bluuebunny/crossref_metadata_2025_split huggingface dataset:
ALTERNATIVE STRATEGIES FOR LEFT SUBCLAVIAN ARTERY REVASCULARIZATION DURING ZONE–2 AORTIC ARCH SURGERYEMENT
Authors: Totaro P , Kushta E , Aiello M , Pelenghi S 
Published: May 2024

Abstract

Objective
Anatomical extension of surgical treatment of thoracic aortic pathologies involving the aortic arch is still controversial. The adoption of distal anastomosis in aortic arch zone–2 (Z2–AAR), in order to facilitate bleeding control, has been widely recommended. In such case the revascularization of left subclavian artery (LSA) may add further concerns. Here we report our different strategy of LSA revascularization in 2 different scenario of Z2–AAR Clinical.

Cases

Case#1
17 yo male patient affected by Loeys–Dietz Syndrome and a previous David procedure at age of 11yo. He presented complaining chest pain and CT scan revealed a dilatation (5,8 cm) of ascending aorta and an intimal flap with preserved previous distal anastomosis. Surgical strategy #1 (Left subclavian artery in situ): Arch replacement (Zone 2 distal anastomosis) with Siena Graft 24mm and modified Elephant Trunk Tecnique (2cm distal endoluminal graft). Innominate artery and left carotid artery reimplantation. Distal Anastomosis Siena 24 (Z2).

Case #2
78 yo male with a previous (6 month before) Biological AVR (Trifecta 25) + ascending aorta replacement (Jotec 30). Presented complaining acute chest pain, CT Scan revealed a residual dilatation of distal ascending aorta, dissection/rupture of distal aortic arch at level of a complicated plaque. Surgical strategy #2 (Left subclavian artery reimplanted): Arch replacement (Zone 2 distal anastomosis) with Siena Graft 30mm and Elephant trunk Teccnique (10cm distal endoluminal graft). Closure of the extended ulcera. Total epiaortic vessels de–branching 10 mm Tube on LSA – Distal Anastomosis Siena 30 (Z2).

Conclusion
Surgical extension of aortic arch replacement is still matter of discussion. Zone–2 approach for aortic arch replacement seems a safe and effective option. In our mind strategy for left subclavian revascularization should be tailored according patient’s anatomy and potential future scenarios.
DECENNIAL ANALYSIS OF AVNRT ABLATION IN A SINGLE CENTRE
Authors: Ciliberti D , Zaccaria C , Perrotta L , Ricciardi G , Checchi L , Brogni F , Porcedda G , De Simone L , Michelucci A , Pieragnoli P 
Published: May 2024

Abstract

Background
Transcatheter ablation represents the first line therapy for atrio–ventricular nodal re–entrant tachycardia (AVNRT). Both radiofrequency (RF) and cryoablation (CRYO) have been shown to be effective, with a better safety profile for CRYO. Data on very long–term efficacy are scarces.

Purpose
To review our experience in AVNRT ablation performed in the last ten years and evaluate safety, efficacy and very long–term outcome of RF and CRYO.

Methods
We retrospectively analyzed all patients who underwent AVNRT ablation (RF or CRYO) between January 2013 and May 2023 at our centre. The majority of procedures were performed under electro–anatomical mapping (EAM) guidance to reduce radiation exposure. Acute efficacy endpoint was defined as slow pathway ablation, while long–term outcome was defined as the absence of AVNRT recurrence.

Results
A total of 387 consecutive patients (60,5% F; mean age 48 ± 19 years) were included; CRYO was performed in 241 patients (62%), RF in 131 patients (34%), hybrid approach (CRYO+RF) in 15 patients (4%). AVNRT induction was obtained during EPS in 295 cases (76%), in 25,4% after isoprotenerol administration. No significant differences for baseline characteristics were observed between the two groups except for age (CRYO: 42,2 ± 18 years vs RF 57,19 ± 16,5 years p &lt;0.001). In pediatric population CRYO was performed in 93% of procedures. Figure 1 shows the distribution of RF/CRYO over 10 years at our centre, with a trend of significant increase in CRYO utilizations in the last years. Acute success was achieved in all 387 cases (100%; delta WP 28,5 ± 23,1 ms, delta AVN ERP 72,4 ± 44,7 ms). No permanent AV block or major periprocedural complications occurred, however transient AH prolongation was observed in 0.8% in CRYO pts vs 2,8% RF pts. The mean follow–up was 73±45 months, range 6–129 months. Overall long–term success rate was 93,3%, ranging from 91,3 % in CRYO and 96,6% in RF. Recurrence occurred in 26 cases (6,7%) after a median time of 20 months (4–40months). Recurrent AVNRT were treated with RF in the majority of cases, CRYO in 6 procedures, hybrid in only 1 case.

