bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing stereotactic arrhythmia radioablation with STOPSTORM.eu consortium support: intermediate results of a prospective Israeli single-institutional trial
Authors: Borzov Egor , Efraim Roi , Suleiman Mahmoud , Bar-Deroma Raquel , Billan Salem , Xie Jingyang , Hohmann Stephan , Blanck Oliver , Charas Tomer 
Published: September 2024

Abstract

Background
Ventricular tachycardia (VT) is a life-threatening arrhythmia originating from the heart’s ventricles. Traditional treatments include antiarrhythmic medications, implantable cardioverter-defibrillators (ICDs), and catheter ablation. Stereotactic body radiation therapy (SBRT) targeting the arrhythmogenic focus in the left ventricle—stereotactic arrhythmia radioablation (STAR)—is an emerging treatment and may offer a potential solution for patients with refractory VT.

Objective
We designed an interventional prospective clinical trial in Israel aligned with the STOPSTORM.eu consortium’s benchmarks, recommendations, and directives to assess the safety and efficacy of STAR in patients with refractory VT.

Methods
Our phase I/II single-institutional trial was approved by the Ministry of Health of Israel for 10 patients, initially assessing safety in the first 3 patients. We included patients with ICDs experiencing symptomatic monomorphic VT after an inadequate response to previous therapies. The primary endpoints were treatment-related serious adverse events and a reduction in VT burden as assessed by ICD interrogation. Secondary outcomes included a reduction in antiarrhythmic medications and changes in quality of life.

Results
From August 2023 to August 2024, 3 patients underwent STAR treatment. The prescription dose was a single fraction of 25 Gy. Planning target volumes were 47.8, 49.7, and 91.8 cc, and treatment was successfully delivered with no grade 3 or higher adverse events reported. Over a follow-up period of 12 months for the first patient and 8 months for the second one, no VT events were recorded after treatment. The third patient died from progressive heart failure 3 months after treatment. Left ventricular ejection fraction remained stable, and no significant radiation-induced inflammatory changes were noted.

Conclusion
The initial results of this trial suggest that STAR can reduce VT episodes in patients with refractory VT without severe adverse effects. The study highlights the importance of international collaboration and standardization in pioneering new treatments. Further follow-up and additional patient data will be necessary to confirm these findings and evaluate long-term outcomes, including potential adjustments to antiarrhythmic medication regimens.
Obstetric Perineal Tears, Birth Characteristics and the Association with Urinary Incontinence Among Primiparous Women 12 Months Postpartum: A Prospective Cohort Study
Authors: Gommesen Ditte , Hjorth Sarah , Nohr Ellen A. , Qvist Niels , Rasch Vibeke 
Published: September 2024

Abstract
Introduction and Hypothesis
Postpartum urinary incontinence (UI) is common and a concern for many women, as UI leads to a lower quality of life and self-esteem. Perineal tears may be a risk factor for UI, yet few studies have investigated the association between the degree of perineal tear and risk of developing UI postpartum. The objective was to examine how the degree of perineal tear and selected obstetric risk factors were associated with any UI and stress ultrasound (SUI) 12 months postpartum among primiparous women.

Methods
A prospective cohort study was conducted at four Danish hospitals. Baseline data were obtained at a clinical examination 2 weeks postpartum. Symptoms of UI were evaluated 12 months postpartum by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form questionnaire (web-based). Multivariate regression analyses were performed to investigate the risk factors for UI.

Results
A total of 603 primiparous women (203 with none/labia/first-degree tears, 200 with second-degree tears and 200 with third-/fourth-degree tears) were included between July 2015 and January 2018. Women with tears involving the perineal muscles reported any UI more often than women with no/labia or first-degree tears (spontaneous second-degree tear: RR 2.04, 95% CI 0.92–4.50; episiotomy: RR 2.22, 95% CI 0.99–4.96; third- or fourth-degree tear: RR 2.73, 95% CI 1.18–6.28). The same was found for SUI, but with wider confidence intervals.

