bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of fossoriality in microteiid lizards
Authors: Oliveira Bruno Halluan S , Colli Guarino R , Vitt Laurie J , Mesquita Daniel O 
Published: July 2024

Abstract
Morphology is among the most important traits influencing the interaction of individual animals with their environments. Fossoriality reflects this functional association between morphology and the use of subterranean habitats and their associated environmental characteristics. Lizards in the families Gymnophthalmidae and Alopoglossidae are model organisms to examine the interplay between morphology and fossoriality because great morphological diversity exists among species, including varying degrees of body elongation and limb reduction, and they have a wide geographical distribution in the Neotropical region. We analysed the morphology of 101 microteiid species and created an index to evaluate their degree of fossoriality. From this index, we traced the evolution of fossoriality in these lizards and assessed its primary environmental correlates. We found that fossoriality evolved independently in several lineages, mainly associated with high temperature and low precipitation, characteristic of more arid and sandy environments.
Higher Accuracy and Better Clinical Outcomes in Navigated Thoraco-Lumbar Pedicle Screw Fixation Versus Conventional Techniques
Authors: Papalia Giuseppe F. , Vadalà Gianluca , Russo Fabrizio , Marcello Gianmarco , Nardi Niccolò , Papalia Rocco , Denaro Vincenzo 
Published: July 2024

Study Design.
A systematic review and meta-analysis.

Objective.
This study aims to compare pedicle screw accuracy, clinical outcomes, and complications between navigated and conventional techniques.

Summary of Background Data.
In the last decades, intraoperative navigation has been introduced in spinal surgery to prevent risks and complications.

Materials and Methods.
The search was executed on Cochrane Central Library, PubMed, and Scopus on April 30, 2023. Randomized controlled trials, prospective and retrospective studies that compared pedicle screw accuracy in the thoracic-lumbar-sacral segments, blood loss, operative time, hospital stay, intraoperative and postoperative revision of screws, neurological and systemic complications, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) between navigated and freehand or fluoroscopy-assisted techniques were included in this study. The meta-analysis was performed using Review Manager software. Clinical outcomes were assessed as continuous outcomes with mean difference, while pedicle screw accuracy and complications were assessed as dichotomous outcomes with odds ratio, all with 95% CIs. The statistical significance of the results was fixed at P<0.05.

Results.
This meta-analysis included 30 studies for a total of 17,911 patients and 24,600 pedicle screws. Statistically significant results in favor of the navigated technique were observed for the accuracy of pedicle screws (P=0.0001), hospital stay (P=0.0002), blood loss (P<0.0001), postoperative revision of pedicle screws (P<0.00001), and systemic complications (P=0.0008). In particular, the positioning of the screws was clinically acceptable in 96.2% of the navigated group and 94.2% with traditional techniques. No significant differences were found in VAS, ODI, and operative time between the two groups.

Conclusion.
Navigated pedicle screw fixation has been demonstrated to be a safe and effective technique with high improvement in clinical outcomes and accuracy in patients undergoing spinal fusion compared with conventional techniques.

Level of Evidence.
Level III.
Changes in Intramedullary Increased Signal Intensity on Axial T2-weighted MRI After Laminoplasty for Cervical Spondylotic Myelopathy
Authors: Ge Tenghui , Xie Linzhen , Li Jianing , Jiang Jile , Sun Yuqing 
Published: July 2024

Study Design:
A retrospective study.

Objective:
To investigate whether the preoperative classification and changes in the intramedullary increased signal intensity (ISI) on axial T2-weighted magnetic resonance imaging (MRI) reflect the postoperative functional outcome in patients after laminoplasty for cervical spondylotic myelopathy (CSM).

Summary of Background Data:
Although patients with CSM exhibit ISI on axial MRI, the association between ISI (preoperative classification and changes) and surgical outcomes has not been investigated.

Patients and Methods:
We retrospectively included patients with CSM who underwent MRI preoperatively and at least 10 years postoperatively after laminoplasty between January 2009 and December 2010. According to axial images for the cervical compressive myelopathy (Ax-CCM) system, the ISI on axial images was classified as follows: type 0, normal; type 1, diffuse; type 2, fuzzy focal; and type 3, discrete focal. Functional outcomes, as measured by the Japanese Orthopaedic Association (JOA) score and JOA recovery rate, were evaluated based on the Ax-CCM classification.

