bluuebunny/crossref_metadata_2025_split huggingface dataset:
Middle Cerebral Artery Thrombectomy: Clinical Findings and Technical Pearls: 2-Dimensional Operative Video
Authors: Rangwala Shivani D , Selvan Pradeep , Tenser Matthew , Mack William ,   Endovascular Neurosurgery Research Group (ENRG), Arthur Adam , Mark Bain , Bendock Bernard , Binning Mandy Jo , Boulos Alan S , Crowley Webster , Fessler Richard , Grande Andrew , Guterman Lee , Hanel Ricardo , Hoit Daniel , Hopkins L Nelson , Howington Jay , James Robert , Jankowitz Brian , Kan Peter , Khalessi Alex A , Kim Louis , Langer David , Lanzino Giuseppe , Levitt Michael , Levy Elad I , Lopes Demetrius , Mack William , Mericle Robert , Mocco J , Ogilvy Chris , Pandey Aditya , Replogle Robert , Riina Howard , Ringer Andrew , Rodriguez Rafael , Saugaveau Eric , Schirmer Clemens , Siddiqui Adnan H , Spiotta Alex , Sultan Ali , Tawk Rabih , Thomas Ajith , Turner Raymond , Veznedaroglu Erol , Welch Babu , White Jonathan 
Published: April 2021

Abstract
Mechanical thrombectomy as a treatment for large vessel occlusion to achieve rapid revascularization is supported in the literature.
1-3
The presenting symptoms will localize to functions of the ischemic area. The middle cerebral artery (MCA) supplies areas of the frontal, temporal, and parietal cortices, as well as the basal ganglia. Occlusion of the MCA will present with contralateral hemiplegia, sensory loss, and, if the dominant hemisphere is involved, language deficits.
We present a right-hand-dominant 79-yr-old female with right MCA syndrome—her last known well time was 1.5 h prior to presentation. Her NIH (National Institutes of Health) Stroke Scale was 16, most notable for left hemiplegia. Although the patient presented early in the clinical time course, as part of our institution protocol, a computed tomography (CT) head, CT perfusion, and CT angiogram (CTA) were performed. CT head did not demonstrate acute hemorrhage, so she received intravenous tissue plasminogen activator. CTA demonstrated a right MCA occlusion and CT perfusion suggested a large area of salvageable tissue, so she was taken to the angiography suite for mechanical thrombectomy. Angiography of the right internal carotid artery (ICA) showed MCA occlusion (insular segment). A thrombectomy device was deployed over the area of occlusion and allowed to engage for 5 min. An aspiration catheter was advanced over the stentriever up against the clot. The stentriever device was withdrawn under continuous aspiration and follow-up angiography showed complete reperfusion. The patient demonstrated improvement and was eventually discharged to an inpatient rehabilitation center.
Patient provided consent for photography per university protocol. Institutional review board (IRB) approval was not needed for the single-patient data included in this report.
Endovascular Treatment of Basilar Bifurcation Aneurysms With PulseRider-Assisted Coiling: 2-Dimensional Operative Video
Authors: Sattur Mithun G , Al Kasab Sami , Porto Guilherme B , Spiotta Alejandro M ,   Endovascular Neurosurgery Research Group (ENRG), Arthur Adam , Mark Bain , Bendock Bernard , Binning Mandy Jo , Boulos Alan S , Crowley Webster , Fessler Richard , Grande Andrew , Guterman Lee , Hanel Ricardo , Hoit Daniel , Hopkins L Nelson , Howington Jay , James Robert , Jankowitz Brian , Kan Peter , Khalessi Alex A , Kim Louis , Langer David , Lanzino Giuseppe , Levitt Michael , Levy Elad , Lopes Demetrius , Mack William , Mericle Robert , Mocco J , Ogilvy Chris , Pandey Aditya , Replogle Robert , Riina Howard , Ringer Andrew , Rodriguez Rafael , Saugaveau Eric , Schirmer Clemens , Siddiqui Adnan , Spiotta Alex , Sultan Ali , Tawk Rabih , Thomas Ajith , Turner Raymond , Veznedaroglu Erol , Welch Babu , White Jonathan 
Published: April 2021

