bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Incidence of Incisional Hernia after Colorectal Surgery Depends on the Extraction Site: A Cohort Analysis
Authors: Burgard M , Liot E , Meurette G , Toso C , Ris F , Meyer J 
Published: May 2024

Abstract

Background
Although minimally invasive surgery has reduced the incidence of incisional hernia in colorectal surgery, specimen extraction site still constitutes a risk for incisional hernia.

Aims
We aimed to analyse the incidence of incisional hernia according to the specimen extraction site.

Methods
We conducted a retrospective observational cohort study of consecutive patients who underwent elective laparoscopic colorectal surgery for colorectal cancer between 01.2013 and 12.2021. The primary outcome was the CT-proven incidence of incisional hernia at the level of the extraction site until the end of follow-up (12.2023). Patients with open surgery, previous hernia repair, reoperations during the study period or without imaging follow-up were excluded.

Results
One hundred and fifty-eight patients were included. One hundred and four patients (65,8 %) had an extraction site located on the midline, and 54 patients (34,2 %) had an extraction site which was off midline. The midline was preferably used as extraction site during right and transverse colectomy (96,5% and 100% respectively), and off midline was used in left hemicolectomy, sigmoid colectomy and anterior resection (60%, 88%, 93,8% respectively). The overall incidence of incisional hernia at the level of the extraction site was of 29,8 % (31 patients) when midline was chosen as the extraction site, and of 1,9% (1 patient) when the extraction site was off-midline (p-value&lt;0,001). Seven patients (6,7%) required hernia repair in the midline group and no patient (0%) in the off-midline group (p-value=0.051). The mean follow-up was of 3.1+/-2.1 years. Uni-and multivariate logistic regression identified the choice of extraction site as a risk factor for incisional hernia (odds ratio: 22,5, 95%CI: 2,3-27,1, p-value: 0,03).

Conclusion
Choosing the midline as an extraction site exposes patients to the risk of incisional hernia. Fully minimally invasive colorectal resection using off-midline incision as extraction site should be encouraged.
Risk Factors for Prolonged Air Leakage after Uniportal Anatomical Segmentectomy
Authors: Rieder O , Gioutsos K , Galanis M , Nguyen T L , Senbaklavaci Ö , Dorn P 
Published: May 2024

Abstract

Background
As the population ages and comorbidities increase, minimal invasive anatomical segmentectomies are increasingly being performed. Complications are to be considered in this vulnerable population.

Aims
Our aim was to investigate the incidence and risk factors for prolonged air leak in patients undergoing minimally invasive single-port pulmonary segmentectomy at our institution.

Methods
Retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to August 2023. Prolonged air leak (PAL) was defined as an air leak that lasted longer than 5 days.

Results
575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery (uVATS). 374 complex segmentectomies (65.0%) and 405 (70.4%) single segmentectomies were performed. Prolonged air leak occurred in 88 patients (15.3%). Length of stay and duration of drainage were 8.6 (±4.86) and 10.6 (±8.12) days in the PAL subgroup, whereas they wer 3.6 (±2.25) and 2.0 (±1.3) days in the non-PAL group, both statistically significant. Patients with COPD GOLD II/III were significantly more common in the PAL group.
Using machine learning, two models were developed that predicted the occurrence of PAL with an accuracy of 70 %. The first model detected the following parameters as significant: removal of segment 2 or 8, diabetes, inhalers, squamous cell carcinoma. The second model recognized DLCO (%), pack-years, FEV1 (%) and operation time as parameters.
Furthermore, we used recursive partitioning to develop a decision tree that stratified PAL risk by answering 1-3 yes/no questions. Patients with &gt;28 pack-years and DLCO &lt; 71% had a 77% probability of developing prolonged air leak.

