bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midbrain area and the hummingbird sign from brain MRI in progressive supranuclear palsy and idiopathic normal pressure hydrocephalus
Authors: Virhammar Johan , Blohmé Harald , Nyholm Dag , Georgiopoulos Charalampos , Fällmar David 
Published: September 2021

ABSTRACTBackground and PurposeThe main radiological finding in progressive supranuclear palsy (PSP) is reduced midbrain volume. Both qualitative (e.g., hummingbird sign) and quantitative (e.g., area measurements) markers have been noted. Recent studies have shown a similar reduction also in idiopathic normal pressure hydrocephalus (iNPH). The purpose was to investigate the reliability and accuracy of these markers in discriminating PSP from iNPH and controls.MethodsEight neuroradiologists viewed sagittal MR images of the midbrain from 104 subjects: 26 PSP patients, 40 iNPH patients, and 38 healthy controls. They visually assessed whether the hummingbird sign was present or not, grading their confidence from 1 to 5. Assessments were translated into a score between +5 and –5: from maximum confidence of presence to maximum confidence of absence. A positive median score was considered to indicate hummingbird sign. Sagittal midbrain area was manually measured in each subject.ResultsSeventy‐seven percent of PSP patients, 65% of iNPH, and 3% of controls were visually assessed as having the hummingbird sign. Manually measured midbrain area also showed overlap between PSP and iNPH. Regarding discrimination of PSP patients, midbrain area measurements, using a cutoff of 90 mm2, yielded a higher area under the curve (AUC = 0.86) than visual assessment scores (AUC = 0.83), and higher reliability.ConclusionsMeasuring sagittal midbrain area is more accurate and reliable than visual assessment. Due to significant overlap in appearance, a midbrain with a hummingbird sign or reduced sagittal area should raise the suspicion of PSP only after other signs of iNPH have been considered.
Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy
Authors: Karamchandani Rahul R. , Strong Dale , Rhoten Jeremy B. , Prasad Tanushree , Selig Jacob , Defilipp Gary , Asimos Andrew W. 
Published: September 2021

AbstractBackground and PurposeThe role of CT perfusion (CTP)in the evaluation of acute basilar artery occlusion (aBAO) patients undergoing endovascular thrombectomy (EVT) is unclear. We investigated the association of individual CTP parameters with functional outcomes in aBAO patients undergoing EVT.MethodsA health system's prospectively collected code stroke registry was used in this retrospective analysis of aBAO patients treated with EVT presenting between January 2017 and February 2021 with pre‐EVT CTP. The primary outcome measure was modified Rankin Scale (mRS) score 0‐2 at 90 days. Factors with a univariate association (p < .05) with mRS 0‐2 were combined in a multivariable regression model to determine independent predictors of 90‐day favorable functional outcome.ResultsForty‐six subjects, with median age 67 years and median National Institutes of Health Stroke Scale 16, were included, of whom 17 (37%) achieved mRS 0‐2 at 90 days. In the multivariable logistic regression model, CTP cerebral blood volume (CBV) index (per 0.1‐point increase, odds ratio = 1.843; 95% confidence interval: 1.039, 3.268; p‐value .0365) was independently associated with a favorable 90‐day outcome.ConclusionsCBV index was independently associated with a favorable 90‐day outcome in aBAO patients treated with EVT, a novel finding in this patient population. CBV index may assist in treatment and prognosis discussions and inform future studies investigating the role of CTP in aBAO.
Comparative outcomes of Riata and Fidelis lead management strategies: Results from the NCDR‐ICD Registry
Authors: Zeitler Emily P. , Wang Yongfei , Pokorney Sean D. , Curtis Jeptha , Prutkin Jordan M. 
Published: September 2021

