bluuebunny/crossref_metadata_2025_split huggingface dataset:
The value of fractional flow reserve based on coronary computed tomography angiography with low-dose contrast agent in noninvasive diagnosis of coronary artery disease
Authors: Wang Zengkun , Luan Xiaomei , Zhang Qian , Chu Chu , Xu Xiaodie , Chai Huijing , Song Peiji 
Published: December 2024

Aim
The study aimed, using invasive coronary angiography (ICA) as the gold standard, to investigate the noninvasive diagnostic value of flow reserve fraction derived from coronary computed tomography angiography (CCTA) with low-dose contrast agent in coronary artery disease (CAD).

Methods
A total of 163 patients with clinical symptoms related to CAD were enrolled between 1 January 2022 and 30 January 2023. The patients received CCTA with a low dose of contrast agent to rule out CAD. If significant (CCTA ≥ 50%) stenosis is suspected, ICA is performed to further evaluate the CCTA for coronary lesions. CT-FFR is calculated from the CCTA dataset using a machine learning-based algorithm. Compared with ICA as a reference standard, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of low-dose contrast agent CT-FFR in the diagnosis of myocardial ischemia were calculated. Coronary lesions with CT-FFR ≤0.80 were defined as hemodynamically significant.

Results
Obstructive CAD was excluded by low-contrast CCTA in 87 of 163 patients (53.7%). In the remaining 75 patients (42.35%), at least one coronary artery stenosis was greater than 50%. The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a patient-based evaluation in diagnosing CAD were 93.06, 93.44, 90.01, 98.28, and 71.43%, respectively (Kappa = 0.759). The accuracy, sensitivity, specificity, PPV, and NPV of low-dose contrast agent CT-FFR on a vessel-based evaluation in diagnosing CAD were 86.72, 82.76, 91.58, 92.31, and 81.31%, respectively (Kappa = 0.735). Pearson correlation analysis showed that the ICA examination had a good correlation with CT-FFR value of low-dose contrast media (r = 0.731, P < 0.01). Moreover, in 81.31% of cases, additional analysis of CT-FFR correctly excluded the hemodynamic significance of stenosis.

Conclusion
CT-FFR based on low-dose contrast agent CCTA is a very promising noninvasive approach to exclude hemodynamically significant coronary artery stenosis in patients with suspected coronary heart disease while reducing renal burden and helping to reduce the rate of ICA in this high-risk population.
Effect of PCSK9 inhibitors on major cardiac adverse events and lipoprotein-a in patients with coronary heart disease: a meta-analysis
Authors: Hu Enze , Wan Macao 
Published: December 2024

Background
Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease due to its unique apo(a) component and its association with atherosclerosis and thrombogenesis. This meta-analysis was conducted to evaluate the effects of PCSK9 inhibitors on major adverse cardiac events (MACE) and Lp(a) levels in patients with coronary heart disease.

Methods
Randomized controlled trials (RCTs) were systematically searched in PubMed, the Cochrane Library, and other databases. Stata 15.1 software was used for data analysis, and a random- or fixed-effects model was selected based on inter-study heterogeneity. Egger’s test was applied to detect publication bias.

Results
A total of 12 RCTs were included, involving 48 116 patients with a mean age of 62 years, comprising 65% males and diverse ethnic backgrounds. The results showed that compared with the control group, PCSK9 inhibitors significantly reduced low-density lipoprotein cholesterol (WMD = −1.24 mmol/L, 95% confidence interval (CI): −1.28 to −1.20), total cholesterol, triglycerides, and Lp(a) levels while increasing high-density lipoprotein cholesterol levels. In terms of safety, there was no increased risk of adverse reactions other than injection site reactions. For MACE, PCSK9 inhibitors significantly reduced the risk of nonfatal myocardial infarction, stroke, and coronary revascularization events (RR = 0.87, 95% CI: 0.84–0.89).

