bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early results of female patients who underwent mitral valve surgery through periareolar incision approach
Authors: Kocaoglu Alper Selim , Ovali Cengiz 
Published: November 2024

Background Approaches that require less invasive procedures, offer heal in a shorter time and provide better cosmetic results have gained importance with the technological and modern developments in cardiac surgery. Esthetically preferred results can be achieved after heart valve surgery using a periareolar incision, especially in female patients. In the present study, we aimed to present our results after surgery using periareolar incision in female patients. Methods We retrospectively evaluated the 1-year follow-up results in the postoperative period of isolated mitral valve replacement and tricuspid valve repair with mitral valve replacement using a periareolar incision with direct observation in 32 patients between 2020 and 2023. At the end of 1-year follow-up, we evaluated the patients’ visual satisfaction with the incision site using a visual analog scale. Results According to the postoperative follow-up results, no prosthetic mitral valve dysfunction was detected in any of the patients at the 1st year echocardiography controls. Mild tricuspid valve insufficiency was detected in 3 patients who underwent tricuspid valve repair. Besides, a high level of satisfaction was observed in the patients’ incision site evaluations with a visual analog scale at the end of the first year, and no numbness was reported in the periareolar region in any of the patients. Conclusion Our study shows that surgical results similar to conventional methods can be achieved with the periareolar approach, and patient satisfaction and recovery times are shorter and more satisfying. We also think that the periareolar incision can be made without videoassisted equipment and this may reduce the surgical cost.
Sevoflurane preconditioning attenuates myocardial cell damage caused by hypoxia and reoxygenation via regulating the NORAD/miR-144-3p axis
Authors: Qian Duo , Wen Jie , Yuan Yawei , Wang Long , Feng Xiaona 
Published: November 2024

Objective This study aimed to investigate the function and mechanism of lncRNA NORAD in Sevoflurane (Sev) protection against myocardial hypoxia-reoxygenation (H/R). Methods Preprocess rat cardiomyocytes H9c2 cells with Sev at concentrations of 0.5%, 1.0%, and 1.5%, and subjected them to H/R treatment. qRT-PCR was used to detect levels of NORAD and miR-144-3p. Measure concentrations of the inflammatory cytokines IL-6, TNF-α, and IL-10, as well as cardiac injury markers cTnI, CK-MB, and LDH using ELISA. Assess cell proliferation and apoptosis using CCK-8 and flow cytometry. Perform dual-luciferase reporter assay and RIP assay to validate the targeting relationship between NORAD and miR-144-3p. Results H/R induced inhibition of cell proliferation, increase in apoptosis, and production of IL-6, TNF-α, CK-MB, LDH, and cTnI were significantly attenuated by Sev. As hypoxic treatment time lengthened, the NORAD levels in myocardial cells showed an increase, with Sev pretreatment being able to suppress the NORAD levels elevation. The overexpression of NORAD notably weakened the cardioprotective effect of Sev. NORAD targetedly binds to miR-144-3p and negatively regulates miR-144-3p. Increased miR-144-3p levels inhibited the antagonistic effect of NORAD on the cardioprotective effects of Sev. Conclusion The current study confirmed that sevoflurane attenuated H/R-induced cardiomyocyte injury via the NORAD/miR-144-3p axis.
Outbreaks of mushroom poisoning associated with acute kidney injury
Authors: Adibelli Zelal , Sermenli Hayrunisa Bas , Uc Ziynet Alphan 
Published: November 2024

