bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circumscribed Thinning of the Calvaria - A Long-Term Sequela After Vacuum Extraction Delivery
Authors: Liniger B 
Published: May 2024

Abstract

Background
Vacuum extraction deliveries are associated with a number of complications like injuries to the skin, subperiosteal, subgaleal and intracranial hemorrhages. Even skull fractures have been described, but data on persistent changes in the bone structure of the skull like thinning of the calvaria is lacking in the literature.

Aims
We describe a previously unreported long-term sequela of vacuum extraction delivery.

Methods
We present a series of 8 children, who were referred because of an irregularity of the cranial surface without other symptoms. The investigations revealed a circumscribed thinning of the calvaria in all 8 cases. Detailed history and the specific clinical findings were crucial in the assessment. Various imaging techniques were used to visualize the lesions and rule out some differential diagnoses.

Results
All children had undergone a vacuum-assisted delivery. All irregularities of the cranial surface were discovered incidentally. Clinical examination revealed a round (6) or linear (1) channel-shaped indentation of the calvaria in 7 cases. The shape and size of the annular thinning of the calvaria matched devices commonly used in vacuum extraction very well. In one patient, a localized protrusion of the calvaria was investigated, but an indentation more posteriorly was detected in the CT scan. CT scan was performed in 6 patients, in 2, parents refused this examination. In the follow-up, no progression or symptoms was observed in any of the patients.

Conclusion
Such long-term sequelae after vacuum-assisted delivery have not been reported yet and the underlying mechanism is unclear. In children who present with irregularities of the cranium, an accurate history, including the mode of birth, and detailed clinical examination should be performed. Knowledge about the presented pathology may help to avoid extensive investigations, particularly CT scan. The publication of further cases could help to propagate the circumscribed thinning of the calvaria after vacuum extraction as a distinctive clinical entity.
New Diagnostic-Based Systematic Classification for Skier's Thumb Injuries: A Revision That is Needed
Authors: Strohmaier A , Wirtz C , Krafft L , Häfeli M 
Published: May 2024

Abstract

Background
Acute injuries to the ulnar collateral ligament (UCL) of the first metacarpophalangeal joint (MCPj), commonly referred to as Skier’s thumb injuries, can be further categorized into different types based on bone lesions and joint instability. However, none of the existing classifications encompasses all types and combinations of injuries. A unified classification system that provides direct treatment recommendations for each type is required, particularly for cases with no clear indications.

Aims
To develop a new classification system for acute UCL injuries of the first MCPj that comprehensively defines all possible combinations and types of injuries and facilitates treatment decision-making for each specific type in daily clinical practice.

Methods
The retrospective study included patients with acute UCL lesions who underwent conservative or operative treatment at our clinic between 2018 and 2023. This classification addresses ligamentous or osseous lesions, fracture fragment size and dislocation, ligament configuration (e.g. Stener lesions), and joint stability. Correlated radiography, ultrasonography, MRI, and intraoperative findings were used to define all combinations and variants of skier`s thumb injuries. Pre-therapeutic joint stability was characterized according to the criteria established in the literature. Dislocation criteria for bone lesions were defined in a preliminary observer trial. The classification was applied by three hand surgeons with different training levels. Treatment applied and a 3-months follow-up was documented.

Results
In 213 patients with acute UCL tears, the new classification was consistently applied, and the treatment derived was largely aligned with the recommendations in the literature for both absolute and relative indications for splint or operative therapy. The vast majority of the patients were stable after 3 months.

Conclusion
This new classification is the first to combine the clinical and radiological aspects of skier`s thumb injuries into one classification and encompasses all variants. It is comprehensive, can be easily applied retrospectively, and provides clear treatment recommendations in most cases.
Decoding the Clavien-Dindo Classification: Artificial Intelligence (AI) as a Novel Tool to Grade Postoperative Complications
Authors: Staubli S , Walker H L , Saner F , Salinas C H , Broering D C , Malago M , Spiro M , Raptis D A 
Published: May 2024

Abstract

Background
The CDC standardizes grading of postoperative complications. However, consistent, and precise application in dynamic clinical settings is challenging. AI offers a potential solution for efficient automated grading.