Conclusions
A higher prevalence of any UI and SUI was found among women with perineal tears involving any perineal muscles, compared with women with no, labia, or first-degree tears.
Logarithmic Corrections to the Alexander–Orbach Conjecture for the Four-Dimensional Uniform Spanning Tree
Authors: Halberstam Noah , Hutchcroft Tom 
Published: September 2024

AbstractWe compute the precise logarithmic corrections to Alexander–Orbach behaviour for various quantities describing the geometric and spectral properties of the four-dimensional uniform spanning tree. In particular, we prove that the volume of an intrinsic n-ball in the tree is $$n^2 (\log n)^{-1/3+o(1)}$$

n
2

(
log
n
)

-
1
/
3
+
o
(
1
)

, that the typical intrinsic displacement of an n-step random walk is $$n^{1/3} (\log n)^{1/9-o(1)}$$

n

1
/
3

(
log
n
)

1
/
9
-
o
(
1
)

, and that the n-step return probability of the walk decays as $$n^{-2/3}(\log n)^{1/9-o(1)}$$

n

-
2
/
3

(
log
n
)

1
/
9
-
o
(
1
)

.
A Boundary-Local Mass Cocycle and the Mass of Asymptotically Hyperbolic Manifolds
Authors: Čap Andreas , Gover A. Rod 
Published: September 2024

AbstractWe construct a cocycle that, for a given n-manifold, maps a pair of asymptotically locally hyperbolic (ALH) metrics to a tractor-valued $$(n-1)$$

(
n
-
1
)

-form field on the conformal infinity. This requires the metrics to be asymptotically related to a given order that depends on the dimension. It then provides a local geometric quantity on the boundary that is naturally associated to the pair and can be interpreted as a relative energy-momentum density. It is distinguished as a geometric object by its property of being invariant under suitable diffeomorphisms fixing the boundary, and that act on (either) one of the argument metrics. Specialising to the case of an ALH metric h that is suitably asymptotically related to a locally hyperbolic conformally compact metric, we show that the cocycle determines an absolute invariant c(h), which still is local in nature. This tractor-valued $$(n-1)$$

(
n
-
1
)

-form field on the conformal infinity is canonically associated to h (i.e. is not dependent on other choices) and is equivariant under the appropriate diffeomorphisms. Finally specialising further to the case that the boundary is a sphere and that a metric h is asymptotically related to a hyperbolic metric on the interior, we show that the invariant c(h) can be integrated over the boundary. The result pairs with solutions of the KID (Killing initial data) equation to recover the known description of hyperbolic mass integrals of Wang, and Chruściel–Herzlich.
Universality in the 2d Quasi-periodic Ising Model and Harris–Luck Irrelevance
Authors: Gallone Matteo , Mastropietro Vieri 
Published: September 2024

AbstractWe prove that in the 2D Ising model with a weak bidimensional quasi-periodic disorder in the interaction, the critical behavior is the same as in the non-disordered case; that is, the critical exponents for the specific heat and energy-energy correlations are identical, and no logarithmic corrections are present. The disorder produces a quasi-periodic modulation of the amplitude of the correlations and a renormalization of the velocities, that is, the coefficients of the rescaling of positions, and of the critical temperature. The result establishes the validity of the prediction based on the Harris–Luck criterion, and it provides the first rigorous proof of universality in the Ising model in the presence of quasi-periodic disorder in both directions and for any angle. Small divisors are controlled assuming a Diophantine condition on the frequencies, and the convergence of the series is proved by Renormalization Group analysis.
Cluster analysis of 100 Marfan patients based on aortic 4D flow MRI and Z-score: insights into disease heterogeneity and stratification of subgroups
Authors: Lenz Alexander , Bahr Flora , Riedel Christoph , Wright Felicia , Sinn Martin , Zhang Shuo , Schuett Marion , Well Lennart , Adam Gerhard , von Kodolitsch Yskert , Schoennagel Bjoern P. , Bannas Peter 
Published: September 2024

Abstract
Objectives
4D flow MRI-derived variables from Marfan patients are highly heterogeneous. Our aim was to identify distinct Marfan patient subgroups based on aortic 4D flow MRI and Z-score for stratification of distinct hemodynamic profiles and clinical features by means of hierarchical cluster analysis.

