bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Cerebral Perfusion Pressure Guided by Brain Oxygen Pressure Measurement
Authors: Kovacs Matyas , Peluso Lorenzo , Njimi Hassane , De Witte Olivier , Gouvêa Bogossian Elisa , Quispe Cornejo Armin , Creteur Jacques , Schuind Sophie , Taccone Fabio Silvio 
Published: October 2021

Background: Although increasing cerebral perfusion pressure (CPP) is commonly accepted to improve brain tissue oxygen pressure (PbtO2), it remains unclear whether recommended CPP targets (i. e., &gt;60 mmHg) would result in adequate brain oxygenation in brain injured patients. The aim of this study was to identify the target of CPP associated with normal brain oxygenation.Methods: Prospectively collected data including patients suffering from acute brain injury and monitored with PbtO2, in whom daily CPP challenge using vasopressors was performed. Initial CPP target was &gt;60 mmHg; norepinephrine infusion was modified to have an increase in CPP of at least 10 mmHg at two different steps above the baseline values. Whenever possible, the same CPP challenge was performed for the following days, for a maximum of 5 days. CPP “responders” were patients with a relative increase in PbtO2 from baseline values &gt; 20%.Results: A total of 53 patients were included. On the first day of assessment, CPP was progressively increased from 73 (70–76) to 83 (80–86), and 92 (90–96) mmHg, which resulted into a significant PbtO2 increase [from 20 (17–23) mmHg to 22 (20–24) mmHg and 24 (22–26) mmHg, respectively; p &lt; 0.001]. Median CPP value corresponding to PbtO2 values &gt; 20 mmHg was 79 (74–87) mmHg, with 2 (4%) patients who never achieved such target. Similar results of CPP targets were observed the following days. A total of 25 (47%) were PbtO2 responders during the CPP challenge on day 1, in particular if low PbtO2 was observed at baseline.Conclusions: PbtO2 monitoring can be an effective way to individualize CPP values to avoid tissue hypoxia. Low PbtO2 values at baseline can identify the responders to the CPP challenge.
Case Report: Amphiphysin Antibody-Associated Stiff-Limb Syndrome and Myelopathy: An Unusual Presentation of Breast Cancer in an Elderly Woman
Authors: Gogia Bhanu , Shanina Elena , Fang Xiang , He Jing , Li Xiangping 
Published: October 2021

Background: Paraneoplastic stiff-limb syndrome (SLS) is a rare manifestation of underlying malignancy and could have distinctive features different from the classic stiff-person syndrome (SPS).Case Description: We present a case of anti-amphiphysin antibody (Ab)-associated paraneoplastic SLS, in an 83-year-old woman with invasive ductal carcinoma of the breast. She presented with stiffness, painful spasms of the distal legs, and asymmetrical fixed posturing of the foot. There are coexisting long-tract disturbance and lower-extremity weakness. Treatment with diazepam provided symptomatic relief while plasma exchange (PLEX) did not lead to significant clinical improvement. The patient was bedridden within 3 months and passed away within 6 months from symptom onset.Conclusion: This case highlights the importance of recognition of uncommon presentation of SPS and its oncological significance. This entity requires a high degree of suspicion for initiation of the proper workup. The rapid identification and treatment of the underlying tumor might offer the best chance for recovery.
Hepatic Resection Versus Transarterial Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma: A Cohort Study
Authors: Lu Linbin , Zheng Peichan , Wu Zhixian , Chen Xiong 
Published: October 2021