Conclusions
Transcatheter ablation is a safe and effective therapy for AVNRT. Our very long–term outcome data confirmed very high success rate even after 10 years follow–up. The increasing choice for CRYO may be due to the increasing number of pediatric and young patient referred to our centre.
A CAROTID GLOMUS TUMOR TREATED WITH SAPHENOUS BYPASS: A 15–YEAR FOLLOW–UP
Authors: Fazio G 
Published: May 2024

Abstract

Background
Carotid glomus is an exceptional extra–adrenal paraganglioma in childhood originating at the carotid body. Only 3% of paragangliomas occur in the head and the neck. Surgical resection of complex glomus tumors can be complicated by extensive blood loss and might require surgical sacrifice of an encased internal carotid artery. We report a 15 years follow up of a patient treated for a carotid glomus tumor.

Case Report
A 81 years old patient was admitted in our surgery division for a inguinal hernia. Before the surgery treatment a cardiological consult was performed. The patients reported a clinical history of carotid glomus tumor (Figure 1) detected for a transient ischemic attack. 15 years before a venous by–pass was performed, and till now the patients was asymptomatic. We investigated the saphenous vein bypass that presented a normal flow and was in good conditions. So the surgery for hernia was permitted.
LEFT BUNDLE BRANCH BLOCK AND ACUTE CORONARY SYNDROME: WHAT IS THE ROLE OF MODIFIED SGARBOSSA–SMITH CRITERIA AND THE WELLENS‘ PATTERN?
Authors: Pierfelice F , Ottaviani A , Zimarino M , Ricci F , Renda G , Gallina S 
Published: May 2024

Abstract
A 55–year–old man presented to the emergency room with intermittent chest pain that started the day before. His medical history included hypertension, and dyslipidemia. The initial electrocardiogram (ECG) showed sinus rhythm (75 bpm) with pre–existing left bundle branch block (LBBB), without modified Sgarbossa–Smith criteria, despite the hyperacute appearance of T waves in V2–V4 (Fig. 1). Additionally, there were alterations in ventricular repolarization in the lateral region, morphologically not fully justifiable by the mentioned conduction delay. Echocardiography revealed normal left and right ventricular systolic function and no valvular abnormalities. Laboratory tests showed a pathological release of myocardial necrosis enzymes, with a typical rise–and–fall curve (10 pg/mL, 100 pg/mL, 200 pg/mL; normal range: 1.7–34.2 pg/mL). Therefore, the patient was admitted to the intensive cardiac care unit (ICCU) with a working diagnosis of non–ST–segment elevation myocardial infarction (NSTEMI). There were no recurrent angina episodes or signs/symptoms of heart failure on physical examination. During hospitalization, ECG and echocardiography were repeated. The follow–up ECG (12 hours after admission) showed persistent LBBB with biphasic T waves in leads V2–V5 with slight negative deflection at the end. This T wave abnormality can be interpreted as Wellens’ ECG Type A (Fig. 3A). The echocardiogram remained unchanged. Consequently, the catheterization lab was activated for urgent coronary angiography. The examination revealed subocclusion of the mid–segment of the left anterior descending artery (LAD). A drug–eluting stent was deployed in the culprit lesion (Fig. 2), restoring coronary flow completely (TIMI Flow 3). The subsequent hospital stay proceeded without complications. The ECG performed before discharge showed a typical LBBB, with normalization of T waves in precordial leads (Fig 3B). The presented case is about ECGs containing a pre–existing LBBB pattern in a patient with chest pain. The modified Sgarbossa–Smith criteria were not met in either the first recorded ECG or the second, whereas Wellens’ signs were detectable. Wellens’ syndrome can be diagnosed in a case of LBBB and help detect a high–grade LAD stenosis even if modified Sgarbossa–Smith criteria are not met.
THE SIGN OF THE HORNS: A RARE CASE OF DOUBLE PERI–COMMISSURAL MITRAL FLAIL
Authors: Tofoni P , Capodaglio I , Lofiego C , Vagnarelli F , Patani F , Brugiatelli L , Maurizi K , Pietrucci F , Perna G , Dello Russo A , Di Eusanio M 
Published: May 2024