Conclusion
Severe COPD, low DLCO and FEV1, increased pack-years, inhalers, diabetes, and segment 2 or 8 surgery were identified as risk factors for prolonged air leak. These findings may help in the planning of surgery and the use of sealants at the end of surgery in high-risk patients.
Gaining exposure on perceptions of sunscreen: a national survey of patients with melanoma
Authors: Raza Sami A , Cannon Diane , Ali Faisal R 
Published: May 2024

Abstract
The incidence of melanoma is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all members of a support group for people with melanoma. In total, 571 responses were received across 6 weeks. Most respondents (n = 452/571; 79.2%) indicated that they knew how much sunscreen to apply; the most popular frequency of application was once daily (n = 180/571; 31.5%). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of the skin (n = 418/571; 73.2%). Most respondents (n = 552/571; 96.7%) agreed that more education is needed regarding the importance of wearing sunscreen. The three most popular factors influencing sunscreen choice were a sun protection factor (SPF) &gt; 50 (n = 299/571; 52.4%), dermatologist recommendation (n = 267/571; 46.8%) and price (n = 262/571; 45.9). Sustainable packaging (n = 45/571; 7.9%) and ethical sourcing of ingredients (n = 65/571; 11.4%) were not ranked highly. Given that 42.0% (n = 240/571) only applied sunscreen on sunny days, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining the views and perceptions of sunscreen in a cohort of people without melanoma is strongly encouraged.
CardioHotspots: a database of mutational hotspots for cardiac disorders
Authors: García S Alberto , Costa Mireia , García-Zarzoso Alba , Pastor Oscar 
Published: May 2024

Abstract
Mutational hotspots are DNA regions with an abnormally high frequency of genetic variants. Identifying whether a variant is located in a mutational hotspot is critical for determining the variant’s role in disorder predisposition, development, and treatment response. Despite their significance, current databases on mutational hotspots are limited to the oncology domain. However, identifying mutational hotspots is critical for any disorder in which genetics plays a role. This is true for the world’s leading cause of death: cardiac disorders. In this work, we present CardioHotspots, a literature-based database of manually curated hotspots for cardiac diseases. This is the only database we know of that provides high-quality and easily accessible information about hotspots associated with cardiac disorders. CardioHotspots is publicly accessible via a web-based platform ( https://genomics-hub.pros.dsic.upv.es:3099/).
Database URL: https://genomics-hub.pros.dsic.upv.es:3099/.
Mixing properties of coronary infusion catheters assessed by in vitro experiments and computational fluid dynamics
Authors: de Vos Annemiek , Troost Sophie , Waterschoot Anke , Pijls Nico , van ‘t Veer Marcel 
Published: May 2024

Abstract

Aims
Continuous infusion thermodilution is an established technique for the assessment of absolute coronary blood flow and microvascular resistance due to its proven accuracy and reproducibility. However, for this technique to yield reliable measurements, direct and homogenous mixing of injected saline and blood is mandatory. This study aimed to assess and compare the mixing properties of two different microcatheters, namely the Rayflow® (with sideholes for infusion) and the Finecross® catheter (single end-hole for infusion), which are commonly used in the catheterization laboratory.

Methods and results
The study employed three different methods to evaluate the mixing properties of the catheters. Firstly, a qualitative assessment of mixing was performed using ink injections in an in vitro bench model of a coronary artery. Secondly, in analogy to the human catheterization laboratory, mixing properties over the length of the coronary artery were assessed semi-quantitatively by temperature measurements in the bench model. Lastly, a quantitative assessment was performed by 3D computational fluid dynamics, where the standard deviation and entropy ratio of the temperature over the cross-section in the coronary artery model were calculated for both catheters.

Conclusion
All three evaluation methods demonstrated that the Rayflow catheter’s specific design leads to a more optimal, homogeneous mixture of blood and saline over both the cross-section and length of a coronary vessel, as compared with the standard end-hole catheter.
Ticagrelor monotherapy for acute coronary syndrome: an individual patient data meta-analysis of TICO and T-PASS trials
Authors: Lee Yong-Joon , Shin Sanghoon , Kwon Sung Woo , Suh Yongsung , Yun Kyeong Ho , Kang Tae Soo , Lee Jun-Won , Cho Deok-Kyu , Park Jong-Kwan , Bae Jang-Whan , Kang Woong Cheol , Kim Seunghwan , Lee Seung-Jun , Hong Sung-Jin , Ahn Chul-Min , Kim Jung-Sun , Kim Byeong-Keuk , Ko Young-Guk , Choi Donghoon , Jang Yangsoo , Hong Myeong-Ki 
Published: May 2024

Abstract

Background and Aims
In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS.