BackgroundThe selection criteria for hepatic resection (HR) in intermediate-stage (IM) hepatocellular carcinoma (HCC) are still controversial. We used real-world data to evaluate the overall survival (OS) in treatment with HR or transarterial chemoembolization (TACE).MethodsIn total, 942 patients with IM-HCC were categorized into the HR group and the TACE group. OS was analyzed using the Kaplan–Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched (PSM) analysis. Curve smoothing was performed through the generalized additive model. The interaction test was performed to evaluate the impact of HR on OS concerning risk factors. Also, we used multiple imputation to deal with missing data.ResultsIn total, 23.0% (n = 225) of patients received HR. At a median OS of 23.7 months, HR was associated with improved OS in the multivariate analysis [hazard ratio (HzR) = 0.45, 95%CI = 0.35–0.58; after PSM: HzR = 0.56, 95%CI = 0.41–0.77]. Landmark analyses limited to long-term survivors of ≥6 months, ≥1 year, and ≥2 years demonstrated better OS with HR in all subsets (all p &lt; 0.05). After PSM analysis, however, HR increased the risk of death by 20% (HzR = 1.20, 95%CI = 0.67–2.15) in the subgroup of patients with lactate dehydrogenase (LDH) ≤192 U/L (p for interaction = 0.037). Furthermore, the significant interaction was robust between the LDH and HR with respect to the 1-, 3-, and 5-year observed survival rates (all p &lt; 0.05).ConclusionHR was superior to TACE for intermediate-stage HCC in patients with LDH levels &gt;192 U/L. Moreover, TACE might be suitable for patients with LDH levels ≤192 U/L.
Superselective Transarterial Chemoembolization for Unresectable or “Ablation Unsuitable” Hepatocellular Carcinoma in the Caudate Lobe: A Real World, Single-Center Retrospective Study
Authors: Yan Liangliang , Ren Yanqiao , Qian Kun , Kan Xuefeng , Zhang Hongsen , Chen Lei , Liang Bin , Zheng Chuansheng 
Published: October 2021

ObjectivesTo analyze the clinical outcomes of Transarterial chemoembolization (TACE) for unresectable or “ablation unsuitable” hepatocellular carcinoma (HCC) in the caudate lobe (CL) found at initial presentation in clinical practice.MethodsFifty-eight patients with HCC-CL undergoing conventional TACE from January 2015 to January 2020 were enrolled in our medical center. Overall survival (OS), progression-free survival (PFS), tumor response rate and major complication rates were analyzed. Multivariate analyses for potential clinical and radiologic factors were performed by using the Cox proportional hazard model.ResultsThe median OS was 23 months (95%CI: 18.1-27.9), and the median PFS was 11 months (95%CI: 7.4-14.6). The 1-, 3-, and 5-years OS rates were 66.5%, 31.9% and 15.7%, respectively. The 0.5, 1-, and 3-years PFS rates were 60.3%, 44.5% and 6.3%, respectively. Objective response rate was 53.4% and disease control rate was 79.3%. The most serious complication was bile duct injury, with an incidence of 3.4%. Multivariable analysis revealed that total bilirubin, Barcelona Clinic Liver Cancer stage, nonselective chemoembolization and TACE session were four significant factors associated with OS.ConclusionsSuperselective TACE treatment might be associated with better survival benefits in unresectable or “ablation unsuitable” HCC in the CL without macroscopic vascular invasion (MVI) and adequate liver function, compared with the non-selective TACE group, and should be considered as an important reliable therapy for surgeons and interventional radiologists.
Targeted Near-Infrared Fluorescence Imaging With Iodized Indocyanine Green in Preoperative Pulmonary Localization: Comparative Efficacy, Safety, Patient Perception With Hook-Wire Localization
Authors: Ding Ning , Wang Kefei , Cao Jian , Hu Ge , Wang Zhiwei , Jin Zhengyu 
Published: October 2021

BackgroundPrecise preoperative localization is of great importance to improve the success rate and reduce the operation time of VATS surgery. This study aimed to assess the efficacy, safety, patient perception between CT-guided indocyanine green (ICG) preoperative localization of lung nodule and hook-wire localization.Methods65 patients with 85 clinically suspicious pulmonary nodules underwent ICG preoperative localization in this study, and 92 patients with 95 nodules localized by conventional hook-wire served as controls. Both hook-wire localization and ICG injection were performed under CT guidance. Successful targeting rate, success rate in the operative field, incidence rate of complications and respiratory pain score were recorded and compared.ResultsThe successful targeting rate for both groups is 100%, however, due to hook-wire dislodgement, the success rate in the VATS operation field of the hook-wire group (95.6%) is lower than that of the ICG group (100%), with no significant difference(p=0.056). The overall complication rate of the hook-wire group (37.0%) is significantly higher than the ICG group (35.4%) (p=0.038). The mean respiratory pain score of the hook-wire group is 3.70 ± 1.25, which is significantly higher than that of the ICG group (2.85 ± 1.05) (p&lt;0.001).ConclusionsICG composed with contrast mixture are superior to the conventional hook-wire preoperative lung nodule localization procedure, with a lower complication rate, lower pain score, and relatively higher success rate. ICG is a promising alternative method for pulmonary nodule preoperative localization.
Analysis of a Cooperation and Interventional Model in Humanitarian Medicine
Authors: Marianeschi Stefano M. , Uricchio Nicola , Cerri Gianandrea Bern , Ghiselli Simone , Carro Cristina , Albano Giulia , Viola Nicola 
Published: October 2021

