bluuebunny/crossref_metadata_2025_split huggingface dataset:
Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds): study protocol and statistical analysis plan for a multicentre international observational cohort study
Authors: Quintão Vinícius Caldeira , de Sousa Gabriel Soares , Torborg Alexandra , Vieira Alexandra , Consonni Francesco , Rodrigues Samuel , Proença Julia , Carlos Ricardo Vieira , Clemente Marcella , Alonso Nivaldo , Neville Mariana , Leite Fernanda , Tonello Cristiano , Evans Faye , Garcia-Marcinkiewicz Annery , Guris Rodrigo , Herrera Jose , Andersen Ana , Schaigorodsky Lorena , Biondini Nanci , Cajas Ninón , Cruzat Francisco , Cortínez Luis Ignacio , Giraldo Marisol , Valle Alioth , Pozo Cristian , Betancourt Ana , Echeto Maria Alejandra , Dominguez Alma , Sarmiento Lina , González Kenya , Ábrego Gesely , Leguizamón Lorena , Paula Leila , Lauber Clarisa , Lopez Gabriela , Biccard Bruce M , Carmona Maria José , Hajjar Ludhmila Abrahão 
Published: September 2024

IntroductionSurgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries.Methods and analysisLASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission.Ethics and disseminationThis study received approval from the Institutional Review Board of the coordinating centre (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences.Trial registration numberNCT05934682.
Patients’ perspectives on ethical principles to fairly allocate scarce surgical resources during the COVID-19 pandemic in the Netherlands: a Q-methodology study
Authors: van Alphen Anouk , Lekkerkerker Caroline , Exel Job van , Baatenburg de Jong Rob , Ahaus Kees 
Published: September 2024

ObjectivesDuring the COVID-19 pandemic, healthcare professionals were faced with prioritisation dilemmas due to limited surgical capacity. While the views of healthcare professionals on fair allocation have been given considerable attention, the views of patients have been overlooked. To address this imbalance, our study aimed to identify which ethical principles are most supported by patients regarding the fair allocation of surgical resources.DesignA Q-methodology study was conducted. Participants ranked ordered 20 statements covering different viewpoints on fair allocation according to their point of view, followed by an interview. Principal component analysis followed by varimax rotation was used to identify subgroups who broadly agreed in terms of their rankings.SettingThe setting of this study was in the Netherlands.Participants16 patient representatives were purposively sampled.ResultsTwo perspectives were identified, both of which supported utilitarianism. In perspective 1, labelled as ‘clinical needs and outcomes’, resource allocation should aim to maximise the health gains based on individual patient characteristics. In perspective 2, labelled as ‘population outcomes and contribution to society’, allocation should maximise health gains as with perspective 1, but this should also consider societal gains.ConclusionsThere was a broad agreement among patient representatives that utilitarianism should be the guiding ethical principle for fair allocation of scarce surgical resources. The insights gained from this study should be integrated into policymaking and prioritisation strategies in future healthcare crises.
Assessment of radiological capacity and disparities in TB diagnosis: a comparative study of Mozambique, South Africa and Spain
Authors: Munyangaju Isabelle , José Benedita , Bassat Quique , Esmail Ridwaan , Tlhapi Liebe Hendrietta , Maphophe Mqondisi , Mutemba Crimenia , Cossa Loide , Perez Patricia , Palmer Megan , Mudaly Vanessa , Carruana Eliseo Vañó , Pitcher Richard D , Lopez Varela Elisa , Thierry-Chef Isabelle 
Published: September 2024

