bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Safety of Combined Cardiac and Vascular Operations: How Much is too Much?
Authors: Gangemi James J. , Kron Irving L. , Ross Scott D. , Tribble Curtis G. , Kern John A. 
Published: September 2024

Objective: The purpose of this study was to identify factors correlating with a poor outcome following combined cardiac and vascular procedures. Methods: We reviewed 45 consecutive patients undergoing combined cardiac and vascular operations. These included cardiac/CEA ( n = 27), cardiac/AAA ( n = 13), cardiac/AAA/one other vascular reconstruction ( n = 4), and cardiac/renal artery bypass ( n = 1). Group 1 included all patients with no morbidity or mortality ( n = 41) and Group II included patients who died or suffered significant morbidity (stroke, renal failure) ( n = 4). Results: Overall mortality was 4.4% (2/45). These two patients underwent cardiac surgery combined with two additional vascular procedures (cardiac/AAA/other). In patients undergoing cardiac/CEA or cardiac/AAA, there were no deaths and one stroke (contralateral to CEA). Group II had significantly decreased ejection fraction (39% ± 6% vs 52% ± 1%) and an increased number of procedures (2.75 vs 2.04). Conclusions: Combined cardiac surgery and vascular reconstruction can be performed safely. However, multiple vascular reconstructions or the presence of decreased ejection fraction increased operative risk.
Early Experience with Left Ventricular Volume Reduction Surgery in Syria
Authors: Kabbani S. S. , Izzat M. B. , Jamil H. , Hammoud A. , Nabhani F. , Kabbani L. S. 
Published: September 2024

Objective: To review our early experience with left ventricular volume reduction surgery (the Batista operation) in the management of patients with end-stage heart failure. Methods: Between December 1996 and April 1998, 10 patients (9 males, mean age 32 yr) with advanced symptomatic cardiomyopathy underwent left ventricular volume reduction surgery at Damascus University Cardiovascular Surgical Center. The cause of cardiomyopathy was idiopathic in three patients, valvular in four, ischemic in two, and viral myocarditis in one patient. Concomitant procedures included aortic valve replacement in four patients, mitral valve repair in six patients, and coronary artery bypass grafting in two patients. Results: All patients survived the procedure. Echocardiography prior to discharge documented significant improvement in ejection fraction in all but two patients. Mean follow-up was 7.6 months. After discharge, three patients developed progressive congestive heart failure to which they subsequently succumbed, and two more patients died suddenly late postoperatively. Only two patients continue to show both clinical and echocardiographic evidence of improvement. Conclusion: Left ventricular volume reduction surgery cannot be freely advocated until better means are found to identify patients who will benefit from the procedure, and proper prophylaxis against fatal postoperative complications can be afforded.
Infrainguinal Reconstructions: Influence of Surgical Experience on Outcome
Authors: Luther M. , Lepäntalo M. 
Published: September 2024

Objectives: To evaluate the influence of surgical experience and operation technique on the outcome of infrainguinal reconstructions. Design: A longitudinal observational study of patients undergoing reconstructions to the popliteal and crural arteries. Setting: A regional hospital and an academic referral centre. Materials: 392 patients undergoing 442 reconstructions, 218 to the popliteal and 228 to the crural vessels. Chief outcome measures: Graft patency and leg salvage. Main results: At the popliteal level. 5-year patency after autogenous vein reconstruction was 76%. No difference was found between in situ and transposed vein reconstructions, but prosthetic reconstructions had a worse patency. At the crural level, 5-year patency for in situ vein, transposed vein and prosthetic bypass were 66, 55 and 21%, respectively. Corresponding leg salvage for chronic critical leg ischaemia was 91% with vein and 55% with prosthetic reconstruction at popliteal level, and 66 and 33% at the crural level. Surgical experience improved the outcome, as 3-year patency for in situ and transposed vein bypasses to the popliteal level were 82 and 95% for experienced surgeons, and 53 and 75% for less experienced surgeons. Corresponding leg salvage rates for reconstructions to the popliteal and crural levels were 85 and 67% for experienced surgeons, and 61 and 52% for less experienced surgeons. Conclusions: Outcome of infrainguinal reconstructions is influenced by the reconstruction level. Surgical experience and choice of the appropriate reconstruction technique can improve outcome.
Value of Preoperative EEG for Carotid Endarterectomy
Authors: Illig K. A. , Burchfiel J. L. , Ouriel K. , DeWeese J. A. , Shortell C. K. , Green R. M. 
Published: September 2024

