bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Postoperative Atrial Fibrillation Incidence and Outcomes After Cardiac Surgery According to Assessment Method and Definition: A Systematic Review and Meta‐Analysis
Authors: Perezgrovas‐Olaria Roberto , Alzghari Talal , Rahouma Mohammed , Dimagli Arnaldo , Harik Lamia , Soletti Giovanni J. , An Kevin R. , Caldonazo Tulio , Kirov Hristo , Cancelli Gianmarco , Audisio Katia , Yaghmour Mohammad , Polk Hillary , Toor Rajbir , Sathi Swetha , Demetres Michelle , Girardi Leonard N. , Biondi‐Zoccai Giuseppe , Gaudino Mario 
Published: September 2023

Background
Postoperative atrial fibrillation (POAF) is the most frequent complication of cardiac surgery. Despite clinical and economic implications, ample variability in POAF assessment method and definition exist across studies. We performed a study‐level meta‐analysis to evaluate the influence of POAF assessment method and definition on its incidence and association with clinical outcomes.

Methods and Results

A systematic literature search was conducted to identify studies comparing the outcomes of patients with and without POAF after cardiac surgery that also reported POAF assessment method. The primary outcome was POAF incidence. The secondary outcomes were in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay. Fifty‐nine studies totaling 197 774 patients were included. POAF cumulative incidence was 26% (range: 7.3%–53.1%). There were no differences in POAF incidence among assessment methods (27%, [range: 7.3%–53.1%] for continuous telemetry, 27% [range: 7.9%–50%] for telemetry plus daily ECG, and 19% [range: 7.8%–42.4%] for daily ECG only;
P
>0.05 for all comparisons). No differences in in‐hospital mortality, stroke, intensive care unit length of stay, and postoperative length of stay were found between assessment methods. No differences in POAF incidence or any other outcomes were found between POAF definitions. Continuous telemetry and telemetry plus daily ECG were associated with higher POAF incidence compared with daily ECG in studies including only patients undergoing isolated coronary artery bypass grafting.

Conclusions
POAF incidence after cardiac surgery remains high, and detection rates are variable among studies. POAF incidence and its association with adverse outcomes are not influenced by the assessment method and definition used, except in patients undergoing isolated coronary artery bypass grafting.
Introduction: Enacting Peace Amid Violence: Nonviolent Civilian Agency in Violent Conflict
Authors: Bliesemann de Guevara Berit , Allouche Jeremy , Gray Felicity 
Published: September 2023

Abstract
Worldwide, civilians experiencing violence make agential choices about how they interact with conflict landscapes. This special issue assembles contributions that specifically deepen our understanding of nonviolent civilian agency amid violence. Our Introduction embeds these contributions in a wider overview of the study of civilian agency in war. First, we unpack the state/military versus civilian binary upon which dominant scholarship’s idea of agency in violent conflict is often still based and show how this has contributed to an analytical gap in our understanding of nonviolent civilian action. We then provide an overview of the growing literature that has started to fill this gap and discuss how its recentering of nonviolence and civilian agency enables a more nuanced understanding of conflict management and transformation across diverse contexts. Finally, we provide an overview of the contributions to this special issue and how they take the state of the art of scholarly work forward.
The Impact of Fibrinogen to Prognostic Nutritional Index Rate on Prognosis of Pancreatic Ductal Adenocarcinoma
Authors: Igarashi Yosuke , Shirai Yoshihiro , Tanji Yoshiaki , Hamura Ryoga , Yanagaki Mitsuru , Abe Kyohei , Onda Shinji , Furukawa Kenei , Matsumoto Michinori , Tsunematsu Masashi , Ikegami Toru 
Published: September 2023

