bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges With Robot-Assisted Surgery Setup for Complex Minimally Invasive Upper Gastrointestinal Surgery
Authors: Kanji Falisha F. , Marselian Aleeque , Burch Miguel , Jain Monica , Cohen Tara N. 
Published: April 2024

Background The utilization of robot-assisted approaches to surgery has increased significantly over the last two decades. This has introduced novel complexities into the operating room environment, requiring management of new challenges and workflow adaptation. This study aimed to analyze challenges in the surgical setup for complex upper gastrointestinal robot-assisted surgery (UGI-RAS) and identify opportunities for solutions. Methods Direct observations of surgical setup processes for UGI-RAS were performed by a trained Human Factors researcher at a non-profit academic medical center in Southern California. Setup tasks were subdivided into five phases: (1) before wheels-in; (2) patient transfer and anesthesia induction; (3) patient preparation; (4) surgery preparation; and (5) robot docking. Start/end times for each phase/task were documented along with workflow disruption (FD) narratives and timestamps. Setup tasks and FDs were analyzed using descriptive statistics. Results Twenty UGI-RAS setup procedures were observed between May-November 2023: sleeve gastrectomy +/− hiatal hernia repair (n = 9, 45.00%); para-esophageal hernia repair +/− fundoplication (n = 8, 40.00%); revision to Roux-en-Y gastric bypass (n = 2, 10.00%); and gastric band removal (n = 1, 5.00%). Frequent FDs included planning breakdowns (n = 20, 29.85%), equipment/supply management (n = 17, 25.37%), patient care coordination (n = 8, 11.94%), and equipment challenges (n = 8, 11.94%). Eleven of 20 observations were first-start cases, of which 10 experienced delayed starts. Discussion Interventions aimed at improving workflows during UGI-RAS setup include performing pre-operative team huddles and conducting trainings aimed at team coordination and equipment challenges. These solutions could result in improved teamwork, efficiency, and communication while reducing case start delays and turnover time.
Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis
Authors: Scott Adam W. , Amateau Stuart K. , Leslie Daniel B. , Ikramuddin Sayeed , Wise Eric S. 
Published: April 2024

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions. Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated. Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56 years and body-mass index (BMI) was 43 kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint. Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.
Digital fashion and metaverse platforms: Do platform attributes drive shopper’s purchase intention?
Authors: Prashar Atul , Prashar Anupama 
Published: April 2024

This study aims to understand consumer behavior in fashion shopping on the Metaverse platforms. It proposes a behavioral model grounded on a stimulus-organism-response (S-O-R) framework, where the platform attributes namely interactivity, personalization, and sociability act as stimuli to activate the experiential (utilitarian and hedonic value) and immersive responses, which in turn drive the purchase intention of digital fashion shoppers. The moderating role of shoppers’ personal characteristics is also tested. Survey data of 327 users of Metaverse platforms are used to test the proposed model. DRESSX, a multibrand fashion retailer offering branded nonfungible tokens (BNFTs) in the form of digital clothing and accessories, is used to simulate the Metaverse. The results show that personalization is the strongest platform attribute offering experiential value, and sociability features of the platform play the key role in driving immersiveness. Furthermore, both experiential value and immersiveness drive the shoppers’ purchase intention. JEL Code: M30 Marketing and Advertising: General
Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems
Authors: Pugliese Cara E , Handsman Rebecca , You Xiaozhen , Anthony Laura Gutermuth , Vaidya Chandan , Kenworthy Lauren 
Published: April 2024

