bluuebunny/crossref_metadata_2025_split huggingface dataset:
Synthesis of Dibenzo[b,h][1,5]naphthyridin-7(12H)-ones: The Pictet–Spengler Reaction versus a Rearrangement of 4-Phenyl[1,3]oxazolo[4,5-c]quinolines
Authors: Fisyuk Alexander S. , Shatsauskas Anton L. , Kirnosov Sergey A. , Keyn Ekaterina S. , Shuvalov Vladislav Yu. , Kostyuchenko Anastasia S. 
Published: May 2024

AbstractTwo approaches were proposed for the synthesis of dibenzo[b,h][1,5]naphthyridin-7(12H)-ones. The one-step method based on the Pictet–Spengler reaction of 3-amino-2-phenylquinolin-4(1H)-one with aromatic aldehydes requires heating in a strong acidic media, which leads to significant limitations on the possible products. The second approach is based on the conversion of 3-amino-2-phenylquinolin-4(1H)-one to 4-phenyl[1,3]oxazolo[4,5-c]quinolines followed by rearrangement under the action of AlCl3. A significant advantage of the two-step synthesis is the possibility of obtaining a wider range of dibenzo[b,h][1,5]naphthyridin-7(12H)-ones, including those not available using the Pictet–Spengler reaction.
Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan
Authors: Shakir Muhammad , Altaf Ahmed , Irshad Hammad Atif , Khan Muhammad Ali Akbar , Enam Syed Ather 
Published: May 2024

Abstract
Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes.
Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis.
Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan (p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association (p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals.
Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.
Charcot Arthropathy of the Shoulder Associated with Syringomyelia: A Report of 2 Cases
Authors: Rodrigues Mateus de Sousa , Coelho Camila Maciel Martins , Pereira Alexsandro da Silva , Neto Fernanda Tavares , Silva Wanderson Ricardo Serapião da , Neto Heverty Rocha Alves , Maciel Cícero do Juazeiro Job , Lima Cícero Santos de , Feitosa Randson Ranilson Modesto 
Published: May 2024

AbstractCharcot arthropathy of the shoulder caused by syringomyelia is a unusual degenerative disorder, frequently misdiagnosed and with few cases described in the literature. The diagnosis is made by clinical evaluation and radiological examinations with radiography and magnetic resonance imaging. However, the correct diagnosis and treatment is possible by carefully medical evaluation and can improve patient symptoms. Therefore, this study aimed to report two cases of Charcot arthropathy caused by syringomyelia. After achieving correct neurosurgical evaluation and magnetic resonance imaging, the diagnosis was made. The first case is a 53-year-old man with a click on his right shoulder for at least 12 months, associated with local edema, pain and limitation of joint range of motion. The second is a 45-year-old man with pain in the right upper limb and difficulty moving the joint for at least 24 months, associated with progressive worsening of the collection and edema in the ipsilateral upper limb. Posterior fossa decompression was performed, with symptoms relief after surgery. Posterior fossa decompression is a treatment that seems to be effective in reducing symptoms, especially when the diagnosis is early. However, this type of treatment still remains controversial, requiring further studies.
Is Obstructive Sleep Apnea Associated with Higher Covid-19 Severity?
Authors: Zacarias Laíla Cândida , Torres Danielle Mesquita , Magalhães Samir Câmara , Sobreira-Neto Manoel Alves , Leite Camila Ferreira 
Published: May 2024

Abstract
Objective To investigate the associations between obstructive sleep apnea (OSA) and coronavirus disease 2019 (COVID-19) severity.
Methods Twelve individuals hospitalized in a Brazilian tertiary hospital diagnosed with COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) underwent respiratory polygraphy.
Results Polygraphic records identified seven participants without obstructive sleep apnea (OSA) (OSA-) and five with OSA (OSA + ). The OSA+ group presented worse peripheral oxygen saturation (77.6% ± 7.89%) than the OSA- group (84.4% ± 2.57%) (p = 0.041). Additionally, the OSA+ group showed greater COVID-19 severity (100%) than the OSA- group (28.57%) (p = 0.013) and required longer oxygen therapy (p = 0.038), but without difference in the length of hospitalization. The OSA+ group also presented higher rates of platelets (p = 0.008) and D-dimer (1,443 ± 897) than the OSA- group (648 ± 263 ng/mL) (p = 0.019).
Conclusion Obstructive sleep apnea in individuals hospitalized due to COVID-19 was associated with higher COVID-19 severity, worse peripheral oxygen saturation, longer oxygen therapy time, and higher platelet and D-dimer rates.
Female Surgeons in Cardiac Surgery: Does the Surgeon's Gender Affect the Outcome of Routine Coronary Artery Bypass Graft and Isolated Aortic Valve Surgery?
Authors: Sido Viyan , Schröter Filip , Rashvand Jacqueline , Ostovar Roya , Chopsonidou Sofia , Albes Johannes M. 
Published: May 2024

