bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of hippocampal sparing whole brain radiotherapy in a resource-limited setting.
Authors: Lee David Dai-Wee , Jamalludin Zulaikha , Abdul Satar Nur Fadhlina , Ho Gwo Fuang 
Published: August 2024

31 Background: Whole brain radiotherapy (WBRT) is a common treatment for brain metastases, but it often leads to cognitive decline due to hippocampal damage. Hippocampal avoidant technique has emerged to mitigate this cognitive toxicity. Our institution began hippocampal-avoidant WBRT (HA-WBRT) in 2021. We report our experience in implementing this technique in a resource-limited setting. Methods: We reviewed the medical records of patients who underwent HA-WBRT in our institution between January 2021 and March 2024. Clinical characteristics, treatment details, and dosimetry were reviewed. Hippocampal sparing was achieved using volumetric-modulated arc therapy (VMAT). Results: A total of 11 patients were included in the analysis. The median age was 57 years old, with a male-to-female ratio of 3:8. Most patients had metastatic breast cancer (7/11) followed by lung cancer (2/11). Among the breast cancer patients, 5 of them had HER2 positive subtype. Ten patients had good performance status (ECOG 0). Most patients (8/11) were treated with 20Gy in 5 fractions (with or without boost to tumor), and 3 patients with 30Gy in 10 fractions. The median time from CT simulation to treatment was 20.5 days. The target volume and organ-at-risk contouring were performed as per the AROMA trial (20Gy in 5 fractions) or RTOG 0933 study (30Gy in 10 fractions). The median beam-on time was 5.61 minutes. Nine patients completed WBRT with minimal acute toxicities. Two patients did not complete treatment due to a decline in performance status. Most patients were treated in multiple institutions thus, follow-up data was scarce. Conclusions: In our experience, HA-WBRT is feasible for suitable patients. Patients that benefit from this technique are younger, have good performance status, and have longer life expectancy e.g. breast primary. The challenges of implementing this treatment are a longer time for contouring and treatment planning, and longer treatment time compared with 2D or 3D WBRT. Long-term follow-up is needed to validate the benefit of this technique. Patient selection is key in implementing HA-WBRT in a resource-limited setting.
Effect of TTYH3 on cholangiocarcinoma invasion, metastasis and lymph node metastasis through Wnt/β-catenin pathway.
Authors: Xie Yuwei , Wu Shengze , Du Fangqian , Gao Ruiqian , Wu Tingting , Jin Chen , Cao Jingyu , Zhu Chengzhan 
Published: August 2024

57 Background: Cholangiocarcinoma is a malignant tumor originating from the bile duct epithelium. Metastasis is an important factor affecting the prognosis of cholangiocarcinoma. To explore the role and mechanism of calcium-activated chloride channel protein Tweety homolog 3 (TTYH3) in cholangiocarcinoma metastasis. Methods: TTYH3 was overexpressed and knocked down in cholangiocarcinoma cells, and in vitro experiments were performed to clarify the biological function of TTYH3 in cholangiocarcinoma. Experiments on xenograft tumor mice model have shown that TTYH3 promotes tumorigenesis of cholangiocarcinoma cells. Analysis of the relationship between TTYH3 expression and patient prognosis and lymph node metastasis in cholangiocarcinoma tissue specimens. Exosomes were extracted from bile of patients with cholangiocarcinoma and bile duct stones, and the expression of TTYH3 in exosomes was compared. TTYH3 overexpressed exosomes were used to treat endothelial cells, and their function and mechanism in promoting lymphangiogenesis were analyzed. Results: In vitro experiments confirmed that TTYH3 promoted the migration and invasion of cholangiocarcinoma cell line QBC939. In vivo experiments confirmed that TTYH3 promotes the tumorigenesis of cholangiocarcinoma cells. TTYH3 promotes epithelial-to-mesenchymal transition of cholangiocarcinoma cells through the Wnt/β-catenin signaling pathway. TTYH3 promotes cholangiocarcinoma cell self-expression through positive feedback. TTYH3 is highly expressed in cholangiocarcinoma tissues. Patients with high TTYH3 expression have poor prognosis and a high incidence of lymph node metastasis. The TTYH3 protein content of bile exosomes in patients with cholangiocarcinoma is increased, which promotes the invasion and metastasis of cholangiocarcinoma cells, while also promoting lymphangiogenesis and increased permeability. TTYH3 promotes the uptake of exosomes by lymphatic cells and promotes lymphangiogenesis by regulating the influx of calcium ions and chloride ions in lymphatic cells. Conclusions: TTYH3 promotes the invasion and metastasis of cholangiocarcinoma cells through the Wnt/β-catenin signaling pathway, and exosome TTYH3 promotes lymphangiogenesis and lymph node metastasis.
Clinical Anatomy of the Sacral Nerve Roots and Its Relevance to Their Reconstruction After Sacrectomy
Authors: Kaiser Radek , Khadanovich Anhelina , Benes Michal , Reynolds Jeremy , Mawhinney Gerard , Giele Henk , Kachlik David 
Published: August 2024

