bluuebunny/crossref_metadata_2025_split huggingface dataset:
The risk factors affecting the persistence of corpus callosum splenium lesions
Authors: Orhan Varoglu Asuman , Avarisli Aysenur , Keskin Havva , Darici Didem 
Published: August 2024

Background The most compact portion of the corpus callosum (CC) is the corpus splenium (CS). Purpose To evaluate the connection between clinical and demographic features to determine whether neuroimaging findings will be permanent or temporary in CS patients. Material and Methods We enrolled 93 patients (age range = 18–86 years) with CS lesions. Demographic and clinical information were recorded. We examined the lesions depending on the location. Group 1 (n = 20) had lesions limited to the CS (egg-shaped or round); group 2 (n = 15) had “boomerang sign” lesions; and group 3 (n = 58) had splenium involvement in conditions affecting the whole brain (Boomerang sign+ plus). Results Group 1 had a lower mean age, shorter disease duration, and fewer persistent lesions than others ( P < 0.01, P < 0.001, and P < 0.001, respectively). The mean disease onset age (in years) in group 1 was higher than that of the other groups ( P < 0.045). Group 2 had lower potassium (K) ( P < 0.003) and red cell distribution width levels ( P < 0.029) than the other groups. Age <41.5 years ( P < 0.001), age at illness initiation <48.5 years ( P < 0.002), disease duration <5.5 months ( P < 0.001), and eosinophil level <0.29 uL ( P 0.014) all point to temporary lesions. Conclusion Cases with limited CS lesions have younger onset ages, lower disease onset ages, and shorter disease durations. Age, age of disease onset, disease duration, and eosinophil level are risk variables that affect whether CS lesions are permanent or temporary.
Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation
Authors: Elshahid Ahmed Rashad , Taher Abobakr Osama Abdel-Goad , Nouh Ahmed Hassan 
Published: August 2024

Background: Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. Aim of study: This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. Material and methods: This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. Results: There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. Conclusion: Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.
Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model
Authors: Perry Ralph T. , Weimer John W. , Pratt Carrie , Newcome Marci D. , Bagameri Gabor , Bohman J. Kyle 
Published: August 2024

Objectives To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). Design Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. Setting A large tertiary referral academic cardiac surgery ICU. Participants There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. Interventions Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. Measurements and Main Results Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort ( P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort ( P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% ( P = .30). Conclusions Overall, implementation of an NP/PA-led postcardiac surgical ICU team ( rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.
Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study
Authors: Baburin Aleksei , Veerus Piret , Lang Katrin , Innos Kaire 
Published: August 2024

Background Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. Methods Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. Results Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. Conclusions The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.
Six-Year Outcomes of Total Arch Replacement vs Debranching With TEVAR for Aortic Arch Pathologies: Meta-Analysis of Kaplan-Meier–Derived Data From Propensity Score–Matched Studies
Authors: Sá Michel Pompeu , Iyanna Nidhi , Jacquemyn Xander , Brown James A. , Yousef Sarah , Ahmad Danial , Singh Michael J. , Serna-Gallegos Derek , Sultan Ibrahim 
Published: August 2024

Background: Total arch replacement (TAR) and debranching plus thoracic endovascular aortic repair (TEVAR) serve as significant therapeutic options for aortic arch pathologies. It remains unclear whether one of these approaches should be considered preferable. Our study aimed to compare the long-term outcomes of these 2 approaches. Methods: We carried out a pooled meta-analysis of time-to-event data extracted from studies published by December 2023. Eligibility criteria included populations with any aortic arch pathology who underwent debranching plus TEVAR or TAR, propensity score–matched (PSM) studies (prospective/retrospective; single-center/multicentric), and the outcomes included follow-up for overall survival/mortality and/or reinterventions. Results: Eleven PSM studies met our eligibility criteria, including a total of 1142 patients (571 matched pairs). We did not observe any statistically significant difference in the risk of all-cause death between the groups (hazard ratio [HR]=1.20, 95% confidence interval [CI]=0.91-1.56, p=0.202), but patients who underwent TAR had a significantly lower risk of late aortic reinterventions compared with patients who underwent debranching plus TEVAR (HR=0.38, 95% CI=0.23-0.64, p<0.001). Our meta-regression analyses for all-cause mortality identified statistically significant coefficients for age (coefficient=−0.047; p=0.012) and type A aortic dissections (coefficient=0.012; p=0.010). Conclusions: Debranching plus TEVAR and TAR demonstrate no statistically significant differences in terms of survival in patients with aortic arch pathologies, but TAR is associated with lower risk of late aortic reinterventions over time. Although older patients may benefit more from debranching plus TEVAR rather than from TAR, patients with dissections may benefit more from TAR. Clinical Impact Although the 2 strategies seem to be equally valuable in terms of survival, total aortic arch replacement (when compared with debranching plus TEVAR to treat patients with aortic arch pathologies) is associated with reduction of late aortic reinterventions over time in patients with and without aortic dissections. However, we should consider debranching plus TEVAR in older patients as it is associated with lower risk of death in this population. The novelty of our study lies in the fact that, instead of comparing study-level effect estimates, we analyzed the outcomes with reconstructed time-to-event data. This offered us the opportunity of performing our analyses with a mathematically appropriate model which consider events and time; however, these findings might be under the influence of treatment allocation bias.
Comparison of Subsequent Inframalleolar Bypass Surgery and Repeat Endovascular Therapy for Infrapopliteal Restenosis in Patients With Chronic Limb-Threatening Ischemia Undergoing Primary Endovascular Therapy
Authors: Suzuki Riho , Horiuchi Katsumi , Iida Osamu , Takahara Mitsuyoshi , Dannoura Yutaka , Asakawa Naoya , Makino Takao , Yokoshiki Hisashi 
Published: August 2024