AbstractBackgroundThe Medtronic Sprint Fidelis® and Abbott Riata®/Riata ST® leads are at risk of failure and are subject to FDA recall. Comparative risks of various lead management strategies during elective generator change in a multi‐center population are unknown. We aim to describe patients with functional, recalled ICD leads undergoing elective generator replacement and report outcomes according to lead management strategies.MethodsUsing data from the NCDR ICD Registry, patients with a functioning Riata® or Fidelis® lead undergoing generator replacement are described according to lead management: reuse, abandon/replace, and extract/replace. Adjusted rates of death and pre‐discharge complications are reported.ResultsThere were 13,144 generator replacement procedures involving a functioning, non‐infected Riata® or Fidelis® lead (extraction n = 414, abandonment n = 427). Extraction patients were younger (mean 58 vs. 67 years) with fewer comorbidities than the reuse group. Maximum lead dwell time was similar between groups with average 94, 90, and 99 months in the extraction, abandonment, and reuse groups, respectively. In‐hospital complications or mortality were more common in the extraction group (10.14%, 4.35%) compared with abandonment (1.64%, 0.47%) and reuse (0.22%, 0.07%). Compared with reuse, the adjusted odds of death or pre‐discharge complication were significantly higher in the extraction group (OR 7.77 95% CI 2.42–24.95, p < .001) but not the abandonment group (OR 1.70 95% CI 0.52–5.61, p = .38).ConclusionsIn this real‐world population, extraction of functional recalled ICD leads was associated with significant risk of in‐hospital mortality and complications. Additional work is needed to clarify whether longer term outcomes balance these peri‐procedural risks.
The first case of gastric leiomyosarcoma developed through malignant transformation of leiomyoma
Authors: Yamamoto Amane , Tateishi Yoko , Aikou Susumu , Seto Yasuyuki , Ushiku Tetsuo 
Published: September 2021

AbstractMalignant transformation of gastric leiomyoma has not been reported, and therefore it is considered to have virtually no malignant potential. We report a case of gastric leiomyosarcoma arising from leiomyoma. The patient is a 72‐year‐old man with a submucosal mass measuring 20 mm in diameter, which was incidentally identified by an endoscopic surveillance. A biopsy suggested a diagnosis of leiomyosarcoma, and local excision was performed. Pathological examination revealed that the tumor was composed of two distinct components: typical leiomyoma‐like area in the periphery and leiomyosarcoma component exhibiting higher cellularity, prominent nuclear atypia, necrosis, and increased mitosis. Immunohistochemically, in the latter, p53 overexpression, increased Ki‐67 labeling index, and attenuated expression of smooth muscle markers were noted. This is the first report to demonstrate the presence of leiomyoma–leiomyosarcoma sequence in the stomach that is well recognized in the uterus. Our observation highlights the potential occurrence of malignant transformation of gastrointestinal leiomyoma.
How physical activity, fitness, and motor skills contribute to math performance: Working memory as a mediating factor
Authors: Syväoja Heidi J. , Kankaanpää Anna , Hakonen Harto , Inkinen Virpi , Kulmala Janne , Joensuu Laura , Räsänen Pekka , Hillman Charles H. , Tammelin Tuija H. 
Published: September 2021

PurposeThe purpose of this study was to examine whether physical activity, fitness, and motor skills have an indirect association with math performance via cognitive outcomes and if so, through which aspects of cognition?MethodsThis study comprised 311 6th–9th grade adolescents (12–17 years [M age = 14.0 years], 59% girls) from seven schools throughout Finland in 2015. Math performance was measured via a teacher‐rated math achievement and the Basic Arithmetic test. Cognitive functions were measured by broad cognitive test battery. Physical activity was assessed with a self‐reported questionnaire and a hip‐worn accelerometer. Aerobic fitness was estimated using a maximal 20‐m shuttle run test, muscular fitness with curl‐up and push‐up tests, and motor skills with a 5‐leaps test and a throwing‐catching combination test. Structural equation modeling was applied to examine the associations.ResultsIn both boys and girls, motor skills had a positive indirect association with math outcomes through visuospatial working memory. Among girls, muscular fitness had a positive indirect association with math outcomes through visuospatial working memory. Aerobic fitness was positively associated with math achievement, but the indirect path via cognition was not observed. Self‐reported physical activity had a borderline indirect positive association with math outcomes through visuospatial working memory. Accelerometer‐based physical activity did not correlate with math performance.ConclusionMotor skills and muscular fitness had indirect positive associations with math performance, mediated by visuospatial working memory. The results give support to the viewpoints that the connections between motor skills, fitness, and physical activity to academic skills are mediated via specific cognitive skills.
Development of synchrony‐dominant expectations in observers
Authors: Meng Xianwei , Kato Masaharu , Itakura Shoji 
Published: September 2021