Abstract
Wide-necked bifurcation aneurysms pose technical and anatomical challenges to endovascular treatment, which make the simpler assisted (balloon or single stent) coiling techniques less effective.
1
Consequently, unique endovascular solutions to treat such aneurysms have been devised.
2,3
One such device is PulseRider (Cerenovus, New Brunswick, New Jersey), which is designed to provide neck support for a coil mass while protecting the bifurcation.
3
The device comprises a body or stem that is deployed in the parent artery and a saddle component that sits at the aneurysm neck to keep the coil mass away from the bifurcation. There are several technical nuances involved in successful use of the device during positioning, deployment, and detachment.
3
We present a surgical video detailing the steps of PulseRider-assisted coiling of unruptured basilar bifurcation (or basilar apex) aneurysms. The first case highlights index treatment at diagnosis and the second showcases treatment of a recurrent basilar apex aneurysm. Both patients provided informed consent to the procedure. We also briefly discuss the rationale for treating basilar apex aneurysms.
4,5
Management of an Uncommon Complication: Anterior Choroidal Artery Occlusion by Posterior Clinoid Process Detected Through Intraoperative Monitoring After Clipping of Paraclinoid Aneurysm: 2-Dimensional Operative Video
Authors: Marani Walter , Mannará Francisco , Noda Kosumo , Kondo Tomomasa , Ota Nakao , Perrini Paolo , Montemurro Nicola , Kinoshita Yu , Tsuji Shoichiro , Kamiyama Hiroyasu , Tanikawa Rokuya 
Published: April 2021

Abstract
Despite technological advances in endovascular therapy, surgical clipping of paraclinoid aneurysms remains an indispensable treatment option and has an acceptable profile risk. Intraoperative monitoring of motor and somatosensory evoked potentials has proven to be an effective tool in predicting and preventing postoperative motor deficits during aneurysm clipping.
1,2

We describe the case of a 61-yr-old Japanese woman with a history of hypertension and smoking. During follow-up for bilateral aneurysms of ophthalmic segment of the internal carotid artery (ICA), left-sided aneurysm growth was detected. A standard pterional approach with extradural clinoidectomy was used to approach the aneurysm. After clipping, a significant intraprocedural change in motor evoked potential (MEP) amplitude was observed despite native vessel patency was confirmed through micro-Doppler and indocyanine green video angiography.
3-5
After extensive dissection of the sylvian fissure and exposure of the communicating segment of ICA, the anterior choroidal artery was found to be compressed and occluded by the posterior clinoid because of an inadvertent shift of the ICA after clip application and removal of brain retractors. Posterior clinoidectomy was performed intradurally with microrongeur and MEP amplitude returned readily to baseline values.
Computed tomography (CT) angiogram demonstrated complete exclusion of the aneurysm, and magnetic resonance imaging (MRI) was negative for postoperative ischemic lesions on diffusion weighted images. The patient tolerated the procedure well and was discharged home on postoperative day 3 with modified Rankin Scale (mRS) 0. The patient signed the Institutional Consent Form to undergo the surgical procedure and to allow the use of her images and videos for any type of medical publications.
Species limits in birds: Australian perspectives on interrelated challenges of allopatry, introgression of mitochondrial DNA, recent speciation, and selection
Authors: Joseph Leo 
Published: April 2021

Abstract
Four main challenges that can underpin ongoing, intransigent debates about species limits in birds are reviewed: allopatry (population subdivision vs. speciation), geographically widespread introgression of mitochondrial DNA (mtDNA), recent speciation, and selection. Examples from birds of the Australian region show how these challenges, their interplay, and the molecular-phenotypic discordance they generate can clarify or mislead species limits. Examples of how phylogenetic frameworks help reject or retain hypotheses of species limits under these challenges are given. Although mtDNA’s strengths and limitations are well known, an underappreciated limitation of mtDNA is geographically widespread introgression that homogenizes mtDNA diversity across species, subspecies, or population boundaries and across hundreds of kilometers. The resulting discordance between mtDNA and phenotype can be profound. If undetected, the setting of species limits and evolutionarily significant units are misled. An example shows how recent genomic analyses can detect and solve the problem. Other examples concern legacy mtDNA-only datasets. These are often essentially unfinished studies leaving residual uncertainty in species limits. Examples illustrate when the possibility of large-scale introgression across species boundaries needs to be considered, and how genomic scale data offer solutions. Researchers must carefully parse 3 questions: has there been introgression of mtDNA and, if so, which population genetics-based driver has caused introgression, and do species limits need altering? Understanding of allopatry, mtDNA introgression, recent speciation, and selection must be properly integrated if species limits are to be robustly understood and applied with maximum benefit in downstream applications such as conservation and management.
Comparative phylogeographic analysis suggests a shared history among eastern North American boreal forest birds
Authors: Ralston Joel , FitzGerald Alyssa M , Burg Theresa M , Starkloff Naima C , Warkentin Ian G , Kirchman Jeremy J 
Published: April 2021