BackgroundTuberculosis (TB) remains a significant global health challenge, particularly in children, where diagnosis is challenging. Radiological resources such as chest X-rays and CT scans play a crucial role in early screening and diagnosis, especially in the absence of microbiological confirmation of disease. However, radiological capacity and access vary widely across regions and countries.MethodsThis study retrospectively audited licensed X-ray and CT units in Mozambique, South Africa and Spain in 2022. Population data were used to calculate units per million people. The study used choropleth maps to visualise regional disparities and to explore potential interactions between radiological capacity, population density and TB notifications.ResultsMozambique had the lowest radiological capacity, with 3.6 X-ray units and 0.4 CT units per million people, compared with South Africa’s 34.2 X-ray units, 5.8 CT units and Spain’s 811.5 X-ray units and 19.3 CT units. The private sector exhibited higher capacity than the public sector in all countries. Regional disparities were evident, particularly in Mozambique, highlighting urban–rural discrepancies and in-country inequalities.ConclusionThis study underscores significant disparities in radiological capacity between low-income, middle-income and high-income countries, with economic factors playing a pivotal role. Addressing these disparities is crucial for improving TB and other disease diagnostic capabilities, particularly in resource-limited settings. Potential solutions include establishing dedicated national radio-diagnostic departments, developing national guidelines and integrating portable AI-powered X-ray or point-of-care ultrasonography technology. These findings provide valuable insights for policymakers and stakeholders to advocate for improved radiological resources and equitable healthcare access.
Exploring the Effect of Sn Doping on the Optical and Dielectric Characteristics of Nano ZnMn2−xSnxO4 Samples
Authors: Heiba Zein K. , Ghannam M. M. , Ali Essam E. , Badawi Ali , Arafat Shadia W. , Sanad Moustafa M. S. , Meselhy Neama K. , Mohamed Mohamed Bakr 
Published: September 2024

ZnMn2−xSnxO4 specimens with x = 0.0, 0.03, 0.05, 0.07, 0.1 and 0.2 were obtained utilizing the sol-gel method. Rietveld refinement was employed to explore modifications in structural and microstructural features of the specimens upon Sn doping. Utilizing the SEM/EDS technique, the morphology and composition of the specimens were inspected. Inclusion of Sn ions into the ZnMn2O4 (ZMO) lattice was evidenced by the EDS analysis and confirmed by the shift in the wavenumber of IR vibrational bands of both tetrahedral and octahedral sites. From photoluminescence (PL) measurements, the pristine ZMO specimen exhibited a peak emission at 547 nm, consistent with the bandgap value E
g = 2.42 eV, recognized as edge-to-edge emissions. PL intensity diminished upon doping with Sn up to x = 0.07, then increases by increasing (x); for x = 0.2, it exceeds the peak of pure ZMO. The sample with x = 0.2 exhibited the ultimate dielectric and the greatest conductivity among other doped samples. The electrical conductivity of pure ZMO and samples with x = 0.1 adhered to the CBH model. Samples with x = 0.05 and 0.07 were characterized by the occurrence of both SP and CBH models. A sample with x = 0.2 demonstrated OLPT mechanism. The influence of the amount of Sn and temperature on the complex impedance and electric modulus were explored. All samples demonstrated a semiconductor feature except the sample with x = 0.07, which has metallic characteristics.
Blocking Tryptophan Catabolism Reduces Triple-Negative Breast Cancer Invasive Capacity
Authors: Kuo Li-Wei , Crump Lyndsey S. , O’Neill Kathleen , Williams Michelle M. , Christenson Jessica L. , Spoelstra Nicole S. , Roy Micaela Kalani , Argabright Amy , Reisz Julie A. , D’Alessandro Angelo , Boorgula Meher P. , Goodspeed Andrew , Bickerdike Mike , Bitler Benjamin G. , Richer Jennifer K. 
Published: September 2024

Abstract
Anchorage-independent triple-negative breast cancer (TNBC) cells exhibit elevated levels of the tryptophan (TRP)-catabolizing enzyme tryptophan 2,3-dioxygenase 2 (TDO2) compared with the same cells grown under two-dimensional culture conditions. Tracing of 13C11-TRP demonstrated that anchorage-independent culture and/or inflammatory cytokines that activate NF-κB increase TRP catabolism and production of downstream catabolites such as kynurenine, which activate the aryl hydrocarbon receptor (AhR). TDO2 expression is heterogeneous within TNBC cell lines. To determine the function of TDO2, both pharmacologic inhibition and genetic manipulation were conducted. TDO2 knockdown revealed a compensatory increase in indoleamine 2,3-dioxygenase 1 (IDO1), a nonhomologous TRP-catabolizing enzyme, indicating that dual inhibition of these two enzymes is necessary to reliably block TRP catabolism. Thus, we tested a newly developed TDO2/IDO1 dual inhibitor, AT-0174, and found that it effectively inhibits TNBC TRP catabolism. Furthermore, AT-0174 treatment or AhR inhibitor significantly decreased TNBC anchorage-independent survival, invasive capacity, and expression of mesenchymal genes and proteins, whereas exogenous kynurenine increased invasion through AhR-mediated zinc finger E-box–binding homeobox 1 (ZEB1) expression. Thus, dual inhibition of TDO2/IDO1 may prove efficacious against TNBC progression.

