bluuebunny/crossref_metadata_2025_split huggingface dataset:
The “microcephalic hydrocephalus” paradox as a paradigm of altered neural stem cell biology
Authors: Duy Phan Q , Mehta Neel H , Kahle Kristopher T 
Published: November 2023

Abstract
Characterized by enlarged brain ventricles, hydrocephalus is a common neurological disorder classically attributed to a primary defect in cerebrospinal fluid (CSF) homeostasis. Microcephaly (“small head”) and hydrocephalus are typically viewed as two mutually exclusive phenomenon, since hydrocephalus is thought of as a fluid “plumbing” disorder leading to CSF accumulation, ventricular dilatation, and resultant macrocephaly. However, some cases of hydrocephalus can be associated with microcephaly. Recent work in the genomics of congenital hydrocephalus (CH) and an improved understanding of the tropism of certain viruses such as Zika and cytomegalovirus are beginning to shed light into the paradox “microcephalic hydrocephalus” by defining prenatal neural stem cells (NSC) as the spatiotemporal “scene of the crime.” In some forms of CH and viral brain infections, impaired fetal NSC proliferation leads to decreased neurogenesis, cortical hypoplasia and impaired biomechanical interactions at the CSF–brain interface that collectively engender ventriculomegaly despite an overall and often striking decrease in head circumference. The coexistence of microcephaly and hydrocephalus suggests that these two phenotypes may overlap more than previously appreciated. Continued study of both conditions may be unexpectedly fertile ground for providing new insights into human NSC biology and our understanding of neurodevelopmental disorders.
Resting-state neural correlates of individual differences in ignored experience and its deleterious effect
Authors: Cen Yu-Shan , Li Wei , Xia Ling-Xiang 
Published: November 2023

Abstract
Uncovering the neural mechanisms of ostracism experience (including its subclasses of excluded and ignored experiences) is important. However, the resting-state functional brain substrates responsible for individual differences in ostracism experience and its negative effects remain largely undefined. This study explored these issues in a sample of 198 Chinese college students by assessing the amplitude of low-frequency fluctuations and functional connectivity. The findings indicated a positive correlation between ignored experience and the amplitude of low-frequency fluctuations in the right superior frontal gyrus and the functional connectivity between the right superior frontal gyrus and left cerebellum posterior lobe. Additionally, a negative correlation was found between ignored experience and the functional connectivity between the right superior frontal gyrus and the bilateral insula as well as the bilateral inferior parietal lobule. Moreover, the mediation analysis demonstrated that the effects of the functional connectivities of right superior frontal gyrus–left cerebellum posterior lobe and right superior frontal gyrus–right inferior parietal lobule on revenge intention were mediated by ignored experience. Our study offers novel insights into the neural correlates of both individual variations in ignored experience and its typical deleterious effect. These results could deepen our understanding of individual differences in negative experiences and inspire the development of targeted interventions for social stress from the perspective of the brain.
Thalamic connectivity topography in newborns with spina bifida: association with neurological functional level but not developmental outcome at 2 years
Authors: Ji Hui , Payette Kelly , Speckert Anna , Tuura Ruth , Grehten Patrice , Kottke Raimund , Ochseinbein-Kölble Nicole , Hagmann Cornelia , Mazzone Luca , Meuli Martin , Padden Beth , Hackenberg Annette , Wille David-Alexander , Moehrlen Ueli , Latal Beatrice , SPINA BIFIDA STUDY GROUP ZURICH  , Jakab Andras 
Published: November 2023

Abstract
Spina bifida affects spinal cord and cerebral development, leading to motor and cognitive delay. We investigated whether there are associations between thalamocortical connectivity topography, neurological function, and developmental outcomes in open spina bifida. Diffusion tensor MRI was used to assess thalamocortical connectivity in 44 newborns with open spina bifida who underwent prenatal surgical repair. We quantified the volume of clusters formed based on the strongest probabilistic connectivity to the frontal, parietal, and temporal cortex. Developmental outcomes were assessed using the Bayley III Scales, while the functional level of the lesion was assessed by neurological examination at 2 years of age. Higher functional level was associated with smaller thalamo-parietal, while lower functional level was associated with smaller thalamo-temporal connectivity clusters (Bonferroni-corrected P &lt; 0.05). Lower functional levels were associated with weaker thalamic temporal connectivity, particularly in the ventrolateral and ventral anterior nuclei. No associations were found between thalamocortical connectivity and developmental outcomes. Our findings suggest that altered thalamocortical circuitry development in open spina bifida may contribute to impaired lower extremity function, impacting motor function and independent ambulation. We hypothesize that the neurologic function might not merely be caused by the spinal cord lesion, but further impacted by the disruption of cerebral neuronal circuitry.
A 1-month-old infant with pulmonary hypertensive crisis after cardiac surgery was successfully rescued with connection of left atrial and right ventricular pressure measurement tubes: a case report
Authors: Zhang Huijun , Song Hailong 
Published: November 2023