Purpose: Although endovascular therapy (EVT) is considered a vital strategy for treating infrapopliteal lesions in chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT exceeds that after bypass surgery (BSX). The optimal approach for managing infrapopliteal lesion recurrence in patients with CLTI and unhealed ulcers remains uncertain. This study aimed to evaluate the clinical outcomes of repeat EVT and subsequent inframalleolar BSX for CLTI with infrapopliteal lesion recurrence. Materials and Methods: We conducted a retrospective analysis of 140 patients with CLTI (mean age, 70±10 years; male, 71.4%; diabetes mellitus, 73.6%; dialysis, 74.3%; Rutherford 5, 79.3%; and Rutherford 6, 20.7%) who had an unhealed wound due to the recurrence of infrapopliteal lesions between January 2015 and May 2020. We compared the clinical outcomes of 40 patients who underwent the subsequent inframalleolar BSX with those of 100 patients who underwent repeat EVT. The outcome measures were amputation-free survival (AFS) and wound healing rate. Propensity score matching analysis was conducted to minimize differences in baseline characteristics. Results: Propensity score matching extracted 38 pairs (38 patients in the subsequent BSX group and 83 patients in the repeat EVT group). AFS was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). No baseline characteristics had any significant interaction effect on the association between repeat EVT, subsequent BSX, and failure of AFS. Conclusion: This study using propensity score matching revealed that the clinical outcomes following repeat EVT were comparable with those following subsequent inframalleolar BSX, indicating that repeat EVT may be a viable treatment option for CLTI with infrapopliteal lesion recurrence. Clinical Impact Although endovascular therapy (EVT) has expanded the treatment options for chronic limb-threatening ischemia (CLTI), the recurrence rate after EVT is higher than that after bypass surgery (BSX). This retrospective study compared the clinical outcomes of repeat EVT with those of subsequent BSX for CLTI with infrapopliteal lesion recurrence. After propensity score matching, amputation-free survival (AFS) was not significantly different between the repeat EVT and subsequent BSX groups (81.9% vs 82.6% at 1 year, p=0.97). Neither was cumulative wound healing (42.8% vs 43.3% at 1 year, p=0.55). There was no difference between the 2 revascularization strategies when treating infrapopliteal restenosis lesions.
Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery
Authors: Agorgianitis Loukas , Karassava Heleni , Mavrommatis Evaggelos 
Published: August 2024

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his career Purpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy. Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.
Effect of a 15-Week Whole Foods, Plant-Based Diet, Physical Activity, and Stress Management Intervention on Cardiometabolic Risk Factors in a Population of US Veterans: A Retrospective Analysis
Authors: Yiaslas Themis A. , Rogers-Soeder Tara S. , Ono Gregory , Kitazono Rachel E. , Sood Ajay 
Published: August 2024

Military Veterans have a higher risk of incident atherosclerotic cardiovascular disease (ASCVD) than the general population and are often clinically complex. We studied the changes in cardiovascular risk factors with a lifestyle intervention in this population. We retrospectively analyzed data from 67 participants (mean age 69.2 (SD 7.9) years; 97% male) with atherosclerotic heart disease and/or type 2 diabetes in a 15-week, multiple health behavior change (MHBC) intervention implemented in a Veterans Affairs (VA) Behavioral Medicine Clinic. The intervention promoted a whole foods, plant-based (WFPB) diet, physical activity, and cognitive-behavioral stress management. We assessed cardiometabolic risk factors at baseline, 1 month into the intervention, and at 15 weeks (post-treatment). Among intervention completers (n = 67), we observed statistically significant improvements in waist circumference (−2.8 inches, P = .03), systolic blood pressure (−7.9 mmHg, P = .03), LDL cholesterol (−11.27 mg/dL, P = .04), fasting glucose (−15.10 mg/dL, P = .03), and hemoglobin A1c (−0.55%, P = .017) at post-treatment. Participants with type 2 diabetes (n = 34) achieved improvements in hemoglobin A1c (−0.80%, P = .007), systolic blood pressure (−10.98 mmHg, P = .01), and diastolic blood pressure (−6.65 mmHg, P = .03) at post-treatment. Medication usage did not significantly change. Veterans who completed the MHBC intervention achieved significant improvements in cardiometabolic risk in a routine VA clinical practice setting.
Prediction of patient flow in the emergency department using explainable artificial intelligence
Authors: Moreno-Sánchez Pedro A , Aalto Matti , van Gils Mark 
Published: August 2024