Conclusion
PCSK9 inhibitors not only significantly improve blood lipid profiles and reduce Lp(a) levels but also reduce the risk of MACE in patients with coronary heart disease. Therefore, PCSK9 inhibitors offer an effective and safe treatment option for these patients.
A pilot clinical trial of exercise program for elderly patients with cirrhosis and frailty: comprehensive exercise rehabilitation intervention
Authors: Ma Yanmei , Yuan Yuan , Lu Yang , Li Siyu 
Published: December 2024

Background and aim:
Comprehensive exercise rehabilitation has the potential to increase muscle mass and performance by stimulating protein synthesis and accelerating muscle catabolism. We developed the comprehensive exercise rehabilitation intervention (CERI) for elderly patients with cirrhosis, and we aimed to evaluate the safety and efficacy of CERI.

Methods:
Eligible were elderly patients with cirrhosis and frailty. Patients were randomized 1 : 1 to 12 weeks of CERI. Physical function were assessed using the gait speed, grip strength, 5 Sit-down Tests, and Balance Test, respectively.

Results:
Finally, 58 and 58 completed the study in CERI and SOC arms, respectively. The age range is 60–73. After 12 weeks, gait speed improved from 0.89 to 1.06 in CERI participants (Δgait speed 0.17) and 0.87–0.91 (Δgait speed 0.04) in SOC arm (P = 0.001 for Δgait speed difference). Grip strength improved from 15.44 to 15.94 in CERI participants (Δgrip strength 0.50) and 15.52–15.16 (Δgrip strength −0.36) in SOC arm (P = 0.044 for Δgrip strength difference). 5 Sit-down Tests Score improved from 16.17 to 15.46 in CERI participants (Δ5 Sit-down Tests 0.71) and 16.78–16.61 (Δ5 Sit-down Tests 0.17) in SOC arm (P = 0.037 for Δ5 Sit-down Tests difference). Median Balance Test score improved from 26.11 to 28.82 in CERI participants (ΔBalance Test 2.71) and 25.94–26.13 (ΔBalance Test 0.19) in SOC arm (P < 0.001 for ΔBalance Test difference); 92% of CERI participants adhered to the study for 12 weeks. No adverse events were reported by CERI participants.

Conclusion:
CERI was safely administered at pilot randomized clinical trial, while all participants showed minimal improvement in gait speed, grip strength, 5 Sit-down Tests, and Balance Test. But multicenter, larger sample clinical trials are needed to track the effects of CERI.
Characteristics and survival of patients with viral versus nonviral associated hepatocellular carcinoma: a multicenter cohort study
Authors: El-Kassas Mohamed , Barakat Eman M.F. , Shousha Hend Ibrahim , Kohla Mohamed , Said Mohamed , Moustafa Ehab Fawzy , Tawheed Ahmed , Shamkh Mostafa Abd Alfattah , Nabeel Mohamed Mahmoud , Elkhateeb Eman , Dabees Hossam , Abdelmalek Mohamed Omar , Sayed Hamdy , Abdallah Nourhan Mohamed , Elbaz Tamer , Rewisha Eman , Nassief Anwar , Riad Ahmed Radwan , Sweedy Ahmad Taha , Askar Safaa Ragab , Abdelmaksoud Ahmed Hosni , Gaber Yasmine , Eysa Basem , Shaker Mohamed , Hashem Mohamed Bassam , Kaddah Mona , Radwan Hend , Hassan Mohammed Sobhi , Lithy Rania , AbouElmaaty Mohamed ElGharib , Abo-Elazm Omnia M. , Abdelaziz Ashraf Omar ,   representing The Egyptian Network for the Study of HCC (ENSH) group
Published: December 2024

Background:
Viral hepatitis B and C are the leading causes of hepatocellular carcinoma (HCC). With obesity, metabolic-related disorders are increasingly associated with a higher incidence of nonviral HCC. This study aimed to investigate the characteristics, tumor features, treatment outcomes, and survival of patients with viral versus nonviral HCC.

