bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stratification of Barrett’s esophagus surveillance based on p53 immunohistochemistry: a cost-effectiveness analysis by an international collaborative group
Authors: Menon Shyam , Norman Richard , Iyer Prasad G. , Ragunath Krish 
Published: May 2024

Abstract
Background Surveillance of nondysplastic Barrett’s esophagus (NDBE) is recommended to identify progression to dysplasia; however, the most cost-effective strategy remains unclear. Mutation of TP53 or aberrant expression of p53 have been associated with the development of dysplasia in BE. We sought to determine if surveillance intervals for BE could be stratified based on p53 expression.
Methods A Markov model was developed for NDBE. Patients with NDBE underwent p53 immunohistochemistry (IHC) and those with abnormal p53 expression underwent surveillance endoscopy at 1 year, while patients with normal p53 expression underwent surveillance in 3 years. Patients with dysplasia underwent endoscopic therapy and surveillance.
Results On base-case analysis, the strategy of stratifying surveillance based on abnormal p53 IHC was cost-effective relative to conventional surveillance and a natural history model, with an incremental cost-effectiveness ratio (ICER) of $8258 for p53 IHC-based surveillance. Both the conventional and p53-stratified surveillance strategies dominated the natural history model. On probabilistic sensitivity analysis, the p53 IHC strategy ($28 652; 16.78 quality-adjusted life years [QALYs]) was more cost-effective than conventional surveillance ($25 679; 16.17 QALYs) with a net monetary benefit of $306 873 compared with conventional surveillance ($297 642), with an ICER <$50 000 in 96% of iterations. The p53-stratification strategy was associated with a 14% reduction in the overall endoscopy burden and a 59% increase in dysplasia detection.
Conclusion A surveillance strategy for BE based on abnormal p53 IHC is cost-effective relative to a conventional surveillance strategy and is likely to be associated with higher rates of dysplasia diagnosis.
Inhalation of Hydrogen-rich Gas before Acute Exercise Alleviates
Exercise Fatigue: A Randomized Crossover Study
Authors: Dong Gengxin , Wu Jianxin , Hong Yinglu , Li Qian , Liu Meng , Jiang Guole , Bao Dapeng , Manor Brad , Zhou Junhong 
Published: May 2024

AbstractHydrogen, as an antioxidant, may have the potential to mitigate fatigue and
improve selected oxidative stress markers induced by strenuous exercise. This
study focused on a previously unexplored approach involving pre-exercise
inhalation of hydrogen-rich gas (HRG). Twenty-four healthy adult men first
completed pre-laboratories to determine maximum cycling power (Wmax)
and maximum cycling time (Tmax). Then they were subjected to ride
Tmax at 80% Wmax and 60–70 rpm on cycle ergometers
after inhaled HRG or placebo gas (air) for 60-minute in a double-blind,
counterbalanced, randomized, and crossover design. The cycling frequency in the
fatigue modeling process and the rating of perceived exertion (RPE) at the
beginning and end of the ride were recorded. Before gas inhalation and after
fatigue modeling, visual analog scale (VAS) for fatigue and counter-movement
jump (CMJ) were tested, and blood samples were obtained. The results showed that
compared to a placebo, HRG inhalation induced significant improvement in VAS,
RPE, the cycling frequency during the last 30 seconds in the fatigue modeling
process, the ability to inhibit hydroxyl radicals, and serum lactate after
exercise (p<0.028), but not in CMJ height and glutathione peroxidase
activity. The cycling frequency during the last 30 seconds of all other segments
in the fatigue modeling process was within the range of 60–70 rpm. In
conclusion, HRG inhalation prior to acute exercise can alleviate
exercise-induced fatigue, maintain functional performance, and improve hydroxyl
radical and lactate levels.
Implementation of a Real-Time Documentation Assistance Tool: Automated Diagnosis (AutoDx)
Authors: Cerasale Matthew T. , Mansour Ali , Molitch-Hou Ethan , Bernstein Sean , Nguyen Tokhanh , Kao Cheng-Kai 
Published: May 2024

