bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic valve replacement in pediatric patients: 30 years single center experience
Authors: Schlein Johanna , Simon Paul , Wollenek Gregor , Base Eva , Laufer Günther , Zimpfer Daniel 
Published: September 2021

Abstract
Background
The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options.

Methods
A chart review of patients aged < 18 years at time of surgery, who had undergone AVR from May 1985 until April 2020 was conducted. Contraindications for Ross procedure, which is performed since 1991 at the center were reviewed in the observed non-Ross AVR cohort. The study endpoints were compared between the mechanical AVR and the biological AVR cohort.

Results
From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged < 1 year at time of surgery. Two late deaths occurred and survival was 94.5% ± 3.1% at 10 years and 86.4% ± 6.2% at 30 years. Freedom from aortic valve re-operation was higher (p < 0.001) in the mechanical AVR than in the biological AVR cohort with 95.2% ± 4.6% and 33.6% ± 13.4% freedom from re-operation at 10 years respectively.

Conclusions
Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.
Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection
Authors: Luo Zeng-Rong , Lin Zhi-Qin , Chen Liang-wan , Qiu Han-Fan 
Published: September 2021

Abstract
Objective
To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD).

Methods
Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed.

Results
A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS.

Conclusion
Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.
In the VEST trial: are we missed to address the pathology incurred by the external stent?
Authors: Palanisamy Vijayanand , Kurian Valikapthalil Mathew , sethuratnam Rajan 
Published: September 2021

AbstractIn the VEST IV trial, the author concluded that external stenting of saphenous vein graft mitigates its remodeling and also significantly reduces the diffuse intimal hyperplasia and development of lumen irregularities at 4.5 years after coronary artery bypass grafting surgery. We also have valuable a suggestion in addition to external stenting that might nullify the pathology caused by the stent and might enhances graft patency.
The effects of the COVID-19 pandemic on patients with lysosomal storage disorders in Israel
Authors: Kristal Eyal , Pode-Shakked Ben , Hazan Guy , Banne Ehud , Ling Galina , David Odeya , Shany Eilon , Raas-Rothschild Annick , Anikster Yair , Kneller Katya , Hershkovitz Eli , Landau Yuval E. , Spiegel Ronen , Zehavi Yoav , Staretz-Chacham Orna 
Published: September 2021

Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is the causative agent of the current COVID-19 pandemic. Lysosomal storage disorders (LSD) comprise of 70 inherited inborn errors of metabolism. Affected individuals suffer from multi-systemic involvement with variable severity and rate of disease progression between different diseases. Some of the LSDs have established treatments, whether parenteral or oral therapies. The full impact of the COVID-19 pandemic together with the lockdown on the wellbeing and medical management of patients with rare diseases, such as LSDs, is widely unknown. Herein, we describe the effects of the COVID-19 pandemic and its associated mandatory home lockdown on patients with LSDs in Israel.

Results
We present a prospective multi-center questionnaire study including 48 LSD patients from four medical centers in Israel. The study objective was to assess the impact of the COVID-19 pandemic restrictions on individuals with LSDs in Israel, as reported by their caregivers. Secondary objectives were to assess the morbidity from SARS CoV-2 in LSD patients and the impact of changes in mood and behavior on compliance to treatment and to assess the relationship between changes in mood to changes in cognition and behavior. Thirty one of 38 patients (82%) who received any kind of regular treatment did not miss treatments. Among patients receiving enzyme replacement therapy (ERT) in the in-hospital setting, 5 patients (20%) experienced treatment disruptions. Four patients had tested positive for SARS-Cov-2 virus infection by PCR. Seven out of the 48 patients (14%) described mood changes with cognitive and motor deterioration during the home quarantine.

Conclusions
We observed high rates of treatment adherence and low morbidity through the COVID-19 pandemic in patients with LSDs in Israel. LSDs patients can be a model for patients with complex chronic diseases requiring routine treatments and surveillance during a pandemic or other disruption of daily routine.
Functional organization of the midbrain periaqueductal gray for regulating aversive memory formation
Authors: Yeh Li-Feng , Ozawa Takaaki , Johansen Joshua P. 
Published: September 2021