Abstract

A 80–year–old man with history of hypertension and dyslipidemia was admitted to our Cardiology Unit for exertional dyspnea (NYHA III) occurred during the last few days. The physical examination showed a systolic heart murmur (4/6 on Levine scale) and signs of pulmonary congestion. Transthoracic echocardiography revealed a massive mitral regurgitation (Fig.1) together with severe dilation of the left atrium, mild–to–moderate aortic regurgitation, high probability of pulmonary hypertension and normal biventricular systolic function. A transesophageal echocardiography (TEE) was performed to clarify mitral valve anatomy. A double flail of the posterior leaflet was present involving the peri–commissural portions due to a single chordal rupture on P1 scallop and a double chordal rupture on P3 scallop (Fig.2). P2 scallop was prolapsing and there was a billowing of the anterior leaflet. In addiction mitral annulus was dilated (antero–posterior diameter of 43 mm and intercommissural diameter of 45 mm). We named this finding “sign of the horns” for his 3D echocardiographic appearance (Fig.3) given the double flail resembling two fingers. A surgical correction was performed with 3 GoreTex neochords implantation on the posterior leaflet and an annuloplasty ring (Physio II n. 34) implantation during extracorporeal circulation through right anterior minithoracotomy. Surgical and echocardiographic results were optimal. The patient was discharged after 7 days of hospitalization.

Conclusion
Coexistence of a double peri–commissural flail in the same leaflet is a very rare echocardiographic finding and we named it “double horn sign”. TEE is an essential examination in this scenario in order to understand the exact mechanism of the regurgitation for an optimal preoperative planning.
Causal relationship between primary biliary cholangitis and inflammatory bowel disease: a Mendelian randomization study
Authors: Zhu Qi , Fu Yunfeng , Qiu Jianhao , Guan Langyi , Liao Foqiang , Xing Yawei , Zhou Xiaodong 
Published: May 2024

Abstract

Background
Several studies indicated that inflammatory bowel disease (IBD) may contribute to increased susceptibility to primary biliary cholangitis (PBC). However, the causal relationship between IBD and PBC remains unclear.

Methods
The genetic variant data of patients with IBD and PBC were obtained from published genome-wide association studies (GWASs). The IBD data were further divided into a discovery dataset and a validation dataset depending on the data source. We conducted a two-sample Mendelian randomization (MR) analysis using the inverse variance weighting (IVW), MR-Egger, weighted median (WM), MR robust adjusted profile score (MR-RAPS), and maximum likelihood (ML) methods, with IVW being the main focus, to verify the causal relationship between IBD and PBC. Additionally, a series of sensitivity analyses were performed to ensure the reliability of the results.

Results
In the discovery cohort, the IVW analysis results (OR = 1.114, P = 0.011) indicated a significant association between IBD and PBC. The MR-RAPS (OR = 1.130, P = 0.007) and ML (OR = 1.115, P = 0.011) analyses yielded results consistent with those of IVW in confirming IBD as a risk factor for PBC. In the validation cohort, consistent findings were observed regarding the causal relationship between IBD and PBC using IVW, MR-RAPS, and ML analyses; all three methods identified IBD as a risk factor for developing PBC. By the IVW analysis, Crohn's disease (CD) emerged as the most prominent subtype of IBD associated with an increased risk of developing PBC in both the discovery cohort (OR = 1.068, P = 0.049) and the validation cohort (OR = 1.082, P = 0.019).