Methods
Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year.

Results
Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56–1.13; P = .194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40–0.72; P &lt; .001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome.

Conclusions
In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT.

Study registration
PROSPERO (ID: CRD42023476470).
Long QT syndrome: importance of reassessing arrhythmic risk after treatment initiation
Authors: Dusi Veronica , Dagradi Federica , Spazzolini Carla , Crotti Lia , Cerea Paolo , Giovenzana Fulvio L F , Musu Giulia , Pedrazzini Matteo , Torchio Margherita , Schwartz Peter J 
Published: May 2024

Abstract

Background and Aims
Risk scores are proposed for genetic arrhythmias. Having proposed in 2010 one such score (M-FACT) for the long QT syndrome (LQTS), this study aims to test whether adherence to its suggestions would be appropriate.

Methods
LQT1/2/3 and genotype-negative patients without aborted cardiac arrest (ACA) before diagnosis or cardiac events (CEs) below age 1 were included in the study, focusing on an M-FACT score ≥2 (intermediate/high risk), either at presentation (static) or during follow-up (dynamic), previously associated with 40% risk of implantable cardioverter defibrillator (ICD) shocks within 4 years.

Results
Overall, 946 patients (26 ± 19 years at diagnosis, 51% female) were included. Beta-blocker (βB) therapy in 94% of them reduced the rate of those with a QTc ≥500 ms from 18% to 12% (P &lt; .001). During 7 ± 6 years of follow-up, none died; 4% had CEs, including 0.4% with ACA. A static M-FACT ≥2 was present in 110 patients, of whom 106 received βBs. In 49/106 patients with persistent dynamic M-FACT ≥2, further therapeutic optimization (left cardiac sympathetic denervation in 55%, mexiletine in 31%, and ICD at 27%) resulted in just 7 (14%) patients with CEs (no ACA), with no CEs in the remaining 57. Additionally, 32 patients developed a dynamic M-FACT ≥2 but, after therapeutic optimization, only 3 (9%) had CEs. According to an M-FACT score ≥2, a total of 142 patients should have received an ICD, but only 22/142 (15%) were implanted, with shocks reported in 3.

Conclusions
Beta-blockers often shorten QTc, thus changing risk scores and ICD indications for primary prevention. Yearly risk reassessment with therapy optimization leads to fewer ICD implants (3%) without increasing life-threatening events.
PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN DISEASE IN HIGH BLEEDING RISK: OUTCOMES FROM A SUBANALYSIS OF THE DELTA 2 REGISTRY
Authors: Federico F , Botti G , Meliga E , Daemen J , D‘Ascenzo F , Capodanno D , Tchetche D , Van Mieghem N , Nakamura S , Tamburino C , Mehran R , Montorfano M , Chieffo A 
Published: May 2024

Abstract

Introduction
High bleeding risk (HBR) can represent a challenge, especially in patients with complex coronary lesions undergoing PCI. This study aims at investigating the prevalence of HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI, describing their clinical phenotype, and reporting their procedural outcomes.

Methods
The analysis was performed on data from the DELTA 2 Registry, which prospectively included patients who underwent LM PCI at 19 centers worldwide. The patients were defined to be at HBR if ≥1 Major Criteria or ≥2 Minor Criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all–cause death, myocardial infarction (MI) or stroke at median follow–up.