Abstract
Background The increasing presence of female doctors in the field of cardiac surgery has raised questions about their surgical quality compared to their male colleagues. Despite their success, female surgeons are still underrepresented in leadership positions, and biases and concerns regarding their performance persist. This study aims to examine whether female surgeons perform worse, equally well, or better than their male counterparts in commonly performed procedures that have a significant number of female patients.
Method A retrospective cohort of patients from 2011 to 2020 who underwent isolated coronary artery bypass graft (CABG) and aortic valve surgery was studied. To compare the surgical quality of men and women, a 1:1 propensity score matching (two groups of 680 patients operated by men and women, respectively, factors: age, logarithm of EuroSCORE (ES), elective, urgent or emergent surgery, isolated aortic valve, or isolated CABG) was performed. Procedure time, bypass time, x-clamp time, hospital stay, and early mortality were compared.
Results After propensity score matching between surgeons of both sexes, patients operated by males (PoM) did not differ from patients operated by females (PoF) in mean age (PoM: 66.72 ± 9.33, PoF: 67.24 ± 9.19 years, p = 0.346), log. ES (PoM: 5.58 ± 7.35, PoF: 5.53 ± 7.26, p = 0.507), or urgency of operation (PoM: 43.09% elective, 48.97% urgent, 7.94% emergency, PoF: 40.88% elective, 55.29% urgent, 3.83% emergency, p = 0.556). This was also the case for male and female patients separately. Female surgeons had higher procedure time (PoM: 224.35 ± 110.54 min; PoF: 265.41 ± 53.60 min), bypass time (PoM: 107.46 ± 45.09 min, PoF: 122.42 ± 36.18 min), and x-clamp time (PoM: 61.45 ± 24.77 min; PoF: 72.76 ± 24.43 min). Hospitalization time (PoM: 15.96 ± 8.12, PoF: 15.98 ± 6.91 days, p = 0,172) as well as early mortality (PoM: 2.21%, PoF: 3.09%, p = 0.328) did not differ significantly. This was also the case for male and female patients separately.
Conclusion Our study reveals that in routine heart surgery, the gender of the surgeon does not impact the success of the operation or the early outcome of patients. Despite taking more time to perform procedures, female surgeons demonstrated comparable surgical outcomes to their male counterparts. It is possible that women's inclination for thoroughness contributes to the longer duration of procedures, while male surgeons may prioritize efficiency. Nevertheless, this difference in duration did not translate into significant differences in primary outcomes following routine cardiac surgery. These findings highlight the importance of recognizing the equal competence of female surgeons and dispelling biases regarding their surgical performance.
Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep
Authors: Schreiber Kévin , Haudiquet Philippe , Hamon Martin 
Published: May 2024

Abstract
Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator.
Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks.
Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved.
Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.
Complete Agenesis of Right Half of Soft Palate—A Case Report
Authors: Agnihotri Ishan , Nayak Bibhuti Bhusan 
Published: May 2024

AbstractAgenesis of soft palate is an extremely rare occurrence and is usually seen in conjunction with other congenital anomalies like Nager syndrome, Treacher Collins syndrome, and multiple congenital anomalies. Only a handful of isolated complete agenesis of one half of the soft palate has been reported in literature. Despite extensive literature review, incidence of such a case is practically unheard of. We present to you a case checking all the above boxes. We present this case of agenesis of right half of soft palate that was managed by our technique.
Crohn's-like Ileal Pouch Illness and Ileal Pouch Salvage Strategies
Authors: Huang Alex L. , Abeshouse Marnie , Lee Katherine C. , Rinebold Emily , Kayal Maia , Plietz Michael C. 
Published: May 2024