Materials and methods
One hundred Marfan patients underwent baseline aortic 4D flow MRI at 3 T. Z-scores, degree of helical and vortical flow, wall shear stress, flow displacement, and peak velocity were determined in the ascending aorta. Sex, age, BMI, antihypertensive medication, and dural ectasia were recorded. Hierarchical cluster analysis was performed using 4D flow MRI variables and Z-scores as input.

Results
Cluster analysis resulted in three distinct clusters characterized by different Z-scores (mean ± SD); cluster 1: 0.4 ± 1.1 vs. cluster 2: 3.1 ± 1.1 vs. cluster 3: 3.6 ± 1.9. The three clusters delivered differences in helical and vortical flow patterns (global p = 0.003 and p < 0.001, respectively), wall shear stress (0.49 ± 0.11 vs. 0.44 ± 0.12 vs. 0.37 ± 0.09 N/m2, global p < 0.001), flow displacement (0.11 ± 0.05 vs. 0.16 ± 0.08 vs. 0.15 ± 0.07, global p = 0.006), and peak velocity (76.3 ± 9.0 vs. 60.1 ± 7.3 vs. 56.0 ± 7.8 cm/s, global p < 0.001). Patients in cluster 1 and 2 were relevantly younger than in cluster 3 (32.3 ± 13.8 vs. 32.8 ± 12.6 vs. 40.2 ± 15.0 years, all pairwise ∆p < 0.0297).

Conclusion
Hierarchical cluster analysis based on aortic 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients, each characterized by specific hemodynamic profiles and clinical features. Follow-up of our patients is warranted to assess if 4D flow MRI- and Z-score-based stratification can predict future aortic diameter growth and ultimately improve outcomes.

Clinical relevance statement
A combination of Z-score and 4D flow MRI-derived parameters may help identify subgroups of Marfan patients representing different stages or phenotypes of aortic disease, which require specific management strategies.

Key Points

Four-dimensional (4D) flow MRI-derived variables of Marfan patients are highly heterogeneous across varying Z-scores.

Cluster analysis based on 4D flow MRI and Z-score revealed three distinct subgroups of Marfan patients.

A combination of Z-score and 4D flow MRI-derived parameters may identify different stages of aortic disease in Marfan patients.

Graphical Abstract
Effects of Azithromycin on Blood Inflammatory Gene Expression and Cytokine Production in Sarcoidosis
Authors: Fraser Simon D. , Thackray-Nocera Susannah , Wright Caroline , Flockton Rachel , James Sally R. , Crooks Michael G. , Kaye Paul M. , Hart Simon P. 
Published: September 2024

Abstract
Introduction
In sarcoidosis granulomas, monocyte-derived macrophages are activated by pro-inflammatory cytokines including TNF and IL-6. Current drug treatment for sarcoidosis aims to suppress inflammation but disabling side effects can ensue. The macrolide azithromycin may be anti-inflammatory. We aimed to determine whether treatment with azithromycin affects blood inflammatory gene expression and monocyte functions in sarcoidosis.

Methods
Blood samples were collected from patients with chronic pulmonary sarcoidosis enrolled in a single arm, open label clinical trial who received oral azithromycin 250 mg once daily for 3 months. Whole blood inflammatory gene expression with or without LPS stimulation was measured using a 770-mRNA panel. Phenotypic analysis and cytokine production were conducted by flow cytometry and ELISA after 24h stimulation with growth factors and TLR ligands. mTOR activity was assessed by measuring phosphorylated S6RP.

Results
Differential gene expression analysis indicated a state of heightened myeloid cell activation in sarcoidosis. Compared with controls, sarcoidosis patients showed increased LPS responses for several cytokines and chemokines. Treatment with azithromycin had minimal effect on blood gene expression overall, but supervised clustering analysis identified several chemokine genes that were upregulated. At the protein level, azithromycin treatment increased LPS-stimulated TNF and unstimulated IL-8 production. No other cytokines showed significant changes following azithromycin. Blood neutrophil counts fell during azithromycin treatment whereas mononuclear cells remained stable. Azithromycin had no detectable effects on mTOR activity or activation markers.