Results
A total of 1531 patients were included, the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR had higher prevalence of ACS at presentation (49.2% vs 26.8%, p&lt;0.001), and experienced higher in hospital mortality (1.8% vs 0.2%; p=0.029) and MI (5.0% vs 2.1%, p=0.009) (Figure, Panel A). The median follow–up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs 6.1%; HR 3.3; 95% CI: 2.2–4.8) (Figure, Panel B), and significantly driven by all cause death (16.2% vs 4.6%; HR: 3.3; 95% CI:2.2–5.1) and MI (5.8% vs 1.9%; HR 2.9; 95% CI: 1.5–5.7). Conversely no significant difference was reported in terms of target lesion revascularization (TLR) probable or defined stent thrombosis.

Conclusions
HBR patients undergoing LM PCI experienced higher rates of all cause death and MI at follow–up; similar outcomes were also reported in–hospital.
THE COPRESENCE OF HYPOVITAMINOSIS D AND DIABETES MELLITUS TRIPLES THE OCCURRENCE OF SEVERE CAD IN WOMEN
Authors: Aleksova A , Fluca A , Zandonà L , Stenner E , Chicco A , Pani B , Derin A , Marketou M , D‘Errico S , Sinagra G , Janjusevic M 
Published: May 2024

Abstract

Background
Suboptimal levels of vitamin D have been associated with imbalanced calcium homeostasis, impaired glucose and lipid metabolism, increased oxidative stress, inflammatory state and endothelial dysfunction. Despite a growing prevalence of hypovitaminosis D affecting all age groups and mostly female gender (defined as vitamin D levels ≤ 20 ng/ml), our knowledge about the relationship between vitamin D levels and the severity of coronary artery disease (CAD) between genders remains limited.

Aim and Methods
In order to study the gender variations in hypovitaminosis D levels and the severity of CAD in individuals suffering from acute myocardial infarction (AMI), blood samples were obtained on hospital admission from patients with AMI enrolled from 2014 to 2022. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three–vessel disease.

Results
1484 patients were enrolled in the study. The mean age within the cohort was 66.25 (11.47) years, with a predominant male representation (71.8%). Overall, 86.2% of patients exhibited CAD, while 32.9% had severe CAD. The median concentration of serum vitamin D was 17.25 [10.3 – 24.7] ng/ml, and hypovitaminosis D was observed in 59.7% of patients. The prevalence of hypovitaminosis D was significantly higher in women with severe CAD (74.1% vs 58.1%, p=0.002), whereas no statistically significant difference was noted among men with this clinical presentation (61.3% vs 57.1%, p=0.193). In female patients, hypovitaminosis D (OR: 1.85, p=0.013), alongside diabetes mellitus (DM) and advanced age, emerged as a predictive factor for severe CAD after adjusting for confounding variables such as glomerular filtration rate &lt;60 mL/min/1.73 m², elevated cholesterol levels, and body mass index. However, hypovitaminosis D did not demonstrate independent predictive significance for severe CAD in male patients. Among female patients, those who had both hypovitaminosis D and DM exhibited a risk of more than three times higher for a severe CAD diagnosis compared to those who did not have hypovitaminosis D or DM (OR: 3.56 [1.8–7.03], p=0.021).

Conclusion
The identification of hypovitaminosis D as a predictor for severe CAD specifically in women represents the original aspect of our research. Moreover, our findings highlight that the risk of the incidence of severe CAD is more than tripled for women having both vitamin D deficiency and DM.
A LONG QT SYNDROME WITHOUT MANIFESTATION
Authors: Magnano R , Rossi D , Pezzi L , Scollo D , Civitarese T , Odoardi A , Carnesale R , Vitulli P , D‘Alleva A , Forlani D , Genovesi E , Gallina S , Paloscia L , Di Marco M 
Published: May 2024