Significance:
TDO2 is more highly expressed than the nonhomologous TRP-catabolizing enzyme IDO1 in TNBC. We find that TDO2 knockdown can lead to a compensatory increase in IDO1. Therefore, we tested a newly developed TDO2/IDO1 dual inhibitor and found that it decreases TRP catabolism, anchorage-independent survival, and invasive capacity.
Realizing Synthetic Active Inference Agents, Part II: Variational Message Updates
Authors: van de Laar Thijs , Koudahl Magnus , de Vries Bert 
Published: September 2024

Abstract
The free energy principle (FEP) describes (biological) agents as minimizing a variational free energy (FE) with respect to a generative model of their environment. Active inference (AIF) is a corollary of the FEP that describes how agents explore and exploit their environment by minimizing an expected FE objective. In two related papers, we describe a scalable, epistemic approach to synthetic AIF by message passing on free-form Forney-style factor graphs (FFGs). A companion paper (part I of this article; Koudahl et al., 2023) introduces a constrained FFG (CFFG) notation that visually represents (generalized) FE objectives for AIF. This article (part II) derives message-passing algorithms that minimize (generalized) FE objectives on a CFFG by variational calculus. A comparison between simulated Bethe and generalized FE agents illustrates how the message-passing approach to synthetic AIF induces epistemic behavior on a T-maze navigation task. Extension of the T-maze simulation to learning goal statistics and a multiagent bargaining setting illustrate how this approach encourages reuse of nodes and updates in alternative settings. With a full message-passing account of synthetic AIF agents, it becomes possible to derive and reuse message updates across models and move closer to industrial applications of synthetic AIF.
Patient Selection for Endovascular Repair of Aortoiliac Aneurysms
Authors: Yano Osvaldo J. , Marin Michael , Hollier Larry 
Published: September 2024

Purpose: This study was conducted to establish criteria to aid in the selection of patients for endovascular repair of aorto-iliac aneurysms. Methods: Characterization of pertinent factors used to determine whether a patient is eligible to undergo stent-graft repair of an aorto-iliac aneurysm. Principal findings and conclusions: The determinant factor that dictates whether or not one is eligible to undergo endovascular repair of aorto-iliac aneurysm is the arterial anatomy of the affected area and its surrounding vessels. Some of the initial limitations imposed in this technology have changed such as an acceptance of much shorter neck than initially conceptualized, by the use of supra-renal stent deployment. However, unsolved issues remain regarding the differentiation of thrombus and atherosclerotic plaque in the infra-renal aortic region, iliac artery disease, and the need to have an enhanced flexibility of the delivery system for proper deployment in tortuous aortic necks. The question of long-term device durability remains the most important issue that has to be taken into consideration before one chooses minimally invasive endovascular approaches.
Impact of Sequential Grafting of the Internal Thoracic or Right Gastroepiploic Arteries on Multiple Coronary Revascularization
Authors: Ochi M. , Yamada K. , Ishii Y. , Ogasawara H. , Fujii M. , Yajima T. , Kanno S. , Tanaka S. 
Published: September 2024

Objective. The aim of the study is to clarify the efficacy of the sequential anastomotic technique of the arterial conduits for multiple coronary revascularization. Background. The internal thoracic artery (ITA) is now widely accepted as a durable conduit for myocardial revascularization. The right gastroepiploic artery (GEA) has been developed as a third in situ arterial graft with an outcome similar to that of the ITA. Material and method. One hundred and forty five consecutive patients (116 male, 29 female, mean age 60.4 yr) who received sequential grafting of either the ITA or GEA or both were retrospectively analysed. Results. Sequential anastomoses were performed in 121 in situ left ITAs. 36 in situ GEAs and 12 composite right ITAs. No in situ right ITA was anastomosed sequentially. Two to six vessels (mean 3.8) were revascularized for each patient. Of the total 543 bypassed vessels, 432 (79.6%) were reconstructed with the arterial grafts. In 85 patients with quadruple bypass or more, the arterial grafts were able to reconstruct 266 out of 360 (74.0%) target vessels. Seventy one patients (49.0%) were revascularized without venous grafts. The arterial grafts could revascularize 293 out of 310 vessels (94.5%) in the LAD ∼ Diagonal region, 83 out of 113 (73.4%) in the distal RCA or Cx region. There were no cardiac events responsible for the arterial grafts in the follow up period. Conclusion. In light of our experience, multiple revascularization with in situ arterial sequential grafts is feasible. Aggressive application of this technique provides patients requiring multiple coronary revascularization with favorable long-term results.
Calcification and Degeneration Characteristics of the Biocor No-React Bovine Internal Mammary Artery (BIMA) — in Vivo Evaluation in a Sheep Model
Authors: Jashari Ramadan , Herijgers Paul , Verbeken Eric , Van Lommel Alfons , Nishimura Yosuke , Ràcz Rozalia , Flameng Willem 
Published: September 2024

