bluuebunny/crossref_metadata_2025_split huggingface dataset:
Free Flap Perfusion in Microvascular Head and Neck Reconstruction: Influence of the Number of Ischemia Intervals and Ischemia Duration—A Retrospective Study
Authors: Ooms Mark , Winnand Philipp , Heitzer Marius , Peters Florian , Katz Marie Sophie , Bickenbach Johannes , Hölzle Frank , Modabber Ali 
Published: July 2024

Background In microvascular head and neck reconstruction, ischemia of the free flap tissue is inevitable during microsurgical anastomosis and may affect microvascular free flap perfusion, which is a prerequisite for flap viability and a parameter commonly used for flap monitoring. The aim of this study was to investigate the influence of the number of ischemia intervals and ischemia duration on flap perfusion. Methods Intraoperative and postoperative flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation at 2 and 8 mm tissue depths, as measured with the O2C tissue oxygen analysis system, were retrospectively analyzed for 330 patients who underwent microvascular head and neck reconstruction between 2011 and 2020. Perfusion values were compared between patients without (control patients) and with a second ischemia interval (early or late) and examined with regard to ischemia duration. Results Intraoperative and postoperative flap blood flow at 8 mm tissue depth were lower in patients with early second ischemia intervals than in control patients [102.0 arbitrary units (AU) vs 122.0 AU, P = .030; 107.0 AU vs 128.0 AU, P = .023]. Both differences persisted in multivariable analysis. Intraoperative and postoperative flap blood flow at 8 mm tissue depth correlated weakly negatively with ischemia duration in control patients ( r = −.145, P = .020; r = −.124, P = .048). Both associations did not persist in multivariable analysis. Conclusions The observed decrease in microvascular flap blood flow after early second ischemia intervals may reflect ischemia-related vascular flap tissue damage and should be considered as a confounding variable in flap perfusion monitoring.
Non-contrast magnetic resonance evaluation of active multiple sclerosis lesions: Emerging role of quantitative synthetic magnetic resonance imaging
Authors: Girdhar Sachin , Nair Sruthi S , Thomas Bejoy , Kesavadas Chandrasekharan 
Published: July 2024

Purpose The current study aims to explore the utility of novel synthetic MRI-derived quantitative parameters including myelin-correlated volume (MyC) in identifying active MS lesions without injecting gadolinium contrast. Methods 43 MS patients underwent institutional MS protocol including 3D FLAIR and post-contrast 3D T1VIBE sequence on a 1.5 T MR Scanner in addition to synthetic MRI sequence. MS plaques were categorised into enhancing (C) and non-enhancing (N) lesions. They were also sub-categorised based on location into periventricular WM lesions (P), deep WM lesions (D), infratentorial lesions (I) and cortical-juxtacortical (C) lesions. ROIs were placed on Synthetic FLAIR images in MS lesions and quantitative parameters of R1, R2, PD and myelin-correlated volume (MyC) obtained. Sensitivity and specificity for various cut-off values to differentiate enhancing from non-enhancing multiple sclerosis lesions were calculated by performing ROC curve analysis and logistic regression analysis. Results Contrast enhancing lesions demonstrated significantly higher mean R1, R2 values and lower mean PD values in comparison to non-enhancing lesions ( p < 0.05) but with limited specificity. Region-wise analysis revealed high AUC values for mean R1 and R2 at cortical-juxtacortical lesions ( p < 0.001) followed by periventricular lesions ( p < 0.003) for differentiating enhancing from non-enhancing lesions with no significant contribution from MyC and PD values. Conclusion Synthetic MRI-derived quantitative parameters of mean R1, R2, MyC and PD hold value in differentiating contrast enhancing and non-enhancing MS lesions without administering gadolinium-based contrast agent. However, the current study did not achieve significant specificity for establishing the same.
An accessible, non-invasive tool for endometriosis diagnosis reveals an association between age at symptom onset and endometriosis symptom prevalence
Authors: Samanta Nandini , Schiller Emily , López-Molini Isabel , Martin Meghan , Flores Idhaliz , Meyer Anne S , Chen Nancy 
Published: July 2024

