated mice. The histopathological investigation of the FX + RAD organ tissues support the biochemical findings where the improvements in the tissues’ architecture were obvious when compared with those of RAD. FX was thus shown to have a noticeable radioprotective action mediated through its regulatory effect on the apelin-13/APJ/NF-κB signalling pathway attributed to its antioxidant and anti-inflammatory activity that was reflected in different physiological processes. It could be recommended to use FX in cases of radiation exposure to protect normal tissues.
Modelling the Rongorongo tablets: A new transcription of the Échancrée tablet and the foundation for decipherment attempts
Authors: Lastilla Lorenzo , Ravanelli Roberta , Valério Miguel , Ferrara Silvia 
Published: April 2021

AbstractThe Rongorongo is a system of writing, still undeciphered, from Easter Island in the Pacific. It consists of a corpus of twenty-six inscriptions, scattered around the world. This article presents the state-of-the art in the study of one of these inscriptions, Text D or the ‘Échancrée’ tablet housed in a museum in Rome, Italy. Through an integrated methodology based on photogrammetry and high-precision structured light scanning, a 3D model of the inscriptions is made available through a public 3D Viewer for the first time. The technique made use of the benefits of both methods of image acquisition: a very accurate, precise, high resolution, and metric reconstruction of the tablet geometry gained through the scanning process, and a high-quality texture achieved through photogrammetry. In addition, we present a new analysis of the text, through a close palaeographic examination of its signs, and corrections of previous hand drawings and transcriptions. The ultimate aim is to reach unbiased ‘readings’ of the signs through an integrated synergy of traditional palaeographic analysis and an advanced 3D model. These, applied to all the inscriptions, constitute the necessary stepping-stones for any decipherment attempt.
Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses
Authors: Abraham Kristen M , Chang Ming-Un Myron , Van Tony , Resnick Sandra G , Zivin Kara 
Published: April 2021

ABSTRACT

Introduction
Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans’ employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans’ employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA).

Materials and Methods
This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA’s employment services programs between fiscal years 2006 and 2010. Veterans’ employment status (employed/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods.

Results
Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1 year and 5 years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits.

Conclusions
VHA’s investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.
A lack of constraints on the cold opaque H i mass: H i spectra in M31 and M33 prefer multicomponent models over a single cold opaque component
Authors: Koch Eric W , Rosolowsky Erik W , Leroy Adam K , Chastenet Jérémy , Chiang (江宜達) I-Da , Dalcanton Julianne , Kepley Amanda A , Sandstrom Karin M , Schruba Andreas , Stanimirović Snežana , Utomo Dyas , Williams Thomas G 
Published: April 2021

ABSTRACT
Previous work has argued that atomic gas mass estimates of galaxies from 21-cm H i emission are systematically low due to a cold opaque atomic gas component. If true, this opaque component necessitates a $\sim 35{{\ \rm per\ cent}}$ correction factor relative to the mass from assuming optically thin H i emission. These mass corrections are based on fitting H i spectra with a single opaque component model that produces a distinct ‘top-hat’ shaped line profile. Here, we investigate this issue using deep, high spectral resolution H i VLA observations of M31 and M33 to test if these top-hat profiles are instead superpositions of multiple H i components along the line of sight. We fit both models and find that ${\gt}80{{\ \rm per\ cent}}$ of the spectra strongly prefer a multicomponent Gaussian model while ${\lt}2{{\ \rm per\ cent}}$ prefer the single opacity-corrected component model. This strong preference for multiple components argues against previous findings of lines of sight dominated by only cold H i. Our findings are enabled by the improved spectral resolution (0.42 ${\rm km\, s^{-1}}$), whereas coarser spectral resolution blends multiple components together. We also show that the inferred opaque atomic ISM mass strongly depends on the goodness-of-fit definition and is highly uncertain when the inferred spin temperature has a large uncertainty. Finally, we find that the relation of the H i surface density with the dust surface density and extinction has significantly more scatter when the inferred H i opacity correction is applied. These variations are difficult to explain without additionally requiring large variations in the dust properties. Based on these findings, we suggest that the opaque H i mass is best constrained by H i absorption studies.
The central region of a void: an analytical solution
Authors: Baushev A N 
Published: April 2021