Purpose: This study was designed to determine whether the preoperative, baseline electroencephalogram (EEG) can be used for intraoperative decision making during carotid endarterectomy, and to identify circumstances where the EEG can be eliminated. Methods: The charts of all patients undergoing carotid endartectomy at the authors' institution from June 1991 to May 1995 were reviewed to identify those patients that had adequate pre- and intraoperative EEG monitoring. EEGs during 331 carotid endartectomies in 303 patients were coded without knowledge of outcome; primary and secondary endpoints were EEG changes with clamping and clinical outcome, respectively. Results: The incidence of mortality and major neurological morbidity was 1.8%. Baseline-EEGs were abnormal in 105 patients (32%). Whereas baseline-EEG changes were highly predictive of EEG changes after anesthetic induction ( P < .0001), they were not predictive of EEG changes with clamping or of clinical outcome. Prior stroke (CVA) predicted abnormal baseline-EEGs ( P < .0001) and abnormal post-anesthetic EEGs ( P < .0001) but did not predict changes with clamping or perioperative CVA. EEG changes with clamping occurred during 18% of operations; such changes were predicted only by contralateral occlusion ( P < .0016) and EEG changes during a prior contralateral carotid endartectomy ( P < .0001). The only variable that predicted an adverse neurological outcome was the presence of contralateral occlusion, which increased the likelihood of a perioperative neurological event seven-fold ( P = .0038). Clinical outcomes in the 57 of 105 patients with abnormal baseline-EEGs and the 49 of 83 with prior CVA who were shunted were not different from those who were not. Conclusions: baseline-EEG is not of value for the prediction of adverse events during carotid endartectomy and can be eliminated. Because contralateral occlusion is highly predictive of changes with clamping, and patients undergoing a second carotid endartectomy will usually manifest EEG changes identical to those at the first, operative EEG monitoring can also be eliminated from both these circumstances. Finally, prior stroke does not lead to a higher incidence of clamp-induced EEG changes, and thus is not an indication for shunting in and of itself.
Uridine-mediated Activation of the Keap1-Nrf2 Pathway for Alleviating Sepsis-induced Acute Lung Injury
Authors: Li Guoping , Hu Yalan , Xu Fan , Li Fei 
Published: September 2024

Background Sepsis-induced pulmonary injury poses a significant challenge in critical care due to its high morbidity and mortality rates. Purpose This study explores the potential of uridine to mitigate sepsis-induced pulmonary damage, specifically targeting the activation of the Kelch-like ECH-associated protein 1 (Keap1)-nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway. Methods Both in vitro and in vivo approaches were utilized, incorporating MH-S cell lines exposed to lipopolysaccharide (LPS) to simulate inflammatory conditions and cecal ligation and puncture (CLP)-induced sepsis model in mice. The effects of uridine were evaluated on survival rates, pulmonary damage, bacterial colonization, as well as the expression of NRF2, KEAP1, heme oxygenase-1 (HO-1), and inflammatory cytokines. Results Uridine treatment led to elevated levels of Nrf2 and HO-1, reduced KEAP1 expression, improved survival rates, decreased pulmonary damage and bacterial presence, and modulation of the Keap1-Nrf2 pathway. adeno-associated virus-mediated Nrf2 overexpression alleviated lung injury. The NRF2 inhibitor ML385 counteracted the beneficial effects of uridine, underscoring the critical role of the Keap1-Nrf2 pathway in these outcomes. Conclusion Activation of the Keap1-Nrf2 pathway by uridine holds promise as a therapeutic strategy to enhance outcomes in sepsis-induced pulmonary damage. Further investigation is warranted to assess the therapeutic potential of uridine in sepsis management and to elucidate the underlying mechanisms of its protective effects.
Evaluating the Impact of Different Education Methods on Cleft Lip and Palate Anatomy Training
Authors: Dalgalı Perihan , Topsakal Kübra Gülnur , Eser Mısır Selcen , Samur Ergüven Sara , Duran Gökhan Serhat , Görgülü Serkan 
Published: September 2024