Conclusion
Blood myeloid cells are activated in sarcoidosis, but azithromycin therapy did not suppress inflammatory gene expression or cytokine production in blood.
Trial registration: EudraCT 2019-000580-24 (17 May 2019)
Heart rate to identify non-febrile children with dehydration and acute kidney injury in emergency department: a prospective validation study
Authors: Marzuillo Pierluigi , Rivetti Giulio , Galeone Antonietta , Capasso Giusy , Tirelli Paola , Di Sessa Anna , Miraglia del Giudice Emanuele , Guarino Stefano , Nunziata Felice 
Published: September 2024

AbstractWe previously developed and retrospectively validated the estimated percentage of heart rate variation (EHRV) as a predictor of the composite outcome of ≥ 5% dehydration and/or acute kidney injury (AKI) in non-febrile children. The current study aimed to prospectively validate EHRV as a predictor for dehydration or AKI in a different cohort of children attending the Pediatric Emergency Department. From July 2022 to August 2023, 256 pediatric patients aged 0–18 years attending the Pediatric Emergency Department were enrolled. EHRV was calculated as follows: [(HR at admission − 50th percentile of HR for age and sex)/HR at admission] × 100. Dehydration was categorized as < 5% or ≥ 5% fluid deficit. AKI was defined according to KDIGO creatinine criteria. Statistical analyses included receiver-operating characteristic (ROC) curves and logistic regression analysis. Among enrolled patients, 52 had ≥ 5% dehydration, 50 had AKI, and 16 had both conditions. EHRV demonstrated significant predictive ability for both ≥ 5% dehydration (AUROC = 0.71; 95% confidence interval (CI), 0.63–0.78; p < 0.001) and AKI (AUROC = 0.78; 95% CI, 0.71–0.84; p < 0.001). An EHRV > 24.5% was associated with an increased odds ratio (OR), adjusted for confounders, of ≥ 5% dehydration (OR = 3.5; 95% CI, 1.6–8.0; p = 0.003) and AKI (OR = 3.4; 95% CI, 1.6–7.3; p = 0.002). The sensitivity and specificity of this cut-off were 34% and 83% for ≥ 5% dehydration and 36% and 84% for AKI, respectively.Conclusions: This study prospectively validates the clinical utility of EHRV in predicting dehydration and AKI in a pediatric emergency care setting. An EHRV > 24.5% could serve as a marker for suspecting dehydration or AKI. Further validation across diverse patient populations and settings is needed.

What is Known:• An increased heart rate (HR) is a readily detectable sign of dehydration in children.• In a retrospective validation cohort, an estimated HR variation (EHRV) greater than 24.5% compared to the 50th percentile of HR was predictive of ≥ 5% dehydration and/or acute kidney injury (AKI) in non-febrile patients.

What is New:• We prospectively validated the clinical utility of EHRV in predicting dehydration and AKI in a pediatric emergency care setting.• We confirmed that an EHRV greater than 24.5% is associated with increased odds of ≥ 5% dehydration and AKI.
National trends in pediatric drowning — insights from the Israeli Ministry of Health registry-based cohort
Authors: Applbaum Yael , Cohen-Cymberknoh Malena , Avniel-Aran Adi , Yahav Ayala , Weinblatt Ezra , Brooks Rebecca , Reiter Joel , Gordon Shulamit , Haklai Ziona , Pollak Uri 
Published: September 2024

AbstractThis study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health’s administrative databases, covering all children aged 0–17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1–4 years) and teenagers (15–17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020–2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units.Conclusions: Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively.

What is Known:• Pediatric drowning represents a significant public health challenge globally, with varying rates.• In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough.