Objective: To determine what symptom differences are prevalent in patients with differing ages of endometriosis symptom onset. Material and methods: We obtained clinical and demographic data from 1560 individuals with suspected pelvic conditions undergoing laparoscopy from the Endometriosis Patient Registry at Ponce Health Science University-Ponce Research Institute. We then generated predictive models by fitting logistic regressions to the patient data. We determined association between symptoms and age at symptom onset in patients with endometriosis by generating predictive linear and multinomial logistic regression models. Results: Our best model had an accuracy of 81.76%, with a sensitivity of 89.32% and a specificity of 64.57% at an optimal threshold of 0.75. Classic endometriosis symptoms such as dyspareunia and pelvic pain showed different prevalence rates based on patient age at onset of symptoms. Conclusion: Symptom-based predictive models are able to predict patients’ likelihood of having endometriosis in a non-invasive and accessible manner. Gynecologic and pelvic symptoms including dyspareunia and presence of uterine fibroids are significantly associated with age at symptom onset.
Limited Evidence to Support the Use of Intra-Articular Injection of Hyaluronic Acid for the Management of Hallux Rigidus: A Systematic Review
Authors: Butler James J. , Hartman Hayden , Mener Amanda , Mercer Nathaniel P. , Randall Grace W. , Petropoulos Stephen , Rosenbaum Andrew J. , Kennedy John G. 
Published: July 2024

Background: The purpose of this systematic review was to evaluate outcomes following intra-articular injection of hyaluronic acid (HA) for the treatment of hallux rigidus. Methods: During April 2024, a systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data collected and analyzed were number of patients, patient age, follow-up, subjective clinical outcomes, complications, and failures. Results: Five studies were included. In total, 218 patients (218 feet) underwent intra-articular injection of HA at a weighted mean follow-up time of 4.4 ± 1.4 months (range, 3-6). There was an improvement in postinjection visual analog scale (VAS) pain at rest scores, VAS pain during activity scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and Foot Health Status Questionnaire (FHSQ) scores. In total, 21 complications (10.0%) were observed, the most common of which was transient postinjection pain in 20 patients (9.6%). There were 7 patients (3.2%) who underwent secondary procedures (3.2%). One randomized control trial (RCT) demonstrated no difference in outcomes between an intra-articular injection of HA compared to an intra-articular injection of saline. One RCT demonstrated superior FHSQ scores following between an intra-articular injection of HA compared to an intra-articular injection of triamcinolone acetonide. Conclusion: This systematic review suggests that intra-articular injection of HA for the treatment of hallux rigidus may lead to improved clinical outcomes with a low complication rate at short-term follow-up. However, the low level and quality of evidence underscores the need for further high-quality studies to be conducted to identify the precise role of HA in the treatment of hallux rigidus.
Racial Disparities in the Utilization of Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability in the United States
Authors: Chao Myra , Hamama Britanny A. , Bariteau Jason , Kadakia Rishin , Coleman Michelle M. 
Published: July 2024

Background: Previous studies have reported on the impact of race and ethnicity on access to orthopaedic procedures in the United States. However, there are few studies evaluating racial disparities in elective foot and ankle surgeries. Recognizing and addressing disparities in the access of health resources are steps to improve care rationing. Our study specifically investigated potential racial disparities with utilization and perioperative metrics of lateral ankle ligament reconstruction. Methods: A retrospective study was performed using the National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology ( CPT) code 27698 was used to identify patients who underwent LALR from 2011 to 2020. Sixty-one percent of these patients had available race/ethnicity data and were included in the study. Designations of race and ethnicity were standardized as White non-Hispanic, Black non-Hispanic, Hispanic, Asian American and Pacific Islander, and Other. Race/ethnicity stratifications of NSQIP patients were compared to 2010 and 2020 census data from the United States (US) Census Bureau. Thirty-day postoperative complications and total length of hospital stay, for all complications, were also compared between White patients and all other patients combined. Independent t tests, χ2, and Fisher exact tests were performed to compare differences including age, gender, and postoperative complications. Results: Overall, 1295 patients were included in the study. White non-Hispanic patients underwent 3.3 times more LALR than all other patients during the study period. This finding shows a higher prevalence of surgery on White non-Hispanic patients than all others reported in the US Census Bureau data for 2010 and 2020, where the ratio of White non-Hispanic vs all others were 1.9 and 1.5-fold, respectively. White patients were marginally older with a mean age of 38 years, compared with 36 years for Black patients ( P < .05). There were no differences in 30-day complication rates or total length of hospital stay based on race and ethnicity. Conclusion: Our study found that there was increased utilization of LALR for White non-Hispanic patients compared with all other racial/ethnic groups. These numbers do not mimic the current population trends based on the national census data. Despite this discrepancy, no differences in postoperative complications and length of stay were found based on race and ethnicity. These results suggest that there may be barriers for patients who are not White non-Hispanic to undergo care for LALR. Level of Evidence: Level III, retrospective cohort study.
Exploring the pharmacological potential of Lepionurus sylvestris blume: from folklore medicinal usage to modern drug development strategies using in vitro and in silico analyses
Authors: Ralte Laldinfeli , Sailo Hmingremhlua , Kumar Nachimathu Senthil , Singh Y. Tunginba 
Published: July 2024

Abstract
Background
Lepionurus sylvestris Blume has a long history of folklore medicinal usage against various ailments. However, studies on these plants were neglected particularly their pharmacological potential.