Objective: The No-React process for biomaterials was suggested to prevent calcification and degeneration. We examined in vivo in a chronic sheep model the performance of a Biocor bovine internal mammary artery (BIMA) graft after No-React processing. Methods: ‘No-React’ processing consists of aldehyde cross-linkage following a detoxification process with multiple physical variables and incubation with surfactant. Biocor BIMA No-React treated grafts have been interposed in the carotid artery in seven sheep with a Dacron graft as control. Grafts were explanted after 3 or 6 months and were grossly examined, by X-ray, histology, transmission and scanning electron microscopy, and atomic absorption spectrophotometry. Results: In the BIMA, good healing was found with a smooth intimal surface, minimal inflammatory reaction, and a well preserved ultrastructure. Calcification increased progressively. In the Dacron grafts, a fibrous covering the inner surface and infiltration with fibroblasts, histiocytes and macrophages was noted. Calcium content was stable. Conclusion: Calcification increased progressively in Biocor BIMA No-React grafts. Minimal inflammatory changes, a smooth inner surface and well preserved ultrastructure were noted.
Combined Carotid Endarterectomy and Coronary Bypass: A Decade Experience at UCLA
Authors: Farooq Michael M. , Reil Todd D. , Gelabert Hugh A. , Ahn Samuel S. , Baker J. Dennis , Moore Wesley S. , Quiñones-Baldrich William J. , Freischlag Julie A. 
Published: September 2024

Purpose: The purpose of this review was to determine outcomes for combined carotid endarterectomy (CEA) and coronary revascularization (CABG) in patients with asymptomatic carotid stenosis. Methods: We reviewed the medical records of consecutive combined procedures (CEA and CABG), performed at UCLA Medical Center from October, 1989 to January, 1999. Findings: There were 43 patients, 27 men and 16 women, with a mean age of 71 yr (range 51–87). Thirty-four patients 79% (34/43) had asymptomatic carotid stenosis. Stroke occurred in three patients (3/43 = 6.9%). Stroke ipsilateral to the CEA occurred in two patients: one asymptomatic (1/34 = 2.9%) and one symptomatic (1/9 = 11.1%). Conclusions: The majority of patients undergoing combined CEA/CABG have asymptomatic carotid stenosis identified in preparation for elective CABG. The asymptomatic carotid subset stroke rate of 2.9% resulting from a combined CEA/CABG is higher than our reported rate for CEA performed alone. In patients with asymptomatic carotid stenosis, the combined procedure should be selectively performed.
Reconstructive Surgery for Carotid Artery Occlusive Disease in the Elderly — a High Risk Operation?
Authors: Ommer A. , Pillny M. , Grabitz K. , Sandmann W. 
Published: September 2024

Patients over 80 yr of age may require carotid surgery for symptomatic or critical asymptomatic carotid artery occlusive disease. A total of 2262 operations were performed between 1990 and 1999; 76 (3.4%) were carotid reconstructions in 70 patients over 80 yr of age. Twenty patients (26%) presented with asymptomatic critical stenosis. Transient ischemic symptoms were the reason for presentation in 35 patients (46%). Progressive stroke was documented in two patients (3%) and a stroke with persisting neurological deficit was demonstrated in 19 cases (25%). Coronary artery disease was present in 47 patients (38%) and arterial hypertension in 55 (72%). Fifty-nine patients (84%) were classified as ASA group 3. Seventy-one thromboendarterectomies of the carotid bifurcation with vein-patch closure were performed. Five patients had other types of reconstruction. Simultaneous operations (aorto-coronary vein-bypass, aortic interposition graft etc.) were performed in nine patients. Postoperative complications occurred in three patients. One had a transient neurological deficit and another a lethal stroke; the third patient died from myocardial infarction. The in-hospital mortality was 2.9%, which was not significantly higher than the results of the other 2186 reconstructions (1.5%). Surgery for carotid artery occlusive disease can be safely performed in selected patients of more than 80 yr of age.
Long-Term Survival after Aortic Valve Replacement for Native Active Infective Endocarditis
Authors: Pompilio G. , Brockmann C. , Bruneau M. , Buche M. , Amrani M. , Louagie Y. , Eucher P. , Rubay J. , Jamart J. , Dion R. , Schoevaerdts J.-C. 
Published: September 2024