Introduction The outbreak of acute kidney injury (AKI) due to mushroom poisoning is not a frequently encountered medical challenge. Herein, we present 13 mushroom poisoning cases associated with AKI related to Amanita Proxima (A. Proxima) causing poisoning reported in a short time period in Turkey. Methods A total of 13 patients with AKI due to mushroom poisoning admitted to Usak Research and Training Hospital between November and December 2020 were included. Under morphological and microscopical investigations of mushroom specimens (from three patients), the species of the mushrooms were identified. Results The median age of 13 patients presenting with AKI due to mushroom poisoning was 55 (ranging between 19 and 72 years), and 60.4% were males. Nausea and vomiting were the first symptoms in most patients and appeared at a mean time of 12.8 ± 7.6 h after ingesting mushrooms. Mean serum creatinine on admission was 7.2 ± 3.8 mg/dL. Kidney replacement therapy (KRT) was administered to all patients, and mortality occurred in two due to sepsis and heart failure (HF). Species of the mushroom specimens obtained from three patients were identified as A. Proxima, a rarely encountered type of mushroom. A. Proxima has a considerable similarity to a common and edible species specific to the Mediterranean Basin, known as A. Ovoidea. Discussion Based on our findings, we emphasize the consideration of nephrotoxic mushrooms of the genus Amanita in the evaluation of mushroom poisoning cases, as well as the efforts needed to increase public awareness regarding the risk of fatal outcomes of consuming wild mushrooms.
Model-based optimal randomization procedure for treatment–covariate interaction tests
Authors: Liu Zhongqiang 
Published: November 2024

Linear models are extensively used in the analysis of clinical trials. However, required model assumptions (e.g. homoscedasticity) may not be satisfied in practice, resulting in low power of treatment–covariate interaction tests. Various interaction tests have been proposed to improve the efficiency of detecting differences in treatment–covariate interactions. Aiming to fundamentally improve the power of treatment–covariate interaction tests, for heteroscedasticity of treatment responses, we develop a model-based optimal randomization procedure, referred to as model-based Neyman allocation (MNA) in this article. The derived limiting allocation proportion indicates that the procedure MNA is a generalization of response-adaptive randomization targeting Neyman allocation (RAR-NA). In theory, we demonstrate that the procedure MNA can maximize the power of treatment–covariate interaction tests. The issue of sample size estimation is also addressed. Simulation studies show, in the framework of the heteroscedastic linear model, compared with Pocock and Simon’s minimization method and RAR-NA, the procedure MNA has the greatest power of tests for both systematic effects and treatment–covariate interactions, even under model misspecification. Finally, the efficiency of the procedure MNA is illustrated by a hypothetical case study based on a real schizophrenia clinical trial.
Efficacy of Agnikarma (Cauterization) in the Management of Mashaka (Elevated Mole): A Case Study
Authors: Gautam Jagrati , Mhaiskar Bhushan , Mandal Sonia , Pal Pratyendra , Bansal Priyal 
Published: November 2024

Introduction A mole or naevus is a lesion that can exist from birth. While some moles are present at birth, others become apparent later in life. The two main symptoms associated with moles are black spots and potential disfigurement. In Ayurveda, an elevated mole is comparable to a condition known as Mashaka. Mashaka is described as a firm, painless, black, and raised eruption on the skin, typically caused by an aggravated Vata Dosha (humor). Modern medical practice commonly manages moles through surgical excision and radioactive procedures to prevent potential malignancy or aesthetic concerns. However, in the Ayurvedic tradition, Mashaka is treated using the Agnikarma (cauterization) procedure. This approach is efficient as it soothes the Vata-Kapha Doshas (humors). Materials and Methods Agnikarma (cauterization) is a minor surgical treatment that involves the application of heat ( Agni) for therapeutic purposes aimed at reducing and eliminating the lesion. In this case study, a patient complained of a lesion on the right side of the nose. The lesion was diagnosed as Mashaka based on the ABCDE criteria for melanoma assessment, which considers Asymmetry, Border irregularity, Color variation, Diameter, and Evolution of the lesion. An Agnikarma procedure (cauterization) was carried out in a single sitting for this lesion. Results After four weeks, the lesion had healed without complaints of bleeding, wound infection, pain, or scarring. Discussion The case study demonstrates the efficacy of Agnikarma (cauterization), highlighting its scope as a treatment option for similar conditions, providing a safe and satisfactory outcome for the patient.
Comparative Analysis of Structural Differences in Progressive Collapsing Foot Deformity With and Without Hallux Valgus
Authors: Wang Chien-Shun , Huánuco Casas Erik Jesús , Talaski Grayson M. , Acker Antoine S. , Easley Mark E. , de Cesar Netto Cesar 
Published: November 2024