Methods:
This multicenter cohort study was conducted at six tertiary care centers. Patients were recruited between February 2007 and June 2022 and follow-up was recorded until death or the study end (July 2023). The patients were divided into viral-related and nonviral HCC groups. We studied baseline patient characteristics, tumor characteristics, treatment, and overall survival (OS).

Results:
This study included 2233 patients, 1913 patients with viral and 320 patients with nonviral HCC. Patients with nonviral HCC presented with more advanced Barcelona Clinic Liver Cancer (BCLC) stages (BCLC stage C or D were present in 26.3% and 53.8% of patients with viral and nonviral HCC, respectively) that affected the median OS (19.167 vs. 13.830 months, P-value <0.001 for viral and nonviral HCC, respectively). The OS did not differ between patients with viral and nonviral HCC treated with resection, percutaneous ablation, trans-arterial chemoembolization, or Sorafinib. The independent factors affecting the survival of nonviral HCC were albumin-bilirubin score (hazard ratio = 2.323, 95% confidence interval (CI): 1.696–3.181, P-value <0.001), tumor size (hazard ratio = 1.085, 95% CI: 1.019–1.156, P-value 0.011), and alpha-fetoprotein (hazard ratio = 1.000, 95% CI: 1.000–1.000, P-value 0.042).

Conclusion:
Patients with nonviral HCC had higher BMI, worse performance status, BCLC stage, and tumor response than those with viral HCC.
Increased Intracranial Pressure in Myelin-Oligodendrocyte Glycoprotein Antibody–Associated Disease
Authors: Rempe Torge , Elfasi Aisha , Alkabie Samir , Christy Alison , Rodriguez Elsa , Castrodad-Molina Rhaisa , Buchowicz Bryce , Cuascut Fernando X. , Hutton George , Kinkel Revere , Graves Jennifer 
Published: December 2024

Objectives:
To assess characteristics of increased intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Methods:
This is a multicenter retrospective review of 84 MOGAD cases at the University of Florida, Baylor College of Medicine, the University of California San Diego, and Providence Health and Services, Portland, Oregon, to identify cases with a documented increased opening pressure >25 cm H2O. A literature review was conducted to identify previously reported MOGAD cases with an opening pressure >25 cm H2O.

Results:
Of 28 MOGAD cases with available opening pressures, 6 (21.4%) patients (age: 5 to 36 y; 2/6 females) had documented increased ICP with an opening pressure of 26 to 46 cm H2O and optic nerve head edema on funduscopic examination. The increased ICP occurred in the setting of bilateral optic neuritis in all cases. In 5/6 patients, this was the initial presentation of the disorder. Anti-MOG titers were 1:40 (n = 1), 1:100 (n = 4), and 1:1000 (n = 1). In our literature review, we identified 13 additional MOGAD cases with ICP elevations in the setting of meningo-cortical presentations (n = 10), as well as bilateral optic neuritis (n = 3).

Conclusions:
Increased ICP may occur in MOGAD and may be more common in patients with optic neuritis or meningoencephalitis.
Spectrum of Intracranial Hemorrhages in Cerebral Venous Thrombosis
Authors: Jha Shreyashi , Kulanthaivelu Karthik , Raja Pritam , Kenchiah Raghavendra , Ramakrishnan Subasree , Kulkarni Girish Baburao , Asranna Ajay 
Published: December 2024

Objective:
We aim to provide a pictorial representation of the broad spectrum of intracranial hemorrhages associated with cerebral venous thrombosis (CVT), emphasizing atypical locations and rare intracerebral hemorrhage (ICH) types. We also hypothesize the pathophysiology leading to atypical locations of the ICH in CVT and the outcomes with anticoagulation therapy.

Background:
ICH complicates about 40% of cases with CVT and is known to cause various types of ICH, including subarachnoid hemorrhage (SAH) and subdural hemorrhage (SDH). A combination of hemorrhages is also reported.