Mental health conditions such as anxiety, depression, aggression, and inattention are common in autistic youth and are challenging to treat by community providers. We aim to parse the heterogeneity of autism based on dimensions of executive function and determine whether specific executive function profiles are differentially related to psychiatric symptoms. Parents of 397 well-characterized 8–14-year-old autistic children without an intellectual disability reported on their child’s executive function skills and psychiatric symptoms. We applied a data-driven, graph theory-based, community-detection approach to a common executive function measure, revealing three distinct executive function profile subgroups. Despite having similar social challenges, the executive function subgroups differed on anxiety, aggression, affect, and inattention symptoms. Results support the need for more intensive subtyping with autistic youth to develop appropriate, individualized mental health treatments and supports. Characterizing youth through neurocognitive strengths and challenges can guide the development of precision medicine, allowing for more meaningful, specialized treatment. Lay Abstract Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges—like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.
Energy-economic-environmental analysis of a net-zero energy greenhouse with fan-coil units and hot-water pipes: Experiment and modelling
Authors: Adesanya Misbaudeen Aderemi , Na Wook-Ho , Kim Min-Hwi , Lee Hyun-Woo 
Published: April 2024

This study analysed the performance of a hot-water pipe (HWP) and fan-coil units (FCUs) in controlling microclimate conditions in a net-zero energy greenhouse (NZEG). The performance of a previously developed TraNsient SYstem Simulation (TRNSYS) model for the NZEG was enhanced to include a crop model and several HWP emission standards, and the improved TRNSYS model was used to analyse heating, ventilation and air-conditioning (HVAC) systems for different greenhouse sizes in the Republic of Korea. Further, an economic analysis was conducted. The model validation showed excellent agreement between the measured and simulated values, with Nash-Sutcliffe efficiency of 0.98. The presence of crop in the simulation model reduced the total heating load by 14.5 MWh and increased the cooling load by 4 MWh. The capacity of the FCU was increased as the outside temperature rose from 33.4[Formula: see text] to 36.4[Formula: see text] in summer, and the diameter of the HWP was decreased from 25A to 10A as the outside temperature rose from −21.7[Formula: see text] to −12.2[Formula: see text] in winter to maintain the greenhouse at the desired temperature of 15[Formula: see text]. Notably, the payback period was reduced by 9 years when the annual savings in heating energy costs and revenue from carbon trading were considered as a part of the net economic cash flow.
Robotic Renal Vein Bypass: A Novel Technique for Treating a Challenging Case of Nutcracker Syndrome
Authors: Choudhry Asad , DeNoble Daniel , Bratslavsky Gennady , Feghali Anthony 
Published: April 2024

This case report highlights the successful application of a robotic-assisted surgical approach in managing Nutcracker syndrome. The patient, a 36-year-old female presented with severe symptoms and underwent robotic left renal vein transposition after failing conservative management. The procedure was performed through a minimally invasive approach utilizing the Da Vinci robotic system™ which offers enhanced visualization and precision. However, challenges arose during the renal vein anastomosis due to tension and poor flow through the transposition, requiring two revisions with a bovine pericardial patch. Ultimately, an 8 mm ringed PTFE bypass was anastomosed from the distal left renal vein to the Inferior Vena Cava. Despite these challenges, the patient experienced a successful outcome with complete symptom resolution of this complicated pathology.
The Median Effective Dose of Dexmedetomidine for the Inhibition of Emergence Delirium in Preschool Children Undergoing Tonsillectomy and/or Adenoidectomy: A Retrospective Dose-response Trial
Authors: Wei BaiYun , Yu CuiYu , Xiao JinBo , Xu Huang , Zheng Ping , Wang WeiBing 
Published: April 2024