Aims
To assess ChatGPT’s capability of grading postoperative complications using the Clavien-Dindo classification (CDC) via Artificial Intelligence (AI) with Natural Language Processing (NLP).

Methods
ChatGPT's accuracy in defining the CDC, generating clinical examples, grading complications from existing scenarios, and interpreting complications from fictional clinical summaries, was tested.

Results
ChatGPT 4 precisely mirrored the CDC, outperforming version 3.5. In generating clinical examples, ChatGPT 4 showcased 99% agreement with minor errors in urinary catheterization. For single complications, it achieved 97% accuracy. ChatGPT was able to accurately extract, grade, and analyze complications from free text fictional discharge summaries.

Conclusion
ChatGPT 4 demonstrates promising proficiency and accuracy in applying the CDC. In the future, AI has the potential to become the mainstay tool to accurately capture, extract, and analyze CDC data from clinical datasets.
New Generation Superior Single Plating versus Low-Profile Dual Mini-Fragment Plating of Diaphyseal Clavicle Fractures - A Biomechanical Study
Authors: Pastor T , Pastor T , Zderic I , Berk T , Souleiman F , Vögelin E , Beeres F , Gueorguiev B 
Published: May 2024

Abstract

Background
Recently, a new generation of superior clavicle plates was developed featuring the variable-angle locking technology for enhanced screw positioning and optimized plate-to-bone fit design. On the other hand, mini-fragment plates used in dual plating mode have demonstrated promising clinical results. However, these two bone-implant constructs have not been investigated biomechanically in a human cadaveric model.

Aims
To compare the biomechanical competence of single superior plating using the new generation plate versus dual plating with low-profile mini-fragment plates.

Methods
Sixteen paired human cadaveric clavicles were assigned pairwise to two groups for instrumentation with either a 2.7 mm Variable Angle Locking Compression Plate placed superiorly (Group 1), or with one 2.5 mm anterior plate combined with one 2.0 mm superior matrix mandible plate (Group 2). An unstable clavicle shaft fracture AO/OTA15.2C was simulated by means of a 5 mm osteotomy gap. All specimens were cyclically tested to failure under craniocaudal cantilever bending, superimposed with bidirectional torsion around the shaft axis and monitored via motion tracking.

Results
Initial stiffness was significantly higher in Group 2 (9.28±4.40 N/mm) compared to Group 1 (3.68±1.08 N/mm), p=0.003. The amplitudes of interfragmentary motions in terms of craniocaudal and shear displacement, fracture gap opening, and torsion were significantly bigger over the course of 12500 cycles in Group 1 compared to Group 2; p≤0.038. Cycles to 2 mm shear displacement were significantly lower in Group 1 (22792±4346) compared to Group 2 (27437±1877), p=0.047.

Conclusion
From a biomechanical perspective, low-profile 2.5/2.0 dual plates demonstrated significantly higher initial stiffness, less interfragmentary movements, and higher resistance to failure compared to 2.7 single superior variable-angle locking plates and can therefore be considered as a useful alternative for diaphyseal clavicle fracture fixation especially in unstable fracture configurations.
Reconstruction Techniques and Associated Morbidity after Minimally Invasive Gastrectomy for Cancer – Insights from the GastroBenchmark and GASTRODATA databases
Authors: Schneider M , Kim J , Berlth F , Sugita Y , Grimminger P , Baiocchi G L , de Manzoni G , Bencivenga M , Nunobe S , Consortium T G , Consortium T G , Yang H K , Gutschow C A 
Published: May 2024

Abstract

Background
Various anastomotic and reconstruction techniques are used to restore intestinal continuity after minimally invasive total (TG) and subtotal distal gastrectomy (DG).

Aims
Their effects on anastomotic leakage and postoperative morbidity have not been extensively studied.

Methods
Patients after minimally invasive TG and DG were selected from a cohort of 9356 oncological gastrectomies performed between 2017-2021 in 44 specialized centers.