AbstractMovement synchrony is an essential feature of rituals and collective displays around the world. Previous studies have shown that synchronous movements increase observers’ perceived group entitativity and fighting capacity in agonistic contexts; however, little is known about the developmental roots of synchrony‐dominant attributions. In this study, adult participants (Exp 1), 5‐ to 6‐year‐old children (Exp 2) and 7‐ to 8‐year‐old children (Exp 3) predicted outcomes of zero‐sum conflicts between two groups of animated agents after each group exhibited either synchronised or non‐synchronised movements. Predictions were made for conflicts between two individual members from different groups (individual‐conflict condition) and between all members of the two groups (group‐conflict condition). Results showed that none of the participant groups showed a synchrony‐dominant preference in the individual‐conflict condition. In the group‐conflict condition, most adult participants expected the groups exhibiting synchronised movements to be socially dominant. Although 5‐ to 6‐year‐old children did not show more biased expectations than can be accounted for by chance, adult‐like synchrony‐dominant preference was found in 7‐ to 8‐year‐old children. Moreover, justifications of the synchrony‐dominant expectation in both adults and 7‐ to 8‐year‐old children showed that this expectation was driven by the perceived entitativity of the synchronous group. These findings show that the expectation of group dominance based on synchronous movements is strongly developed in school‐age children, explaining the developmental origins of intergroup attitudes as well as the cognitive mechanisms children employ when making judgments in intergroup contexts.
A Computational Fluid Dynamics Approach for Modeling the Fluid–Structure Interaction of Offshore Aquaculture Cages and Waves
Authors: Martin Tobias , Bihs Hans 
Published: September 2021

Abstract
Open ocean aquaculture cages became a promising alternative to traditional fish cage designs recently. The offshore environment implies larger loads on the structure and thus higher risk for fish loss. Floating rigid aquaculture cages with stiff nets are considered as a possible solution to cope with these new challenges. Their design process requires more advanced tools to account for the non-linear fluid–structure interaction. This paper presents a suitable numerical approach for analyzing the interaction of offshore aquaculture cages and waves using computational fluid dynamics. Here, a numerical wave tank accounts for the accurate propagation of the waves, and dynamic solutions are utilized for the cage system. Two-way coupling is enabled by accounting for the influence of the net on the fluid. The numerical model is validated against measurements for the loads on and the responses of a mobile floating fish farm in waves and current.
Juvenile hafnium isotopic compositions recording a late Carboniferous–Early Triassic retreating subduction in the southern Central Asian Orogenic Belt: A case study from the southern Alxa
Authors: Zheng Rongguo , Li Jinyi , Zhang Jin 
Published: September 2021

AbstractTwo successive and parallel magmatic arcs within the southern Alxa provide an ideal area to examine the influence of tectonic switching on temporal and spatial distribution of magmatism within accretionary orogens. This study presents new geochronological and geochemical data for Yingen and Quagu plutons from the southern Alxa, located in the southern Central Asian Orogenic Belt. Late Permian Yingen granitic dikes (ca. 252 Ma) have depleted whole-rock Nd isotopic compositions, high Sr, low Y and Yb, and high Sr/Y ratios, all of which indicate they were generated by the partial melting of subducted young/hot oceanic slab. The Middle Permian (271 Ma) Yingen hosting granites contain elevated contents of Nb and Zr, and have high 10,000 × Ga/Al ratios, suggesting that they resulted from mixing between Neoproterozoic crust-derived felsic magmas and depleted mantle-derived mafic magmas. The Quagu pluton yields ca. 271–262 Ma zircon U-Pb ages and has an adakitic high-Mg diorite-like geochemical composition, suggesting that it originated from interaction between slab-derived melts and overlying peridotite material. Collectively, these data record the subduction of the Enger Us oceanic slab beneath Mesoproterozoic–Neoproterozoic sialic crust, generating a Japan-type arc within the southern Alxa during Middle–Late Permian. Temporal-spatial variations of zircon Hf isotope for plutons suggest tectonic switching from advancing to retreating subduction during Carboniferous–Early Triassic within the southern Alxa. An advancing subduction resulted from the subduction of the Paleo-Asian Ocean, and a retreating subduction was related to plate boundary reorganization during the assembly of Pangea.
Analysis of Tomographic Images of the Soil Pore Space Structure by Integral Geometry Methods
Authors: Kalnin T. G. , Ivonin D. A. , Abrosimov K. N. , Grachev E. A. , Sorokina N. V. 
Published: September 2021