Conclusion
The results of the MR analysis suggest a causal relationship between IBD and PBC, highlighting the necessity for proactive PBC prevention in patients with IBD, particularly those with CD.
Comparison of different promoters to improve AAV vector-mediated gene therapy for neuronopathic Gaucher disease
Authors: Massaro Giulia , Geard Amy F , Nelvagal Hemanth R , Gore Katrina , Clemo Nadine K , Waddington Simon N , Rahim Ahad A 
Published: May 2024

Abstract
Gaucher Disease (GD) is an inherited metabolic disorder caused by mutations in the GBA1 gene. It can manifest with severe neurodegeneration and visceral pathology. The most acute neuronopathic form (nGD), for which there are no curative therapeutic options, is characterised by devastating neuropathology and death during infancy. In this study, we investigated the therapeutic benefit of systemically delivered AAV9 vectors expressing the human GBA1 gene at two different doses comparing a neuronal-selective promoter with ubiquitous promoters. Our results highlight the importance of a careful evaluation of the promoter sequence used in gene delivery vectors, suggesting a neuron-targeted therapy leading to high levels of enzymatic activity in the brain but lower GCase expression in the viscera, might be the optimal therapeutic strategy for nGD.
Variable effects of captivity on microbiomes in populations of IUCN-endangered Blanding’s turtles (Emydoidea blandingii)
Authors: Jenkins Lauren , McKnight Donald T , Parks Matthew , Byer Nathan W , Oliaro Francis J , Thompson Dan , Scott Rodney 
Published: May 2024

Abstract

Aims
Microbiome composition is increasingly considered in species reintroduction efforts and may influence survival and reproductive success. Many turtle species are threatened by anthropogenic pressures and are frequently raised in captivity for reintroduction efforts, yet little is known about turtle microbiome composition in either wild or captive settings. Here, we investigated trends in microbiome composition of captive and wild IUCN-endangered Blanding’s turtles (Emydoidea blandingii).

Methods and results
We amplified and sequenced the V4 region of the 16S rDNA locus from plastron, cloaca, and water samples of wild E. blandingii adults and two populations of captive E. blandingii juveniles being raised for headstarting. Plastron, cloaca, and water-associated microbiomes differed strongly from each other and were highly variable among captive sites and between captive and wild sites. Across plastron, cloaca, and water-associated microbial communities, microbial diversity changed over time, but not in a predictable direction between captive sites. Plastron beta diversity correlated with growth rate in captive samples, indicating that external microbiomes may correlate with individual fitness.

Conclusions
Our results indicate that external and internal microbiomes vary between captive and wild turtles and may reflect differences in fitness of captive-raised individuals.
Toward a unified understanding of drug-drug interactions: mapping Japanese drug codes to RxNorm concepts
Authors: Kawakami Yukinobu , Matsuda Takuya , Hidaka Noriaki , Tanaka Mamoru , Kimura Eizen 
Published: May 2024

Abstract

Objectives
Linking information on Japanese pharmaceutical products to global knowledge bases (KBs) would enhance international collaborative research and yield valuable insights. However, public access to mappings of Japanese pharmaceutical products that use international controlled vocabularies remains limited. This study mapped YJ codes to RxNorm ingredient classes, providing new insights by comparing Japanese and international drug-drug interaction (DDI) information using a case study methodology.

Materials and Methods
Tables linking YJ codes to RxNorm concepts were created using the application programming interfaces of the Kyoto Encyclopedia of Genes and Genomes and the National Library of Medicine. A comparative analysis of Japanese and international DDI information was thus performed by linking to an international DDI KB.

Results
There was limited agreement between the Japanese and international DDI severity classifications. Cross-tabulation of Japanese and international DDIs by severity showed that 213 combinations classified as serious DDIs by an international KB were missing from the Japanese DDI information.

Discussion
It is desirable that efforts be undertaken to standardize international criteria for DDIs to ensure consistency in the classification of their severity.

Conclusion
The classification of DDI severity remains highly variable. It is imperative to augment the repository of critical DDI information, which would revalidate the utility of fostering collaborations with global KBs.
Validation and clinical discovery demonstration of breast cancer data from a real-world data extraction platform
Authors: Nottke Amanda , Alan Sophia , Brimble Elise , Cardillo Anthony B , Henderson Lura , Littleford Hana E , Rojahn Susan , Sage Heather , Taylor Jessica , West-Odell Lisandra , Berk Alexandra 
Published: May 2024