AbstractPhylogeographic structure within high-latitude North American birds is likely shaped by a history of isolation in refugia during Pleistocene glaciations. Previous studies of individual species have come to diverse conclusions regarding the number and location of likely refugia, but no studies have explicitly tested for biogeographic concordance in a comparative phylogeographic framework. Here we use a hierarchical approximate Bayesian computation analysis of mitochondrial DNA sequences from 653 individuals of 6 bird species that are currently co-distributed in the boreal forest of North America to test for biogeographic congruence. We find support for congruent phylogeographic patterns across species, with shallow divergence dating to the Holocene within each species. Combining genetic results with paleodistribution modeling, we propose that these species shared a single Pleistocene refugium south of the ice sheets in eastern North America. Additionally, we assess modern geographic genetic structure within species, focusing on Newfoundland and disjunct high-elevation populations at the southern periphery of ranges. We find evidence for a “periphery effect” in some species with significant genetic structure among peripheral populations and between peripheral and central populations. Our results suggest that reduced gene flow among peripheral populations, rather than discordant biogeographic histories, can explain the small differences in genetic structure and levels of genetic diversity among co-distributed boreal forest birds.
The fourth scientific discovery paradigm for precision medicine and healthcare: Challenges ahead
Authors: Shen Li , Bai Jinwei , Wang Jiao , Shen Bairong 
Published: April 2021

Abstract
With the progression of modern information techniques, such as next generation sequencing (NGS), Internet of Everything (IoE) based smart sensors, and artificial intelligence algorithms, data-intensive research and applications are emerging as the fourth paradigm for scientific discovery. However, we face many challenges to practical application of this paradigm. In this article, 10 challenges to data-intensive discovery and applications in precision medicine and healthcare are summarized and the future perspectives on next generation medicine are discussed.
Long-term tolerability and efficacy of golimumab in active non-radiographic axial spondyloarthritis: results from open-label extension
Authors: van der Heijde Désirée , Dougados Maxime , Maksymowych Walter P , Bergman Gina , Curtis Sean P , Tzontcheva Anjela , Huyck Susan , Philip George , Sieper Joachim 
Published: April 2021

Abstract

Objectives
We report the open-label extension (OLE) of the GO-AHEAD study evaluating the long-term efficacy and safety of golimumab (GLM) in patients with non-radiographic axial spondyloarthritis (nr-axSpA).

Methods
Patients [both GLM- and placebo (PBO)-treated in the double-blind phase] received GLM 50 mg every 4 weeks during the OLE (36-week treatment; additional 8-week safety follow-up; GLM/GLM and PBO/GLM groups). All patients who entered and received ≥1 dose of study treatment in the OLE were included in the efficacy and safety analyses. The primary efficacy evaluations were the proportions of patients achieving 20% and 40% improvement in the ASAS criteria (ASAS20 and ASAS40, respectively). Responders’ analyses were calculated using a non-responder imputation approach.

Results
Of 198 patients randomised, 189/198 (95.5%) entered the OLE; 174/198 patients (87.9%) completed all visits. Although the proportion of responders increased from week 16 to week 52 in the OLE in both GLM/GLM and PBO/GLM groups, the GLM/GLM group had a higher proportion of responders than the PBO/GLM group throughout the OLE from week 16 to week 52 (ASAS20: 71.1% to 83.9% vs 40.0% to 75.0%, respectively; ASAS40: 56.7% to 76.3% vs 23.0% to 59.4%, respectively; ASAS partial remission: 33.0% to 53.8% and 18.0% to 45.8%). In the OLE, the overall incidence of AEs was lower in the GLM/GLM vs PBO/GLM groups (41.9% and 54.2%).