Background: Progressive collapsing foot deformity (PCFD) and hallux valgus (HV) are complex 3-dimensional deformities of the foot. This study aimed to investigate structural and alignment differences between PCFD with and without HV using weightbearing computed tomography. Methods: Patients with PCFD aged 18 years or older who underwent weightbearing computed tomography were consecutively enrolled. Standard 2-dimensional PCFD and HV parameters were assessed semiautomatically. Foot and ankle offset, forefoot arch angle, and pronation of the medial column bones in the coronal plane, with the ground as a reference, were manually measured. Additionally, the angles from the inferior aspect of subtalar posterior facet of the talus to the ground (subtalar horizontal angle), from the inferior (posterior facet) to superior facets of the talus (infratalar-supratalar angle), and from the inferior (posterior facet) of the talus to the superior facet of the calcaneus (infratalar-supracalcaneal angle) were examined. HV deformity was defined by an HV angle of ≥15 degrees. Results: Among 72 feet (58 patients) studied, 33 displayed HV, whereas 39 did not. In the coronal plane, the PCFD with HV group showed a higher infratalar-supratalar angle and greater pronation at the first tarsometatarsal joint, first metatarsal bone, and head. The PCFD with HV group also exhibited greater naviculocuneiform joint supination. Generalized estimating equation logistic regression analysis revealed significant associations of HV deformity with the intrinsic rotation of the first metatarsal bone ( P < .001), infratalar-supratalar angle ( P = .004), and rotation of the first tarsometatarsal joint ( P < .001). Conclusion: This study confirmed significant structural and alignment differences between PCFD with and without HV. Notably, the infratalar-supratalar angle, rotation of the first tarsometatarsal joint, and intrinsic rotation of the first metatarsal bone were associated with HV deformity. Level of Evidence: Level III, retrospective comparative study.
Direct Oral Anticoagulants Versus Traditional Anticoagulation in Cirrhotic Patients with Portal Vein Thrombosis: Updated Systematic Review
Authors: Xiao Xiulin , Zhu Wengen , Dai Qixin 
Published: November 2024

Background This systematic review aimed to evaluate the comparative effectiveness and safety of direct oral anticoagulants (DOACs) compared to traditional anticoagulation (vitamin K antagonists or low-molecular-weight heparins) in cirrhotic patients with portal vein thrombosis (PVT). Methods We conducted a literature search in PubMed and Embase databases up to May 2024. Studies were selected according to the PICOS criteria, focusing on cirrhotic patients with PVT treated with DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) compared to traditional anticoagulation. Results Our systematic review included four observational studies conducted in Japan, China, and the United States, involving a total of 223 patients with cirrhosis and PVT. The included studies collectively suggested that anticoagulation therapy, including DOACs, was associated with improved recanalization rates and reduced progression of PVT in patients with liver cirrhosis, without a significant increase in bleeding complications. Specifically, edoxaban demonstrated superior effectiveness in reducing PVT volume compared to traditional anticoagulation, while maintaining a favorable safety profile. Conclusion DOACs may provide a promising therapeutic option for PVT in cirrhotic patients. Further research is needed to confirm the potential benefits and risks of DOACs in this population.
Protective effects of geraniol in a male rat model of Alzheimer's disease: A behavioral, biochemical, and histological study
Authors: Bagheri Shokufeh , Rashno Masome , Salehi Iraj , Karimi Seyed Asaad , Raoufi Safoura , Komaki Alireza 
Published: November 2024

Background Alzheimer's disease (AD) as a neurodegenerative disease can cause behavioral impairments due to oxidative stress. Aging and oxidative conditions are some AD risk factors. Objective We assessed the influence of geraniol (GR), an acyclic monoterpene alcohol, on behavioral functions, hippocampal oxidative status, and histological alterations in AD rats induced by amyloid-β (Aβ). Methods Male Wistar rats (n = 70) were randomly allocated to the control, sham, AD, control-GR (100 mg/kg; per oral: P.O.), AD-GR (100 mg/kg; P.O.; treatment), GR-AD (100 mg/kg; P.O.; pretreatment), and GR-AD-GR (100 mg/kg; P.O.; pretreatment + treatment) groups. GR administration was done for four continuous weeks. After treatments, novel object recognition (NOR) and Morris water maze (MWM) tests assessed the animals’ behavior. Then, hippocampal specimens were collected for biochemical assessment. Finally, the number of intact neurons was identified in the hippocampus using hematoxylin and eosin staining. Results Aβ microinjection increased learning and memory deficits in both NOR and MWM tests, oxidative stress status, and neuronal loss. Oral GR administration improved behavioral deficits and reduced oxidative stress status and neuronal loss in the Aβ-infused animals. Conclusions GR ameliorates behavioral impairments through a decrease in neuronal degeneration and oxidative stress.
Cold Intolerance Following Digital Nerve Injury: A Multicenter Prospective Randomized Comparison of Decellularized Nerve Allograft Versus Nerve Conduits
Authors: Ilyas Asif M. , Kirby David J. , Kasper Alexis , Levin L. Scott , Isaacs Jonathan 
Published: November 2024