Introduction The aim of the present study was to evaluate the prognostic value of the ratio of serum fibrinogen to prognostic nutritional index (PNI; Fbg/PNI) in patients undergoing resection for pancreatic ductal adenocarcinoma. Methods A total of 140 patients who had undergone resection for pancreatic cancer were included. Patients were divided into two groups according to a Fbg/PNI ≥8.8 or <8.8. Survival data were analyzed using the log-rank test for univariate analysis and Cox proportional hazards for multivariate analysis. Results Fbg/PNI was a significant prognostic indicator in univariate analysis for overall survival (OS) and disease-free survival (DFS). Fbg/PNI retained significance in multivariate analysis for OS (hazard ratio, 1.81; 95% confidence interval, 1.19-2.77; P < .01) in addition to tumor differentiation and nodal involvement. Fbg/PNI was a significant independent prognostic indicator of poor DFS on multivariate analysis (hazard ratio, 1.54; 95% confidence interval, 1.05-2.26; P = .03). Conclusion Preoperative Fbg/PNI is a novel significant independent prognostic indicator for OS and DFS following resection of pancreatic cancer with curative intent.
Assessing Complication Risk of Pressure Equalizing Tube Placement in Children With Velocardiofacial Syndrome (22q11.2 Deletion Syndrome/DiGeorge Syndrome)
Authors: Kloosterman Nicole , Freeman Michael H. , Belcher Ryan H. 
Published: September 2023

Introduction: Persistent tympanic membrane perforation is a known complication of pressure-equalizing (PE) tube insertion. Conductive hearing loss and otorrhea can necessitate surgical repair of these perforations. Long-term tympanostomy tube placement can increase the risk of these complications. Patients with velocardiofacial syndrome (VCFS) typically require prolonged PE tube placement and are thought to have higher risk of requiring additional otologic interventions after PE tube placement. To date, no work has established rates of post-PE tube complications requiring myringoplasty or tympanoplasty in patients with VCFS. Methods: A retrospective case review including all patients with VCFS at a single large children’s hospital between the years 2000 and 2020 was performed. Number of PE tube insertions required and additional otologic interventions performed were the primary endpoints assessed. Results: Of 212 total patients with VCFS, 66 (31%) underwent PE tube placement. Of these children, 46 (70%) required 2 or more sets of PE tubes. A total of 53 patients (80.3%) required no otologic interventions apart from PE tube insertions. Of the 13 patients (19.7%) requiring additional otologic surgery, 6 (9.5%) underwent myringoplasty, and 9 patients (13.6%) required tympanoplasty. There was no significant difference in tympanoplasty ( P > 1), myringoplasty ( P > 1), or other surgical intervention rates ( P = .7464) between VCFS patients with any type of cleft palate versus those with anatomically normal palates. Conclusion: This work suggests that most VCFS patients that require tubes, require at least 2 sets of PE tubes, and that the rate of post-PE tube complications requiring further otologic surgery is an order of magnitude higher than the rate established at this institution. Counseling for PE tube placement in VCFS patients may require specific dialogue regarding the substantially increased risk of complications and effort to build appropriate expectations for surgical outcomes regardless of palatal status.
Prognostic Correlation of Immune-Inflammatory Markers in Sudden Sensorineural Hearing Loss: A Retrospective Study
Authors: Zhang Xu , Wang Ying , Yan Qi , Zhang Wentao , Chen Li , Wang Maohua , Guan Bing 
Published: September 2023

Background: The mechanism of sudden sensorineural hearing loss (SSNHL) remains incompletely understood, but immune cell infiltration has been identified as a crucial component in the sickness. The patients with SSNHL may benefit from investigating markers related to inflammation. Methods: From April 2022 to 2023, 80 patients who were diagnosed with SSNHL in the Department of Otolaryngology at Yangzhou University’s Clinical Medical College were enrolled in the SSNHL group. And patients were separated into effective and ineffective groups based on the degree to which their hearing had recovered prior to discharge. As the control group, 80 healthy volunteers were chosen from hospital’s physical examination center. Neutrophils, lymphocytes, platelets, and white blood cells were counted. Additionally, quantified and statistically examined were the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII). The risk variables for prognosis were identified using logistic regression models, and the prediction accuracy of the model was calculated using the receiver operating characteristic (ROC) curves. Results: The SSNHL group had higher levels of white blood cells, neutrophils, platelets, NLR, PLR, and SII than the control group. While the PLR lacked statistical significance, the NLR and SII of the patients in the ineffective group were noticeably higher than those in the effective group. Conclusion: Patients with SSNHL exhibit inflammatory immune responses. Patients with SSNHL can have their prognosis determined by the simple peripheral blood indicators NLR and SII, particularly SII, which is significant for predicting prognosis and directing treatment.
Keepers of the Flame: Gender, Race, and the Myth of Meritocracy in K–12 Educational Leadership
Authors: Odell Sarah Margaret 
Published: September 2023