AbstractInnately aversive experiences produce rapid defensive responses and powerful emotional memories. The midbrain periaqueductal gray (PAG) drives defensive behaviors through projections to brainstem motor control centers, but the PAG has also been implicated in aversive learning, receives information from aversive-signaling sensory systems and sends ascending projections to the thalamus as well as other forebrain structures which could control learning and memory. Here we sought to identify PAG subregions and cell types which instruct memory formation in response to aversive events. We found that optogenetic inhibition of neurons in the dorsolateral subregion of the PAG (dlPAG), but not the ventrolateral PAG (vlPAG), during an aversive event reduced memory formation. Furthermore, inhibition of a specific population of thalamus projecting dlPAG neurons projecting to the anterior paraventricular thalamus (aPVT) reduced aversive learning, but had no effect on the expression of previously learned defensive behaviors. By contrast, inactivation of dlPAG neurons which project to the posterior PVT (pPVT) or centromedial intralaminar thalamic nucleus (CM) had no effect on learning. These results reveal specific subregions and cell types within PAG responsible for its learning related functions.
Modulating tumor infiltrating myeloid cells to enhance bispecific antibody-driven T cell infiltration and anti-tumor response
Authors: Park Jeong A. , Wang Linlin , Cheung Nai-Kong V. 
Published: September 2021

AbstractBackgroundTumor microenvironment (TME) is a dynamic cellular milieu to promote tumor angiogenesis, growth, proliferation, and metastasis, while derailing the host anti-tumor response. TME impedes bispecific antibody (BsAb) or chimeric antigen receptor (CAR)-driven T cells infiltration, survival, and cytotoxic efficacy. Modulating tumor infiltrating myeloid cells (TIMs) could potentially improve the efficacy of BsAb.MethodsWe evaluated the effects of TIM modulation on BsAb-driven T cell infiltration into tumors, their persistence, and in vivo anti-tumor response. Anti-GD2 BsAb and anti-HER2 BsAb built on IgG-[L]-scFv platform were tested against human cancer xenografts in BALB-Rag2−/−IL-2R-γc-KO (BRG) mice. Depleting antibodies specific for polymorphonuclear myeloid-derived suppressor cell (PMN-MDSC), monocytic MDSC (M-MDSC), and tumor associated macrophage (TAM) were used to study the role of each TIM component. Dexamethasone, an established anti-inflammatory agent, was tested for its effect on TIMs.ResultsBsAb-driven T cells recruited myeloid cells into human tumor xenografts. Each TIM targeting therapy depleted cells of interest in blood and in tumors. Depletion of PMN-MDSCs, M-MDSCs, and particularly TAMs was associated with enhanced T cell infiltration into tumors, significantly improving tumor control and survival in multiple cancer xenograft models. Dexamethasone premedication depleted monocytes in circulation and TAMs in tumors, enhanced BsAb-driven T cell infiltration, and anti-tumor response with survival benefit.ConclusionReducing TIMs markedly enhanced anti-tumor effects of BsAb-based T cell immunotherapy by improving intratumoral T cell infiltration and persistence. TAM depletion was more effective than PMN- or M-MDSCs depletion at boosting the anti-tumor response of T cell engaging BsAb.
Perceptions and satisfaction of a mandatory continuing professional development programme amongst Aotearoa New Zealand podiatrists
Authors: Carroll Matthew , Brenton‐Rule Angela , Jepson Hannah , Molyneux Prue 
Published: September 2021

AbstractBackgroundAotearoa New Zealand (NZ) registered podiatrists are required to participate in a mandatory continuing professional development (CPD) programme. This study investigated podiatrist's perceptions and satisfaction surrounding mandatory CPD requirements following the implementation of a new 2‐year CPD programme.MethodsA cross‐sectional study of NZ registered podiatrists was conducted between October 9th and December 9th, 2020. Data was collected using a web‐based survey. The 39‐item survey included questions to elicit participant characteristics, perceptions of CPD, difficulties undertaking CPD, and satisfaction with the new CPD programme. The survey findings were reported using descriptive statistics and conventional content analysis.ResultsOne hundred and thirty‐four podiatrists completed the survey. Most respondents worked in private practice (n = 107, 80 %), were in full‐time employment (n = 83, 62 %), and had greater than 16 years of work experience (n = 73, 54 %). Respondents agreed it was important to engage in CPD (n = 126, 94 %) and reported that knowledge gained from CPD contributed to their daily work (n = 78, 58 %). 44 % (n = 58) reported difficulties keeping up to date with CPD. The main barriers to CPD participation reported were workload (n = 90, 67 %) and lack of time (n = 84, 63 %). Three categories (understanding the CPD programme; access to CPD; and time to complete CPD) were identified from the qualitative analysis to describe why it was difficult to meet CPD requirements.ConclusionsNZ podiatrists value CPD and are satisfied with most aspects of the mandatory CPD programme apart from the hours attributed to compulsory activities. The current approach to cultural safety CPD requires revision, with a move away from a time‐based approach to a system that promotes an understanding and relevance to practice. Lack of time, practice workload, financial barriers, geographical location, and employment context were factors that influenced a practitioner's ability to engage in CPD. Facilitation of CPD activities that are flexible to ensure relevance to the practitioner's specific work within their scope of practice, and that can occur in the workplace environment, may address barriers and increase engagement with to CPD activities.
The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings
Authors: Coppadoro Andrea , Zago Elisabetta , Pavan Fabio , Foti Giuseppe , Bellani Giacomo 
Published: September 2021