AbstractDe novo Crohn's disease (CD) of the pouch or Crohn's-like Ileal Pouch Illness (CLIPI) is an increasingly common occurrence in an ever-growing ileal pouch population. Although currently undetermined if a subset of classic CD or a completely new entity, it primarily affects the prepouch afferent limb, pouch, and rectal cuff. Symptoms can mimic other more common disorders, such as pouchitis, and requires a thorough workup, including pouchoscopy with biopsy and often cross-sectional imaging, for the diagnosis to be made. There is an increased risk of long-term pouch failure in this population. Treatment is typically dependent upon the disease phenotype with surgical management considered in a step-up fashion. Medical management is primarily performed with “biologics,” such as antitumor necrosis factor agents, although data are limited due to the lack of randomized controlled trials. Surgical management for CLIPI can include endoscopic, anorectal, and abdominal approaches to assist as “pouch-salvage strategies.” The performance of advanced pouch-salvage techniques in the CLIPI population requires careful patient selection and should preferably be performed at high-volume pouch centers.
Concept Recognition and Characterization of Patients Undergoing Resection of Vestibular Schwannoma Using Natural Language Processing
Authors: Marcus Hani J. , Grover Patrick , Williams Simon C. , Noor Kawsar , Sinha Siddharth , Dobson Richard J.B. , Searle Thomas , Funnell Jonathan P. , Hanrahan John G. , Muirhead William R. , Kitchen Neil , Kanona Hala , Khalil Sherif , Saeed Shakeel R. 
Published: May 2024

Abstract
Background Natural language processing (NLP), a subset of artificial intelligence (AI), aims to decipher unstructured human language. This study showcases NLP's application in surgical health care, focusing on vestibular schwannoma (VS). By employing an NLP platform, we identify prevalent text concepts in VS patients' electronic health care records (EHRs), creating concept panels covering symptomatology, comorbidities, and management. Through a case study, we illustrate NLP's potential in predicting postoperative cerebrospinal fluid (CSF) leaks.
Methods An NLP model analyzed EHRs of surgically managed VS patients from 2008 to 2018 in a single center. The model underwent unsupervised (trained on one million documents from EHR) and supervised (300 documents annotated in duplicate) learning phases, extracting text concepts and generating concept panels related to symptoms, comorbidities, and management. Statistical analysis correlated concept occurrences with postoperative complications, notably CSF leaks.
Results Analysis included 292 patients' records, yielding 6,901 unique concepts and 360,929 occurrences. Concept panels highlighted key associations with postoperative CSF leaks, including “antibiotics,” “sepsis,” and “intensive care unit admission.” The NLP model demonstrated high accuracy (precision 0.92, recall 0.96, macro F1 0.93).
Conclusion Our NLP model effectively extracted concepts from VS patients' EHRs, facilitating personalized concept panels with diverse applications. NLP shows promise in surgical settings, aiding in early diagnosis, complication prediction, and patient care. Further validation of NLP's predictive capabilities is warranted.
Free Flap Monitoring Using Infrared Thermography: An Objective Adjunct to Clinical Monitoring
Authors: Singla Priyanka , Dixit Pawan Kumar , Kala Prakash Chandra , Katrolia Deepti , Karmakar Shilpi , Humnekar Akhilesh , Singh Apoorva Pratap 
Published: May 2024

Abstract
Background Early detection of free flap compromise is critical for salvage of the flap. Various methods of free flap monitoring have been described, but clinical assessment is the standard method for among all. In this study, role of infrared thermography is evaluated for free flap monitoring.
Materials and Methods In patients undergoing free flap surgery, monitoring was done using standard clinical parameters and infrared thermography as per our institutional protocol. Mean temperature difference (∆T) between the flap and the surrounding skin was calculated using the temperature readings from the thermal images intra- and postoperatively. The accuracy of infrared thermography in flap monitoring was assessed in comparison to the standard clinical protocol.
Results Forty-one flaps were included in the analysis, out of which five flaps got compromised. It was observed that the mean temperature difference was higher (mean ∆T 0.20–0.59 vs. 2.38–3.32) when there was a flap compromise, and this temperature difference was evident even before the development of clinical signs. The temperature difference in venous thrombosis (mean ∆T 1.0–2.7) was found to be slightly lower than in arterial insufficiency (mean ∆T 2.1–4.4). For a ∆T cutoff value of 2°C, the thermal camera had a sensitivity of 88.6%, specificity of 98.9%, positive predictive value of 93.9%, and negative predictive value of 97.7%.
Conclusion Infrared thermography is a valuable and noninvasive objective tool in free flap monitoring, which can detect flap compromise (increasing value of ∆T) even before it becomes clinically evident.
Evaluating Diagnostic Algorithms for Heparin-Induced Thrombocytopenia using Two Combined Automated Rapid Immunoassays
Authors: Bissola Anna-Lise , Zhang Yi , Cranstone Madison , Moore Jane C. , Warkentin Theodore E. , Arnold Donald M. , Nazy Ishac 
Published: May 2024