Conclusions
Sustained improvement in clinical efficacy was observed at 52 weeks in patients with nr-axSpA following GLM treatment. GLM was well tolerated and provided substantial long-term benefits to patients with nr-axSpA.

Trial registration
NCT01453725; United States National Library of Medicine clinical trials database; www.clinicaltrials.gov.
Mortality in patients with primary Sjögren’s syndrome: a systematic review and meta-analysis
Authors: Huang Hong , Xie Wenhui , Geng Yan , Fan Yong , Zhang Zhuoli 
Published: April 2021

Abstract

Objective
It remains debated whether patients with primary Sjögren’s syndrome (pSS) are at greater risk of mortality. We aimed to determine the magnitude of all-cause mortality risk in patients with pSS compared with the general population through a systematic review and meta-analysis.

Methods
We searched PubMed, EMBASE and Cochrane Library for studies published from inception to October 2020. Stata meta-analysis software was used to calculate the pooled risk estimates for mortality (standardized mortality ratio, SMR).

Results
Our search identified 2796 articles, of which 14 studies with 14 584 patients were eventually included for the analysis. A total of 902 deaths were observed. Overall, we found a 1.46-fold increased risk of death in pSS patients when compared with the general population [meta-standardized mortality ratio (SMR): 1.46, 95% CI: 1.10, 1.93]. Subgroup analyses showed that mortality risks were higher in European countries (meta-SMR: 1.55, 95% CI: 1.04, 2.33), in retrospective studies (meta-SMR: 1.50, 95% CI: 1.09, 2.05), in studies based on referral cohorts (meta-SMR: 1.55, 95% CI: 1.04, 2.30), in studies that enrolled &gt;500 patients (meta-SMR: 1.70, 95% CI: 1.11, 2.61) and in studies with follow-up time longer than 8 years (meta-SMR: 1.55, 95% CI: 0.87, 2.77). Significantly greater mortality risk was found in patients with older age, male gender, vasculitis, interstitial lung disease, low complements, positive anti-La/SSB and cryoglobulinaemia.

Conclusion
The existing data indicated ∼50% increase of mortality among patients with pSS compared with the general population. More attention should be paid to those patients with poor prognostic factors.
Patients with early-onset primary Sjögren’s syndrome have distinctive clinical manifestations and circulating lymphocyte profiles
Authors: Wei Lin , Zhifei Xin , Xiaoran Ning , Meilu Liu , Yang Li , Yixuan Liu , Xiuying Ren , Yashuang Su , Jingjing Cao , Shaoying Guo , Liu Yang , Lijun Sun , Fengxiao Zhang , Wen Zhang 
Published: April 2021

Abstract

Objectives
To further investigate the clinical characteristics and circulating lymphocyte profiles of patients with early-onset primary Sjögren’s syndrome (pSS).

Method
Data of 333 patients with pSS were analysed retrospectively. Early onset was defined as a pSS diagnosis at an age of 35 years or younger. The clinical, laboratory and immunophenotypic profiles of peripheral blood lymphocyte subsets were compared between early- and later-onset pSS.

Results
Thirty-six (10.81%) patients matched the definition of early-onset pSS, with age at disease onset being 28.97  (5.53) years. Elevated serum IgG level (77.14% vs 31.16%, P &lt;0.001), low C3 (41.67% vs 20.20%, P =0.004) and C4 levels (27.78% vs 6.40%, P &lt;0.001), anti-SSA positivity (91.67% vs 51.85%, P &lt;0.001) and anti-SSB positivity (50% vs 20.54%, P &lt;0.001) were more frequent in early-onset patients. The frequencies of hematological (80.56% vs 52.53%, P =0.001), renal (19.44% vs 5.05%, P =0.005) and mucocutaneous involvement (50% vs 22.56%, P &lt;0.001) were significantly higher in the early-onset pSS group, which showed a higher 2010 EULAR SS Disease Activity Index (ESSDAI) [11(6.25–17) vs 7(3–12); P =0.003], compared with the later-onset group. In addition, profound CD4+ T-cell lymphopenia was found in patients with early-onset.