Results
Three anastomotic techniques (circular stapled (CS, 3.7%); linear stapled (LS, 93.8%); hand sewn (HS, 2.5%)) and three types of bowel reconstruction (Roux (RX, 51.5%); Billroth I (BI, 23.1%); Billroth II (BII, 25.4%)) were identified after TG (n=878) and DG (n=3334). Postoperative morbidity was higher after TG compared to DG (AL 5.2% vs. 1.1%, p≤0.001; 90-day mortality 1.6% vs. 0.4%, p≤0.001; overall morbidity 28.6% vs. 16.3%, p≤0.001; major morbidity 15.4% vs. 8.0%, p≤0.001).
Anastomotic leakage rate in the TG cohort was higher after CS (13.1%) and HS (7.9%) than after LS anastomoses (1.9%, p&lt;0.001). Similarly, overall (CS: 43.9%, HS: 28.6%, LS: 23.1%) and major complications rates (CS: 25.2%, HS: 11.1%, LS: 12.0%) as well as mortality (CS: 4.7%, HS: 2.2%, LS: 0.8%) were higher after CS. Multivariate analysis confirmed anastomotic technique as a predictive factor for anastomotic leakage (Fig. 1), but not for occurrence of mortality, overall and major complications.
In the DG cohort, most (98.7%), outcomes were similar for all types of bowel reconstruction: Anastomotic leakage (BI: 1.4%, BII 0.8%, RX 1.2%, p=0.440), 90-day mortality (BI: 0%, BII 0.1%, RY: 1.1%%, p=0.109), overall (BI: 14.5%, BII: 15.0%, RX: 18.7%, p=0.208) and major morbidity (BI: 7.9%, BII: 9.1%, RX: 7.2%, p=0.219).

Conclusion
In suitable situations, DG should be preferred to TG, as postoperative morbidity is significantly lower. In addition, LS should be the preferred method of anastomosis after TG. Conversely, the techniques for bowel reconstruction can be chosen according to the surgeon's preference.
Endovascular Treatment of Complex Aortic Aneurysms Using Inner Branch Device (IBEVAR): A Single Center Experience
Authors: Déglise S , Longchamp J , Ricciardi P , Côté E , Trunfio R , Deslarzes-Dubuis C 
Published: May 2024

Abstract

Background
Due to advances in devices and techniques, the endovascular approach using fenestrated or branched endografts has emerged as a valid and safe alternative for patients with complex aortic aneurysms, especially if considered at high risk for surgery. The use of inner branch devices (iBEVAR) combining benefits of fenestrations and outer branches could offer an ideal configuration in this context.

Aims
The aim of our study was to report our monocentric experience with iBEVAR in the treatment of complex aortic aneurysms.

Methods
A retrospective analysis of prospective data retrieved from 1 center between January 2020 and January 2024 was done. Endpoints were immediate technical success, postoperative morbidity, rate of re-intervention and mortality.

Results
During this period, 72 patients with a mean age of 68.5 years (range 41-88) were identified. The maximum preoperative mean aortic diameter was 56 mm (44-71 mm). The majority of patients was asymptomatic. For diffuse thoraco-abdominal aortic aneurysms, a 2-steps procedure was used. There were 34 off-the-shelf E-nside (47%) and the remaining 38 patients were treated with a custom-made Extra-Design graft (53%). Despite successful endograft deployment in all patients and branch catheterization in 69/72 cases (96%), the technical success was 94% due to an additional open conversion for ilio-mesenteric bypass. The 30-days mortality was 5.5%.
During the post-operative period, 19% of patients presented complications with 1 case of mesenteric ischaemia requiring a visceral resection and 2 cases of paralytic ileus, treated conservatively. 5 cases (6.9) of spinal cord ischemia were observed. During the median follow-up, 22 patients (31%) had a re-intervention, for endoleaks, bridging-stent events or limbs problems. The overall target vessel patency was 94%.