AbstractA helmet, comprising a transparent hood and a soft collar, surrounding the patient’s head can be used to deliver noninvasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration. In this review, we summarize the technical aspects relevant to this device, particularly how to prevent CO2rebreathing and improve patient–ventilator synchrony during NPPV. Clinical studies describe the application of helmets in cardiogenic pulmonary oedema, pneumonia, COVID-19, postextubation and immune suppression. A section is dedicated to paediatric use. In summary, helmet therapy can be used safely and effectively to provide NIV during hypoxemic respiratory failure, improving oxygenation and possibly leading to better patient-centred outcomes than other interfaces.
Machine-learning-based COVID-19 mortality prediction model and identification of patients at low and high risk of dying
Authors: Banoei Mohammad M. , Dinparastisaleh Roshan , Zadeh Ali Vaeli , Mirsaeidi Mehdi 
Published: September 2021

Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-Cov2 virus has become the greatest health and controversial issue for worldwide nations. It is associated with different clinical manifestations and a high mortality rate. Predicting mortality and identifying outcome predictors are crucial for COVID patients who are critically ill. Multivariate and machine learning methods may be used for developing prediction models and reduce the complexity of clinical phenotypes.

Methods
Multivariate predictive analysis was applied to 108 out of 250 clinical features, comorbidities, and blood markers captured at the admission time from a hospitalized cohort of patients (N = 250) with COVID-19. Inspired modification of partial least square (SIMPLS)-based model was developed to predict hospital mortality. Prediction accuracy was randomly assigned to training and validation sets. Predictive partition analysis was performed to obtain cutting value for either continuous or categorical variables. Latent class analysis (LCA) was carried to cluster the patients with COVID-19 to identify low- and high-risk patients. Principal component analysis and LCA were used to find a subgroup of survivors that tends to die.

Results
SIMPLS-based model was able to predict hospital mortality in patients with COVID-19 with moderate predictive power (Q2 = 0.24) and high accuracy (AUC > 0.85) through separating non-survivors from survivors developed using training and validation sets. This model was obtained by the 18 clinical and comorbidities predictors and 3 blood biochemical markers. Coronary artery disease, diabetes, Altered Mental Status, age > 65, and dementia were the topmost differentiating mortality predictors. CRP, prothrombin, and lactate were the most differentiating biochemical markers in the mortality prediction model. Clustering analysis identified high- and low-risk patients among COVID-19 survivors.

Conclusions
An accurate COVID-19 mortality prediction model among hospitalized patients based on the clinical features and comorbidities may play a beneficial role in the clinical setting to better management of patients with COVID-19. The current study revealed the application of machine-learning-based approaches to predict hospital mortality in patients with COVID-19 and identification of most important predictors from clinical, comorbidities and blood biochemical variables as well as recognizing high- and low-risk COVID-19 survivors.
Efficacy and safety of electroacupuncture combined with Suanzaoren decoction for insomnia following stroke: study protocol for a randomized controlled trial
Authors: Huang Hui-lian , Yang Song-bai , Mei Zhi-gang , Huang Ya-guang , Chen Mao-hua , Mei Qun-li , Lei Hua-ping , Mei Qing-xian , Chen Jian-hua 
Published: September 2021

Abstract
Background
Insomnia is a common but frequently overlooked sleep disorder after stroke, and there are limited effective therapies for insomnia following stroke. Traditional Chinese medicine (TCM), including acupuncture and the Chinese herbal medication (CHM) Suanzaoren decoction (SZRD), has been reported as an alternative option for insomnia relief after stroke in China for thousands of years. Here, this study aims to investigate the efficacy and safety of electroacupuncture (EA) in combination with SZRD in the treatment of insomnia following stroke.