BACKGROUND AND OBJECTIVES:
En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy.

METHODS:
Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy).

RESULTS:
The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements.

CONCLUSION:
The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.
Comparative Analysis of Duroplasty Techniques in Decompressive Craniectomy: The CANDID Study
Authors: Ramola Mahesh , Ramola Monika , Singh Jagjeet , Khurana Lavleen , Chhabra Sarab , Garg Ritish , Singh Udisha , Nath Kavindra 
Published: August 2024

BACKGROUND AND OBJECTIVE:
At present, there is no consensus regarding the most optimal dural substitute to use for duroplasty in primary decompressive craniectomy (PDC) for traumatic brain injury (TBI). The author's objective was to conduct a retrospective analysis comparing 2 techniques of PDC: duroplasty using anterior-based vascularized galea pericranium (VP group) with synthetic dural substitute duroplasty (SR group).

METHODS:
From April 2015 to February 2022, 379 craniotomies were done for TBI. The outcome of eligible 97 consecutive patients receiving PDC treatment were examined. Out of 97, 60 received vascularized galea pericranium and 37 received synthetic dural graft for dural augmentation. Propensity matching generated 28 pairs (56 patients) for analysis. The primary outcome was extended Glasgow Outcome Scale (GOS-E) measured at 6 months after injury. Secondary outcomes included were incidence of surgical complications (neurosurgical site infections, and hemorrhagic and hydrodynamic complications), surgical time, days in intensive care unit, hospital length of stay, hospital mortality, and GOS-E at 1 year after injury.

RESULTS:
Patients in VP group, compared with those in SR group had better GOS-E score at 6 months (P = .011) and 1 year (P = .026). Hospital mortality (P = .342), days in intensive care unit (P = .574), hospital stay (P = .155), surgical time (P = .131), medical and surgical complications including neurosurgical infections, and hemorrhagic and hydrodynamic complications did not differ significantly in both groups. Complication of brain abscess was found exclusively in the SR group (P = .327).

CONCLUSION:
In this retrospective study, adults who underwent PDC for TBI using anterior-based vascularized galea pericranial graft were associated with better clinical outcomes at 6 months and 1 year compared with standard repair group using synthetic dural substitute (G patch).
Microsurgical Repair of Ventral Cerebrospinal Fluid Leaks in Spontaneous Intracranial Hypotension: Efficacy and Safety of Patch-Sealing Versus Suturing
Authors: Petutschnigg Thomas , Häni Levin , Goldberg Johannes , Dobrocky Tomas , Piechowiak Eike I. , Raabe Andreas , Jesse C. Marvin , Schär Ralph T. 
Published: August 2024

BACKGROUND AND OBJECTIVES:
In patients with spontaneous intracranial hypotension (SIH), microsurgical repair is recommended in Type 1 (ventral) dural leaks, when conservative measures fail. However, there is lacking consensus on the optimal surgical technique for permanent and safe closure of ventral leaks.

METHODS:
We performed a retrospective analysis of surgically treated SIH patients with Type 1 leaks at our institution between 2013 and 2023. Patients were analyzed according to the type of surgical technique: (1) Microsurgical suture vs (2) extradural and intradural patching (sealing technique). End points were resolution of spinal longitudinal epidural cerebrospinal fluid collection (SLEC), change in brain SIH-Score (Bern-Score), headache resolution after 3 months, surgery time, complications, and reoperation rates.