The incidence of emergence delirium (ED) is higher in preschool children undergoing tonsillectomy and/or adenoidectomy. The purpose of this study was to determine the median effective dose (ED50) of dexmedetomidine (DEX) for the inhibition of ED in preschool children by using probit regression analysis. A total of 140 anesthesia records were retrieved and divided into seven groups based on the infusion rate of DEX: .2, .25, .3, .35, .4, .45, and .5 μg·kg−1·h−1. The Pediatric Anesthesia Emergence Delirium Scale (PAEDS) was used to assess ED in preschool children, and ED was defined as a PAEDS score ≥ 10. Probit regression analysis revealed that the ED50 and ED95 of DEX were .31 μg·kg−1·h−1 (95% CI: .29–.35) and .48 μg·kg−1·h−1 (95% CI: .44–.56), respectively. Probit(p) = −2.84 + 9.28 × ln (Dose), (χ2 = 1.925, P = .859). The PAEDS score was significantly increased in the ED group, and the rate of bradycardia was significantly decreased in the ED group compared with the without ED group (27.3% vs 54.1%, P = .02). DEX can effectively inhibit the ED in preschool children undergoing tonsillectomy and/or adenoidectomy, however, bradycardia was the main complication.
Surgical procedures to improve hand function in tetraplegic patients: patient satisfaction and outcomes over a 20-year period
Authors: Stevens Cyriëlle , Vanden Berghe Alex , Hollevoet Nadine 
Published: April 2024

The aim of the present study was to report our experience in the evolution in surgical strategy and patient satisfaction after upper limb reconstruction in tetraplegic patients. A total of 72 patients (114 upper limbs) underwent surgery between 1997 and 2017. Since April 2003, tenodesis of the extensor digitorum communis tendons was no longer performed because it limited wrist flexion, and two-stage operations to restore active grasp were replaced by one-stage procedures. In total, 34 patients (58 upper limbs) completed questionnaires about function and satisfaction at a mean follow-up of 14 years (range 4–24) since their first operation; 26 were satisfied, 30 would have the operation again and 31 benefitted from the surgery. Surgical procedures, such as tendon transfers, arthrodesis and tenodesis, can have a positive effect on patient-perceived function and satisfaction in the long term in most of these patients. Level of evidence: IV
The emerging therapies are reshaping the first-line treatment for advanced hepatocellular carcinoma: a systematic review and network meta-analysis
Authors: Peng Wei , Pan Yangxun , Xie Lan , Yang Zhoutian , Ye Zhiwei , Chen Jinbin , Wang Juncheng , Hu Dandan , Xu Li , Zhou Zhongguo , Chen Minshan , Fang Aiping , Zhang Yaojun 
Published: April 2024

Background: Given the superior performance of various therapies over sorafenib in advanced hepatocellular carcinoma (HCC) and the absence of direct comparisons, it is crucial to explore the efficacy of these treatments in phase III randomized clinical trials. Objectives: The goal is to identify which patients are most likely to benefit significantly from these emerging therapies, contributing to more personalized and informed clinical decision-making. Design: Systematic review and network meta-analysis Data sources and methods: PubMed, Embase, ClinicalTrials.gov, and international conference databases have been searched from 1 January 2010 to 1 December 2023. Results: After screening, 17 phase III trials encompassing 18 treatments were included. In the whole-population network meta-analysis, the newly first-line tremelimumab plus durvalumab (Tre + Du) was found to be comparable with atezolizumab plus bevacizumab (Atezo + Beva) in providing the best overall survival (OS) benefit [hazard ratio (HR) 1.35, 95% confidence interval (CI): 0.93–1.92]. Concerning OS benefits, sintilimab plus bevacizumab biosimilar (Sint + Beva), camrelizumab plus rivoceranib (Camre + Rivo), and lenvatinib plus pembrolizumab (Lenva + Pemb) appear to exhibit similar effects to Tre + Du and Atezo + Beva. In the context of progression-free survival, Atezo + Beva seemed to outperform Tre + Du (HR: 0.66 CI: 0.49–0.87), while the effects are comparable to Sint + Beva, Camre + Rivo, and Lenva + Pemb. Upon comparison between Asia-Pacific and non-Asia-Pacific cohorts, as well as between hepatitis B virus (HBV)-infected and non-HBV-infected populations, immune checkpoint inhibitor (ICI)-based treatments seemed to exhibit heightened efficacy in the Asia-Pacific group and among individuals with HBV infection. However, combined ICI-based therapies did not show more effectiveness than molecular-targeted drugs in patients without macrovascular invasion and/or extrahepatic spread. As for grades 3–5 adverse events, combined therapies showed comparable safety to sorafenib and lenvatinib. Conclusion: Compared with sorafenib and lenvatinib, combination therapies based on ICIs significantly improved the prognosis of advanced HCC and demonstrated similar safety. At the same time, the optimal treatment approach should be tailored to individual patient characteristics, such as etiology, tumor staging, and serum alpha-fetoprotein levels. With lower incidence rates of treatment-related adverse events and non-inferior efficacy compared to sorafenib, ICI monotherapies should be prioritized as a first-line treatment approach for patients who are not suitable candidates for ICI-combined therapies. Trial registration: PROSPERO, CRD42022288172.
Glucose Color Index: Development and Validation of a Novel Measure of the Shape of Glycemic Variability
Authors: Sartini Joseph , Fang Michael , Rooney Mary R. , Selvin Elizabeth , Coresh Josef , Zeger Scott 
Published: April 2024