Background: Every year, around 15 million children, in developing countries, die or develop life-long disabilities because of congenital cardiac diseases. In this report we measure the effect of a pediatric cardiac surgery humanitarian project on the health of the individual and on the potential influence this has on the countries economy and its growing health services.Methods: We collected and analyzed data from the Italian NGO, Mission Bambini's database, including all congenital cardiac missions undertaken in Cambodia between 2012 and 2019. DALY's (Disability Adjusted Life Years) saved by the humanitarian mission were estimated and used to reflect on the impact this had on the populations economy. Progression in the local medical teams skills emulated the advancements made in the health sector of the region.Results: Between 2012 and 2019, 128 patients underwent a congenital cardiac operation at Angkor Hospital for Children at Siem Reap, Cambodia. The median age was 6 years. The majority of the pathologies included VSD, TOF, ASD. The mean Aristotle's Complexity Score was 6. Post-operative mortality was 0.8% (1/128). The cost-effectiveness analysis identified 5.360 DALY's saved by surgery. The competency of the local team was progressive with them being able to handle more complex cases on subsequent missions.Conclusion: In developing Countries, performing congenital cardiac surgery cases can be carried out successfully with improvement in both the economy and the health system of the country by increasing the years and the quality of life of the working population and developing the expertise of the regional team.
Single-Target Versus Multi-Target Drugs Versus Combinations of Drugs With Multiple Targets: Preclinical and Clinical Evidence for the Treatment or Prevention of Epilepsy
Authors: Löscher Wolfgang 
Published: October 2021

Rationally designed multi-target drugs (also termed multimodal drugs, network therapeutics, or designed multiple ligands) have emerged as an attractive drug discovery paradigm in the last 10–20 years, as potential therapeutic solutions for diseases of complex etiology and diseases with significant drug-resistance problems. Such agents that modulate multiple targets simultaneously are developed with the aim of enhancing efficacy or improving safety relative to drugs that address only a single target or to combinations of single-target drugs. Although this strategy has been proposed for epilepsy therapy &gt;25 years ago, to my knowledge, only one antiseizure medication (ASM), padsevonil, has been intentionally developed as a single molecular entity that could target two different mechanisms. This novel drug exhibited promising effects in numerous preclinical models of difficult-to-treat seizures. However, in a recent randomized placebo-controlled phase IIb add-on trial in treatment-resistant focal epilepsy patients, padsevonil did not separate from placebo in its primary endpoints. At about the same time, a novel ASM, cenobamate, exhibited efficacy in several randomized controlled trials in such patients that far surpassed the efficacy of any other of the newer ASMs. Yet, cenobamate was discovered purely by phenotype-based screening and its presumed dual mechanism of action was only described recently. In this review, I will survey the efficacy of single-target vs. multi-target drugs vs. combinations of drugs with multiple targets in the treatment and prevention of epilepsy. Most clinically approved ASMs already act at multiple targets, but it will be important to identify and validate new target combinations that are more effective in drug-resistant epilepsy and eventually may prevent the development or progression of epilepsy.
Impact of Behavioral and Psychological Symptoms on Caregiver Burden in Patients With Dementia With Lewy Bodies
Authors: Kanemoto Hideki , Sato Shunsuke , Satake Yuto , Koizumi Fuyuki , Taomoto Daiki , Kanda Atsushi , Wada Tamiki , Yoshiyama Kenji , Ikeda Manabu 
Published: October 2021