RESULTS:
In total, 85 (66% women) patients with consecutive SIH (mean age 47 ± 11 years) underwent transdural microsurgical repair. The leak was sutured in 53 (62%) patients (suture group) and patch-sealed in 32 (38%) patients (sealing group). We found no significant difference in the rates of residual SLEC and resolution of headache between suture and sealing groups (13% vs 22%, P = .238 and 89% vs 94%, P = .508). No changes were found in the postoperative Bern-Score between suture and sealing groups (1.4 [±1.6] vs 1.7 [±2.1] P = 1). Mean surgery time was significantly shorter in the sealing group than in the suture group (139 ± 48 vs 169 ± 51 minutes; P = .007). Ten patients of the suture and 3 of the sealing group had a complication (23% vs 9%, P = .212), whereas 6 patients of the suture and 2 patients of the sealing group required reoperation (11% vs 6%, P = .438).

CONCLUSION:
Microsurgical suturing and patch-sealing of ventral dural leaks in patients with SIH are equally effective. Sealing alone is a significantly faster technique, requiring less spinal cord manipulation and may therefore minimize the risk of surgical complications.
Membrane structures and functional correlates in the bi-segmented eye lens of the cephalopod
Authors: Regini Justyn W. , Yagi Naoto , Young Robert D. , Tanioka Hidetoshi , Kinoshita Shigeru , Hoshino Masato , Uesugi Kentaro , Meek Keith M. , Augousti Andy T. , Knupp Carlo , Pierscionek Barbara K. , Quantock Andrew J. , Elliott Gerald F. 
Published: August 2024

ABSTRACT
The cephalopod eye lens is unique because it has evolved as a compound structure with two physiologically distinct segments. However, the detailed ultrastructure of this lens and precise optical role of each segment are far from clear. To help elucidate structure–function relationships in the cephalopod lens, we conducted multiple structural investigations on squid. Synchrotron x-ray scattering and transmission electron microscopy disclose that an extensive network of structural features that resemble cell membrane complexes form a substantial component of both anterior and posterior lens segments. Optically, the segments are distinct, however, and Talbot interferometry indicates that the posterior segment possesses a noticeably higher refractive index gradient. We propose that the hitherto unrecognised network of membrane structures in the cephalopod lens has evolved to act as an essential conduit for the internal passage of ions and other metabolic agents through what is otherwise a highly dense structure owing to a very high protein concentration.
Simultaneous laparoscopic management of coexisting cholecystitis and appendicitis - a case report
Authors: Błaszczyszyn Katarzyna , Bińczyk Wiktoria , Dróżdż Olgierd , Siudek Bartosz , Grzelka Michalina , Pupka Dominika , Orzechowski Janusz 
Published: August 2024

Background: Acute cholecystitis and acute appendicitis are among the most common conditions leading to surgical admissions. However, their concurrent presentation is rare and poses significant diagnostic and therapeutic challenges. Compared with traditional open surgery, laparoscopy has revolutionized the management of various abdominal pathologies by providing enhanced visualization, shorter hospital stays, and faster recovery times.

Case Presentation: A 66-year-old woman with severe right upper quadrant and lateral abdominal pain, and nausea was admitted to the general surgical ward. Physical examination showed tenderness and muscle guarding in the right upper quadrant, and a positive Murphy's sign. Laboratory investigations revealed leukocytosis, elevated inflammatory markers, and abnormal liver function. An inconclusive ultrasound led to a CT scan, diagnosing acute cholecystitis and acute appendicitis. A decision was made to perform simultaneous laparoscopic cholecystectomy and appendectomy. The patient had an uneventful recovery and was discharged after ten days with standard surgical recommendations.