Background: The objective of this study was to analyse the impact of acute surgery for native aortic valve endocarditis and its influence on the long-Term prognosis after surgery. Methods: A total of 161 patients underwent aortic valve replacement for native active aortic valve endocarditis (NAAVE) during a 29-year period, from 1967 to 1995 (age range: 10 to 72 years; mean 48 ± 12). The main indication for surgery was progressive congestive heart failure (76%). Other indications were untreatable sepsis (27%), peripheral or central emboli (12%) and, from 1978, echocardiographic evidence of friable, pedunculated vegetations (3%). Streptococcal and staphylococcal infections predominated. Concomitant procedures were performed in 27% of the patients, including mitral and tricuspid valve surgery and coronary bypass procedures. Results: Operative mortality was 8% in the majority of cases caused by heart failure or multiorgan failure. Multivariate logistic regression analysis identified NYHA class IV to be an independent predictor for postoperative death. Long-term survival for discharged patients was 75% at 10 years and 58% at 15 years, with a mortality rate of 3.6%/patient/year. Cox regression analysis identified the year of operation, trivalvular endocarditis and staphylococcal infection as independent predictors of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients, respectively, were free of recurrent endocarditis. The presence of an abscess cavity at first operation was found to be predictive of recurrent endocarditis. Conclusions: Valve replacement for NAAVE offers a good chance for a cure and satisfactory long-term survival. Improvements in pre- and per-operative management of the very ill patient, and the use of allograft valves are likely to further improve long-term results. Finally, the presence of staphylococcal endocarditis requires long-term postoperative antibiotic therapy.
An Unusual Neurological Complication of Multiple Wasp Stings: AIDP
Authors: Kaur Amandeep , Gupta Monica , Ahuja Ishreen , Koul Anuka 
Published: September 2024

Background and Aims: Wasp stings often result in vascular problems and local irritation. Rarely neurological difficulties result from a delayed immune response, which causes acute inflammatory demyelinating polyradiculopathy, stroke and Parkinson’s disease. Patient’s Concern: Here we are describing a young male, who presented to us with ascending paralysis a few days after being stung by multiple wasps. The patient did not have any infection or recent vaccination. Nerve conduction velocity (NCV) suggested increased latencies in peripheral nerves. Hence, a temporality between Guillain–Barré syndrome (GBS) and the wasp sting was hypothesised. Intervention: After establishing a diagnosis, the patient received standard treatment for acute inflammatory demyelinating polyneuropathy (AIDP). Intravenous immunoglobulins were given over 5 days in divided doses. The patient had gross improvement in the weakness by day 7 and fully recovered in 2 months. Conclusion: This case study highlights the possibility of acute demyelinating polyradiculopathy, a serious neurological consequence that can arise from wasp stings. Nevertheless, the pathophysiology of the same is not well recognised in the literature. This emphasises the importance of identifying uncommon causes of GBS and comprehending the mechanism and curative measures.
Calcific Myonecrosis of the Leg: A Clinical and Diagnostic Dilemma
Authors: Hussein Mohsin , Iyengar Karthikeyan P. , Beale David , Botchu Rajesh 
Published: September 2024

Background: Calcific myonecrosis (CMN) is a rare condition, often considered to be a late sequela of antecedent trauma. Case Report: We describe here our experience in managing a 56-year-old male referred with a painless swelling on the lateral aspect of the left lower leg with a suspicion of a tumour. Results: Clinical and imaging features were classic of CMN. Conclusion: Clinical assessment, role of ultrasound scan in reaching a diagnosis and the management are highlighted.