Abstract
The technique of numerical analysis of three-dimensional tomographic images of the pore space of soil objects has been used in this paper. It applies methods of integral geometry, topology and morphological analysis. To characterize quantitatively the transformation of the pore space structure, tomographic images of four undisturbed soils were analyzed, i.e., heavy loamy agro-gray soil (Retic Phaeozem), agromineral (Sapric Rheic Mineralic Histosols), and hypnum (brown moss Sapric Rheic Histosols) peat soils in dry and wet conditions. For samples of the subplow horizon in agro-gray soil, a decrease in both Betty numbers was observed on wetting, where the zero number (b0) stands for the amount of topologically simple closed pores, and the first number (b1) indicates a decrease in pore connectivity, which varies in a narrower range of pore sizes as compared to b0. When a sample of agromineral peat soil is moistened, the Euler–Poincaré characteristic is negative ​in the pore range of 0.1–0.16 mm, which points to the predominating complicated branched structure of the pore space and high pore connectivity. When hypnum moss is saturated, a lot of tunnel pores get narrower (“collapse”), and the connectivity decreases due to the structural specifics of long-stemmed plant residues. The number of pores and connections between them in peat soils is an order of magnitude higher than those in the subplow horizon A of the agro-gray soil. The provided quantitative changes in the considered parameters of tomographic images of the soil pore space confirm the possibility of applying them for estimating the transformation of the pore space in soils.
Effects of Ocufolin on retinal microvasculature in patients with mild non-proliferative diabetic retinopathy carrying polymorphisms of the MTHFR gene
Authors: Liu Zhiping , Jiang Hong , Townsend Justin H , Wang Jianhua 
Published: September 2021

IntroductionTo evaluate effects of Ocufolin on retinal microvasculature in mild non-proliferative diabetic retinopathy patients who carried methylenetetrahydrofolate reductase (MTHFR) polymorphisms (DR+MTHFRP).Research design and methodsThis is a prospective cohort study. Eight DR+MTHFRP (administrated Ocufolin for 6 months) and 15 normal controls (NCs) were recruited. MTHFR polymorphisms were subtyped as normal, C677T, or A1298C. Best-corrected visual acuity (BCVA) was evaluated. Retinal vessel density (VD) and microstructure were evaluated by optical coherence tomography angiography.ResultsBCVA and vascular indices of DR+MTHFRP at baseline were worse than those of NC and improved. Compared with baseline, DR+MTHFRP had significantly improved BCVA during follow-up period (p<0.05). VD of superficial vascular plexus was increased at 4 months (p=0.012), while VD of retinal vascular network did not change (p>0.05). Carriers of A1298C and C677T showed statistically significant increase in VD at all layers by 6 months, while carriers of C677T alone showed no significant change and carriers of A1298C alone showed decreased density from 4 months to 6 months. Microstructure did not change during the follow-up period.ConclusionA 6-month intake of Ocufolin is capable of reversing structural changes of microangiopathy in mild non-proliferative DR+MTHFRP. This suggests a novel way to address these impairments prior to catastrophic vision loss.
Open organisational culture: what does it entail? Healthcare stakeholders reaching consensus by means of a Delphi technique
Authors: Malik Romana Fattimah , Buljac-Samardžić Martina , Amajjar Ihsane , Hilders Carina G J M , Scheele Fedde 
Published: September 2021