AbstractObjectiveTo validate and demonstrate the clinical discovery utility of a novel patient-mediated, medical record collection and data extraction platform developed to improve access and utilization of real-world clinical data.Materials and MethodsClinical variables were extracted from the medical records of 1011 consented patients with breast cancer. To validate the extracted data, case report forms completed using the structured data output of the platform were compared to manual chart review for 50 randomly-selected patients with metastatic breast cancer. To demonstrate the platform’s clinical discovery utility, we identified 194 patients with early-stage clinical data who went on to develop distant metastases and utilized the platform-extracted data to assess associations between time to distant metastasis (TDM) and early-stage tumor histology, molecular type, and germline BRCA status.ResultsThe platform-extracted data for the validation cohort had 97.6% precision (91.98%-100% by variable type) and 81.48% recall (58.15%-95.00% by variable type) compared to manual chart review. In our discovery cohort, the shortest TDM was significantly associated with metaplastic (739.0 days) and inflammatory histologies (1005.8 days), HR−/HER2− molecular types (1187.4 days), and positive BRCA status (1042.5 days) as compared to other histologies, molecular types, and negative BRCA status, respectively. Multivariable analyses did not produce statistically significant results.DiscussionThe precision and recall of platform-extracted clinical data are reported, although specificity could not be assessed. The data can generate clinically-relevant insights.ConclusionThe structured real-world data produced by a novel patient-mediated, medical record-extraction platform are reliable and can power clinical discovery.
Functional response and predation rate of Cryptolaemus montrouzieri (Coleoptera: Coccinellidae) to Paracoccus marginatus (Hemiptera: Pseudococcidae) at different temperatures
Authors: Rostami Elahe , Huang Dao-Ling , Shi Meng-Zhu , Zheng Li-Zhen , Li Jian-Yu , Madadi Hossein , Fu Jian-Wei 
Published: May 2024

Abstract
The ladybug, Cryptolaemus montrouzieri (Mulsant) (Coleoptera: Cocccinellidae)(Mulsant)(Coleoptera: Cocccinellidae), is a highly efficient predator in controlling mealybug populations and is considered an effective agent for controlling the papaya mealybugs (Paracoccus marginatus) (Williams & Granara de Willink) (Hemiptera: Pseudococcidae). Various criteria have been proposed for evaluating predator effectiveness, with the consumption rate of prey by individual predators, specifically the functional response, emerging as a common and crucial metric. This study evaluated the functional responses of third- and fourth-instar larvae, as well as male and female adults (&lt;48 h old) of C. montrouzieri to adult females of P. marginatus at 3 different temperatures (22 °C, 28 °C, and 35 °C) with 70% ± 5% RH and a 12L:12D h photoperiod. Prey densities were 2, 4, 8, 16, 32, 45, or 60 papaya mealybugs per predator for all tests. The response to prey density by third- and fourth-instar larvae or both sexes of adult C. montrouzieri was a type II at all temperatures. The highest attack rate and lowest handling time were estimated at 28 °C in males and 35 °C in females, respectively. The highest daily prey consumption rate occurred at 35 °C in both the immature and adult stages of C. montrouzieri. These findings support the potential of C. montrouzieri in controlling the papaya mealybug, especially in tropical and subtropical regions, given its search efficiency at high temperatures tested in this study. However, additional field investigations are needed to ascertain the control efficacy of C. montrouzieri for this mealybug in biocontrol programs.
Eschewing the discretionary court-based approach to child maintenance in Singapore: towards a consistent and predictable legal framework
Authors: Tan Ming Ren 
Published: May 2024

Abstract
Divorcing parents generally agree that they should maintain their children. What they often disagree on, however, is the quantification and apportionment of child maintenance. Put simply, how should child maintenance be quantified? After quantifying child maintenance, how should child maintenance be apportioned between the parents? Should the apportionment be numerically equal? Or should the apportionment be numerically different, and if so, how? Although these are deceptively simple questions, they have no easy answers. Unlike jurisdictions such as the UK and Australia, which rely on administrative agencies for the determination of child maintenance, Singapore serves as an interesting case study in that it adopts a discretionary court-based approach to child maintenance against the backdrop of an absence of child maintenance guidelines that could potentially guide the courts in their exercise of discretion. In this regard, this article critiques Singapore’s discretionary court-based approach to child maintenance and advances a consistent and predictable legal framework that the courts can apply when dealing with child maintenance disputes in the interests of promoting certainty and reducing acrimony between divorcing parents.
Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report
Authors: Agee Olivia A , Leggit Jeffery C 
Published: May 2024

ABSTRACT
Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.