Conclusions
Patients with early-onset pSS have distinctive clinical manifestations and greater activation of the cellular immune system, present with more severe clinical symptoms and immunological features, have increased activation of circulating T cells and have an unfavourable prognosis. Thus, they require more positive treatment with glucocorticoids and/or immunosuppressants and merit closer follow-up and regular monitoring.
Sleep spindles comprise a subset of a broader class of electroencephalogram events
Authors: Dimitrov Tanya , He Mingjian , Stickgold Robert , Prerau Michael J 
Published: April 2021

Abstract

Study Objectives
Sleep spindles are defined based on expert observations of waveform features in the electroencephalogram (EEG) traces. This is a potentially limiting characterization, as transient oscillatory bursts like spindles are easily obscured in the time domain by higher amplitude activity at other frequencies or by noise. It is therefore highly plausible that many relevant events are missed by current approaches based on traditionally defined spindles. Given their oscillatory structure, we reexamine spindle activity from first principles, using time-frequency activity in comparison to scored spindles.

Methods
Using multitaper spectral analysis, we observe clear time-frequency peaks in the sigma (10–16 Hz) range (TFσ peaks). While nearly every scored spindle coincides with a TFσ peak, numerous similar TFσ peaks remain undetected. We therefore perform statistical analyses of spindles and TFσ peaks using manual and automated detection methods, comparing event cooccurrence, morphological similarities, and night-to-night consistency across multiple datasets.

Results
On average, TFσ peaks have more than three times the rate of spindles (mean rate: 9.8 vs. 3.1 events/minute). Moreover, spindles subsample the most prominent TFσ peaks with otherwise identical spectral morphology. We further demonstrate that detected TFσ peaks have stronger night-to-night rate stability (ρ = 0.98) than spindles (ρ = 0.67), while covarying with spindle rates across subjects (ρ = 0.72).

Conclusions
These results provide compelling evidence that traditionally defined spindles constitute a subset of a more generalized class of EEG events. TFσ peaks are therefore a more complete representation of the underlying phenomenon, providing a more consistent and robust basis for future experiments and analyses.
Measuring sleep regularity: theoretical properties and practical usage of existing metrics
Authors: Fischer Dorothee , Klerman Elizabeth B , Phillips Andrew J K 
Published: April 2021

AbstractStudy ObjectivesSleep regularity predicts many health-related outcomes. Currently, however, there is no systematic approach to measuring sleep regularity. Traditionally, metrics have assessed deviations in sleep patterns from an individual’s average; these traditional metrics include intra-individual standard deviation (StDev), interdaily stability (IS), and social jet lag (SJL). Two metrics were recently proposed that instead measure variability between consecutive days: composite phase deviation (CPD) and sleep regularity index (SRI). Using large-scale simulations, we investigated the theoretical properties of these five metrics.MethodsMultiple sleep–wake patterns were systematically simulated, including variability in daily sleep timing and/or duration. Average estimates and 95% confidence intervals were calculated for six scenarios that affect the measurement of sleep regularity: “scrambling” the order of days; daily vs. weekly variation; naps; awakenings; “all-nighters”; and length of study.ResultsSJL measured weekly but not daily changes. Scrambling did not affect StDev or IS, but did affect CPD and SRI; these metrics, therefore, measure sleep regularity on multi-day and day-to-day timescales, respectively. StDev and CPD did not capture sleep fragmentation. IS and SRI behaved similarly in response to naps and awakenings but differed markedly for all-nighters. StDev and IS required over a week of sleep–wake data for unbiased estimates, whereas CPD and SRI required larger sample sizes to detect group differences.ConclusionsDeciding which sleep regularity metric is most appropriate for a given study depends on a combination of the type of data gathered, the study length and sample size, and which aspects of sleep regularity are most pertinent to the research question.
Engineering a mobile platform to promote sleep in the pediatric primary care setting
Authors: Mitchell Jonathan A , Morales Knashawn H , Williamson Ariel A , Huffnagle Nicholas , Eck Casey , Jawahar Abigail , Juste Lionola , Fiks Alexander G , Zemel Babette S , Dinges David F 
Published: April 2021

AbstractStudy ObjectivesPediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion. The objective of this study is to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.MethodsChildren aged 10–12 years were enrolled (Study #1: N = 30; Study #2: N = 43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.ResultsIn study #1, 1514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: −8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.ConclusionsWe have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the optimization phase of the MOST framework.Clinical TrialsBoth studies included in this manuscript were registered at clinicaltrials.gov:-Study #1: NCT03263338-Study #2: NCT03426644