Background: Standard continuous glucose monitoring (CGM) metrics: mean glucose, standard deviation, coefficient of variation, and time in range, fail to capture the shape of variability in the CGM time series. This information could facilitate improved diabetes management. Methods: We analyzed CGM data from 141 adults with type 2 diabetes in the Hyperglycemic Profiles in Obstructive Sleep Apnea (HYPNOS) trial. Participants in HYPNOS wore CGM sensors for up to two weeks at two time points, three months apart. We calculated the log-periodogram for each time period, summarizing using disjoint linear models. These summaries were combined into a single value, termed the Glucose Color Index (GCI), using canonical correlation analysis. We compared the between-wear correlation of GCI with those of standard CGM metrics and assessed associations between GCI and diabetes comorbidities in 398 older adults with type 2 diabetes from the Atherosclerosis Risk in Communities (ARIC) study. Results: The GCI achieved a test-retest correlation of R = .75. Adjusting for standard CGM metrics, the GCI test-retest correlation was R = .55. Glucose Color Index was significantly associated ( p < .05) with impaired physical functioning, frailty/pre-frailty, cardiovascular disease, chronic kidney disease, and dementia/mild cognitive impairment after adjustment for confounders. Conclusion: We developed and validated the GCI, a novel CGM metric that captures the shape of glucose variability using the periodogram signal decomposition. Glucose Color Index was reliable within participants over a three-month period and associated with diabetes comorbidities. The GCI suggests a promising avenue toward the development of CGM metrics which more fully incorporate time series information.
Q-Score Complements the Time in Range in the Evaluation of Short-Term Glycemic Control
Authors: Augstein Petra , Heinke Peter , Nowak Alexandra , Salzsieder Eckhard , Kerner Wolfgang 
Published: April 2024

Background and aims: The Q-Score is a single-number composite metric that is constructed based on the following components: central glycemic tendency, hyperglycemia, hypoglycemia, and intra- and interday variability. Herein, we refined the Q-Score for the screening and analysis of short-term glycemic control using continuous glucose monitoring (CGM) profiles. Methods: Continuous glucose monitoring profiles were obtained from noninterventional, retrospective cross-sectional studies. The upper limit of the Q-Score component hyperglycemia‚ that is, the time above target range (TAR), was adjusted from 8.9 to 10 mmol/L ( n = 1562 three-day-sensor profiles). A total of 302 people with diabetes mellitus treated with intermittent CGM for ≥14 days were enrolled. The time to stability was determined via correlation-based analysis. Results: There was a strong correlation between the Q-Scores of the two TARs, that is, 8.9 and 10 mmol/L (Q-ScoreTAR10 = −0.03 + 1.00 Q-ScoreTAR8.9, r = .997, p < .001). The times to stability of the Q-Score and TIR were 10 and 12 days, respectively. The Q-Score was correlated with fructosamine concentrations, the glucose management indicator (GMI), the time in range (TIR), and the glycemic risk index (GRI) ( r = .698, .887, –.874, and .941), respectively. The number of Q-Score components above the target increased as the TIR decreased, from two (1.7 ± 0.9) in CGM profiles with a TIR between 70% and 80% to four (3.9 ± 0.5) in the majority of the CGM profiles with a TIR below 50%. A conversion matrix between the Q-Score and glycemic indices was developed. Conclusions: The Q-Score is a tool for assessing short-term glycemic control. The Q-Score can be translated into clinician opinion using the GRI.
Isolated Orbital Fracture – Treatment and Outcomes in a Single Tertiary Care Centre
Authors: Maunula Mirko K. K. , Blomgren Karin , Sinkkonen Saku T. , Nyman Kristofer , Tapiovaara Laura K. 
Published: April 2024