Background/Objective: Behavioral and psychological symptoms of dementia (BPSD) have been reported to affect caregiver burden in patients with dementia with Lewy bodies (DLB). However, the factor structure of BPSD and the factors that affect caregiver burden in DLB remain unknown. This study sought to classify BPSD and to reveal what type of BPSD affects caregiver burden in patients with DLB.Methods: We collected data on neuropsychiatric inventory-plus (NPI-plus), Zarit Burden Interview (ZBI), Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living and Physical Self-Maintenance Scale (IADL/PSMS), age, and sex of 102 patients with probable DLB. An exploratory factor analysis of 13 items of the NPI-plus was carried out to classify BPSD. Multivariate regression analyses were conducted to extract the clinical variables related to caregiver burden, including factors resulting from the aforementioned factor analysis.Results: The mean age and MMSE score were 78.6 (5.6) and 20.2 (5.2), respectively. Factor analysis revealed four factors of “psychosis,” “affection,” “wakefulness,” and “hyperactivity.” “Psychosis” and “affection” factors as well as MMSE, IADL, and PSMS were significantly associated with ZBI. Multivariate regression analyses revealed that the total score of ZBI was associated with “psychosis,” “affection,” and IADL, that the personal strain score of ZBI was associated with “affection” and IADL, and that the role strain score of ZBI was associated with “wakefulness” and IADL.Conclusions: BPSD in DLB consists of three factors common to Alzheimer's disease and a specific “wakefulness” factor. In addition to IADL, each BPSD factor would affect caregiver burden in different ways in DLB.
German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities
Authors: Geissler Julia M. , Werner Elisabeth , Dworschak Wolfgang , Romanos Marcel , Ratz Christoph 
Published: October 2021

Background: Approximately 10% of children, adolescents and young adults with an intellectual and developmental disability (IDD) in Bavaria live in residential institutions. 2015 saw media reports raising suspicions about excessive use of coercive measures (cM) in those institutions. Until a law reform at the end of 2017 made permission from family courts mandatory for cM, their use was governed by parental consent. The REDUGIA project conducted a representative survey comparing cM and their relation to challenging behaviour (cB) and employee stress in Bavaria pre and post reform.Methods: We sent questionnaires to 65 residential institutions for children, adolescents and young adults with IDD in 2017 (pre reform, T1) and 2019 (post reform, T2). To assess changes, we analysed data from all available questionnaire pairs (T1 and T2, N = 43). We calculated paired t-test and correlative analyses concerning the relationship between cB, cM, and employee stress.Results: The number of residents overall (T1: N = 1,661; T2: N = 1,673) and per institution (T1: m = 38.6 ± 32.0; T2: m = 38.9 ± 34.5, p = 0.920) remained stable. We did not see any changes in the Index cB (p = 0.508) or the proportion of residents per institution displaying various types of challenging behaviour (all ps&gt;0.220). There was no change in the Index cM (p = 0.089) or any indicator of employee stress, all ps &gt; 0.323. At follow-up, the Index cB correlated positively with the Index cM (r = 0.519 p &lt; 0.001). Regarding employee stress, the Index cB correlated positively with the frequency of sick leave (r = 0.322, p = 0.037) and physical attacks on employees (r = 0.552, p &lt; 0.001). The Index cM also correlated positively with the frequency of sick leave (r = 0.340, p = 0.028) and physical attacks on employees (r = 0.492, p = 0.001).Discussion: Coercive measures are not a general phenomenon, but are focused on specialised institutions. The law reform did not lead to changes in the number of children, adolescents and young adults with IDD affected by coercive measures in residential institutions in Bavaria. There were still large discrepancies between institutions in the prevalence of challenging behaviour and coercive measures. Coercive measures were associated with challenging behaviour and employee stress. Taken together, findings from REDUGIA emphasise the need to prevent challenging behaviour and thus coercive measures.
Global Trends in Intertrochanteric Hip Fracture Research From 2001 to 2020: A Bibliometric and Visualized Study
Authors: Zhang Ze , Qiu Yudian , Zhang Yawen , Zhu Yi , Sun Fengpo , Liu Junchuan , Zhang Tongyi , Wen Liangyuan 
Published: October 2021