What is New:• Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring.• There was a notable increase in drowning incidents during the last 3 years of the study period (2020–2022), coinciding with the COVID-19 pandemic.
Safety and efficacy of the new modified technique for c2 nerve root resection in 3d fluoroscopy navigated instrumentation in the cranio-cervical junction
Authors: Bobinski Lukas , Sandberg Linda , Bylander Frida , Hållberg Hampus , Berglund Anders , Duff John M. 
Published: September 2024

Abstract

Purpose
Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots.

Methods
This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group).

Results
The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, p = 0.039. Surgical time was significantly shorter in the No group (p = 0.001). The fusion rates were very high for both groups, without difference between groups (p = 1.0). Autografting from the iliac crest (p = 0.001) as well as postoperative immobilisation with a hard collar (p < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (p = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (p = 0.023 and p = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (p = 0.042).

Conclusions
Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. The technique tends to mitigate the odds of developing postoperative complications.
Comparison of eTEP and IPOM for ventral hernia surgery in the early postoperative period: a retrospective cohort study of a tertiary university centre
Authors: Wieland Lukas , Alfarawan Fadl , Bockhorn Maximilian , El-Sourani Nader 
Published: September 2024

Abstract
Purpose
The extended totally extraperitoneal technique (eTEP) is a relatively new laparoscopic approach to address ventral hernias. Since this technique is not widely used yet, the literature regarding its efficacy and safety is limited, especially when compared to more established surgical techniques like intraperitoneal onlay mesh (IPOM). This study aimed at contributing to the expanding body of evidence for eTEP, by comparing the early outcomes of eTEP and IPOM surgeries for ventral hernias.

Methods
This monocentric, retrospective cohort study compared patients with ventral hernias that were treated with eTEP or IPOM from 2019 to 2023.

Results
A total of 123 patients were analysed. 92 underwent eTEP and 31 IPOM respectively. Both groups were overall comparable. The IPOM group had a higher proportion of incisional hernias (61,29% vs. 21,74%, p < 0,001). This was taken into account for in a subgroup analysis of only primary hernias. The IPOM group had a significantly longer admission time (eTEP: 3 days, IPOM: 4 days, p < 0,001). The subgroup analysis revealed a statistically significant shorter surgery time in IPOM (median of 66,5 min vs. 106,5 min; p = 0,043) and a lower rate of postoperative complications in eTEP (eTEP: 4,17%, IPOM: 25%. p = 0,009). The eTEP group reported lower postoperative pain, yet without statistical significance.

Conclusion
eTEP for ventral hernia repair appears to be non-inferior to IPOM. Compared to IPOM it leads to shorter postoperative hospital stay and a potentially lower complication rate, despite a longer operation time.
Reaching China’s fertilizer reduction goals through nitrogen and phosphorus recovery: a substance flow analysis case study
Authors: Santolin Julia , Larsen Oliver Christopher , Fritze Albrecht , Xue Bing , Yang Zheng , Rotter Vera Susanne 
Published: September 2024

AbstractLinear agricultural nutrient regimes are the principal cause for perturbation of the geochemical cycles for nitrogen (N) and phosphorus (P) and other planetary boundaries. Nutrient cycles are characterized by high spatial disparity and China is a hotspot due to high fertilizer application rates. Using substance flow analysis, this study identified and quantified nutrient flows from agricultural production to residue management of Huangyan tangerines (Citrus reticulata) and water bamboo (Zizania latifolia) in a case study of Huangyan district (Taizhou City, Zhejiang province). About 754 Mg/a of N and 105 Mg/a of P can theoretically be recovered in the tangerines and water bamboo systems from currently untapped material flows. This could replace 59% of the N and 15% of the P currently applied as chemical fertilizer, reducing environmental impacts. Combining the nutrient recovery of both systems and upscaling the results to Taizhou City, the goal from the 14th Five-Year Plan for Agricultural and Rural Modernization to save 1182 Mg of nutrients per year could be exceeded by almost 12 times. This study’s data have varying degrees of uncertainty. The analysis of data representativeness shows potential for improvements, especially in the agricultural production of water bamboo and the nutrient contents of material flows.