Conclusion
The use of iBEVAR appears to be safe and effective for the treatment of complex aortic aneurysms with an acceptable rate of complications. Strict follow-up is mandatory and about one-third of patients required a re-intervention. Further patients and longer follow-up are needed.
Breakthrough Invasive Fungal Infections in Patients With High-Risk Hematological Disorders Receiving Voriconazole and Posaconazole Prophylaxis: A Systematic Review
Authors: Boutin Catherine-Audrey , Durocher Florence , Beauchemin Stéphanie , Ziegler Daniela , Abou Chakra Claire Nour , Dufresne Simon Frédéric 
Published: May 2024

Abstract

Background
Primary antifungal prophylaxis with mold-active azoles is used to prevent invasive fungal infections in patients with high-risk hematological disorders; however, breakthrough infections occur, and the reasons for treatment failure are still not fully understood. To help inform clinical decisions, we sought to define microbiological, clinical, and pharmacological characteristics of proven and probable breakthrough invasive fungal infections (bIFIs) in patients with high-risk hematological disorders receiving voriconazole or posaconazole prophylaxis.

Methods
We performed a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy was last conducted on 19 April 2023.

Results
We assessed 5293 studies for eligibility, and 300 were selected for data extraction. These studies described 1076 cases of bIFIs occurring under voriconazole (42.5%) or posaconazole (57.5%). The most commonly found pathogens were Aspergillus (40%), Mucorales (20%), Candida (18%), and Fusarium (9%) species. Mucorales were more frequent among voriconazole-emerging cases, whereas Aspergillus and Fusarium were more prevalent among posaconazole-emerging cases. Definitive, putative, or probable antifungal resistance was found in 31% of cases. Therapeutic drug monitoring showed subtherapeutic azole concentration in 32 of 90 (36%) cases. Infection-related mortality was reported in 117 cases and reached 35%.

Conclusions
In our systemic review, the most common bIFIs were aspergillosis, mucormycosis, candidiasis, and fusariosis. Antifungal resistance explains only a minority of cases. Subtherapeutic prophylaxis was frequent but rarely reported. Prospective studies are needed to better understand these infections and to establish optimal management.
Degenerative mitral regurgitation due to flail leaflet: sex-related differences in presentation, management, and outcomes
Authors: Avierinos Jean-Fançois , Tribouilloy Christophe , Bursi Francesca , Grigioni Francesco , Vanoverschelde Jean-Louis , Resseguier Noémie , Théron Alexis , Pasquet Agnes , Pradier Julie , Biagini Elena , Barbieri Andrea , Michelena Hector , Benfari Giovanni , Rusinaru Dan , Zaffran Stéphane , Vancraeynest David , Collart Fréderic , Bohbot Yohann , Essayagh Benjamin , Enriquez-Sarano Maurice 
Published: May 2024

Abstract

Background and Aims
Presentation, outcome, and management of females with degenerative mitral regurgitation (DMR) are undefined. We analysed sex-specific baseline clinical and echocardiographic characteristics at referral for DMR due to flail leaflets and subsequent management and outcomes.

Methods
In the Mitral Regurgitation International Database (MIDA) international registry, females were compared with males regarding presentation at referral, management, and outcome (survival/heart failure), under medical treatment, post-operatively, and encompassing all follow-up.

Results
At referral, females (n = 650) vs. males (n = 1660) were older with more severe symptoms and higher MIDA score. Smaller cavity diameters belied higher cardiac dimension indexed to body surface area. Under conservative management, excess mortality vs. expected was observed in males [standardized mortality ratio (SMR) 1.45 (1.27–1.65), P &lt; .001] but was higher in females [SMR 2.00 (1.67–2.38), P &lt; .001]. Female sex was independently associated with mortality [adjusted hazard ratio (HR) 1.29 (1.04–1.61), P = .02], cardiovascular mortality [adjusted HR 1.58 (1.14–2.18), P = .007], and heart failure [adjusted HR 1.36 (1.02–1.81), P = .04] under medical management. Females vs. males were less offered surgical correction (72% vs. 80%, P &lt; .001); however, surgical outcome, adjusted for more severe presentation in females, was similar (P ≥ .09). Ultimately, overall outcome throughout follow-up was worse in females who displayed persistent excess mortality vs. expected [SMR 1.31 (1.16–1.47), P &lt; .001], whereas males enjoyed normal life expectancy restoration [SMR 0.92 (0.85–0.99), P = .036].