Abstract
A 66–year–old Caucasian woman presented for outpatient evaluation due to elevated blood pressure levels at home (approximately 220/120 mmHg) and a significant family history of long QT syndrome. The index case in the family appeared to be her sister, investigated following an ECG showing markedly prolonged QT interval and a family history of sudden cardiac death. The patient underwent genetic analysis, revealing a positive mutation in KCNQ1. She was currently on treatment with Levotiroxina for recently discovered hypothyroidism.The ECG showed sinus rhythm with a heart rate of 85 bpm, signs of left ventricular hypertrophy, particularly Sokolow (SV1 + RV6 70 mm) and Peguero Lo Presti (SD + SV4 50 mm). The QTc interval was 515 ms (Bazett). Echocardiography revealed severe left ventricular hypertrophy (SIVd 14 mm; PWd 12 mm; LVMi 128 g/m2; RWT 0.5) with normal overall systolic function (EF 60%). No significant valvular pathologies were observed, and the right ventricle appeared normal in size and function.The hypertrophy was attributed to uncontrolled severe arterial hypertension. However, the identification of a prolonged QT interval in a patient with a strong family component (Schwartz score 4, high probability) led to genetic testing, confirming a mutation in KCNQ1. As the patient was asymptomatic with a low risk of major arrhythmias over the next 5 years (1–2–3–LQTS–risk score 2.77%), she entered follow–up and received beta–blocker therapy, specifically nadolol, combined with other antihypertensive medications.This clinical case describes an entire family with LQTS1 (type 1) positive for KCNQ1 mutation, exhibiting phenotypic manifestations distinct from those reported in the literature. Notably, there was a prevalence in females, and the condition was incidentally discovered during a routine checkup conducted for unrelated reasons, without any history of major arrhythmias.Long QT syndrome (LQTS) is characterized by a prolonged QT interval, predisposing individuals to life–threatening arrhythmias leading to syncope and sudden death. Mutations in genes encoding ion channels account for 75% of LQTS cases. LQTS1, associated with a "loss–of–function" mutation in the KCNQ1 gene, represents one of the three genetic subtypes. LQTS1 typically manifests with arrhythmias in childhood, with a male predominance. Adrenergic triggers are crucial precipitants for arrhythmic events
THE “BACK TO THE FUTURE” OF CARDIOTHORACIC SURGERY: HIGH–RISK INTERVENTIONAL PROCEDURE TURNED DOWN TO CONVENTIONAL CARDIAC SURGERY
Authors: Totaro P , Aiello M , Pelenghi S 
Published: May 2024

Abstract

Background
Structural interventional cardiology has been introduced at the beginning of our century to address high–risk patient suffering from severe aortic stenosis. Since then several technique and technology have been proposed to address an increasing population of patients and mitral valve diseases have been also addressed. While several authors are pushing up the indications for structural interventional procedures, however, we are experiencing some situations were conventional surgery is considered an alternative to high risk interventional procedures. Here we present a peculiar case of “back to the future” in cardiothoracic surgery.

Case Description
A 76 yo female patient, was referred to our Division from a peripheral Hospital suffering from severe aortic stenosis and coronary artery diseases. Medical history of the patient included persistent AF, COPD, arterial peripheral vascular disease, moderate chronic renal insufficiency and moderate dilatation of ascending aorta. Patient was previously assessed by another Centre and a percutaneous treatment (PTCA+TAVI) was proposed. Due to further admission for cardiac failure–related symptoms, however, patient was urgently referred to our Division. Fig 1 and 2 summarized clinical findings. “Heart team” evaluation, based also on the product specialist evaluation, considered the patient not suitable for interventional procedure due to the high risk of sub–optimal medium–term prognosis. Due to further clinical deterioration an extremely high–risk surgical procedure was mandatory.

Results
Surgical procedure included a sutureless aortic valve replacement, a MV plasty, a double coronary graft + a cpmbined carotid endoarterectomy. Postoperative course was free from significant complications and the patient was discharged to rehabilitation clinic on 15th postoperative days.

Conclusion
Despite interventional procedure are continuing to increase either as number of procedure either as complexity of diseases treated, conventional cardiac surgery remains still the only option for treatment in many clinical scenario. As a sort of “back to the future” situation, patient originally referred for interventional procedures are turned down due to the high risk of sub–optimal results. In such condition conventional cardiac surgery, performed with high level of accuracy could represent the last and only treatment option for high risk patients.