Abstract

Background
Pulmonary hypertensive crisis is a complication with extremely high mortality after surgery of congenital heart disease. However, there are still no treatment guidelines or expert consensus on the standard treatment of pulmonary hypertensive crisis, and the effect of conventional treatment is still unsatisfactory. We present a case of a patient who developed pulmonary hypertensive crisis after cardiac surgery, and was successfully rescued with a pioneering method, which has never been reported so far.

Case summary
An infant with congenital heart disease had undergone cardiac surgery successfully. Due to obvious myocardial oedema, sternal closure was delayed. The left atrial and right ventricular pressure monitoring tubes, both of which were connected through a triplet, were inserted into right pulmonary vein and pulmonary artery, respectively, and the triplet was in closed condition. On the night of the surgery, pulmonary hypertensive crisis occurred. Emergency bedside thoracotomy was given, and the triplet was turned on urgently to make the left atrial and right ventricular pressure monitoring tubes connected. Meantime, conventional treatment was performed. Eventually, the pulmonary hypertensive crisis was quickly relieved, and the infant was discharged 9 days later.

Discussion
The left atrial and right ventricular pressure monitoring tubes are placed intraoperatively in patients who both need delayed sternal closure and have high risk factors for pulmonary hypertensive crisis, by which could not only monitor the pressure of left atrium and right ventricle in real time but also effectively relieve the right ventricular pressure instantaneously when pulmonary hypertensive crisis occurs, as well as remedy ischaemia of systemic and coronary circulation.
Left atrial appendage occlusion guided by intracardiac echocardiography in a patient with a 34 mm atrial septal defect occluder: a case report
Authors: Korsholm Kasper , Jensen Jesper Møller , Nielsen-Kudsk Jens Erik 
Published: November 2023

Abstract

Background
Intracardiac echocardiography (ICE)–guided left atrial appendage occlusion (LAAO) is increasingly common. Patients with previous atrial septal defect closure constitute a significant challenge for transseptal access.

Case summary
A 49-year-old man with persistent atrial fibrillation, hypertension, and reduced left ventricular function was considered for LAAO after a life-threatening intrathoracic bleeding while on oral anticoagulation. Percutaneous atrial septal defect closure was performed 15 years before with a 34 mm Amplatzer Septal Occluder. Preprocedural cardiac computed tomography demonstrated the atrial septal occluder device with a small native interatrial septum at the inferior margin. The left atrial appendage landing zone measured 17 × 22 mm. The LAAO was performed under local analgesia. A steerable sheath was used to guide the transseptal puncture, and the ICE probe was traced along a guidewire across the atrial septum. A 12-F Amulet delivery sheath was advanced through the same transseptal hole. Under ICE and fluoroscopy guidance, a 25 mm Amplatzer Amulet was deployed. Follow-up imaging showed a well-positioned device with a small peridevice leak at the disc.

Discussion
This case report illustrates the feasibility of LAAO performed with ICE guidance from the left atrium in a patient with a large Amplatzer Septal Occluder with a small native interatrial septum. It demonstrates that prior atrial septal defect closure should not be considered as a contraindication for LAAO but warrants careful preprocedural planning.
Aortic root reinforcement combined with vascular rafts eversion and built-in procedure for Acute Type A Aortic dissection surgery
Authors: Li J , Li B H , Yan Y P , Guo F W , Wang H , Zhang Y J , Li Y X , Ma T , Wang Q , He X , Zheng X L , Yan Y 
Published: November 2023

Abstract

Background
Acute type A aortic dissection (ATAAD) is a life-threatening disease with high mortality. Surgery remains the gold standard for the treatment of ATAAD. However, ATAAD surgery, especially the aortic root reinforcement technique, is still a challenge for surgeons.