Results:
Forty-three patients were enrolled. The mean follow-up time was 11.0±1.0 years. At the final follow-up, postoperative changes in the type of ISI were observed in 62.8% of patients. The type of ISI improved in 5 patients (11.6%), remained unchanged in 16 patients (37.2%), and worsened in 22 patients (51.2%). Patients with preoperative type 2 ISI had worse postoperative JOA scores and JOA recovery rates than those with other types. A worse ISI type was related to a lower postoperative JOA score and a lower recovery rate at the final follow-up.

Conclusions:
Type 2 ISI was associated with poor postoperative symptoms and low postoperative function improvement. ISI changed after laminoplasty in 27 patients (62.8%), and worsened ISI was related to poor surgical outcomes.
A Survey of Mean Glandular Doses and Suggestions on National Diagnostic Reference Levels for Digital Mammography in China
Authors: Xu Hui , Yue Baorong , Cheng Jinsheng , Deng Jun , Su Yinping , Zhao Qiaoqiao , Xue Ke , Feng Zechen , Niu Yantao , Sun Quanfu 
Published: July 2024

Abstract
The primary purpose of this study was to report the mean glandular doses and to determine the national diagnostic reference levels for digital mammography based on data between 2016 and 2018 in China. The data from 19,076 mammograms (4,769 examinations) by random sampling from 118 digital mammography systems were compiled. Exposure factors included age, compressed breast thickness, kVp, mAs, target/filter combination, entrance surface air kerma, and mean glandular doses, which were retrospectively surveyed and recorded from the monitor. The national diagnostic reference levels (75th percentiles) in mean glandular dose were calculated across median value obtained for all included data and stratified to specific compressed breast thickness ranges. The patients’ ages ranged from 22 to 88 y, with a median age of 45. The applied voltage and output medians were 28 kVp and 75.1 mAs for all exposure, respectively. The median CBTs were 45 mm and 48 mm for craniocaudal views and mediolateral oblique views, and the corresponding median mean glandular doses were 1.32 mGy and 1.40 mGy, respectively. The national diagnostic reference level at compressed breast thickness of 40–50 mm was 1.67 mGy for CC views and 1.71 mGy for MLO views. The median mean glandular doses varied significantly and increased with compressed breast thickness, demonstrating the necessity of establishing DRL according to breast thickness and optimizing the clinic's digital mammography practice in China.
Conversion of Site-Specific Meteorological Data for use in CAP-88 PC
Authors: Fritz B.G. , Peterson J.A. 
Published: July 2024

Abstract
CAP-88 PC is a commonly used radiological atmospheric dispersion model. This US EPA-approved model is used to demonstrate compliance with atmospheric emission regulations for radionuclides. While the model includes a large library of meteorological data for use across the United States, there are applications when users may wish to use onsite meteorological data as an input to the CAP-88 PC model. Here we present a work-around process for preparing and converting onsite data for use in CAP-88 PC. However, the use of local data should provide a more realistic estimate of doses to members of the public in the immediate vicinity of a facility, although the regulatory agency having jurisdiction may not accept the use of local data for compliance. Additionally, the historical meteorological records from 20+ years ago (at a site many kilometers away) might not be representative of current local weather patterns, highlighting another benefit of using local meteorological data.
Effect of amino acid supplementation on short-term complications after gastrointestinal tumor surgery: the AMIGITS randomized clinical trial
Authors: Wang Junke , Chen Yuezhi , Zhao Zhiwen , Lian Guodong , Peng Lipan , Zhou Xinxiu , Sha Shengxu , Qiao Wenhao , Tian Hui , Li Leping , Tian Feng , Jing Changqing 
Published: July 2024

Background:
There is a scarcity of large randomized clinical trials on the efficacy and safety of high-dose amino acid supplementation (AAS) in patients with gastrointestinal tumors undergoing surgical treatment.

Methods:
This pragmatic, randomized, controlled, single-center, open-label, parallel-group AMIGITS trial was performed in a tertiary care teaching hospital. Patients with gastrointestinal tumors were randomly assigned to receive either AAS or standard care (SC). Amino acid targets were 2.0 g/kg per day in the AAS group and 1.2 g/kg per day in the SC group. The AAS group received additional amino acids intravenously, while the SC group received an iso-energetic 5% glucose intravenously.