Methods
The crude extract was identified using LC-MS analysis. In vitro assays were carried out to determine the properties of antioxidant, anti-microbial, and anti-cancer. Further, network pharmacology was proposed to evaluate the potential targets of the compounds against breast cancer and type II diabetes. Molecular docking and molecular dynamic simulation were used to determine the potential compounds for the drug formulation of diabetes.

Results
Various bioactive compounds were identfied using LC-MS and Galiposin, Fujikinetin, Boeravinone B, 4-Deoxybryaquinone, and Norbaeocystin were described for the first time from the plant. Determination of antioxidant potential showed that the IC50 value of ABTS, DPPH, and phosphomolybdate was 24.33 µg/ml, 37.81 µg/ml, 60.35 µg/ml, and reducing power assays 1.185. The antibacterial activity against Streptococcus pyogenes, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli was determined, and the minimum inhibition concentration (MIC) was found to be 5.3 mg/ml, 3.47 mg/ml, 3.33 mg/ml, and 2.7 mg/ml respectively, revealing the extracts as effective antibacterial agents. The IC50 values for the plant extract were determined to be 26 µg/ml, 30.52 µg/ml, and 24.39 µg/ml for HeLa, MCF-7, and K-562 cells, respectively, and the increasing concentration of the plant extract increased LDH release. Furthermore, the in silico network pharmacology, molecular docking which had the highest docking score for GAPDH and HIF-1 target proteins of -9.3 kcal/mol, and − 11.3 kcal/mol binding affinities, and molecular dynamic simulation analysis revealed the bioactive compound Boeravinone B present in the plant was significant for the treatment of various ailments.

Conclusion
Based on our findings, plant extracts could be a promising option for developing new drug formulations.
Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists
Authors: Lai Hsuan-Wen , See Chun Yin , Chen Jui-Yi , Wu Vin-Cent 
Published: July 2024

Abstract
Background
Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored.

Purpose
This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement.

Methods
A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE).

Results
Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% (n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m2. GLP-1RAs’ new use at dialysis commencement was significantly associated with a lower risk of MACE (p = 0.047) and MAKE (p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE.

Conclusion
Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.
Validation of an web-based dietary assessment tool (RiksmatenFlex) against doubly labelled water and 24 h dietary recalls in pregnant women
Authors: Söderström Emmie , Sandborg Johanna , Nilsson Ellinor , Henström Maria , Lemming Eva Warensjö , Lindroos Anna Karin , Rood Jennifer , Sipinen Jessica Petrelius , Löf Marie 
Published: July 2024

Abstract
Introduction
Digital technologies have enabled new possibilities to assess dietary intake and have shown promise in terms of decreased participant burden, improved accuracy and lower costs. However, their potential and validity in pregnant populations are scarcely explored.

Objectives
This study aimed to (a) validate energy intakes obtained from a web-based dietary recall method developed for national surveys (RiksmatenFlex) against total energy expenditure (TEE) by means of the doubly labelled water (DLW) method, and (b) to compare intakes of macronutrients, key unhealthy and healthy foods as well as adherence to food-based dietary guidelines between RiksmatenFlex and repeated 24 h telephone dietary recalls in healthy Swedish pregnant women.

Methods
This study was conducted as a nested validation within the HealthyMoms trial. Intakes of foods, macronutrients and energy were assessed during three days through RiksmatenFlex and 24 h telephone dietary recalls, and Swedish Healthy Eating Index (SHEI) scores were also calculated for both methods (n = 52). For 24 women, TEE was also assessed through the DLW method. Paired Samples T-tests and Wilcoxon Signed Ranks Tests were used to identify differences between means for foods, macronutrients, energy and SHEI scores. Pearson correlation coefficient or Spearman’s rho were performed to identify relationships between variables. To compare energy intake (RiksmatenFlex) with TEE (DLW method) and 24 h telephone dietary recalls, Bland and Altman plots were constructed.