Conclusion: This case report highlights the importance of considering multiple potential causes of abdominal pain, especially with inconclusive initial imaging. Simultaneous laparoscopic cholecystectomy and appendectomy demonstrated in this case proved to be feasible, safe, and effective. Early and accurate diagnosis, facilitated by thorough clinical examination and advanced imaging, is crucial for prompt treatment. Surgeons must be prepared for rare concurrent presentations and capable of performing synchronous laparoscopic surgeries to improve patient outcomes and streamline recovery.
The Correlation Between Interleukin-6 (IL-6) Levels and the Extent of Coronary Lesions Based on SYNTAX Scores in Patients with Acute Coronary Syndrome (ACS)
Authors: Siallagan Delpiana , Loesnihari Ricke , Hasan Refli 
Published: August 2024

<p><strong>Introduction: </strong>Atherosclerosis plays an important role in the pathogenesis of acute coronary syndrome (ACS). Inflammation plays a causal role in atherosclerosis. There are many inflammatory markers related to ACS, including C-reactive protein (CRP), homocysteine, matrix metal loproteinases, interleukin (IL)-6, IL-8, and IL-27. IL-6 is the sign of synthesis of acute phase proteins. Recently, the clinical trials related to ACS showed that IL-6 may be an indicator of increased risk for ACS. An Interleukin-6 (IL-6) examination is can be used to assess risk factors for acute coronary syndrome (ACS). Interleukin-6 is a marker of local inflammation of coronary plaque and peripheral blood circulation which increases the occurrence of coronary heart disease causing plaque instability and rupture. The SYNTAX scoring system has correlation assessed through angiography assessing the complexity of the severity of coronary artery stenosis. This study aims to determine the between Interleukin-6 (IL-6) levels and the extent of coronary lesions based on the SYNTAX score in patients with acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>This is a cross-sectional study of 45 patients with acute coronary syndrome (ACS) who were treated at H. Adam Malik General Hospital, Medan (February 2023 – May 2023). IL-6 levels were examined using the Electrochemiluminescent Immunoassay (ECLIA) method using Cobas e 411. The extent of the coronary lesion was calculated based on the SYNTAX score from coronary angiography which was calculated by two invasive cardiologist as suggested before using an online calculator. We used the Spearman correlation test and Mann Whitney test to analyze the data.</p><p><strong>Results: </strong>The were 39 male subjects (86.7%) total.<strong> </strong> The mean age of the subjects was 54.89 ± 10.3 years old. Most of the subjects experienced STEMI in total 28 people (62.2%). The Median IL-6 levels was 19.22 pg/mL while the median of SYNTAX score level was 13.00. By using <em>cross-sectional</em> study and the spearman correlationa test, there is a significant correlation between IL-6 and the SYNTAX score with the correlation value obtained r = 0.343 (p = 0.021).</p><p><strong>Conclusion: </strong>There is a significant relationship between IL-6 and the extent of coronary lesions based on the SYNTAX score in patients with acute coronary syndrome.</p><p> </p>
Predictive pixel-wise optical encoding: towards single-shot high dynamic range moving object recognition
Authors: He Yutong , Liang Yu , Huang Honghao , Hu Chengyang , Yang Sigang , Chen Hongwei 
Published: August 2024

Conventional low dynamic range (LDR) imaging devices fail to preserve much information for further vision tasks because of the saturation effect. Thus, high dynamic range (HDR) imaging is an important imaging technology in extreme illuminance conditions, which enables a wide range of applications, including photography, autonomous driving, and robotics. Mainstream approaches require multi-shot methods because the conventional camera can only control the exposure globally. Although they perform well on static HDR imaging, they face a challenge with real-time HDR imaging for motional scenes because of the artifact and time latency caused by multi-shot and post-processing. To this end, we propose a framework, termed POE-VP, which achieves single-shot HDR imaging via a pixel-wise optical encoder driven by video prediction. We use highlighted motional license plate recognition as a downstream vision task to demonstrate the performance of POE-VP. From the results of simulation and real scene experiments, we validate that POE-VP outperforms conventional LDR cameras by more than 5 times in recognition accuracy and by more than 200% in information entropy. The dynamic range could reach 120 dB, and the captured data size is verified to be lower than mainstream multi-shot methods by 67%. The running time of POE-VP is also validated to satisfy the needs of high-speed HDR imaging.
Burden and bacterial etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia
Authors: Ali Musa Mohammed 
Published: August 2024

Background
Meningitis poses a significant challenge to public health in low-income nations, such as Ethiopia, with a particular impact on newborns. The magnitude and etiologies of meningitis vary based on geographic location and age of patients. There is limited data regarding the magnitude and etiology of meningitis from Sidama Regional State, Ethiopia. This study aimed to determine the magnitude and bacterial profile of meningitis among newborns aged less than 90 days at Hawassa University Comprehensive Specialized Hospital (HUCSH).