Methods
All Stanford type A aortic dissection patients undergoing surgery in our hospital from January 2020 to December 2021 were retrospectively entrolled. These patients were divided into three groups according to the surgical procedures of aortic rot: continuous aortic root suture group (CARS group); "intermittent mattress type built-in skirt forming method" group, which was created by our group (XJ-procedure group), aortic root replacement group (Bentall group). The primary outcomes were 30-day mortality and incidence of recurrent dissection of aortic root (before dis-charge, 3 and 6 months of follow-up). The secondly outcomes were the rate of reoperation for aortic root bleeding, the incidence of pseudoaneurysms and the severe aortic valve regurgitation (the residual aortic valve regurgitation greater than grade 2+) rate before discharge, 3 and 6 months of follow-up.

Results
A total of 221 patients were entrolled in this study, including 69, 114 and 38 in CARS group, XJ-procedure group and Bentall group, respectively. The total operation time in the CARS group, XJ-procedure group and Bentall group were 391.74±74.05 minutes, 371.59±79.36minutes and 427.76±100.78 minutes, respectively (P=0.001, Pa=0.108, Pb=0.001). The overall 30-day mortality rate was 6.8% (15/221), 7.2% (5/69), 7.0% (8/114) and 5.3% (2/38) for all patients, CARS group, XJ-procedure group and Bentall group, respectively. In the CARS group, the incidence of recurrent dissection of aortic root was much lower in the XJ-procedure group than the CARS group before discharge (1.8% versus 10.6%), 3 months (9.4% versus 0%) and 6 months (7.8% vs 0%) follow-up, respectively. The rates of reoperation for aortic root bleeding in the CARS group, XJ-procedure group and Bentall group were 4.3%, 0.9%, and 2.6%, respectively (P=0.306, Pa=0.151, Pb=0.439). In the CARS group, the incidence of pseudoaneurysm was 3.0%,3,1%,3.0% before discharge, at 3 months and 6 months follow-up. In the XJ-procedure group, there was no reported pseudoaneurysm. The residual severe aortic valve regurgitation incidence was much lower in the XJ-procedure group than the CARS group at 3 months (0.9% versus 4.7%) and 6 months (0.9% versus 4.7%) follow-up, respectively. Compared with the traditional procedure, the XJ-procedure does not increase the perioperative mortality and reduces the incidence of aortic root complications.

Conclusion
XJ-procedure is a safe and effective aortic root reinforcement technique for ATAAD surgery and reduces aortic root complications by reinforcing the fragile aortic root tissue.
Association of unilateral low ankle-brachial index and bilateral low ankle-brachial index with incident cardiovascular disease and mortality: The Northern Shanghai Study
Authors: Zhao S , Xu C , Xiong J , Tang J M , Yu S K , Maimaitiaili R S T M J , Teliewubai J D L , Chi C , Xu Y W , Zhang Y 
Published: November 2023

Abstract

Background and Aims
Ankle-brachial index (ABI) has been used as a marker for atherosclerosis and a risk factor of cardiovascular disease (CVD). Nevertheless, it is not yet clear whether there is a difference in cardiovascular risk between patients with one leg low ABI (&lt;0.9) (unilateral low ABI) and those with both legs low ABI (bilateral low ABI). Therefore, we investigated the association of target organ damage (TOD) and incident of major cardiovascular events (MACE) in participants with unilateral low ABI and bilateral low ABI.

Methods
We enrolled 3168 participants (mean age 71.3 years, 1361 men) from North Shanghai Study. The participants were divided into 3 groups according to both legs ABI (bilateral low ABI, unilateral low ABI and bilateral normal ABI). TOD, including left ventricular hypertrophy, arterial stiffness, carotid plaque, and renal damage, were measured using standard methods at baseline. MACE was a composite outcome that consisted of nonfatal myocardial infarction, nonfatal stroke and CVD death.