Introduction Overcrowding in emergency departments (ED) is a significant problem affecting patient outcomes, hospital length of stay, and staff job satisfaction. This issue often stems from unpredictable patient flow and suboptimal resource allocation. Objectives This study aims to develop two machine learning (ML) models to assist in early and accurate resource allocation in EDs. The first model predicts patient admission at the time of triage, while the second predicts the specialty of care needed indicated by the initial ward transfer. Methods The study leverages the Medical Information Mart for Intensive Care (MIMIC-IV) database with 425,000 ED visits including basic vital signs, medications, presentation information, diagnoses, and demographic information about the patients. Ensemble tree classifiers are employed for model development, and model's explainability is assessed by investigating feature importance. The best model is selected based on the balance between performance and explainability. Features’ importances are calculated and presented using SHapley Additive exPlanations and models’ intrinsic feature importance. Results The best-balanced admission prediction model in terms of classification performance and explainability achieved an accuracy of 0.775 and an area under the receiver operating curve (AUROC) of 0.779 by using eXtreme Gradient Boosting (XGBoost). The resource allocation prediction model, using a one-vs-rest approach, attained an AUROC of 0.783 again by using XGBoost. The models shared acuity and age in the three most important features, whereas admission ratio and gender were the additional features for admission prediction and resource prediction, respectively. Conclusion The study successfully demonstrates the potential of ML models in predicting patient admission and required specialty care at the ED triage stage. While the admission prediction model shows moderate performance compared to existing studies, the resource prediction model exhibits superior performance compared to related works. The research highlights the importance of explainability in ML models, suggesting the need for further practical implementation to refine and validate these models in real-world settings.
Paraspinal Sarcopenia and Lower Hounsfield Units are Independent Predictors of Increased Risk for Proximal Junctional Complications Following Thoracolumbar Fusions Terminating in the Upper Thoracic Spine
Authors: Pinter Zachariah W. , Bernatz James , Mikula Anthony L. , Lakomkin Nikita , Pennington Zachary A. , Michalopoulos Giorgos D. , Nassr Ahmad , Freedman Brett A. , Bydon Mohamad , Fogelson Jeremy , Sebastian Arjun S. , Elder Benjamin D. 
Published: August 2024

Study Design Retrospective cohort study. Objective The impact of paraspinal sarcopenia following fusions that extend to the upper thoracic spine remain unknown. The purpose of the present study was to assess the impact of sarcopenia on the development of PJK and PJF following spine fusion surgery from the upper thoracic spine to the pelvis. Methods We performed a retrospective review of patients who underwent spine fusion surgery that extended caudally to the pelvis and terminated cranially between T1-6. The cohort was divided into 2 groups: (1) patients without PJK or PJF and (2) patients with PJK and/or PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications. Results We identified 81 patients for inclusion in this study. Mean HU at the UIV was 186.1 ± 47.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK/PJF subgroup (142.4 ± 40.2) ( P < 0.001). Severe multifidus sarcopenia was identified at a higher rate in the subgroup of patients who developed proximal junction pathology (66.7%) than in the subgroup of patients who developed neither PJK nor PJF (7.4%; P < 0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF. Conclusions Severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF in following thoracolumbar fusions from the upper thoracic spine to the pelvis.
Effects of berberine hydrochloride on antioxidant response and gut microflora in the Charybdis japonica infected with Aeromonas hydrophila
Authors: Han Mingming , Guo Yanxia , Tang ShengKai , Li Daming , Wan Jinjuan , Zhu Chenxi , Zuraini Zakaria , Liang Ji , Gao Tianheng , Zhou Zihan , Jiang Qichen 
Published: August 2024

AbstractThis study used berberine hydrochloride to treat the Asian paddle crab, Charybdis japonica infected with the Gram-negative bacterium Aeromonas hydrophila at concentrations of 0, 100, 200 and 300 mg/L. The effect of berberine hydrochloride on the survival rate and gut microbiota of C. japonica was investigated. Berberine hydrochloride improved the stability of the intestinal flora, with an increase in the abundance of probiotic species and a decrease in the abundance of both pathogenic bacteria after treatment with high concentrations of berberine hydrochloride. Berberine hydrochloride altered peroxidase activity (POD), malondialdehyde (MDA), and lipid peroxidation (LPO) in the intestinal tract compared to the control. Berberine hydrochloride could modulate the energy released from the enzyme activities of hexokinase (HK), phosphofructokinase (PFK), and pyruvate kinase (PK) in the intestinal tract of C. japonica infected with A. hydrophila. Zona occludens 1 (ZO-1), Zinc finger E-box binding homeobox 1 (ZEB1), occludin and signal transducer, and activator of transcription5b (STAT5b) expression were also increased, which improved intestinal barrier function. The results of this study provide new insights into the role of berberine hydrochloride in intestinal immune mechanisms and oxidative stress in crustaceans.