Background: Cold intolerance following digital nerve injury burdens patients significantly. To better understand how cold intolerance evolves in the setting of digital nerve injuries, a sub-analysis of a trial comparing conduit-based (CONDUIT) and processed nerve allograft (PNA) repairs was conducted. It was hypothesized that PNA repairs would alleviate cold intolerance more effectively, especially for longer nerve gaps. Methods: A multicenter trial across 20 US-based medical centers was undertaken of patients 18- to 69-year-old presenting with 5 to 25 mm digital nerve gaps within 24 weeks of injury. Patients were randomized (1:1) to PNA or collagen CONDUIT repairs. Cold Intolerance Symptom Severity (CISS) scores and sensory function testers were assessed at first patient visit (FPV), 1-, 3-, 6-, 9-, and 12-months post-surgery, with patients and assessors blinded to treatment. Results: In total, 220 patients were enrolled, with 183 patients included in final analysis with ≥6 months follow-up. At the last evaluable visit (LEV), mean CISS score decreased from FPV for both PNA (from 31.2 ± 27 to 20.8 ± 19) and CONDUIT (from 31.2 ± 30 to 25.9 ± 24). On sub-analysis, more patients converted from severe/extremely severe cold intolerance to mild cold intolerance for PNA compared with CONDUIT at 1 month and LEV ( P < 0.05). The CISS scores correlated significantly with sensory function testing. Conclusions: Although no correlation was demonstrated with nerve gap size, digital nerve gap repaired with PNA had significantly improved cold tolerance outcomes for patients with more severe cold intolerance at FPV relative to nerves repaired with CONDUIT.
Student Critical Self-Reflection and Perceptions of Video-Based Pro-Section Computer-Assisted Instruction
Authors: Ho Emily S. , Dove Erica , Aitkens Lorna , Duncan Andrea , Agur Anne M. R. 
Published: November 2024

Introduction The cost, high resource demands, and psychological significance of in-person cadaveric labs are barriers to their use. Computer-assisted instruction (CAI) of gross anatomy is widely available as an alternative option. However, student engagement, reflections, and expectations of learning anatomy with CAI instead of in-person labs may influence their learning experience and outcomes. Purpose To evaluate students’ critical self-reflection and perceptions of learning using online self-guided anatomy modules with video-based pro-section CAI. Methods A prospective observational cross-sectional study was conducted with first-year occupational therapy students who received anatomy education using CAI involving online self-guided anatomy modules with video-based pro-section instruction. Critical self-reflection was measured using Kember's Critical Self-Reflection Questionnaire scores and open-ended comments. Paired analysis of self-reported Kember nonreflective and reflective actions was conducted followed by quantitative (correlation, Student t-tests) and qualitative (directed content analysis) exploration of factors associated with critical self-reflection. Results Of the 126 students enrolled in the study, 97 consented and completed the study. The students’ Kember Understanding (U) subscale mean score was significantly higher than the Habitual Action (HA), Reflection, and Critical Self-Reflection subscales. The largest effect size was found between the U and HA subscales ( ds = 1.3, 95% CI [1.0, 1.5]). Academic outcomes (anatomy quiz sum score, term grade) did not correlate with the Kember scores. Overall, students felt that video-based anatomy pro-section CAI was best used in a supplementary manner and opportunities for hands-on learning of anatomy were needed. Conclusion Video-based anatomy pro-section CAI helped students understand anatomy but did not readily engage students in critical self-reflection. Strategic course and curriculum design with integrated and hands-on learning opportunities are needed to optimize student anatomy learning experience and academic outcomes while using this type of CAI.
Does FIT have a role in the detection of small bowel pathology: a prospective study
Authors: Oka Priya , Johnson Calvin M. , McAlindon Mark , Sidhu Reena 
Published: November 2024