Objective To compare the effects of different educational methods on short and long-term learning outcomes and to investigate the satisfaction and perception of cleft lip and palate (CLP) education among dental students. Design The theoretical exam on CLP to determine their baseline level of knowledge was taken by the participants(T0). After the exam, the students were randomly divided into three groups and all students attended a lecture-based traditional education on CLP. Students in the first group (n = 40) received no additional teaching (Group A). Students in the second group (n = 38) received model teaching with 3D-printed models (Group B). The third group (n = 39) was trained in e-learning-supported education (Group C). The theoretical exam was repeated immediately after the education (T1/short-term learning), one week later (T2/early long-term learning), and one month later (T3/late long-term learning), and the effect of the education methods on information level was assessed. In addition, a post-training satisfaction questionnaire was administered to participants of Group B and Group C. Results Both 3D model-based and e-learning-supported approaches significantly improved immediate knowledge of CLP. However, no significant differences were found in knowledge retention over time between the all methods. A majority of students favored the incorporation of both methods in orthodontic education. Conclusions While both 3D models and e-learning effectively enhance short-term CLP knowledge among dental students, their long-term educational impacts are comparable. However, student preferences indicated that the use of 3D-printed models and e-learning strategies may be useful augmentations to traditional lecture education.
First Tarsometatarsal Alignment May Self-Correct After Triple Arthrodesis in Progressive Collapsing Foot Deformity
Authors: Cotton Michael O. , Rowe Kenneth , Motsay Morgan , Manchester Maggie , Campbell John T. , Jeng Clifford L. 
Published: September 2024

Background: Triple arthrodesis is commonly used to correct rigid progressive collapsing foot deformity (PCFD). These patients often have associated first tarsometatarsal (TMT) instability on lateral weightbearing radiographs. It has not been well established if it is necessary to add first TMT arthrodesis to adequately correct the overall deformity. This study retrospectively examined pre- and postoperative radiographs of PCFD patients with first TMT instability that were managed by triple arthrodesis alone. Methods: All triple arthrodesis cases were searched for a single surgeon between 2013 and 2021. Inclusion criteria were patients with PCFD who underwent triple arthrodesis without first TMT joint fusion. Preoperative radiographs were examined for first TMT joint instability, demonstrated by plantar gapping of the first metatarsal-medial cuneiform angle or first metatarsal dorsal subluxation at the TMT joint. Measurement of sagittal first metatarsal-medial cuneiform angle and first metatarsal subluxation as described by King and Toolan was performed. Results: Twenty patients satisfied the inclusion criteria. Six patients did not demonstrate at least 30% improvement of one or both measurements of first TMT instability postoperatively and were considered failures. Fourteen patients demonstrated correction of their first TMT joint instability. Average follow-up was 5.0 (range, 1.8-9.4) years. The first metatarsal-medial cuneiform angle improved from 3.8 to 1.1 degrees ( P < .05). The first metatarsal subluxation corrected from 4.1 to 1.5 mm ( P < .05). One patient showed radiographic evidence of arthritis in the first TMT joint at final follow-up. Conclusion: Seventy percent of patients with PCFD with asymptomatic first TMT joint instability demonstrated correction of first TMT radiographic instability with isolated triple arthrodesis. This was maintained at 5-year mean follow-up. In cases of PCFD with medial column instability, triple arthrodesis alone may be adequate to restore overall alignment.
High Expression of NLR and SII in patients With Nasopharyngeal Carcinoma as Potential Prognostic Observations
Authors: Lv He , Chen Xing , Chen Xudong , Li Ji , Lu Xu 
Published: September 2024