Results:
Overall, 407 patients (AAS group, 204; SC group, 203) were included in this study. During the intervention, the actual mean daily energy intake did not differ significantly between the AAS and SC groups (25.53 vs. 25.16 kcal/kg per day, P=0.493). However, the actual mean daily amino acid intake was significantly higher in the AAS group than that in the SC group (1.81 vs. 0.94 g/kg per day, P<0.001). The infection incidence during hospitalization and within 30 days of surgery was significantly lower in the AAS group than that in the SC group (P=0.031 and P=0.024, respectively). The 30-day postoperative incidence of amino acid treatment-related adverse events and other complications did not significantly differ between the two groups. The postoperative hospital stay was significantly different between the two groups (P<0.001).

Conclusions:
AAS was associated with a reduced infection incidence within 30 days of major surgery in patients with gastrointestinal tumors and can be a promising strategy.
Imaging-based surrogate classification for risk stratification of hepatocellular carcinoma with microvascular invasion to adjuvant hepatic arterial infusion chemotherapy: a multicenter retrospective study
Authors: Ma Lidi , Zhang Cheng , Wen Yuhua , Xing Kaili , Li Shaohua , Geng Zhijun , Liao Shuting , Yuan Shasha , Li Xinming , Zhong Chong , Hou Jing , Zhang Jie , Gao Mingyong , Xu Baojun , Guo Rongping , Wei Wei , Xie Chuanmiao , Lu Lianghe 
Published: July 2024

Background:
Patients with microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC) have shown promising results with adjuvant hepatic arterial infusion chemotherapy (HAIC) with FOLFOX after curative resection. The authors aim to develop an imaging-derived biomarker to depict MVI-positive HCC patients more precisely and promote individualized treatment strategies of adjuvant HAIC.

Materials and methods:
Patients with MVI-positive HCC were identified from five academic centers and utilized for model development (n=470). Validation cohorts were pooled from a previously reported prospective clinical study conducted [control cohort (n=145), adjuvant HAIC cohort (n=143)] (NCT03192618). The primary endpoint was recurrence-free survival (RFS). Imaging features were thoroughly reviewed, and multivariable logistic regression analysis was employed for model development. Transcriptomic sequencing was conducted to identify the associated biological processes.

Results:
Arterial phase peritumoral enhancement, boundary of the tumor enhancement, tumor necrosis stratification, and boundary of the necrotic area were selected and incorporated into the nomogram for RFS. The imaging-based model successfully stratified patients into two distinct prognostic subgroups in both the training, control, and adjuvant HAIC cohorts (median RFS, 6.00 vs. 66.00 months, 4.86 vs. 24.30 months, 11.46 vs. 39.40 months, all P<0.01). Furthermore, no significant statistical difference was observed between patients at high risk of adjuvant HAIC and those in the control group (P=0.61). The area under the receiver operating characteristic curve at 2 years was found to be 0.83, 0.84, and 0.73 for the training, control, and adjuvant HAIC cohorts, respectively. Transcriptomic sequencing analyses revealed associations between the radiological features and immune-regulating signal transduction pathways.

Conclusion:
The utilization of this imaging-based model could help to better characterize MVI-positive HCC patients and facilitate the precise subtyping of patients who genuinely benefit from adjuvant HAIC treatment.
Comparison of short-term outcomes and defecatory function following robotic and conventional laparoscopic surgery for stapled-ileal pouch-anal anastomosis: a retrospective cohort study
Authors: Hanaoka Marie , Kinugasa Yusuke , Yao Kenta , Takaoka Ayumi , Sasaki Megumi , Yamauchi Shinichi , Tokunaga Masanori 
Published: July 2024

Background:
This study assessed the potential advantages of robotic-assisted Stapled ileal pouch-anal anastomosis (Ro Stapled-IPAA) in ulcerative colitis (UC) compared to conventional laparoscopic surgery (Lap), with a focus on short-term outcomes and postoperative defecatory function, an aspect not previously explored.

Materials and methods:
Out of a total of 132 patients who underwent proctocolectomy or residual rectal resection, consecutive patients undergoing minimally invasive Stapled-IPAA for UC at our hospital from May 2014 to May 2024 were included. The Ro approach was chosen for individuals with severe colitis extending into the anal canal, deeper rectal cancers (beyond T1), and cases requiring residual rectal resection, taking advantage of its benefits. Perioperative outcomes, including anastomosis height, operative time, intraoperative blood loss, complication rate, postoperative hospital stay, and defecatory function using Wexner scores and anorectal manometry before proctocolectomy and 6 months after stoma closure, were compared between the Ro and Lap groups.