Study Design Retrospective, questionnaire survey. Objective The literature lacks a consensus on treatment of isolated orbital fracture. Our aim was to explore treatment schemes and outcomes of patients with isolated orbital fracture treated at a single tertiary care centre. Methods We performed a retrospective chart review and a cross-sectional questionnaire survey. We reviewed the medical records of all patients diagnosed with isolated orbital fracture at an outpatient referral clinic in an urban university hospital between 2010 and 2016. We included only patients with isolated inferior, medial, or inferomedial orbital fracture in the study cohort. We sent a questionnaire to these patients to assess the prevalence and severity of long-term symptoms. Results We included 246 patients in the study cohort, of which 96 (39%) were treated surgically and 150 (61%) non-surgically. Median time from injury to surgery was 11 days (range = 0–44, IQR = 8,15), and to sending the questionnaire 44 months (range = 16–93). The questionnaire was completed by 89 patients (36%), of whom 51 (57%) reported at least one mild long-term symptom, 24 (27%) at least one moderate long-term symptom, and 17 (19%) at least one severe long-term symptom. Conclusions Patients with isolated orbital fracture treated at our unit reported severe long-term symptoms more frequently than would have been expected based on earlier research. Patients at our unit were treated surgically more often than in other similar units, which suggests that surgical treatment may be chosen over non-surgical treatment unnecessarily often at our unit.
RAS/RAF landscape in monoclonal plasma cell conditions
Authors: Schavgoulidze Anais , Corre Jill , Samur Mehmet Kemal , Mazzotti Celine , Pavageau Luka , Perrot Aurore , Cazaubiel Titouan , Leleu Xavier , Macro Margaret , Belhadj Karim , Roussel Murielle , Brechignac Sabine , Montes Lydia , Caillot Denis , Frenzel Laurent , Rey Philippe , Schiano de Colella Jean-Marc , Chalopin Thomas , Jacquet Caroline , Richez Valentine , Orsini-Piocelle Frederique , Fontan Jean , Manier Salomon , Martinet Ludovic , Sciambi Adam , Mohty Mohamad , Avet-Loiseau Herve 
Published: April 2024

Abstract
Multiple myeloma is characterized by a huge heterogeneity at the molecular level. The RAS/RAF pathway is the most frequently mutated, in ∼50% of the patients. However, these mutations are frequently subclonal, suggesting a secondary event. Because these genes are part of our routine next-generation sequencing panel, we analyzed &gt;10 000 patients with different plasma cell disorders to describe the RAS/RAF landscape. In this large cohort of patients, almost 61% of the patients presented a RAS/RAF mutation at diagnosis or relapse, but much lower frequencies occurred in presymptomatic cases. Of note, the mutations were different from that observed in solid tumors (higher proportions of Q61 mutations). In 29 patients with 2 different mutations, we were able to perform single-cell sequencing, showing that in most cases, mutations occurred in different subclones, suggesting an ongoing mutational process. These findings suggest that the RAS/RAF pathway is not an attractive target, both on therapeutic and residual disease assessment points of view.