Methods
A retrospective cross-sectional study was conducted among newborns under 90 days who were suspected of meningitis at HUCSH from January 2019 to July 2023, and for whom Cerebrospinal fluid (CSF) culture was performed. At HUCSH, bacteria are isolated and identified using standard microbiological techniques. Socio-demographic characteristics and culture results were extracted from the laboratory register. Data were entered into Excel and exported it to SPSS version 20 for analysis.

Results
Overall 1061 newborns suspected of meningitis were included in the study. Among the participants, 767 individuals (72.3%) fell within the age range of 8 to 90 days. Of the total participants, 437 (41.2%) were females. The magnitude of culture-confirmed meningitis was 90(8.5%) 95% CI: 6.8%−10.1%. The magnitude of culture-confirmed meningitis among newborns aged 0−7 days and 8−90 days were 1.6% and 6.9% respectively. The proportion of bacteria among newborns aged 0−7 days and 8−90 days were 18.9% and 81.1% respectively. Coagulase-negative Staphylococci (CONS) were the most common bacteria (n = 26; 28.9%) recovered followed by Acinetobacter species (n = 12, 13.3%), Escherichia coli (n = 9; 10%), and Klebsiella pneumoniae (n = 7; 7.8%). K. pneumoniae was the predominant bacteria among newborns within the age group of 0 to 7 days while Acinetobacter species was the most common among newborns within the 8 to 90 days age group. The prevalence of culture-confirmed neonatal meningitis was found to be greater in male newborns (x2 = 1.74, p = 0.18), newborns aged between 8 to 90 days (x2 = 0.07, p = 3.4), and newborns admitted in 2022 (x2 = 2.4, p = 0.66),

Conclusions
In this study, the overall magnitude of culture-confirmed meningitis was relatively high. Culture-confirmed meningitis was high in newborns within the age range of 8 to 90 days. The most common bacteria were CONS in both age groups followed by Acinetobacter species, E. coli, and K. pneumoniae.
Utility values and electronic device use in low-vision people attending rehabilitation services: Data from a nation-wide registry in Italy
Authors: Virgili Gianni , Costanzo Eliana , Biagini Ilaria , Parravano Mariacristina , Di Simone Alessia , Amore Filippo , Tettamanti Mauro , Di Pietro Simona , Ciaffoni Giovanni L. , Sato Giovanni , Giacomelli Giovanni , Bartolomei Federico 
Published: August 2024

Purpose
To estimate utility values associated with visual loss using EuroQol (EQ-5D) questionnaire, the impact of low-vision (LV) device use on utilities and the contribution of Instrumental Activities of Daily Living (IADL) score in patients attending vision rehabilitation (VR) services enrolled in the Italian Device & Aids Register (D.A.Re).

Methods
This is a multicenter, prospective, cross-sectional study. D.A.Re. collects general and clinical information, vision-specific variables, use of electronic devices and quality of life questionnaires.

Results
A total of 442 patients (75.0±16.6 years, 275 female) were included, 88 (19.9%) used specialised electronic LV devices, and 116 (26.2%) used smartphones and tablets. Users of smartphones and tablets were younger than non-users (67.5 vs. 77.6 years, p<0.001), but overall, their age ranged between 20 and 93. Stronger associations were found between vision-specific variables and IADL score compared to EQ-5D score. In multivariable age-adjusted models, the utility value of using smartphones and tablets on EQ-5D score was 0.12 (p<0.01), slightly larger than that of 1.0 logMAR difference (-0.09, p<0.01) or visual field damage within 10° of fixation (-0.10, p<0.01). Use of portable low-vision electronic devices and being employed or student (vs. retired) was also associated with better utility values (0.12 and 0.15, respectively, p<0.05).

Conclusions
Visual loss is associated with loss of utilities in Italian patients attending VR services, whereas special-purpose electronic aids, and smartphone and tablet use are associated with better utility values. We found that IADL may be more sensitive to visual loss than EQ-5D and could be a valid health-related quality of life outcome in trials on VR.