ABSTRACT
We offer an exact analytical equation for the void central region. We show that the central density is solely determined by the amplitude of the initial perturbation. Our results suggest that N-body simulations somewhat overestimate the emptiness of voids: the majority of them should have the central underdensity $\delta _\mathrm{ c} \gt -73{{\ \rm per\ cent}}$ , and there should be almost no voids with $\delta _\mathrm{ c} \lt -88{{\ \rm per\ cent}}$. The central region of a void is a part of an open Friedmann’s ‘universe’, and its evolution differs drastically from the Universe evolution: there is a long stage when the curvature term dominates that prevents the formation of galaxy clusters and massive galaxies inside voids. The density profile in the void centre should be very flat. We discuss some void models obtained by N-body simulations and offer some ways to improve them. We also show that the dark energy makes the voids less underdense.
DNA Breaks-Mediated Fitness Cost Reveals RNase HI as a New Target for Selectively Eliminating Antibiotic-Resistant Bacteria
Authors: Balbontín Roberto , Frazão Nelson , Gordo Isabel 
Published: April 2021

Abstract
Antibiotic resistance often generates defects in bacterial growth called fitness cost. Understanding the causes of this cost is of paramount importance, as it is one of the main determinants of the prevalence of resistances upon reducing antibiotics use. Here we show that the fitness costs of antibiotic resistance mutations that affect transcription and translation in Escherichia coli strongly correlate with DNA breaks, which are generated via transcription–translation uncoupling, increased formation of RNA–DNA hybrids (R-loops), and elevated replication–transcription conflicts. We also demonstrated that the mechanisms generating DNA breaks are repeatedly targeted by compensatory evolution, and that DNA breaks and the cost of resistance can be increased by targeting the RNase HI, which specifically degrades R-loops. We further show that the DNA damage and thus the fitness cost caused by lack of RNase HI function drive resistant clones to extinction in populations with high initial frequency of resistance, both in laboratory conditions and in a mouse model of gut colonization. Thus, RNase HI provides a target specific against resistant bacteria, which we validate using a repurposed drug. In summary, we revealed key mechanisms underlying the fitness cost of antibiotic resistance mutations that can be exploited to specifically eliminate resistant bacteria.
Traditional African Religion as a Neglected Form of Monotheism
Authors: Metz Thaddeus , Molefe Motsamai 
Published: April 2021

AbstractOur aims are to articulate some core philosophical positions characteristic of Traditional African Religion and to argue that they merit consideration as monotheist rivals to standard interpretations of the Judeo-Christian-Islamic tradition. In particular, we address the topics of how God’s nature is conceived, how God’s will is meant to bear on human decision making, where one continues to exist upon the death of one’s body, and how long one is able to exist without a body. For each of these topics, we note how Traditional African Religion posits claims that clash with mainstream Judaism, Christianity, and Islam and that, being prima facie plausible, indicate the need for systematic cross-cultural philosophical debate.
Direct vs Indirect Revascularization in a North American Cohort of Moyamoya Disease
Authors: Lai Pui Man Rosalind , Patel Nirav J , Frerichs Kai U , Patel Aman B , Aziz-Sultan M Ali , Ogilvy Christopher S , Du Rose 
Published: April 2021

Abstract

BACKGROUND
In adults with ischemic moyamoya disease (MMD), the efficacy of direct vs indirect revascularization procedures remains a matter of debate.

OBJECTIVE
To investigate the outcomes of ischemic MMD in a North American cohort treated by direct and indirect revascularizations.

METHODS
We retrospectively reviewed medical records of adult patients with MMD with ischemic presentation from 1984 to 2018 at the Brigham and Women's Hospital and Massachusetts General Hospital who underwent either direct or indirect bypasses. Early postoperative events and outcome at more than 6 mo postoperatively were evaluated using multivariable logistic regression analyses. Multivariable Cox proportional hazards regression analyses were used to evaluate delayed ischemic and hemorrhagic events. Analyses were performed per hemisphere.