Methods
A total of 240 patients with post-stroke insomnia will be included and randomized into four groups: the EA group, SZRD group, EA & SZRD group, and sham group. The same acupoints (GV20, GV24, HT7, and SP6) will be used in the EA group, EA & SZRD group, and sham group, and these patients will receive the EA treatment or sham manipulation every other day for 4 consecutive weeks. SZRD treatments will be given to participants in the SZRD group and EA & SZRD group twice a day for 4 consecutive weeks. The primary outcome measures include Pittsburgh Sleep Quality Index scores and polysomnography. Secondary outcome measures include the Insomnia Severity Index, the National Institutes of Health Stroke Scale, the Hospital Anxiety and Depression Scale, brain magnetic resonance imaging, functional magnetic resonance imaging, and nocturnal melatonin concentrations. The primary and secondary outcomes will be assessed at baseline (before treatment), during the 2nd and 4th weeks of the intervention, and at the 8th and 12th weeks of follow-up. Safety assessments will be evaluated at baseline and during the 4th week of the intervention.

Discussion
This study will contribute to assessing whether the combination of these two therapies is more beneficial for post-stroke insomnia than their independent use, and the results of this clinical trial will improve our understanding of the possible mechanisms underlying the effects of combination therapies.

Trial registration
Chinese Clinical Trials Register ChiCTR2000031413. Registered on March 30, 2020
Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial
Authors: Holy Marek , MacDowall Anna , Sigmundsson Freyr Gauti , Olerud Claes 
Published: September 2021

Abstract
Background
Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50–55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF)

Methods
A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as “active control.” The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years.

Discussion
Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation.

Trial registration
ClinicalTrials.gov NCT04177849. Registered on November 26, 2019
Voice production model based on phonation biophysics
Authors: Rocha Raissa Bezerra , José Lira de Queiroz Wamberto , Sampaio de Alencar Marcelo 
Published: September 2021

AbstractThis paper presents a proposal to a source-filter theory of voice production, more precisely related to voiced sounds. It is a proposal of a model to generate signal using linear and time-invariant systems and takes into account the phonation biophysics and the cyclostationary characteristics of the voice signal, related to the vibrational behavior of the vocal cords. The model suggests that the oscillation frequency of the vocal cords is a function of its mass and length, but controlled by the longitudinal tension applied to them. The mathematical description of the model of glottal excitation is presented, along with a mathematical closed expression for the power spectral density of the signal that excites the glottis. The voice signal, whose parameters can be adjusted for detection and classification of glottis pathologies, is also present. As a result, the output of each block diagram that represents the proposed model is analysed, including a power spectral density comparison between emulated voice, original voice, and classic source-filter model. The Log Spectral Distortion is computed, providing values below 1.40 dB, indicating an acceptable distortion for all cases.
Exact solutions involving special functions for unsteady convective flow of magnetohydrodynamic second grade fluid with ramped conditions
Authors: Riaz Muhammad Bilal , Abro Kashif Ali , Abualnaja Khadijah M. , Akgül Ali , Rehman Aziz Ur , Abbas Muhammad , Hamed Y. S. 
Published: September 2021

AbstractA number of mathematical methods have been developed to determine the complex rheological behavior of fluid’s models. Such mathematical models are investigated using statistical, empirical, analytical, and iterative (numerical) methods. Due to this fact, this manuscript proposes an analytical analysis and comparison between Sumudu and Laplace transforms for the prediction of unsteady convective flow of magnetized second grade fluid. The mathematical model, say, unsteady convective flow of magnetized second grade fluid, is based on nonfractional approach consisting of ramped conditions. In order to investigate the heat transfer and velocity field profile, we invoked Sumudu and Laplace transforms for finding the hidden aspects of unsteady convective flow of magnetized second grade fluid. For the sake of the comparative analysis, the graphical illustration is depicted that reflects effective results for the first time in the open literature. In short, the obtained profiles of temperature and velocity fields with Laplace and Sumudu transforms are in good agreement on the basis of numerical simulations.