Abstract
Background Clinical documentation improvement programs are utilized by most health care systems to enhance provider documentation. Suggestions are sent to providers in a variety of ways, and are commonly referred to as coding queries. Responding to these coding queries can require significant provider time and do not often align with workflows. To enhance provider documentation in a more consistent manner without creating undue burden, alternative strategies are required.
Objectives The aim of this study is to evaluate the impact of a real-time documentation assistance tool, named AutoDx, on the volume of coding queries and encounter-level outcome metrics, including case-mix index (CMI).
Methods The AutoDx tool was developed utilizing tools existing within the electronic health record, and is based on the generation of messages when clinical conditions are met. These messages appear within provider notes and required little to no interaction. Initial diagnoses included in the tool were electrolyte deficiencies, obesity, and malnutrition. The tool was piloted in a cohort of Hospital Medicine providers, then expanded to the Neuro Intensive Care Unit (NICU), with addition diagnoses being added.
Results The initial Hospital Medicine implementation evaluation included 590 encounters pre- and 531 post-implementation. The volume of coding queries decreased 57% (p < 0.0001) for the targeted diagnoses compared with 6% (p = 0.77) in other high-volume diagnoses. In the NICU cohort, 829 encounters pre-implementation were compared with 680 post. The proportion of AutoDx coding queries compared with all other coding queries decreased from 54.9 to 37.1% (p < 0.0001). During the same period, CMI demonstrated a significant increase post-implementation (4.00 vs. 4.55, p = 0.02).
Conclusion The real-time documentation assistance tool led to a significant decrease in coding queries for targeted diagnoses in two unique provider cohorts. This improvement was also associated with a significant increase in CMI during the implementation time period.
TFL Perforator Flap Complementing and Completing the ALT–AMT Flap Axis
Authors: Jaiswal Dushyant , Saxena Bharat , Mathews Saumya , Mantri Mayur , Pilania Vineet , Bindu Ameya , Shankhdhar Vinay Kant , Yadav Prabha 
Published: May 2024

Abstract
Background Anterolateral thigh (ALT) flap is the most common soft tissue flap used for microvascular reconstruction of head and neck. Its harvest is associated with some unpredictability due to variability in perforator characteristics, injury or unfavorable configuration for complex defects. Anteromedial thigh (AMT) flap is an option, but the low incidence and thickness restrict its utility. Tensor fascia lata (TFL) perforator (TFLP) flap is an excellent option to complement ALT. Its perforator is consistent, robust, in vicinity, and lends itself with the ALT perforator.
Methods This study was an analysis of 29 cases with a free flap for head neck reconstruction with an element of TFLP flap from July 2017 to May 2021.
Results All cases were primarily planned for an ALT reconstruction. There was absence of the ALT perforator in 16 cases but a sizable TFL perforator was available. In 13 cases, the complex defect warranted use of both ALT plus TFL in a conjoint (5), chimeric (5), and multiple (3) free flaps manner. Most common perforator location was septocutaneous between the TFL and gluteus medius. There was complete flap loss in two cases and partial necrosis in two. No adjuvant therapy was delayed.
Conclusion TFLP can reliably complement the ALT/AMT axis. Chimeric ALT–TFL can be harvested for large, complex, multicomponent, and multidimensional defects.
A Rare Case of Clival Hemangioma Simulating Chordoma
Authors: Isolan Gustavo Rassier , Smith Alessandra Locatelli , Meotti Camila , Telles João Paulo Mota , Rabelo Nícollas Nunes , Figueiredo Eberval Gadelha 
Published: May 2024