Background: The faecal immunochemical test (FIT) is an immunoassay used to detect human blood in the stool. The role of FIT as a screening tool for small bowel pathology remains unclear. Objectives: This study aimed to investigate the role of FIT in predicting small bowel pathology in patients with iron deficiency anaemia (IDA). Design: This was a single tertiary centre prospective study. The inclusion criterion was adults (⩾18 years and <80 years) with IDA who were referred to secondary care for endoscopic investigations. Methods: All patients had a FIT test done in primary care. Eligible patients were invited to have a small bowel capsule endoscopy (SBCE) prior to endoscopy. Patients with subsequent upper or lower gastrointestinal tract malignancy were excluded from the study. IDA was defined as a Hb < 131 g/L for men and <110 g/L for women with ferritin <30 µg/L and/or iron levels <11 µmol/L. A further 100 patients with recurrent/refractory IDA who did not have a FIT test done and had an SBCE were used as the control group. Results: In total 179 patients were included in the final analysis with a median age of 64.5 years (interquartile range (IQR 51–75)); haemoglobin 101 (IQR 90–111) and ferritin 11(7–20). In the prospective FIT group of 79 patients, there were 35 (44%) patients with significant findings on SBCE which was classed as contributing to IDA. These findings included angioectasia in n = 21 (26.6%) patients which was the most common finding. The other findings included erosions and ulcers = 5 (7.6%); inflammatory strictures = 3 (3.8%); active Crohn’s n = 1 (1.3%); visible blood with no clear source n = 3 (3.8%) and bleeding angioectasia n = 1 (1.3%). A positive FIT (>10) had a sensitivity, specificity, positive predictive value and negative predictive value of 34.29%, 54.55%, 37.5% and 51.08%, respectively. In the control group ( n = 100), 37% of the patients had significant pathology on SBCE. On logistic regression, age (OR 1.06; 95% CI: 1.03–1.11) was the only factor related to the probability of having a positive finding on SBCE. Conclusion: Over a third of the patients with IDA have significant findings on SBCE. However, in this study, we did not find that FIT conferred any additional benefit in the detection of small bowel pathology.
Prognostic value of mechanical dyssynchrony in patients with heart failure: a systematic review
Authors: Chen Ziqi , Qu Qiang , Cheang Iokfai , Lu Xinyi , Liao Shengen , Gao Rongrong , Zhou Yanli , Li Xinli 
Published: November 2024

Abstract
Background
Heart failure (HF) significantly impacts quality of life and healthcare systems worldwide. Assessing left ventricular mechanical dyssynchrony (LVMD) is crucial for understanding cardiac function and optimizing treatments like cardiac resynchronization therapy (CRT). Phase analysis using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has shown promise in predicting outcomes, yet recent comprehensive reviews are lacking.

Objective
To systematically assess the prognostic value of phase analysis by gated SPECT MPI in the HF population through a systematic review.

Methods
We conducted a systematic review by collecting studies from databases including PubMed, CINAHL, and Web of Science. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Systematic reviews were conducted using Review Manager Software 5.4 and STATA 16.0.

Results
A total of 2004 patients from seven studies were included in our review and analysis. The systematic review indicated that patients with predetermined clinical events had higher PSD [MD = 6.45, 95% CI (5.83, 7.07), p < 0.00001] and PBW [MD = 7.91, 95% CI (5.64, 10.19), p < 0.00001]. The diagnosis of LVMD determined by PSD [HR = 1.05, 95% CI (1.01, 1.08), p = 0.007] was a strong predictor of endpoint events compared to PBW [HR = 1.95, 95% CI (0.48, 7.89), p = 0.35].

Conclusions
The analysis demonstrated that phase information obtained from gated SPECT MPI is of significant prognostic value in patients with heart dysfunction. It effectively enhances clinical risk models, providing reliable guidance for patient treatment.