RESULTS
A total of 95 patients with MMD and 127 hemispheres were included in this study. A total of 3.5% and 8.6% of patients had early surgical complications in the direct and indirect bypass cohorts, respectively (P = .24). Hemispheres with direct bypasses had fewer long-term ischemic and hemorrhagic events at latest follow-up (adjusted hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.058-0.63, P = .007; median follow-up 4.5 [interquartile range, IQR 1-8] yr). There was no difference between the direct and indirect bypass groups when the endpoint was limited to infarction and hemorrhage only (P = .12). There was no difference in outcome (modified Rankin Scale [mRS] ≥ 3) between the 2 cohorts (P = .92).

CONCLUSION
There was no difference in early postoperative events, long-term infarction or hemorrhage, or clinical outcome between direct and indirect revascularization. However, there was a significant decrease in all ischemic and hemorrhagic events combined in direct revascularizations compared to indirect revascularizations.
Foramen Magnum Dural Arteriovenous Fistula Presenting With Thoracic Myelopathy: Technical Case Report With 2-Dimensional Operative Video
Authors: Gadot Ron , Gopakumar Sricharan , Wagner Kathryn , Xu David S , Raper Daniel M S , Burkhardt Jan-Karl , Ropper Alexander E 
Published: April 2021

Abstract

BACKGROUND AND IMPORTANCE
Dural arteriovenous fistulas (dAVFs) are vascular abnormalities of the central nervous system that can cause a wide array of neurological dysfunction depending on their location, flow, and propensity to rupture. Symptomatic dAVFs at the cranio-cervical junction usually result in hemorrhage or cervical myelopathy. Distantly located dAVFs of the foramen magnum are a rare cause of thoracic intrinsic myelopathy.

CLINICAL PRESENTATION
An 83-yr-old man presented with progressive lower extremity weakness, numbness, and difficulty walking along with episodes of bowel incontinence. Magnetic resonance imaging of the cervical spine demonstrated multilevel cervical disc disease with stenosis and longitudinal cervical cord signal change extending into the upper thoracic spinal cord. Cerebral and spinal angiography revealed a dAVF in the lateral foramen magnum region. Given the location, feeding vasculature, and morphology of the fistula, endovascular embolization was not attempted. Microsurgical resection with confirmative indocyanine green fluorescent imaging was performed with adequate obliteration of the fistula. The patient's neurological baseline was preserved postoperatively with improvement of lower extremity numbness.

CONCLUSION
We present a brief overview of this neuropathologic entity and demonstrate microsurgical resection of a foramen magnum dAVF through operative video. Craniocervical dAVFs should remain on the differential diagnosis of patients presenting with progressive thoracolumbar myelopathy.
Subaxial Cervical Pedicle Screw Placement With Direct Visualization of Pedicle Borders: 2-Dimensional Operative Video
Authors: Farber S Harrison , Bohl Michael A , Xu David S , Uribe Juan S , Kakarla U Kumar , Turner Jay D 
Published: April 2021

Abstract
Pedicle screws provide superior fixation of the subaxial cervical spine to other techniques. However, a high degree of accuracy is required for safe placement given the proximity of pedicles to critical neurovascular structures. A variety of techniques are described to maximize accuracy, including freehand, fluoroscopy-guided, and neuronavigation-based methods.
We present a technique for the placement of pedicle screws in the subaxial cervical spine using direct visualization of the pedicle in a patient who required an occipito-cervical fusion construct in the setting of a C2 chordoma. A laminotomy or laminectomy is performed laterally to allow for visualization of the medial, superior, and inferior walls of the pedicle. The entry point for screw placement is determined based on pedicle anatomy and is typically 1 to 2 mm lateral to the midpoint of the lateral mass, just below the base of the superior articulating process. Screw trajectory is determined by visualizing the pedicle borders and is aimed at the junction of the medial pedicle wall, with the posterior vertebral body down the pedicle axis. Tactile feedback (loss of resistance) is used to assess for a breach while drilling. The cannulation is then tapped, and the screw is placed in a standard fashion.
Direct visualization of pedicle anatomy can be a useful adjunct to guide the safe placement of subaxial pedicle screws when superior fixation is required or when normal anatomy is distorted. The technique may be combined with fluoroscopic or navigation-based techniques to provide real-time anatomic guidance during screw placement. The patient provided informed, written consent for this procedure before surgery. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.