Methods:
Patients with computed tomography and magnetic resonance imaging findings consistent with CVT examined between January 2011 and June 2014 were included in this retrospective review. Demographic and clinical data and imaging findings were reviewed with particular attention to the type and location of ICH and sinus involvement. Treatment details and 3-month outcomes, assessed using the modified Rankin Scale, were analyzed.

Results:
Eleven patients (9 males), ranging in age from 22 years to 58 years, were included. The most common clinical presentations were headache (n = 8) and seizures (n = 7). Intraparenchymal hemorrhages were most common (n = 7), followed by SDH and SAH (n = 4), intraventricular hemorrhage (IVH; n = 3), and juxtacortical hemorrhage (n = 1). All patients who received anticoagulation therapy (n = 11) experienced complete resolution of their symptoms, and the median modified Rankin Scale was 0.

Conclusions:
The spectrum of intracranial hemorrhages seen in association with CVT is broad, encompassing atypical locations like basal ganglia, external capsule, and cerebellar hemispheres, and involves multiple intracranial compartments—IVH, SAH, and SDH. While SAH and SDH are seen with superior sagittal sinus thrombosis, ICH is common with lateral sinus thrombosis, and IVH with deep venous thrombosis.
Ergonomic Considerations in Robotic-assisted Microsurgery
Authors: Struebing Felix , Kneser Ulrich , Bigdeli Amir , Gazyakan Emre , Weigel Jonathan , Vollbach Felix Hubertus , Boecker Arne 
Published: December 2024

Objective:
Microsurgery necessitates precision and skill, with conventional methods often leading to surgeon discomfort due to prolonged static postures. The introduction of robot-assisted microsurgery using the Symani surgical system and a three-dimensional exoscope aims to enhance surgical precision while mitigating these ergonomic issues.

Methods:
This prospective, single-center clinical study involved 50 preclinical training sessions and 87 robot-assisted microsurgical procedures at the authors' institution, covering a wide array of interventions from free flap reconstructions to nerve and lymphatic surgeries. Ergonomic assessment was conducted using the Localized Experienced Discomfort (LED) questionnaire, completed post-procedure. The study adhered to the Helsinki Declaration and received local ethics committee approval.

Results:
The neck and back region experienced the most discomfort (P < 0.0001). Notably, operations performed with an exoscope showed significantly lower discomfort scores, particularly in the occipital and neck regions, compared with those using traditional microscopes (P < 0.05). Preclinical and clinical LED scores did not show a significant difference (P < 0.05). Using a Pearson correlation analysis, a correlation between LED scores and operating time was found.

Conclusion:
The authors' study’s findings, in conjunction with existing literature, herald a promising shift towards more ergonomic microsurgical practices through the use of robotic assistance and three-dimensional mesoscopic systems. Continued research and innovation in this direction are not only anticipated but necessary for the evolution of microsurgical techniques and the well-being of surgeons in the field.
Predicting Sepsis Induced Hypotension Patient Attributes for Restrictive vs Liberal Fluid Strategy
Authors: Upadhyaya Pulakesh , Wang Jeffrey , Mathew Daniel T. , Ali Ayman , Tallowin Simon , Gann Eric , Lisboa Felipe A. , Schobel Seth A. , Elster Eric A. , Buchman Timothy G. , Dente Christopher J. , Kamaleswaran Rishikesan 
Published: December 2024

Abstract

Background
Patients with sepsis-induced hypotension are generally treated with a combination of intravenous fluids and vasopressors. The attributes of patients receiving a liberal compared to a restrictive fluid strategy have not been fully characterized. We use machine learning (ML) techniques to identify key predictors of restrictive versus liberal fluids strategy, and the likelihood of receiving each strategy in distinct patient phenotypes.