Results:
Thirty-three patients (Lap, n=21; Ro, n=12) were included. The Ro group demonstrated a significantly lower anastomosis height (0.5 vs. 3.0 cm, P<0.001), reduced intraoperative blood loss (35 vs. 118 ml, P=0.032), shorter postoperative hospital stay (8 vs. 10.5 days), and no cases of anastomotic leakage (0 vs. 14.3%), as compared to the Lap group. Pouch failure occurred in 14% of Lap group; none were observed in the Ro group. Wexner scores favored the Ro group at 12 months after stoma closure (0 vs. 8 points), and there was better maximum voluntary squeeze pressure (302 mmHg vs. 175 mmHg, P=0.03), indicating preserved contraction of the external sphincter muscle despite the lower anastomosis.

Conclusion:
Ro Stapled-IPAA for patients with UC led to better short-term outcomes and preservation of defecatory function with lower anastomosis than Lap, suggesting the clinical advantages of the robotic approach in this field.
Using the Electronic Health Record to Implement Expedited Partner Therapy in the Pediatric Emergency Department
Authors: Brown Angela M. , Kennebeck Stephanie S. , Kerlin Melissa J. , Widecan Michelle L. , Zhang Yin , Reed Jennifer L. 
Published: July 2024

Objectives
Expedited partner therapy (EPT) is a partner treatment strategy for sexually transmitted infections (STIs) including gonorrhea and chlamydia as well as trichomoniasis in some states. The process allows healthcare providers to write prescriptions for STI treatment among partners of infected patients without a previous medical evaluation. The Centers for Disease Control (CDC) has recommended EPT as a useful option to facilitate partner treatment, particularly male partners of women with chlamydia or gonorrhea infections. Our institution implemented EPT in 2016 after Ohio legislation was passed to authorize its use. We aim to describe the implementation process and descriptive outcomes of EPT adoption in a pediatric emergency department.

Methods
This study describes use of the electronic health record for implementation of EPT in our institution. We conducted a retrospective review of EPT utilization from implementation. Electronic records from the implementation date of January 1, 2017, through December 31, 2021, were reviewed. We describe basic demographics and overall uptake of the intervention. Fisher exact tests were used for categorical variables and two-sample t-tests for continuous variables.

Results
There was a total of 3275 positive test results and 739 EPT prescriptions written. Adolescent patients who received prescriptions for EPT were more likely to be female (78.7% of all EPT prescriptions, P = 0.007) and older than other patients (average age 17.7 vs 17.4 years, P = 0.004). There was no significant difference in race, insurance, or ethnicity among adolescent patients receiving and not receiving EPT. The percentage of positive STI tests associated with an EPT prescription ranged between 11.4% and 18.2%. Metronidazole was the most prescribed EPT medication.

Conclusions
The use of the electronic health record provides a platform for implementation of EPT. Our study highlights a potential strategy for increasing treatments of STIs through EPT prescribing in the emergency department setting.
A Review and Economic Analysis of the Dapivirine Vaginal Ring as HIV Pre-Exposure Prophylaxis for Women, to Inform South African Public-Sector Guidelines
Authors: Leong Trudy D. , Nel Jeremy , Jamieson Lise , Osih Regina , Dawood Halima , Subedar Hasina , McCaul Michael , Johnson Leigh F. , Cohen Karen 
Published: July 2024

Background:
South Africa has a high HIV incidence and oral pre-exposure prophylaxis (PrEP) is available as public-sector standard of care. Access to alternative prevention methods for women may further reduce HIV acquisition.

Setting:
South African public sector.

Methods:
We performed a systematic search for high-quality up-to-date guidelines recommending dapivirine rings as PrEP using the Grading of Recommendations Assessment, Development, and Evaluation-Adolopment process. We appraised the systematic review and randomized controlled trial (RCT) evidence underpinning the selected guideline's recommendations and conducted a cost-effectiveness analysis. The Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework guided the adaptation of source guideline recommendations, according to our local context.