Background: Intertrochanteric femur fractures, which are common geriatric osteoporotic fractures, have imposed a huge economic and social burden. This study clarified the global status of research on intertrochanteric fractures between 2001 and 2020 and predicted future research trends in this field using bibliometric and visualized studies.Methods: Publications related to intertrochanteric fractures were retrieved from the Web of Science (WoS) database. All studies were published between 2001 and 2020. Bibliometric and co-occurrence analyses were conducted using VoS viewer software.Results: In total, 2,632 studies were retrieved. The number of global publications regarding intertrochanteric fractures increased annually. The United States was the largest contributor, ranking first in total publications, citations, and the H-index. Switzerland had the highest average citation frequency among the 10 countries with the highest number of publications. The journal that published the most articles regarding intertrochanteric fractures was the Injury International Journal of The Care of The Injured, with 290 articles published. This journal also ranked first in the citation frequency. MJ Parker, an author, published the most papers in the field, and the University of California research team at San Francisco contributed the most publications in this field. During the co-occurrence analysis, all keywords were divided into four clusters: internal fixation study, complication study, risk-factor study, and survival and prognosis analysis study. The internal fixation and survival and prognosis analysis studies were predicted as the next hot topics in the field of intertrochanteric fractures.Conclusions: Intertrochanteric fractures are gaining increasing research attention according to the current global trend, and the number of publications regarding intertrochanteric hip fractures will continue to increase. The United States currently publishes the most articles on intertrochanteric fractures. The number of studies related to internal fixation, survival, and prognosis analysis is increasing, suggesting that these topics may become the next research hotspots in the area of intertrochanteric fractures.
ANALISIS KESANTUNAN BERBAHASA MAHASISWA UNIVERSITAS BINA SARANA INFORMATIKA DALAM BERINTERAKSI DENGAN DOSEN MELALUI PESAN SINGKAT WHATSAPP: KAJIAN PRAGMATIK
Authors: Parancika Rd Bily , Setyawan Erwin 
Published: October 2021

The more younger lecturers among young students, the more they would like to approach them, either during lecture or outside the class. The approach might make the relationship between lecturers and students closer and more emotional. However, it could seem less politeness which students have. This can be seen from the way and the language use through text messages on social medias, particularly on WhatsApp. This research aims to find out the variety of the students' politeness when having interaction with lecturers trough short message on WhatsApp by describing the students' language politeness, the principles of the deviation in politeness, the obedience and the function of the language politeness itself in the relationship between students and lecturers of Universitas Bina Sarana Informatika. Primary data in this research is written conversation records, especially screen shots of chats on WhatsApp. Secondary data is the knowledge of Pragmatic Studies of Bahasa Indonesia including the theories regarding language politeness principles in order to impact to the characters of the nation's next generation. The method used in this research is pragmatic studies, in particular with pragmatic and contextual equivalents.
Schatten des Lichts
Authors: Kodera Sergius 
Published: October 2021

Shadows of Light. Giordano Bruno’s Promethean Dialectic This article examines the status of shadows, in particular in Giordano Bruno’s ars memorativa. As ›traces of light‹, shadows not only embody the universal substrate of an infinitely extended material universe, but human action, thought and communication also necessarily depend on the medium of the shadow. Bruno’s mnemonics teaches the targeted, deliberately steered – if not even deceitful – handling of the shadows. In contrast to the Platonic tradition, he ascribes shadows a status that is independent of Platonic ideas. This article argues that Bruno thus develops out of a Platonic dialectic a specifically Promethean poetics, a universal art of the shadow. This, in turn, enables the embodied individual to shift the boundaries of knowledge and to arrange the things of this world.
Mandel’štam. Rom. Pasolini
Authors: Caradonna Chiara 
Published: October 2021

Mandel’štam. Rome. Pasolini In 1972 a small volume presented for the first time a varied choice of poems by the Russian poet Osip Mandel’štam to the Italian public, translated by Serena Vitale. One of the book’s first and most enthusiastic readers was the poet, film director and intellectual Pier Paolo Pasolini, who immediately reviewed it for the Italian newspaper Il Tempo. This review shows the great significance that Mandel’štam’s poetry acquired for Pasolini in the very last years of his life. So much so, that the first verse of Mandel’štam’s late poem, With the world of the powerful …, became the motto of Pasolini’s last, unfinished novel Petrolio. While offering a reading of this poem by Mandel’štam, the present article investigates the reasons for Pasolini’s passionate interest in the Russian poet, and sheds light on the political dimension of both Mandel’štam’s and Pasolini’s œuvre.