Results
Compared with bilateral normal ABI, bilateral low ABI had higher risk of all TOD, but unilateral low ABI only had higher risk of carotid plaque and renal damage after adjustment covariates. During a median follow-up of 5.4 years, 199 MACE and 192 all-cause mortality occurred. The multivariable-adjusted risk for MACE in individuals with bilateral low ABI (hazard ratio (HR): 1.86; 95% confidence interval (CI), 1.20-2.88) and individuals with unilateral low ABI (HR: 1.58; 95% CI, 1.04-2.41) were higher than individuals with bilateral normal ABI (referent group). Compared with bilateral normal ABI, both unilateral low ABI (hazard ratio: 1.70; 95% CI, 1.13-2.57) and bilateral low ABI (HR: 2.10; 95% CI, 1.39-3.18) had higher risk of all-cause mortality after adjustment covariates.

Conclusion
Both unilateral low ABI and bilateral low ABI are associated with increased CVD risk, but bilateral low ABI with a trend towards increasing CVD risk. More attention should be paid to whether a patient has a unilateral or bilateral low ABI for a more accurate CVD risk assessment.Kaplan-Meier curve for ABI categoriesOR for ABI categories for TOD
Underutilization of guideline-recommended therapy in patients 80 years and older with peripheral artery diseases
Authors: Messiha D , Petrikhovich O , Lortz J , Pinsdorf D , Hogrebe K , Knuschke R , Hering R , Schulz M , Rassaf T , Rammos C 
Published: November 2023

Abstract

Background
Ageing is a major cardiovascular risk factor with detrimental pathophysiological changes that culminate in a high atherosclerotic burden. Peripheral artery disease (PAD) is a major manifestation of atherosclerosis with high mortality. Guideline-recommended treatment is essential, however implementation is inadequate. With an ageing society, age-related inequalities are important and have not been elucidated in a high-risk PAD population on a nation-wide scale. We sought to analyse the outpatient treatment structures and guideline adherence in treatment of PAD patients older than 80 year of age.

Purpose
Aim of the study was to identify age-based inequalities in outpatient treatment care and pharmacotherapy in PAD patients.

Methods
We analyzed age-related differences in prevalence, pharmacotherapy (statins, antiplatelets) and treatment by specialized outpatient care (angiology, vascular surgery, internal medicine, cardiology) in 17,633,970 patients with PAD and statutorily insurance presenting to outpatient care facilities in Germany between 2009 and 2018. The study is based on ambulatory claims data of the panel doctors’ services according to §295 SGB V and drug prescription data according to §300 SGB V, comprising 70.1 million patients per year. Diagnosis of PAD was defined upon medical diagnoses of PAD ICD. Statistical analysis was performed with chi-squared test for trend and two-way Anova.

Results
Of 17,633,970 PAD patients included, 28% were older than 80 years. PAD prevalence increased between 2008 and 2019 (1.85% vs 3.14%), with the proportion of the elderly increasing by a third (24.4% vs 31.2%). Octogenarians were undertreated regarding guideline-recommended statin pharmacotherapy compared to younger patients throughout the observed 10 year time frame (statins 2016: 46.5% vs 52.4%; antiplatelets 2016 30.6% vs 29.3%; p &lt; 0.05). Furthermore, octogenarians received less specialized outpatient care (angiology: 6.4% vs 9.5%, vascular surgery: 8.1% vs 11.8%, cardiology: 25.2% vs 29.2%, p &lt; 0.05).

Conclusions
Our results demonstrate that age-related differences in pharmacotherapy and specialized outpatient care of PAD patients are evident. While overall guideline-recommended outpatient treatment is low, patients 80 years and older are less likely to receive both, leaving age-related health inequalities a challenge of our future.
Effects of PCSK-9 inhibitors on arterial structure and function: preliminary results
Authors: Maloberti A , Vatta A , Grasso A , Garofani I , Morelli M , Giani V , Fortuna M , Gualini E , Giannattasio C 
Published: November 2023

Abstract

Background
One of the latest chapters in the research for new and stronger lipid lowering therapies has led to the development of PCSK9 inhibitors. In addition to the benefit on lipid profile, a limited number of studies have been published showing a possible improvement in vascular function and structure following their administration.

Purpose
To evaluate the effects of PCSK9 inhibitors on structural (via carotid Intima Media Thickness – IMT) and functional (carotid-femoral Pulse Wave Velocity – cf-PWV - and brachial artery Flow Mediated Dilatation - FMD) arterial properties.