AbstractPrimary intraosseous hemangiomas are rare, benign, vascular malformations that account for ∼1% of all primary bone neoplasias. A 59-year-old female patient with unknown comorbidities had a history of headache, visual impairment and dizziness that led to the diagnosis of a clivus tumor. Two resections were attempted through transcranial and transnasal transsphenoidal approach in the last two years in another hospital. The initial MRI scan showed an expansive lesion with T2 hyperintense signal and diffuse, heterogenic contrast enhancement. Clival chordoma was the main diagnostic hypothesis done. A CT scan was performed to evaluate the extent of clival invasion, the sinus anatomy, and the clival destruction - all simulating clival chordoma. The interdisciplinary tumor board decided to proceed with endoscopic endonasal tumor resection. There were no postoperative complications and the histopathological analysis revealed a primary intraosseous haemangioma. Skull base intraosseous hemangiomas are rare entities, with a limited number of case reports found after literature reviews, especially in the clival region. The clinical pattern and imaging characteristics can vary widely according to the tumor extension and development, simulating some other common tumors found at this topography. We present a case report of a clival intraosseous hemangioma presenting as an isolated abducens paresis with a positive outcome after intranasal endoscopic resection after two years of follow-up.
Quiste óseo aneurismático del atlas: Tratamiento con denosumab y reporte de caso
Authors: Droguett Sebastián , Hernández Jorge , Adriazola Francisco 
Published: May 2024

ResumenPresentamos un caso de quiste óseo aneurismático (QOA) de ubicación infrecuente y comportamiento agresivo en un paciente masculino de 28 años, en que la resección quirúrgica es controversial por el riesgo de iatrogenia y eventual recurrencia. El tratamiento con denosumab ha sido recientemente propuesto como una alternativa para el manejo de QOAs irresecables o recurrentes; sin embargo, la literatura disponible es escasa. Reportamos nuestra experiencia en un caso y analizamos la bibliografía disponible.
The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years
Authors: McClure R. Scott , Rommens Kenton L. , Herget Eric J. , Keir Michelle , Gregory Alex J. , Smith Holly N. , Moore Randy D. 
Published: May 2024

Abstract
Background This study aimed to assess feasibility, logistical challenges, and clinical outcomes associated with the implementation of an Aortic Team model for the management of distal arch, descending thoracic and thoracoabdominal aortic disease.
Methods An Aortic Team care pathway was implemented in November 2019. Working as a unit, two cardiac surgeons, two vascular surgeons, an interventional radiologist, a cardiologist, and an anesthesiologist collectively determined care decisions via multispecialty presence at an Aortic Clinic. Cardiac and vascular surgeons operated in tandem for open procedures. Interventional radiology participated alongside cardiac and vascular for endovascular procedures. Cardiology aided in medical therapies for heritable and degenerative disease, and had a lead role for genetics and high-risk pregnancy referrals. The model spanned three hospitals. Clinical outcomes at 3 years were assessed.
Results There were 35 descending thoracic and thoracoabdominal surgeries and 77 thoracic endovascular aortic repairs. Endoarch devices were used in 7 cases (Gore Thoracic Branch Endoprosthesis, 4, Terumo RelayBranch, 3) and an endothoracoabdominal device in 4 cases (Cook Zenith t-branch). The Aortic Clinic acquired 456 patients, with yearly increases (54 patients [year 1], 181 patients [year 2], 221 patients [year 3]). For surgery, mortality was 8.6% (3/35), permanent paralysis 5.7% (2/35), stroke 8.6% (3/35), permanent dialysis 0%, and reinterventions 8.6% (3/35). For endovascular cases, mortality was 3.9% (3/77), permanent paralysis 3.9% (3/77), stroke 5.2% (4/77), permanent dialysis 1.3% (1/77), and reinterventions 16.9% (13/77).
Conclusion An Aortic Team model is feasible and ensures all treatment options are considered. Conventional open thoracoabdominal procedures showed acceptable outcomes. Endoarch technology shows early promise.
Paradoxical Air Embolism in Spinal Surgery: Case Report and Literature Review
Authors: Miotto Guilherme José , Martio Artur Eduardo , Filho Paulo Moacir Mesquita , Karam Octávio Ruschel , Padua Wagner Lazaretto , Berres Taís Otilia , Saltiél Renan Mathias Ferreira 
Published: May 2024