Results
Average energy intake from RiksmatenFlex (10,015 [SD 2004] kJ) was not statistically different from TEE (10,252 [SD 1197] kJ) (p = 0.596) (mean difference: -237 kJ/24 h). Correspondingly, there were small mean differences between average intakes of key unhealthy and healthy foods and average SHEI scores between RiksmatenFlex and 24 h telephone dietary recalls. However, the Bland and Altman plots showed wide limits of agreement for all dietary variables (e.g., for energy intake using RiksmatenFlex versus TEE: ±4239 kJ/24 h). High correlations between the investigated dietary variables for the two dietary methods were observed (r = 0.751 to 0.931; all p < 0.001).

Conclusion
RiksmatenFlex captured average intakes of energy, unhealthy and healthy food groups and adherence to food-based dietary guidelines in a comparable way to 24 h telephone dietary recalls and the DLW method. Our results support the validity of RiksmatenFlex as a web-based dietary assessment method for future use in pregnancy for intervention studies and national dietary surveys.
The uric acid/HDL-C ratio may predict significant coronary stenosis in moderate left main coronary artery lesions: an intravascular ultrasonography study
Authors: Demir Ömer Furkan , Arslan Abdulsamet , Kınık Mustafa , Şensoy Barış , Demir Günseli 
Published: July 2024

Abstract
Background
There may be severe difficulties in determining the severity of LMCA (left main coronary artery) lesions. The use of intravascular ultrasound (IVUS) facilitates decisions about lesion severity in these patients. The aim of this study was to investigate the relationship between the UHR (uric acid to HDL-C ratio) and lesion severity in patients who underwent LMCA IVUS.

Methods
This study included 205 patients with ICS (intermediate coronary stenosis) in the LMCA who underwent IVUS. In the IVUS measurements of these patients, the plaque burden (PB) and the minimal lumen area (MLA) showing lesion severity were measured.

Results
The patients were separated into two groups according to plaque burden (< 65% and ≥ 65%). The UHR was significantly greater in the high plaque burden group (479.5 vs. 428.6, P = 0.001). When the patients were separated into two groups according to the MLA (< 6mm2 and ≥ 6mm2), the UHR was determined to be significantly greater in the group with low MLA (476.8 vs. 414.9, P < 0.001). In the ROC analysis performed according to the MLA and plaque burden values, the UHR cutoff value of 450 was found to have similar sensitivity and the same specificity for both parameters.

Conclusions
The results of this study suggested that there is a relationship between UHR and MLA < 6mm2 and plaque burden ≥ 65%, which are independently evaluated as critical in IVUS, and this could predict anatomically significant lesions in patients with a moderate degree of LMCA stricture.
Role and mechanism of specialized pro-resolving mediators in obesity-associated insulin resistance
Authors: Liu Xinru , Tang Yu , Luo Yuanyuan , Gao Yongxiang , He Lisha 
Published: July 2024

AbstractWith the changing times, obesity has become a characteristic epidemic in the context of the current era. Insulin resistance (IR) is most commonly caused by obesity, and IR is a common basis of the pathogenesis of many diseases such as cardiovascular disease, nonalcoholic fatty liver disease, and type 2 diabetes, which seriously threaten human life, as well as health. A major pathogenetic mechanism of obesity-associated IR has been found to be chronic low-grade inflammation in adipose tissue. Specialized pro-resolving mediators (SPMs) are novel lipid mediators that both function as “stop signals” for inflammatory reaction and promote inflammation to subside. In this article, we summarize the pathogenesis of obesity-associated IR and its treatments and outline the classification and biosynthesis of SPMs and their mechanisms and roles in the treatment of obesity-associated IR in order to explore the potential of SPMs for treating metabolic diseases linked with obesity-associated IR.
Surgical management of native aortic valve leaflet avulsion during TAVR
Authors: Williams David M. , Castellano Andrew , Phillips William , Miller Kelly , Garg Aakash 
Published: July 2024

Abstract
Background
Transcatheter aortic valve replacement (TAVR) has increased in utilization since its approval for management of aortic stenosis patients across all risk strata. We report a rare case of aortic valve leaflet avulsion after balloon expandable TAVR managed with urgent surgery.

Case presentation
A 78-year-old male underwent TAVR complicated by avulsion of the native aortic valve leaflet’s left coronary cusp. He was taken for urgent surgery for cusp resection to prevent thromboembolic complications.

Conclusions
Native aortic valve leaflet avulsion should be suspected during TAVR in instances of extreme hemodynamic instability after balloon aortic valvuloplasty. As TAVR expands in lower risk patients, surgeons should have a low threshold to intervene surgically to treat native leaflet avulsion or other complications.