bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications caused by iatrogenic right-to-left shunt after surgical closure of atrial septal defect: a case report
Authors: Kim Myeong Seop , Jang Se Yong , Yang Dong Heon 
Published: November 2021

Abstract

Background
Atrial septal defect (ASD) is a common congenital heart disease. For this condition, surgical treatment can be required depending on the size and type of ASD. This study included a case of a patient who complained of persistent dyspnoea after the surgical treatment for ASD.

Case summary
A 16-year-old girl who underwent a surgical patch closure for ASD at the age of 2 years presented to the emergency department and was diagnosed with acute stroke. Since childhood, she had suffered from exertional dyspnoea due to an unknown cause. Transthoracic echocardiography revealed normal chambers size and function and no signs of right heart strain. Transoesophageal echocardiography (TOE) revealed a misplaced interatrial patch from the previous surgery, which allowed the whole blood to flow from the inferior vena cava (IVC) to the left atrium (LA), creating a large right-to-left shunt that resulted in stroke and heart failure. The patient underwent surgical treatment, and her symptoms improved significantly. Six months later, she was doing well without neurological complications and dyspnoea.

Discussion
This patient experienced stroke at the age of 16 years and had been suffering from heart failure since childhood. A large right-to-left shunt flow from the IVC to the LA by misplaced interatrial patch was found using TOE, right-sided heart catheterization, and inferior caval venography. This diagnosis should be considered in patients complaining of persistent dyspnoea with hypoxia after the surgical repair of ASD.
Case report: marantic endocarditis in renal cell carcinoma: nephrectomy a treatment
Authors: Harris Andrew Z , Ternouth Ian , Lallu Bhavesh D 
Published: November 2021

Abstract

Background
Marantic endocarditis (non-bacterial thrombotic endocarditis) is a rare condition that involves non-infectious thrombotic lesions typically of the aortic and mitral valves. It is predominantly associated with malignancy and less commonly systemic lupus erythematosus. In this case, we report a patient with marantic endocarditis secondary to a renal cell carcinoma that was successfully treated with nephrectomy and anticoagulation.

Case summary
A 65-year-old male patient with embolic signs and symptoms was found to have non-infective thrombotic vegetations on three cardiac valves through transoesophageal echocardiography. Computed tomography revealed a 70 mm renal mass that confirmed to be a grade two clear-cell renal cell carcinoma. Nephrectomy and anticoagulation led to resolution of the embolic symptoms and of the valvular vegetations.

Discussion
The diagnosis of marantic endocarditis requires high clinical suspicion in a patient who presents with features of embolization. Incidence is highest in patients with an underlying malignancy, particularly adenocarcinoma. This case highlights the importance of echocardiography in diagnosis, removal of the source of thrombus, and prompt treatment with anticoagulation.
Adaptive function and correlates of anxiety during a pandemic
Authors: Salali Gul Deniz , Uysal Mete Sefa , Bevan Abi 
Published: November 2021

AbstractBackground and objectivesMost studies to date have focused on the negative aspects of anxiety. Anxiety, however, is an evolved emotional response that can provide protection in the face of risk. Pandemics are characterized by increased mortality risk coupled with future uncertainties, which both cause heightened anxiety. Here, we examine the factors associated with anxiety levels and risk avoidance behaviours during the first wave of the COVID-19 pandemic. We asked how individual time perspectives (future-oriented consideration and attention to present moment experience) affect anxiety in uncertain times, and whether anxiety reduces mortality risk by promoting risk avoidance behaviour.MethodologyWe conducted an online survey in the UK (N = 1088) and Turkey (N = 3935) and measured participants’ generalized and pandemic-related anxiety levels, future-oriented consideration, mindfulness, intolerance of uncertainty, risk perception and risk avoidance behaviours.ResultsWe found that people less tolerant of uncertainties had higher levels of pandemic anxiety. Those with higher pandemic anxiety exhibited risk avoidance behaviours more frequently. Mindfulness and increased financial satisfaction reduced pandemic anxiety. People in Turkey reported higher levels of generalized and pandemic anxiety and greater engagement in risk avoidance behaviours than people in the UK.Conclusions and implicationsOur study shows an elevated anxiety response can help mitigate infection risk during pandemics and emphasizes the importance of the underlying situation in understanding whether an anxiety response is adaptive or pathological. Maintaining a healthy level of anxiety can promote engagement in protective behaviours. Therapies addressing anxiety can focus on increasing tolerance to future uncertainties.Lay summaryAnxiety is an emotional response triggered in the anticipation of a possible threat. We found that intolerance of uncertainty strongly predicted anxiety and that people with elevated anxiety levels engaged in protective behaviours more frequently during the COVID-19 pandemic, suggesting that anxiety can help mitigate mortality risk.
Removal of Woody Debris from Logging Gaps Influences Soil Physical and Chemical Properties in the Short Term: A Case Study in Central Amazonia
Authors: Trindade Alex de Sousa , Ferraz João Baptista Silva , DeArmond Daniel 
Published: November 2021