AbstractAir embolism (AE) is a subtype of embolism, caused by the entry of air into the vascular system. It is a predominantly iatrogenic complication, and its symptomatic form is severe, although uncommon. In some cases, a venous thrombi may pass into the arterial system through a venous-arterial shunt, characterizing a paradoxical embolism. Here, we describe the case of a previously healthy 44-year-old female who underwent cauda equina decompression and lumbar epidural abscess drainage. The patient suffered a paradoxical AE intraoperatively and died after 4 days. The occurrence of AE in lumbar spine surgeries in the prone position is rare, but the surgical team must be attentive to its clinical signs and quickly institute initial management when necessary.
Potency of the Combination of Chitosan and Hydroxyapatite on Angiogenesis and Fibroblast Cell Proliferation in Direct Pulp Capping of Rattus norvegicus
Authors: Sularsih Sularsih , Fransiska Wanli , Salsabila Syifa , Rahmitasari Fitria , Soesilo Diana , Prananingrum Widyasri 
Published: May 2024

Abstract
Objectives The aim of this research was to analyze expression of vascular endothelial growth factor (VEGF), blood vessels, and fibroblast cell proliferation in direct pulp capping treatment of Rattus norvegicus using a combination of chitosan and hydroxyapatite paste.
Materials and Methods The samples were male R. norvegicus strains of Wistar rats, weighing 200 to 250 g and aged between 8 and 16 weeks. The occlusal surface of the molars of R. norvegicus was prepared with class I cavity and then perforated with the tip of an explorer. Sixty male R. Norvegicus rats were divided into the following: control group (KA) in which the cavity was filled with glass ionomer cement; control group (KB), in which the cavity was filled with Ca(OH)2; PA group, in which the cavity was filled with chitosan (CH); PB group, in which the cavity was filled with hydroxyapatite (HA); and PC group, in which the cavity was filled with chitosan and hydroxyapatite (CH-HA). Each group was divided into 3-, 7-, and 14-day observation groups. The mandibular bone of the molar was cut and histopathological examination was performed to analyze the blood vessels and fibroblast cell proliferation. Immunohistochemistry examination was done to examine the expression of VEGF.
Statistical Analysis The data variation was analyzed with One Way Analysis of Variance (ANOVA) test and continued with multiple comparison Least Significant (LSD) test to determine the different pairs of group.
Results Analysis of variance (ANOVA) showed a significant increase in the expression of VEGF, blood vessels, and fibroblast cell proliferations (p ≤ 0.05;), especially in the PC group compared to the other four groups. The least significant test (LSD) test showed significant differences between the groups on the expression of VEGF, blood vessels, and fibroblast cell proliferations.
Conclusion The combination of chitosan and hydroxyapatite could promote healing of direct pulp capping treatment by increasing the expression of VEGF, blood vessel, and fibroblast cell proliferation.
Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial
Authors: Kalsad Anusha S. , Mishra Gayatri , R. Sripriya , Kameshwar Yasha V. , VR Hemanth Kumar 
Published: May 2024

Abstract
Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility.
Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance.
Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups.
Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.
Pulmonary Arterial Anatomical Patterns: A Classification Scheme Based on Lobectomy and 3D-CTBA
Authors: Xie Zhuolin , Zhu Xinyu , Li Feifei , Zhao Jun , Li Chang 
Published: May 2024