Purpose To assess the value of pretreatment neutrophil-to-lymphocyte ratio (NLR) and systemic immunoinflammatory index (SII) in the prognosis of nasopharyngeal carcinoma (NPC) patients. Methods This retrospective study analyzed a total of 185 NPC patients who visited the clinic from June 2015 to December 2018 and were selected as study subjects. The NLR and SII were calculated based on the collection of demographic information, clinical characteristics, and pre-treatment lymphocyte counts, neutrophil counts, and platelet counts. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve, and survival analysis was performed through life table methods and Cox risk-proportional regression. Results Using the X-tile software, significant differences were found in clinical factors among NPC patients based on NLR (>2.91) and SII (>535.47). Age, TNM staging, SII, and NLR were identified as independent prognostic factors in a Cox regression analysis. SII had the highest area under the curve (AUC) for predicting 1-year survival, TNM staging had the highest AUC for predicting 3-year survival, and NLR had the highest AUC for predicting 5-year survival. The combined model showed superior predictive accuracy across all time points. Conclusion NLR and SII, as biomarkers of inflammation and immune status, have significant clinical applications in the prognostic assessment of NPC. The integrated prediction model combining age, TNM staging, SII, and NLR significantly improved the accuracy of survival prediction and provided a reliable basis for individualised treatment of NPC.
Does enamel deproteinisation with 10% papain affect shear bond strength of orthodontic adhesives: a randomised controlled trial
Authors: Sharma Vishal , Bawaskar Naval , Bhat Shweta , Kontham Rakesh , Chandorikar Harshal , Ghodke Swapnil 
Published: September 2024

Objective: To evaluate the effect of 10% papain as an enamel deproteinising agent on the shear bond strength (SBS) of three orthodontic adhesives: Transbond XT, resin-modified glass ionomer cement (RMGIC) and Biofix. Design: Single-centre, double-blinded, split-mouth randomised controlled trial. Setting: Department of Orthodontics and Dentofacial Orthopaedics, Nair Hospital Dental College, Mumbai, India. Participants: A total of 20 participants requiring bilateral premolar extraction for fixed orthodontic treatment in both the maxillary and mandibular arches were included in this study. Methods: In total, 80 premolars from the above-mentioned participants were divided into four groups as follows: group A: Transbond XT deproteinised with 10% papain gel; group B: Biofix deproteinised with 10% papain gel; group C: RMGIC deproteinised with 10% papain gel; and group D: Transbond XT without enamel deproteinisation as a control group-bonded as instructed by the manufacturer. After deproteinisation, brackets were bonded and after a follow-up period of 28 days, the teeth were extracted. The SBS was then measured using the Universal Testing Machine. The force needed to shear the bracket was documented, and bond strengths were subsequently calculated in megapascals (MPa). The obtained results were subjected to statistical analysis and one-way ANOVA was performed to compare the mean SBS between the groups. Subsequently, pairwise comparisons were conducted using Tukey’s post hoc test. Results: There was a statistically significant difference in SBS among all groups ( P = 0.002). The SBS of TransXT with deproteinisation increased significantly compared with TransXT without deproteinisation ( P = 0.03). There was no statistically significant difference between the SBS of TransXT without deproteinisation and RMGIC ( P = 0.47) and Biofix ( P = 0.39), both with deproteinisation. Conclusion: The use of 10% papain for deproteinising enamel improved the SBS of all materials. Deproteinising improved the SBS of RMGIC and Biofix to the level of TransXT without deproteinisation.
Myelin Oligodendrocyte Glycoprotein G Antibody-Positive Paraneoplastic Myelopathy in Seminoma: A Case Report and Literature Review
Authors: Hamid Umair , Pitton Rissardo Jamir , Alviz Luisa F. , Fornari Caprara Ana Letícia , Franada Tiffani S. 
Published: September 2024