ObjectivesOpen organisational culture in hospitals is important, yet it remains unclear what it entails other than its referral to ‘open communication’ in the context of patient safety. This study aims to identify the elements of an open hospital culture.MethodsIn this group consensus study with a Delphi technique, statements were constructed based on the existing patient safety literature and input of 11 healthcare professionals from different backgrounds. A final framework consisting of 36 statements was reviewed on inclusion and exclusion, in multiple rounds by 32 experts and professionals working in healthcare. The feedback was analysed and shared with the panel after the group reached consensus on statements (>70% agreement).ResultsThe procedure resulted in 37 statements representing tangible (ie, leadership, organisational structures and processes, communication systems, employee attitudes, training and development, and patient orientation) and intangible themes (ie, psychological safety, open communication, cohesion, power, blame and shame, morals and ethics, and support and trust). The culture themes’ teamwork and commitment were not specific for an open culture, contradicting the patient safety literature. Thereby, an open mind was shown to be a novel characteristic.ConclusionsOpen culture entails an open mind-set and attitude of professionals beyond the scope of patient safety in which there is mutual awareness of each other’s (un)conscious biases, focus on team relationships and professional well-being and a transparent system with supervisors/leaders being role models and patients being involved. Although it is generally acknowledged that microlevel social processes necessary to enact patient safety deserve more attention, research has largely emphasised system-level structures and processes. This study provides practical enablers for addressing system and microlevel social processes to work towards an open culture in and across teams.
Assessing treatment effects and publication bias across different specialties in medicine: a meta-epidemiological study
Authors: Schwab Simon , Kreiliger Giuachin , Held Leonhard 
Published: September 2021

ObjectivesTo assess the prevalence of statistically significant treatment effects, adverse events and small-study effects (when small studies report more extreme results than large studies) and publication bias (over-reporting of statistically significant results) across medical specialties.DesignLarge meta-epidemiological study of treatment effects from the Cochrane Database of Systematic Reviews.MethodsWe investigated outcomes from 57 162 studies from 1922 to 2019, and overall 98 966 meta-analyses and 5534 large meta-analyses (≥10 studies). Egger’s and Harbord’s tests to detect small-study effects, limit meta-analysis and Copas selection models to bias-adjust effect estimates and generalised linear mixed models were used to analyse one of the largest collections of evidence in medicine.ResultsMedical specialties showed differences in the prevalence of statistically significant results of efficacy and safety outcomes. Treatment effects from primary studies published in high ranking journals were more likely to be statistically significant (OR=1.52; 95% CI 1.32 to 1.75) while randomised controlled trials were less likely to report a statistically significant effect (OR=0.90; 95% CI 0.86 to 0.94). Altogether 19% (95% CI 18% to 20%) of the large meta-analyses showed evidence for small-study effects, but only 3.9% (95% CI 3.4% to 4.4%) showed evidence for publication bias after further assessment of funnel plots. Adjusting treatment effects resulted in overall less evidence for efficacy.ConclusionsThese results suggest that reporting of large treatment effects from small studies may cause greater concern than publication bias. Incentives should be created so that studies of the highest quality become more visible than studies that report more extreme results.
Reconsidering ‘minimal risk’ to expand the repertoire of trials with waiver of informed consent for research
Authors: Monach Paul A , Branch-Elliman Westyn 
Published: September 2021

BackgroundProgress in therapeutic research is slowed by the regulatory burden of clinical trials, which provide the best evidence for guiding treatment. There is a long delay from evidence generation to adoption, highlighting the need for designs that link evidence generation to implementation.ObjectiveTo identify clinical trial designs that confer minimal risk above that inherent in clinical care, to obviate the need for cumbersome consenting processes to enrol patients in prospective clinical research studies. These designs extend the scope of the Learning Healthcare System, a framework for leveraging retrospective ‘big data’ to advance clinical research, to include data collected from prospective controlled trials.SummaryPragmatic trials may use simplified eligibility criteria, unblinded interventions and objective outcome measures that can all be monitored through the electronic health records (EHR), to reduce costs and speed study conduct. Most pragmatic trials continue to suffer from substantial regulatory burden. Written consent to participate in research can be waived only if the research produces minimal risk above what is encountered in everyday life. However, the ‘consent’ processes for prescribing Federal Drug Administration-approved medications in clinical medicine are informal, even when they involve decisions of uncertain benefit and higher levels of risk. We propose that trial designs that mimic clinical decision-making in areas of uncertainty (clinical equipoise) and in which no data are generated outside of usual care (ideally by EHR embedding) confer minimal additional risk. Trial designs meeting this standard could, therefore, be conducted with minimal documentation of consent, even when interventions contain different risks. To align with risk encountered in clinical practice, allocation to treatment arms should change (adaptive randomisation) as data are collected and analysed. Embedding of informatics tools into the EHR has the additional benefit that, as adaptive randomisation progresses, evidence-generation transitions into implementation via decision-support tools—the ultimate realisation of the Learning Healthcare System.