Methods
We performed a retrospective observational study of patients at Emory University Hospital from 2014-2021 that were hypotensive, met Sepsis-3 criteria, and received at least 1 L of intravenous crystalloid fluids. We excluded patients with non-septic etiologies of hypotension. Supervised ML techniques were used to identify key predictors for the two strategies. Additionally, subset analyses were performed on patients with pneumonia, congestive heart failure (CHF), or chronic kidney disease (CKD). Using unsupervised ML techniques, we also identified three distinct sepsis-induced hypotension phenotypes and evaluated their likelihood of receiving either strategy.

Results
We identified N = 15292 patients and randomly split them into training (N = 12233) and validation (N = 3059) datasets. XGBoost was the most accurate model (AUC:0.84) for predicting the strategies. While worse oxygenation was the strongest predictor of utilizing a restrictive fluid strategy, top predictors of a liberal fluid strategy included higher pulse and blood urea nitrogen. In subset analyses, CHF, CKD and pneumonia were predictive of restrictive fluid strategy. We identified three distinct sepsis-induced hypotension phenotypes; 1) mild organ injury; 2) severe hypoxemia; and 3) renal dysfunction.

Conclusions
We identified key predictors of restrictive versus liberal fluids strategy and distinct patient phenotypes for sepsis-induced hypotension.
Prophylactic Vancomycin Leads to Fewer Device Removals in Sacral Neuromodulation
Authors: Ohene-Agyei Jada A. , Wang Xi , Sahil Suman , Cheng An-Lin , Shepherd Jonathan P , Sutkin Gary 
Published: December 2024

Importance
Sacral neuromodulation (SNM) requires removal for infectious complications in 3–11%.

Objective
The objective of this study was to examine the effect of preoperative antibiotic choice on all-cause SNM device removal rates.

Study Design
This was a retrospective cohort analysis, using the Health Facts Database, representing more than 750 hospitals. We included female patients undergoing SNM implantation from 2010 to 2018. Univariate and multivariate logistic regression identified factors associated with removal. Thirty-five comorbidities were evaluated. Those with P < 0.2 on univariate analysis were included in the multivariate analysis. We decided a priori to include prophylactic antibiotic choice in the final model.

Results
Of 1,433 patients, 170 (11.9%) had device removal. Patients were 63.0 ± 14.9 years old, predominantly Caucasian (90.0%), treated in urban hospitals (94.1%), and married (54.2%). A total of 11.8% were obese, and 18.0% smoked. Those in the removal cohort were more likely from the Northeastern United States; 52.3% received first-gen cephalosporins (CPSN), 7.4% second- or third-generation CPSNs, 9.1% vancomycin, 13.4% aminoglycosides, 4.6% clindamycin, and 13.3% fluoroquinolones. Compared to vancomycin, more removals were associated with first-generation CPSNs (odds ratio [OR] = 3.1, 95% confidence interval [1.4, 6.8]); clindamycin (OR = 3.2, [1.2, 8.4]); second/third-generation CPSNs (OR = 3.1, [1.3, 7.6]); and aminoglycosides (OR = 3.1, [1.3, 7.4]). Additionally, patients treated in the Northeast were more likely to undergo removal (OR = 1.9, [1.0, 3.7]).

Conclusions
Vancomycin as a prophylactic antibiotic was associated with fewer device removals compared to most antibiotics in this retrospective cohort analysis. While prospective trials could confirm this benefit, low removal rates may make this impractical.
Integrated vascular training may not prepare graduates to care for vascular trauma patients
Authors: Kundi Rishi , Dhillon Navpreet K. , Ley Eric J. , Scalea Thomas M. 
Published: December 2024

BACKGROUND
Vascular surgery board eligibility may be secured through 5+0 integrated programs (IV) as well as 5+2 general surgery/vascular fellowship pathway (VF). We hypothesized that IV graduates accrue less experience relevant to vascular trauma than VF graduates. We assessed the first decade of IV graduate experience and compared it to contemporaneous VF graduates.