Myelin oligodendrocyte glycoprotein-associated disorders (MOGAD) are autoimmune diseases that often manifest in the context of infections. They can also arise less commonly following vaccination but even more rarely in a paraneoplastic context. Herein, we will report a patient presenting with subacute inflammatory myelopathy after a fourth dose of the mRNA COVID-19 vaccine. Concurrently, a diagnosis of MOGAD was made with a metastatic abdominal seminoma. The patient was acutely treated with high-dose steroids followed by plasma exchange therapy and was subsequently started on a chemotherapy regimen for the underlying germ cell tumor. The patient had a complete resolution of neurological symptoms upon the last follow-up. Overall, 72 cases of COVID-19 vaccination associated with MOGAD were analyzed (median age at onset 39 years old; female to male ratio = 1.2:1). All cases occurred in adults except for an adolescent, with the majority occurring after vaccination with ChAdOx nCoV-19 (87%), and an average temporal profile between vaccination and symptom onset of 19 days. There were no reported cases after the third or fourth doses, and most patients were diagnosed with new-onset MOGAD after their first vaccine (76%). Although COVID-19 vaccination could be a potential causality, there are significant discrepancies between the reported cases and this patient, alongside the unlikely causality assessment obtained with the Bradford Hill criteria. Vaccination could unmask potential pre-existing autoimmune diseases, such as in this patient, where myelopathy was most likely part of a paraneoplastic syndrome associated with a newly diagnosed seminoma.
Emergency Department team resuscitation training through online simulation - A novel approach
Authors: Koh Shao Hui , Jacqueline Chieh Ling Tan , Lee Chengjie , Venugopal Kuhan 
Published: September 2024

Background Simulation training, an important component of the Emergency Medicine (EM) training curriculum, was affected by the COVID-19 pandemic due to social distancing policies. As a result, there was a need to find alternative approaches to medical simulation that could facilitate effective teaching and practising of team resuscitation. Objectives This paper describes an alternative approach to face-to-face simulation teaching due to pandemic-related limitations. Methods We conducted a virtual simulation session for nine junior doctors (medical officers, emergency medicine residents, and internal medicine residents). The sessions were carried out through video conferencing and medical simulation software. The session included pre-class readings, prior briefing on what to expect during the simulation case scenario, running of three case scenarios, team debriefing, and post-class feedback of the session conducted via Google Forms. Results Student feedback was obtained via a post-class survey. Feedback was largely positive as most participants found the session interactive and the pre-specified outcomes during the pre-simulation brief were achieved. Most participants also felt that fully online simulation training was an effective alternative to face-to-face simulation training. Conclusions A virtual simulation method is a feasible alternative to face-to-face simulation amidst the COVID-19 pandemic. We hope to increase awareness of this mode of teaching in the broader medical education community to benefit more learners.
Tinnitus prevalence and associated risk factors among university students: A cross-sectional study
Authors: Alqub Malik , Tourman Narmeen , Mousa Juliana , Humead Nada , Abd Alrazeq Asmaa , Khatatbh Aya , Nasassrh Saja , Hamdan Anas , Ghanim Mustafa , Allahham Saad , Alkhalidi Samar , Rabayaa Maha , Dwikat Majdi 
Published: September 2024

Introduction: Tinnitus is a common medical condition that affects an individual’s quality of life. It affects 5%–43% of the global population. Only a few research studies have been conducted in Palestine, so knowledge of tinnitus prevalence and risk factors is limited. The purpose of this study was to determine tinnitus prevalence and risk factors among young university students in Palestine. Methods: A cross-sectional study of Palestinian university students was done utilizing an online self-administered questionnaire. The questionnaire for the study was developed using the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire. A logistic regression analysis of the associations between tinnitus and influencing factors was performed to determine the effects of various clinically relevant variables on the likelihood of experiencing tinnitus. Results: A total of 728 participants responded to the questionnaire aged 20.0 ± 2.0. The overall prevalence of tinnitus was 31%. Having a relative with tinnitus, gastroesophageal reflux, depression and anxiety, hearing difficulties, vertigo, tympanic membrane perforation, chronic otitis, acoustic trauma, head and neck radiotherapy, dental surgery, ear surgery, ear pain, headache, neck pain, temporomandibular joint pain, balance disorders, and nasal septal deviation were significantly associated with tinnitus. The logistic regression analysis showed that suffering from frequent vertigo (at least once per year), from slight hearing difficulty, temporomandibular joint pain, performing ear surgery, and having depression and anxiety is associated with an increased risk of having tinnitus. Conclusions: The current study concluded that tinnitus is common among Palestinian university students. Furthermore, the study identified several major risk factors for tinnitus. It is critical to explore the possibly modifiable risk factors for tinnitus in order to have a better understanding of the condition and eventually minimize its prevalence.