Abstract
Generally, woody residues generated from logging remain on site, although recently, forest managers have been harvesting this material for energy generation. We evaluated the impact on an Oxisol’s physical and chemical properties after removal of residues (coarse woody debris, CWD) from logging-created gaps. The logging operations occurred on private timberland in the Central Amazon. Eighteen months after creation of the gaps, soil samples were taken up to 150 cm depth in each treatment: mature undisturbed forest (FOR), gaps with residues retained on site (RET), and gaps with removal of large branches greater than 10 cm in diameter that were from logging (REM). Clay content, up to 20 cm depth, was higher in RET and REM soils than in FOR soils. Soil bulk density values increased progressively from areas of FOR to RET and REM at 0–5 cm. The highest carbon and nutrient contents were observed in the 0–5 and 5–10 cm soil layers of RET. In the 10–30 cm depth, the contents of all nutrients, except phosphorus, were higher in REM soils. According to these short-term results, it is not possible to affirm categorically that the removal of CWD has a negative impact on the nutrient status of soils in gaps created by logging operations.
Orthogonal CRISPR-Cas tools for genome editing, inhibition, and CRISPR recording in zebrafish embryos
Authors: Takasugi Paige R , Wang Shengzhou , Truong Kimberly T , Drage Evan P , Kanishka Sahar N , Higbee Marissa A , Bamidele Nathan , Ojelabi Ogooluwa , Sontheimer Erik J , Gagnon James A 
Published: November 2021

Abstract
The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas universe continues to expand. The type II CRISPR-Cas system from Streptococcus pyogenes (SpyCas9) is the most widely used for genome editing due to its high efficiency in cells and organisms. However, concentrating on a single CRISPR-Cas system imposes limits on target selection and multiplexed genome engineering. We hypothesized that CRISPR-Cas systems originating from different bacterial species could operate simultaneously and independently due to their distinct single-guide RNAs (sgRNAs) or CRISPR-RNAs (crRNAs), and protospacer adjacent motifs (PAMs). Additionally, we hypothesized that CRISPR-Cas activity in zebrafish could be regulated through the expression of inhibitory anti-CRISPR (Acr) proteins. Here, we use a simple mutagenesis approach to demonstrate that CRISPR-Cas systems from S. pyogenes (SpyCas9), Streptococcus aureus (SauCas9), Lachnospiraceae bacterium (LbaCas12a, previously known as LbCpf1) are orthogonal systems capable of operating simultaneously in zebrafish. CRISPR systems from Acidaminococcus sp. (AspCas12a, previously known as AsCpf1) and Neisseria meningitidis (Nme2Cas9) were also active in embryos. We implemented multichannel CRISPR recording using three CRISPR systems and show that LbaCas12a may provide superior information density compared with previous methods. We also demonstrate that type II Acrs (anti-CRISPRs) are effective inhibitors of SpyCas9 in zebrafish. Our results indicate that at least five CRISPR-Cas systems and two anti-CRISPR proteins are functional in zebrafish embryos. These orthogonal CRISPR-Cas systems and Acr proteins will enable combinatorial and intersectional strategies for spatiotemporal control of genome editing and genetic recording in animals.
Regional Gray Matter Volume Changes in Brains of Patients With Ulcerative Colitis
Authors: Zhang Shuming , Chen Fenrong , Wu Jiayu , Liu Chengxiang , Yang Guang , Piao Ruiqing , Geng Bowen , Xu Ke , Liu Peng 
Published: November 2021

Abstract

Background
Ulcerative colitis (UC) and Crohn’s disease (CD) are 2 subtypes of inflammatory bowel disease (IBD). Several studies have reported brain abnormalities in IBD patients. This study aims to identify differences of gray matter volume (GMV) between patients with UC and healthy controls (HCs).

Methods
Fifty-seven patients with UC and 40 HCs underwent structural magnetic resonance imaging. Voxel-based morphometry method was used to detect GMV differences. Receiver operating characteristic (ROC) curve was applied to investigate reliable biomarkers for identifying patients with UC from HCs. Regression analysis was used to examine relationships between the structure alternations and clinical symptoms.

Results
Compared with HCs, patients with UC showed decreased GMV in the insula, thalamus, pregenual anterior cingulate cortex, hippocampus/parahippocampus, amygdala, and temporal pole; they showed increased GMV in the putamen, supplementary motor area, periaqueductal gray, hypothalamus, and precentral gyrus. Receiver operating characteristic analysis showed the highest classification power of thalamus. The inclusion of anxiety and depression as covariates eliminated the differences in the right insula, pregenual anterior cingulate cortex, supplementary motor area, and precentral gyrus. Most of the GMV changes were found in active patients with UC, with few changes in patients with UC in remission. We also found significantly negative correlation between UC duration and GMV in several regions.