Purpose: This study is part of a larger study of 18 aspiring school leaders that aims to understand how gender identity and gender performance impacted their experience in the K–12 independent school leadership pipeline. One of the key findings was that meritocracy played an important role in how individuals understood what the outcomes of their ascent to leadership should be. This article focuses on that finding through the voices of aspiring K–12 independent school leaders who have tried to enter the pipeline or have come through the pipeline. Method: This study uses Carol Gilligan’s Listening Guide method of data analysis. It was important to use a method and frame the study in a methodology that enabled marginalized voices to be heard. The Listening Guide requires the research to go through three “listenings” of the data: listening to the landscape, where the researcher takes note of everything that was said in the interview and what was not said; listening for the I, where the researcher makes I poems out of all of the I statements in the interview to hear for a deeper layer of consciousness; and finally, listening for contrapuntal voices, which acknowledges that people speak in multiple voices. Through these three listenings, a voice emerged from the data of the keepers of the flame: White women believed that specific work would guarantee them access to leadership. Findings: White women believe and are complicit in upholding meritocracy while White men articulated meritocracy as a lie that they benefit from. One of the interviewees, Joe, was unique among the men I interviewed—he was the only sitting head of school that I interviewed, and he was the only man who spoke so pointedly about the leadership pipeline advantaging someone like him. Black women, on the other hand, have always known from their racialized and gendered experience of the world that their hard work will be overlooked. This also came through in study interviews with Black women aspiring to leadership. For them, keeping silent is an issue of survival. As Carol Gilligan wrote, the story of women’s voices and women’s silences is not a simple one: It is not a question of one gender or race being above another. Rather, it is a story about resistance. An individual’s belief about how much work is necessary to gain access to leadership proves how White patriarchy centers the pipeline and either enforces silence or enables voice in one’s ability to move up. Meritocracy, and whether or not the individual believed it, turned out to be explicitly tied to one’s gender and racial identities. More diverse school leadership may lead to more equitable independent schools.
Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery on minimal invasive extracorporeal circulation; A prospective randomized study
Authors: Gkiouliava Anna , Argiriadou Helena , Antonitsis Polychronis , Goulas Antonis , Papapostolou Evangelia , Sarridou Despoina , Karapanagiotidis Georgios T , Anastasiadis Kyriakos 
Published: September 2023

Introduction Individualized heparin and protamine management is increasingly used as a strategy to reduce coagulation activation and bleeding complications. While it is associated with increased heparin requirements during Cardiopulmonary Bypass (CPB), the impact on protamine administration remains controversial. We aim to investigate the effect of heparin level-guided monitoring on protamine dosing during cardiac surgery where low-anticoagulation protocols are implemented. Methods This is a prospective, randomized, controlled trial. A total of 132 patients undergoing elective full-spectrum cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC) were recruited. All patients were managed by the same anaesthetic, surgical and perfusion team. Patients were randomly allocated in two groups; the individualized heparin-protamine titration (IHPT) group and the conventional heparinization and reversal group by using ACT (cACT) with a 0.75:1, protamine: heparin ratio. Titration was accomplished with the Hepcon HMS Plus (Medtronic, Minneapolis, MN) system. The primary outcome of the study was the total protamine dose used. Secondary outcomes comprised of the total heparin dose, the percentage of patients achieving target ACT, 24-h transfusion requirements, postoperative bleeding, duration of mechanical ventilation, major morbidity and length of hospital stay. Patients in each group were divided in two subgroups according to the target ACT; those operated for coronary artery bypass grafting (CABG) using a target ACT >300 s and the rest (non-CABG) patients operated with a target ACT >400 s, respectively. Results Protamine requirements were significantly reduced when IHPT was implemented; CABG (118 ± 24 mg vs 163 ± 61 mg; p < 0.001) and non-CABG cases (151 ± 46 mg vs 197 ± 45 mg; p < 0.001). Moreover, heparin requirements were significantly higher in the non-CABG subgroup managed with IHPT (34,539 ± 7658 IU vs 29,893 ± 9037 IU; p = 0.02). In overall, no significant differences were detected with respect to postoperative bleeding, transfusion of RBC or other blood products. Conclusions Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery with MiECC implementing reduced anticoagulation strategy. Trial registration clinicaltrials.gov; NCT04215588.
Effect of glucocorticoid for patients with type A aortic dissection undergoing surgical repair with deep hypothermic circulatory arrest: A single-center, retrospective study
Authors: Luo Ming-hao , Chen Jia-qi , Luo Jing-chao , Li Jia-kun , Zhang Yi-jie , Xu Xin , Su Ying , Wang Chun-sheng , Lai Hao , Sun Yong-xin , Li Jun , Tu Guo-wei , Luo Zhe 
Published: September 2023