METHODS
The 2013–2022 Accreditation Council for Graduate Medical Education case log data were collected for IV and VF graduates. Vascular fellows' data were combined with synchronousgeneral surgery residency data. Open vascular cases were classed as cerebrovascular, upper extremity, thoracic, abdominopelvic, infrainguinal, and infrapopliteal. Nonvascular open cases were categorized as neck, thoracic, and abdominopelvic. Nonoperative trauma and critical care data were recorded.

RESULTS
There were 1,224 VF and 397 IV graduates. In 2012, 8.3% of graduating vascular surgeons trained in IV programs. By 2022, this proportion was 32.6%. The number of IV programs increased by 4.4 programs per year over the study period (p < 0.05), whereas VF programs remained unchanged. Integrated vascular chiefs logged significantly more lower extremity cases, and VFs logged more upper extremity cases (p < 0.05). IV graduates reported a fraction of the VF open nonvascular cases. Integrated vascular graduates logged 5% of the abdominopelvic, 18% of the thoracic, and 3% of the neck cases of VFs (p < 0.05). Vascular fellows' critical care and nonoperative trauma were each higher than those of IV fellows (p < 0.05). Integrated vascular graduates logged six vascular repairs for every vascular exposure.

CONCLUSION
The proportion of vascular surgeons trained through IV programs has nearly quadrupled. Integrated vascular graduates have a fraction of the experience in critical care, trauma, and nonvascular surgery compared with VF graduates. Relative inexperience with open surgical anatomy and with critically ill patients may limit IV graduates' ability to care for the patient with vascular trauma.

LEVEL OF EVIDENCE
Diagnostic Test/Criteria; Level IV.
Lung contusion complicated by pneumonia worsens lung injury via the inflammatory effect of alveolar small extracellular vesicles on macrophages and epithelial cells
Authors: Nakatsutsumi Keita , Choi Wooil , Johnston William , Pool Katie , Park Dong Jun , Weaver Jessica L. , Coimbra Raul , Eliceiri Brian , Costantini Todd W. 
Published: December 2024

BACKGROUND
Lung contusion (LC) complicated by pneumonia is associated with a higher risk of acute lung injury (ALI) mediated by activation of immune cells and injury to the lung epithelium. Small extracellular vesicles (sEVs) are essential mediators of cellular crosstalk; however, their role in the development of postinjury ALI remains unclear. We hypothesized that LC complicated by pneumonia increases the pro-inflammatory effect of alveolar sEVs on macrophages and the cytotoxicity of alveolar sEVs to pulmonary epithelial cells, worsening the severity of ALI.

METHODS
Studies in C57BL/6 mice were designed with four groups: sham, LC, Pneumonia (Pneu), and LC + Pneu. Lung contusion was induced by a cortical controlled impactor, while pneumonia was conducted by intratracheal injection of 105 cfu Pseudomonas aeruginosa. Bronchoalveolar lavage fluid (BAL) was harvested 24 hours postinfection, and sEVs were purified by centrifugation and size exclusion chromatography. To evaluate the effect of alveolar sEV on cells, sEVs from each group were cocultured with macrophages (RAW 264.7) to assess cytokine release and lung epithelial cells (MLE 12) to assess epithelial cytotoxicity.

RESULTS
The LC + Pneu group severely injured lungs histologically and increased the susceptibility to the bacteria. The LC + Pneu group showed higher concentrations of proteins, macrophage inflammatory protein 1-alpha (MIP1α), and intercellular adhesion molecule 1 (ICAM-1) in BAL. MIP1α and ICAM-1 expression in the macrophages increased after incubation with sEVs from the LC + Pneu group. Moreover, the sEVs demonstrated higher cytotoxicity to epithelial cells and increased apoptosis in epithelial cells after incubation with sEVs from the LC + Pneu group.

CONCLUSION
Lung contusion complicated by pneumonia increased the pro-inflammatory effect of alveolar sEVs on macrophages and the cytotoxicity of alveolar sEVs to pulmonary epithelial cells, worsening the severity of ALI. These results demonstrate the potential importance of alveolar sEVs in lung inflammation following a bacterial infection after trauma.