Conclusion
The current neuroimaging findings were involved in visceral sensory pathways and were partially associated with the levels of anxiety and depression and clinical stage of patients with UC. This study might provide evidence for possible neuromechanisms of UC.
Diffusion and Decentralized Bargaining in International Organizations: Evidence from Mercosur's Dispute Settlement Mechanism
Authors: Lenz Tobias 
Published: November 2021

Abstract
How and with what effects do institutions diffuse between international organizations (IOs)? An emerging literature extends a key insight of the study of diffusion processes among states to the international level, establishing that the adoption of institutions in IOs is regularly conditioned by the choices of other IOs. Yet, this literature neglects a key contextual difference between the two settings: unlike in the hierarchically structured organizations that have dominated the literature on diffusion, institutional creation, and change in IOs are the result of decentralized bargaining among sovereign governments. This paper develops a heuristic model that shows how diffusion between IOs shapes decision-making within them through its impact on the institutional preferences of individual governments. The model establishes that, unlike in diffusion processes among states, convergence is an unlikely outcome of diffusion between IOs. By implication, studies that take institutional convergence as their starting point are likely to underestimate the pervasiveness of diffusion effects. I demonstrate these arguments with a case study of the establishment of a regional dispute settlement system in Mercosur, a regional organization in Latin America.
The Effect of Pension Subsidies on the Retirement Timing of Older Women
Authors: Ye Han 
Published: November 2021

Abstract
I estimate the effect of additional pension benefits on women’s retirement decisions by examining a German pension subsidy program. The subsidies have a kinked relationship with the recipients’ past pension contributions, creating a sharply different slope of benefits for similar women on either side of the kink point. I find that a 100 euro increase in the monthly benefit induces female recipients to claim their pensions six months earlier. Recipients also adjust their labor supply by using unemployment insurance as a stepping stone to retirement and by reducing the time spent in marginal employment. A back-of-the-envelope calculation suggests that the ratio of behavioral to mechanical costs for this subsidy program is 0.25, which is smaller than that of many other income support programs. (JEL: H55, J18, J21, J26)
Curvularia alcornii Aortic Pseudoaneurysm Following Aortic Valve Replacement: Case Report and Review of the Literature
Authors: Narayanasamy Shanti , Williams Adam R , Schell Wiley A , Moehring Rebekah W , Alexander Barbara D , Le Thuy , Bharadwaj Ramesh A , McGauvran Michelle , Schroder Jacob N , Perfect John R 
Published: November 2021

Abstract
We report the first case of Curvularia alcornii aortic pseudoaneurysm following bioprosthetic aortic valve replacement in an immunocompetent host. Infection was complicated by septic emboli to multiple organs. Despite aggressive surgical intervention and antifungal therapy, infection progressed. We review the literature on invasive Curvularia infection to inform diagnosis and management.
Bamlanivimab Efficacy in Older and High-BMI Outpatients With COVID-19 Selected for Treatment in a Lottery-Based Allocation Process
Authors: Rubin Emily B , Boiarsky Jonathan A , Canha Lauren A , Giobbie-Hurder Anita , Liu Mofei , Townsend Matthew J , Dougan Michael 
Published: November 2021

Abstract

Background
Given the challenges associated with timely delivery of monoclonal antibody (mAb) therapy to outpatients with coronavirus disease 2019 (COVID-19) who are most likely to benefit, it is critical to understand the effectiveness of such therapy outside the context of clinical trials.

Methods
This was a case–control study of 1257 adult outpatients with COVID-19, ≥65 years of age or with body mass index (BMI) ≥35, who were entered into a lottery for mAb therapy.

Results
Patients who were called to be offered mAb therapy had a statistically significant 44% reduction in the odds of hospitalization within 30 days of a positive severe acute respiratory syndrome coronavirus 2 test compared with those who were not called (odds ratio [OR], 0.56; 95% CI, 0.36–0.89; P=.01). Patients who actually received bamlanivimab had a statistically significant 68% reduction in the odds of hospitalization compared with those who did not receive bamlanivimab (OR, 0.32; 95% CI, 0.11–0.93; P=.04).

Conclusions
This study supports the effectiveness of bamlanivimab in reducing COVID-19-related hospitalizations in patients ≥65 or with BMI ≥35.
Reimbursement for Female-Specific Compared With Male-Specific Procedures Over Time
Authors: Polan Rosa M. , Barber Emma L. 
Published: November 2021

OBJECTIVE:
To evaluate whether per-procedure work relative value units (RVUs) have changed over time and to compare time-based compensation for female-specific procedures compared with male-specific procedures.