Abstract
Purpose Preoperative evaluation of pulmonary vascular and tracheal routes and variations is of great importance to the surgeon. Three-dimensional computed tomography bronchography and angiography (3D-CTBA) has evolved in recent years with the optimization of 3D reconstruction techniques and artificial intelligence. We aim to apply CT angiography and Exoview 3D reconstruction technology to assess patients' pulmonary arterial tree and its anatomical variants and to try to summarize a set of anatomical typing of the pulmonary arterial tree that is relatively easy and conducive to promoting teaching based on surgical habits of lobectomy.
Methods A total of 358 patients hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Soochow University between July 2020 and August 2021 were included in this study. We carefully analyzed the site of emanation, alignment, and number of branches of the pulmonary artery according to a uniform classification method in conjunction with the two-dimensional CT images and transformed them into 3D reconstruction models.
Results Different types of pulmonary artery were observed in 358 cases. We evaluated the complete pulmonary artery tree and counted the number and frequency of major arteries of the pulmonary based on the surgical habits of anatomical lobectomy.
Conclusion The 3D-CTBA technique enables us to adequately assess the anatomy of the pulmonary arteries. Moreover, we provide a practical classification scheme of pulmonary arterial anatomical patterns based on lobectomy and 3D-CTBA. Our data can be used by clinicians in the teaching of pulmonary artery anatomy and the preoperative preparation for anatomical lobectomy.
Exploring the Epidemiology and Clinico-Demographic Characteristics of Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis
Authors: Bhat Javeed Iqbal , Zargar Shahan Iqbal , Bhat Mudasir Hamid , Tramboo Zubair Mushtaq , Charoo Bashir Ahmad , Thoker Zubair Ahmad 
Published: May 2024

Abstract
Objective This study aimed to find the prevalence and clinico-demographic profile of cystic fibrosis (CF) children with allergic bronchopulmonary aspergillosis (ABPA).
Methods A cross-sectional study was conducted at a CF clinic of a tertiary care hospital. Participants included the diagnosed cases of children with CF, of both genders, from 4 to 18 years of age.
Results A total of 61 patients were enrolled. Sixteen patients (26.2%) had Aspergillus fumigatus sensitization—among these, 10 (16.4%) patients fulfilled the minimum diagnostic criteria for ABPA and 6 (9.8%) had A. fumigatus sensitization only. Two patients were below the age of 5 years, while eight patients were more than 6 years old. The female-to-male ratio was 6:4. High attenuated mucus was the specific finding in our study cohort on computed tomography (CT) chest. All patients with ABPA had significantly higher median (interquartile range [IQR]) levels of total IgE, specific IgE, and IgG for A. fumigatus, and total eosinophil count compared to patients without ABPA. There was also a significant decrease in forced exhalation volume in first second (FEV1) values (6 months apart) in ABPA patients.
Conclusion Our study found that ABPA affects 16.4% of our CF population, with 20% of cases occurring in children aged 4 to 5 years. We observed a higher prevalence of ABPA in patients from rural areas. Eosinophilia and serial decline in FEV1 values were observed as potential early markers for ABPA.
Addressing Low Health Literacy in Surgical Populations
Authors: English Nathan C. , Jones Bayley A. , Chu Daniel I. 
Published: May 2024

AbstractHealth literacy is defined as the ability to obtain, engage, understand, and act upon health information to make decisions about health care. Health literacy is a key determinant of health outcomes and disparities including those in surgery. Over one-third of surgical patients suffer from low health literacy, with disproportionately higher rates among older, rural, and black patients. Low health literacy has been associated with poor adherence to preoperative and discharge instructions, longer lengths-of-stay, higher readmission rates, and higher health care costs. However, health literacy is modifiable, and therefore it is uniquely positioned for meaningful interventions at the patient, provider, and system level. These interventions include using more visual aids with patients and families (patient level), communicating in more understandable ways (provider level), and improving the organizational health literacy of hospitals (system level). Through high-quality research and multilevel interventions, significant opportunities exist to address low health literacy and improve outcomes, eliminate disparities, and reduce costs for this disparity population.