Methods
Twenty-two dyslipidemic patients with a clinical indication to PSCK9 inhibitors were prospectively recruited at the cardiology rehabilitation of a hospital. Anthropometric, clinical and therapeutic data were recorded. Each patient underwent instrumental examinations to assess cf-PWV, IMT and FMD at T0 (before the start of therapy), T1 (after 6 months) and T2 (after 12 months).

Results
In the 22 patients who reached 6 months of follow up there was a significant reduction in LDL cholesterol (from 127.8±31.7 to 47.4±29.1 mg/dl, p&lt;0. 0001) while there was no significant difference in arterial parameters (cf-PWV: from 10.5±3.5 to 9.4±2.3 m/s, p=0.092; FMD: from 11.4±8.1 to 9.8±8.3%, p=0.407; IMT: from 775.6±192.8 to 768.7±144.7, microm, p=0.854). Similar results were also obtained in the 12 patients who reached one year of follow-up: LDL from 129.4±29.1 to 48.8±21.9 mg/dl, p&lt;0.0001; cf-PWV from 10.4±3.3 to 10.5±2.9, p=0.874; FMD from 12.0±9.1 to 11.0±5.6%, p=0.930; IMT from 745.1±203.9 to 770.0±127.3 microm, p=0.710.

Conclusion
Our study confirm the strong LDL reduction with PCSK9 inhibitors that are needed in order to reach the targets set by the ESC 2019 guidelines. In contrast, they do not show a significant effect on arterial function and structure in terms of cf-PWV, FMD and carotid IMT.
Acute limb ischemia registry, the forgotten emergency
Authors: Bluro I , Garagoli F , Chiabrando J , Chas J , Valle Raleigh J , Gonzalez N , Fernandez Villar G , Iroulart J , Pellegrini M N , Herzkovich N , Fernandez Recalde M L , Izaguirre A , Rojas Matas C , Kotowicz V , Pizarro R 
Published: November 2023

Abstract

Background
Although acute limb ischemia (ALI) is a leading cause of death and lower limb amputation, knowledge about its epidemiology, presentation, and treatment is limited.

Aim
The purpose of this study is to describe patient characteristics, diagnostic approaches taken, modes of presentation, and clinical developments in patients with ALI.

Methods
We prospectively included all ALI outpatients between 2016 and 2022. Patients who had ischemia due to trauma, iatrogenic causes, or those who developed it while in the hospital were excluded. We provide descriptive analysis for our registry, and performed a uni and multivariable regression model in order to identify clinical factors associated with the composite primary endpoint of intrahospital death and limb amputation.

Results
We included 89 consecutive patients with ALI. Table 1 describes the baseline characteristics. The median time from clinical presentation to first medical contact was 24 hours (IQR 4-72 hours). Time between clinical consultation and diagnosis was 1 hours (1.1–7 hours), and time between diagnosis and revascularization was 12 hours (4–36 hours). Although patients with a threatened limb sought treatment sooner than those without (12 hours vs 72 hours, p = 0.001), they had a higher rate of events.
Peripheral thromboembolism was the main cause of ALI and the only etiology associated with death or amputation.
Patients considered candidates for reperfusion therapy comprised 92% of the cohort, while 3 patients were considered candidates for direct amputation and 2 patients were considered candidates for anticoagulation due to the comorbidities they presented. Thirteen patients (21%) died or suffered limb amputations (three suprapatellar, two infrapatellar, and one in the forefoot). One third of the patients suffered a complication during hospitalization. Acute renal failure was the most frequent complication (27%).
In a univariable regression analysis, age, embolic origin, higher levels of lactacidemia, and threatened limb were associated with the composite event of death and limb amputation, whereas in a multivariable regression model, serum lactic acid and have the vitality of the member threatened were independently associated with an increased odds of death or amputation (Tabla 2).

Conclusions
Acute limb ischemia is associated with an increased risk of intrahospital death and limb amputation. Serum lactacidemia and limb threatened at presentation were independently associated with an increased risk of clinical events. Risk of events is associated with the limb clinical condition and not with the delay in revascularization. Even those patients who do not die or are amputated have high morbidity and need for prolonged hospitalization. Increased awareness of the disease are critical for improving survival and limb preservation.