Conclusions
Females with severe DMR were referred to tertiary centers at a more advanced stage, incurred higher mortality and morbidity under conservative management, and were offered surgery less and later after referral. Ultimately, these sex-related differences yielded persistent excess mortality despite surgery in females with DMR, while males enjoyed restoration of life expectancy, warranting imperative re-evaluation of sex-specific DMR management.
ANMCO/SIMEU consensus document on the use of reversal agents for antithrombotic therapies in patients with ongoing bleeding or at high risk of haemorrhagic events
Authors: De Luca Leonardo , Pugliese Francesco Rocco , Susi Beniamino , Navazio Alessandro , Corda Marco , Fabbri Andrea , Scicchitano Pietro , Voza Antonio , Vanni Simone , Bilato Claudio , Geraci Giovanna , Gabrielli Domenico , Grimaldi Massimo , Colivicchi Furio , De Iaco Fabio , Oliva Fabrizio 
Published: May 2024

Abstract
In recent decades, an incredible evolution in antithrombotic therapies used for treating patients with atherosclerosis, atrial fibrillation, and venous thromboembolism has been observed, leading to the availability of increasingly safe drugs. Nonetheless, bleeding complications remain a significant concern, with considerable health, social, and economic implications. To improve the acute management of patients experiencing or at risk for major bleeding events, specific reversal agents for antithrombotic drugs have been recently developed. While these agents demonstrate effectiveness in small-scale pharmacodynamic studies and clinical trials, it is imperative to balance the benefits of reversing antiplatelet or anticoagulant therapy against the risk of prothrombotic effects. These risks include the potential loss of antithrombotic protection and the prothrombotic tendencies associated with bleeding, major surgery, or trauma. This joint document of the Italian Association of Hospital Cardiologists (Associazione Nazionale Medici Cardiologi Ospedalieri) and the Italian Society of Emergency Medicine (Società Italiana di Medicina d’Emergenza-Urgenza) delineates the key features and efficacy of available reversal agents. It also provides practical flowcharts to guide their use in patients with active bleeding or those at elevated risk of major bleeding events.
PREVALENCE OF WILD–TYPE TRANSTHYRETIN CARDIAC AMYLOIDOSIS IN ELDERLY SUBJECTS FROM THE GENERAL POPULATION
Authors: Aimo A , Vergaro G , Castiglione V , Fabiani I , Barison A , Gentile F , Ferrari Chen Y , Giorgetti A , Genovesi D , Buda G , Franzini M , Moscardini S , Rapezzi C , Fontana M , Passino C , Emdin M 
Published: May 2024

Abstract

Background
Wild–type transthyretin cardiac amyloidosis (ATTRwt–CA) affects older adults, and is currently considered as a rare disorder.

Objective
We investigated for the first time the prevalence of ATTRwt–CA in elderly individuals from the general population.

Methods
General practitioners from Pisa, Italy, proposed a screening for ATTRwt–CA to all their patients aged 65–90 years, until 1,000 accepted. The following red flags were searched: interventricular septal thickness ≥12 mm, any echocardiographic, ECG or clinical hallmark of CA, or high sensitivity–troponin T ≥14 ng/L. Individuals with at least one red flag (n=346) were asked to undergo the search for a monoclonal protein and bone scintigraphy, and 216 accepted.

Results
Four patients received a non–invasive diagnosis of ATTRwt–CA. All complained of dyspnoea on moderate effort. A woman and a man aged 79 and 85 years, respectively, showed an intense cardiac tracer uptake (grade 3), left ventricular (LV) wall thickening, grade 2 to 3 diastolic dysfunction, and N–terminal pro–B–type natriuretic peptide (NT–proBNP) &gt;1,000 ng/L. Two other patients (a man aged 74 years and a woman aged 83 years) showed a grade 2 uptake, an increased LV septal thickness, but preserved diastolic function, and NT–proBNP &lt;300 ng/L. The prevalence of ATTR–CA in subjects ≥65 years was calculated as 0.46% (i.e., 4 out of the 870 subjects completing the screening, namely 654 not meeting the criteria for Step 2 and 216 progressing to Step 2).

Conclusions
ATTRwt–CA has a prevalence of 0.46% in elderly subjects from the general population.