AbstractHeparin-induced thrombocytopenia (HIT) is an autoimmune disorder caused by antibodies against platelet factor 4 (PF4) and heparin complexes. Rapid immunoassays (IAs) for detection of these antibodies mark a milestone in HIT diagnosis, despite a higher false-positive rate compared with functional platelet-activation assays. However, combining different rapid IAs may help to improve their diagnostic specificity. Here, we compared the individual performance of the latex immunoturbidimetric assay (LIA; HemosIL HIT-Ab [PF4-H]; sensitivity 91.7%, specificity 68.4%) and chemiluminescence immunoassay (CLIA; HemosIL AcuStarHIT-Ab [PF4-H]; sensitivity 92.4%, specificity 85.8%) with their combined performance using two unique diagnostic algorithms in a single prospective cohort of suspected HIT patients. Using the simultaneous algorithm adapted from Warkentin et al, the combined LIA–CLIA had a sensitivity of 99.0% and specificity of 64.3%. The sequential algorithm adapted from Rittener-Ruff et al was applied in two theoretical scenarios to reflect real-world circumstances in diagnostic laboratories where access to clinical information is limited: (1) assuming all patients had an intermediate 4Ts score and (2) assuming all patients had a high 4Ts score. This algorithm correctly predicted HIT in 94.5% (high 4Ts) and 96.0% (intermediate 4Ts) and excluded HIT in 82.6% (high 4Ts) and 80.1% (intermediate 4Ts) of patients in either scenario, respectively. Although both combined algorithms improved diagnostic performance of individual IAs, the simultaneous algorithm showed fewer false predictions (7.9%) than the sequential algorithm (intermediate 4Ts: 37.6% and high 4Ts: 41.5%) and proved more practical as it does not rely on physician evaluations. Our findings highlight the importance of accounting for clinician and interlaboratory variability when evaluating diagnostic tests for HIT.
“They Surge-on…The Journey of an Early Career Plastic Surgeon in India as I see it”
Authors: Bhat Sowrabha 
Published: May 2024

AbstractThe journey to becoming a plastic surgeon is a long one. Most nonsurgeons are unaware of the actual scope of plastic surgery and the spectrum of surgeries done by plastic surgeons. The constant look-out for “cutting chances” from early in the career can be quite exhausting and may take a toll on the professional relationships as well as personal lives of plastic surgeons. Many a time in the wake of striving for operative opportunities, research may take a back seat. Being an endocrinologist, who has witnessed closely, the life of a young lady plastic surgeon I have come to understand that the grind and struggle for development of skills in microsurgical techniques can be overwhelming. To prevent professional burnout, encouragement and guidance from mentors as well as setting priorities may go a long way.
Congenital/Primitive Hydrocephalus: Classification, Clinical Aspects, and Rehabilitation Approach
Authors: Caltabiano Giusi , La Cognata Daria , Zanghì Antonio , Falsaperla Raffaele , Vecchio Michele , Marino Francesco , Palmucci Stefano , Belfiore Giuseppe , Basile Antonio , Polizzi Agata , Praticò Andrea D. 
Published: May 2024

AbstractHydrocephalus is a heterogeneous disorder of cerebrospinal fluid (CSF) flow that leads to abnormal enlargement of the brain ventricles. The prevalence of infant hydrocephalus is approximately one case per 1,000 births. Hydrocephalus occurs due to an imbalance between the production and the absorption of CSF. The causes of hydrocephalus secondary to CSF overproduction are papilloma of the choroid plexus and rarely diffuse hyperplasia of the villi. All the other hydrocephalus forms are secondary to obstruction to normal CSF reabsorption and are also known as obstructive hydrocephalus. According to the location of obstruction, obstructive hydrocephalus can be defined as communicating, when caused by extraventricular obstruction of the CSF flow or decreased resorption of CSF distal to the fourth ventricle in the cisterns of the base or in the subarachnoid spaces, or as not communicating, in case of intraventricular obstruction to fluid flow. There is a third category, common in preterm infants, called external hydrocephalus which is secondary to delayed development of arachnoid function. Hydrocephalus leads to an increase in intraventricular pressure because of the lack of the mechanism regulating the homeostasis of the CSF flow. Increased intraventricular pressure is responsible for the clinical symptoms in affected child. Clinical presentation varies with age. In the neonatal period, prolonged or frequent apneic or bradycardic events, increasing head circumference, presence of sunsetting eyes or upward gaze palsy, evidence of full or tense anterior/posterior fontanelle, and splayed cranial sutures are signs of increased intracranial pressure. In infants, the most common signs are progressive macrocephaly, irritability, nausea/vomiting, headache, gait changes, and regression of developmental milestones. The extent of brain damage depends on the cause that led to hydrocephalus, the patient's age, and the rapidity of onset. The surgical treatment modalities consist of endoscopic ventriculostomy of the third ventricle and ventriculoperitoneal or ventriculoatrial CSF shunt.