Results:
We identified the 2021 World Health Organization PrEP Guidelines, informed by 2 placebo-controlled RCTs, which were included in a contemporaneous systematic review. There were 23 fewer HIV acquisitions per 1000 clients with dapivirine ring vs placebo (95% confidence interval: 10 to 34), with no increase in adverse events (moderate certainty evidence). We found no RCTs comparing dapivirine to oral PrEP or among adolescent/pregnant/breastfeeding clients. Dapivirine is less cost-effective than oral PrEP at $14.59/ring, at the current price.

Conclusions:
The source guideline recommendation was adapted for the local context. Dapivirine ring seems to be less efficacious than oral PrEP, although comparative studies are lacking. Data on adolescents and pregnancy are also lacking, currently limiting the use of dapivirine as an alternative for women unable to take oral PrEP. At the current price, dapivirine is not cost-effective and unaffordable for inclusion in the South African Essential Medicines List.
The role of emergency department thoracotomy in patients with cranial gunshot wounds
Authors: Hatchimonji Justin S. , Meredyth Nicole A. , Gummadi Sriharsha , Kaufman Elinore J. , Yelon Jay A. , Cannon Jeremy W. , Martin Niels D. , Seamon Mark J. 
Published: July 2024

BACKGROUND
Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low.

METHODS
We used Pennsylvania Trauma Outcomes Study data, 2002 to 2021, and included EDTs for GSWs. We defined EDT by International Classification of Diseases codes for thoracotomy or procedures requiring one, with a location flagged as emergency department. We defined head injuries as any head Abbreviated Injury Scale (AIS) score of ≥1 and severe head injuries as head AIS score of ≥4. Head injuries were “isolated” if all other body regions have an AIS score of <2. Descriptive statistics were performed. Discharge functional status was measured in five domains.

RESULTS
Over 20 years in Pennsylvania, 3,546 EDTs were performed; 2,771 (78.1%) were for penetrating injuries. Most penetrating EDTs (2,003 [72.3%]) had suffered GSWs. Survival among patients with isolated head wounds (n = 25) was 0%. Survival was 5.3% for the non–head injured (n = 94 of 1,787). In patients with combined head and other injuries, survival was driven by the severity of the head wound—0% (0 of 81) with a severe head injury (p = 0.035 vs. no severe head injury) and 4.5% (5 of 110) with a nonsevere head injury. Of the five head-injured survivors, two were fully dependent for transfer mobility, and three were partially or fully dependent for locomotion. Of 211 patients with a cranial injury who expired, 2 (0.9%) went on to organ donation.

CONCLUSION
Although there is clearly no role for EDT in patients with isolated head GSWs, EDT may be considered in patients with combined injuries, as most of these patients have minor head injuries and survival is not different from the non–head injured. However, if a severe head injury is clinically apparent, even in the presence of other body cavity injuries, EDT should not be pursued.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Cysteine as an Innovative Biomarker for Kidney Injury
Authors: Woo Hye Young , An Jong Min , Park Min Young , Han Ahram , Kim Youngwoong , Kang Jisoo , Ahn Sanghyun , Min Seung-Kee , Ha Jongwon , Kim Dokyoung , Min Sangil 
Published: July 2024

Background.
Kidney transplantation is a widely used treatment for end-stage kidney disease. Nevertheless, the incidence of acute kidney injury (AKI) in deceased donors poses a potential hazard because it significantly increases the risk of delayed graft function and potentially exerts an influence on the kidney allograft outcome. It is crucial to develop a diagnostic model capable of assessing the existence and severity of AKI in renal grafts. However, no suitable kidney injury markers have been developed thus far.

Methods.
We evaluated the efficacy of the molecular probe NPO-B, which selectively responds to cysteine, as a new diagnostic tool for kidney injury. We used an in vitro model using ischemia/reperfusion injury human kidney-2 cells and an in vivo ischemia/reperfusion injury mouse model. Additionally, cysteine was investigated using urine samples from deceased donors and living donors to assess the applicability of detection techniques to humans.

Results.
This study confirmed that the NPO-B probe effectively identified and visualized the severity of kidney injury by detecting cysteine in both in vitro and in vivo models. We observed that the fluorescence intensity of urine samples measured using NPO-B from the deceased donors who are at a high risk of renal injury was significantly stronger than that of the living donors.

Conclusions.
If implemented in clinical practice, this new diagnostic tool using NPO-B can potentially enhance the success rate of kidney transplantation by accurately determining the extent of AKI in renal grafts.