METHODS:
Using the National Surgical Quality Improvement Program files for 2015–2018, we compared operative time and RVUs for 12 pairs of sex-specific procedures. Procedures were matched to be anatomically and technically similar. Procedure-assigned RVUs in 2015 were compared with 1997. Procedure compensation was determined using median dollars per RVU provided in SullivanCotter's 2018 Physician Compensation and Productivity Survey. This was compared with specialty-specific McGraw-Hill per-RVU data from 1994. Statistical analysis was performed with chi-square and Kruskal-Wallis tests.

RESULTS:
A total of 12,120 patients underwent 6,217 male-specific procedures and 5,903 female-specific procedures. Male-specific procedures had a median (interquartile range) RVU of 25.2 (21.4–25.2), compared with 7.5 (7.5–23.4) for female-specific procedures (P<.001). Male-specific procedures were 79 minutes longer (median [interquartile range] 136 minutes [98–186] vs 57 minutes [25–125], P<.001). Female-specific procedures were reimbursed at a higher hourly rate (10.6 RVU/hour [7.2–16.2] vs 9.7 RVU/hour [7.4–12.8], P<.001). However, male-specific procedures were better reimbursed ($599/h [$457–790] vs $555/h [$377–843], P<.001). Overall, per-procedure RVUs for male-specific surgeries have increased 13%, whereas, for female-specific surgeries, per-procedure RVUs have increased 26%. Reimbursement per RVU for male-specific procedures has decreased 8% ($67.30 to $61.65), whereas for female-specific procedures it has increased 14% ($44.50 to $52.02).

CONCLUSION:
Increases in RVUs and specialty-specific compensation have resulted in more equitable reimbursement for female-specific procedures. However, even with these changes, there is a lower relative value of work, driven by specialty-specific compensation rates, for procedures performed for women-only compared with equivalent men-only procedures.
Technical Note on Placement of Low-Profile Triangular Osteosynthesis for Unstable Posterior Pelvic Ring Injuries
Authors: Steelman Kevin , Bray Ryan , Vaidya Rahul 
Published: November 2021

Summary:
Triangular osteosynthesis is a technique used to stabilize posterior pelvic ring injuries. Conventional triangular fixation can be problematic for several reasons, including the need for advanced skill sets to place instrumentation, difficulty with pelvic reduction and placing the connecting construct, and prominent instrumentation. The purpose of this study is 2-fold: (1) to describe in detail a technique for lumbopelvic fixation using implants that are easy to connect, allow distraction for complex lumbosacral displacements, and are placed in a location minimizing soft tissue prominence and (2) to present our initial case series using this technique. We present a retrospective review of 18 consecutively treated patients with this technique. Inclusion criteria were patients with complete disruption through the sacrum or sacroiliac joint from blunt trauma (OTA/AO type C injuries). Outcomes included pelvic reduction/malreduction, wound healing, and complications. Fourteen patients underwent unilateral fixation (81%), and 4 patients underwent bilateral fixation (19%). All patients (18 of the 18) had a well-reduced pelvis after fixation. No patient (0%) required a return trip to the operating room for loss of reduction/malreduction, wound breakdown, or implant failure. This study presents an updated technique for a low-profile triangular osteosynthesis construct with straightforward application for unstable posterior pelvic ring injuries. This technique does not require rod bending, results in a consistently more recessed iliac screw and connecting rod, and can be used in a wide variety of unstable posterior pelvic ring injuries, including comminuted sacral fractures, L5/S1 facet fractures, and vertical shear injuries.
Short-term combined treatment with exenatide and metformin for overweight/obese women with polycystic ovary syndrome
Authors: Ma Rui-Lin , Deng Yan , Wang Yan-Fang , Zhu Shi-Yang , Ding Xue-Song , Sun Ai-Jun 
Published: November 2021

Abstract

Background:
Obesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.

Methods:
Fifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.

Results:
Forty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m2 and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m2 and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.

Conclusions:
COM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.

Trial registration:
ClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272
Virtual Surgical Planning for Oncologic Mandibular and Maxillary Reconstruction
Authors: Myers Paige L. , Nelson Jonas A. , Rosen Evan B. , Allen Robert J. , Disa Joseph J. , Matros Evan 
Published: November 2021

Summary:
Virtual surgical planning (VSP) with computer-aided design and computer-aided modeling (CAD/CAM) enables the opportunity to provide personalized medicine in complex head and neck reconstruction. This innovative technology allows ablative and reconstructive surgeons to virtually create and manipulate three-dimensional anatomic models to plan both the resection and reconstruction of complicated maxillofacial defects. Studies demonstrate improvements in preoperative planning, operative efficiency and accuracy, and postoperative outcomes. VSP facilitates immediate dental implantation in selected patients, which can improve the likelihood of achieving dental restoration. This article outlines strategies for technique optimization as well as the applications, advantages and disadvantages of VSP in complex oncologic head and neck reconstruction.