Background Postoperative patients with Type A aortic dissection (TAAD) often experience severe inflammatory responses caused by multiple factors perioperatively. However, the effect of postoperative glucocorticoid (GC) use, which is a potent anti-inflammatory agent, on complications or all-cause mortality is unclear. Methods Patients with TAAD who underwent surgical repair requiring deep hypothermic circulatory arrest between January 2020 and December 2021 were included in the study. Characteristics of patients treated with and without GCs were compared. The primary outcome was in-hospital mortality, and a composite secondary outcome was defined as in-hospital death or any major complications. Propensity score matching was used to balance baseline differences between groups. Kaplan-Meier curves were used to compare survival probability. Results A total of 393 postoperative patients with TAAD were included in the study. Forty of them (10.2%) received GC treatment at a median daily methylprednisolone-equivalent dose of 0.6 mg/kg (0.4–0.7) for a median period of 2 (1–3) days. Patients on GCs had more intraoperative blood transfusions, higher postoperative APACHE II (12 vs 9, p = .004) and SOFA (9 vs 6, p < .001) scores, worse perioperative hepatic, renal and cardiac function. The in-hospital mortality in the matched cohort did not differ between groups [GC n = 11/40 (27.5%) versus Non-GC n = 19/80 (23.8%); p = .661]. Conclusions The propensity to use GCs correlated with the critical status of the patient. However, low dose and short-term postoperative GC treatment did not reduce in-hospital mortality rates among patients with TAAD. A more appropriate regimen should be further investigated.
The Fragment of a Model of a Tower House from Kom el-Gir, Central Northwestern Delta
Authors: Schiestl Robert 
Published: September 2023

This article discusses a fragment of a model of a tower house found on the surface at Kom el-Gir in the central northwestern Delta. The settlement of Kom el-Gir, which was used at least from the Ptolemaic to the Late Roman Periods, showed a dense occupation of tower houses, based on magnetic prospection. A reconstruction of what the house model may have looked like is suggested and the possible uses of such house models are discussed. [Formula: see text]
Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry
Authors: Rahardja Richard , Love Hamish , Clatworthy Mark G. , Young Simon W. 
Published: September 2023

Background: The bone–patellar tendon–bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. Purpose: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of “severe” or “extreme” difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. Results: A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales. Conclusion: At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.
A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy
Authors: Gupta Naveen Kumar , Huda Noushim Akram , Pal Dilip Kumar 
Published: September 2023

Background: Percutaneous nephrolithotomy (PCNL) is the first line treatment for treating kidney stones larger than 2 cm size with the advantages of lower morbidity and faster post-operative recovery. Creation of a nephrostomy access is one of the major steps of PCNL. It can be done either by single-step dilatation or by multi-step serial dilatation technique. Objectives: To compare the outcome and evaluate the efficacy of percutaneous nephrolithotomy done by single-step versus serial dilatation technique with specific reference to access time, fluoroscopy time, rate of blood transfusion, length of hospital stay (post-op) and complication rate. Methods: It was a prospective study with a sample size of 100 where 50 patients underwent one-step dilatation and other 50 patients underwent serial-dilatation technique. These patients were analysed on the basis of their demographic profile, renal access time, total fluoroscopy time for access, post-operative haematuria, duration of post-operative hospital stay and complications after operative procedure. Data was analysed and reported using statistical tools. Results: Demographic profile of the patients and stone characteristics were equivalent between two groups. Mean access tract dilatation time, mean total fluoroscopy time were significantly less in one of the groups. Requirement of blood transfusion, and post-operative complications rate were not significant between two groups. Conclusion: Both methods are safe and effective for tract dilatation. However, PCNL can be successfully performed by one-step dilatation with the added advantages of lesser time of renal access, lesser radiation exposure. Blood loss and hospital stay after operative procedure were not statistically significant between two groups.
A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population
Authors: Golomb Dor , Cooper Amir , Raz Orit 
Published: September 2023

Objective: To assess trends of surgical intervention in adults with upper urinary tract stones in Israel. Methods: A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend. Results: Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively. Conclusions: Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.