bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurological outcomes in minimally invasive mitral valve surgery: risk factors analysis from the Mini-Mitral International Registry
Authors: Cresce Giovanni Domenico , Berretta Paolo , Fiore Antonio , Wilbring Manuel , Gerdisch Marc , Pitsis Antonios , Rinaldi Mauro , Bonaros Nikolaos , Kempfert Jorg , Yan Tristan , Van Praet Frank , Nguyen Hoang Dinh , Savini Carlo , Lamelas Joseph , Nguyen Tom C , Stefano Pierluigi , Färber Gloria , Salvador Loris , Di Eusanio Marco 
Published: October 2023

Abstract

OBJECTIVES
The aim of this study was to examine the incidence and predictors of stroke after minimally invasive mitral valve surgery (mini-MVS) and to assess the role of preoperative CT scan on surgical management and neurological outcomes in the large cohort of Mini-Mitral International Registry.

METHODS
Clinical, operative and in-hospital outcomes in patients undergoing mini-MVS between 2015 and 2021 were collected. Univariable and multivariable analyses were used to identify predictors of stroke. Finally, the impact of preoperative CT scan on surgical management and neurological outcomes was assessed.

RESULTS
Data from 7343 patients were collected. The incidence of stroke was 1.3% (n = 95/7343). Stroke was associated with higher in-hospital mortality (11.6% vs 1.5%, P &lt; 0.001) and longer intubation time, ICU and hospital stay (median 26 vs 7 h, 120 vs 24 h and 14 vs 8 days, respectively). On multivariable analysis, age (odds ratio 1.039, 95% confidence interval 1.019–1.060, P &lt; 0.001) and mitral valve replacement (odds ratio 2.167, 95% confidence interval 1.401–3.354, P &lt; 0.001) emerged as independent predictors of stroke. Preoperative CT scan was made in 31.1% of cases. These patients had a higher risk profile and EuroSCORE II (median 1.58 vs 1.1, P &lt; 0.001). CT scan influenced the choice of cannulation site, being ascending aorta (18.5% vs 0.5%, P &lt; 0.001) more frequent in the CT group and femoral artery more frequent in the no CT group (97.8% vs 79.7%, P &lt; 0.001). No difference was found in the incidence of postoperative stroke (CT group 1.5, no CT group 1.4%, P = 0.7).

CONCLUSIONS
Mini-MVS is associated with a low incidence of stroke, but when it occurs it has an ominous impact on mortality. Preoperative CT scan affected surgical cannulation strategy but did not led to improved neurological outcomes.
Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice
Authors: Heuts Samuel , Ceulemans Angelique , Kuiper Gerhardus J A J M , Schreiber Jan U , van Varik Bernard J , Olie Renske H , Ten Cate Hugo , Maessen Jos G , Milojevic Milan , Maesen Bart 
Published: October 2023

Abstract

OBJECTIVES
Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the management of patients on DOACs in the perioperative phase.

METHODS
A general literature review was conducted on the pharmacology of DOACs and for recommendations on the management of cardiac surgical patients on DOACs. Additionally, we performed a systematic review for studies on the use of direct DOAC reversal agents in the emergency cardiac surgical setting.

RESULTS
When surgery is elective, the DOAC cessation strategy is relatively straightforward and should be adapted to the renal function. The same approach applies to urgent cases, but additional DOAC activity drug level monitoring tests may be useful. In emergency cases, idarucizumab can be safely administered to patients on dabigatran in any of the perioperative phases. However, andexanet alfa, which is not registered for perioperative use, should not be administered in the preoperative phase to reverse the effect of factor Xa inhibitors, as it may induce temporary heparin resistance. Finally, the administration of (activated) prothrombin complex concentrate may be considered in all patients on DOACs, and such concentrates are generally readily available.

CONCLUSIONS
DOACs offer several advantages over vitamin K antagonists, but care must be taken in patients undergoing cardiac surgery. Although elective and urgent cases can be managed relatively straightforwardly, the management of emergency cases requires particular attention.
How the notion of epistemic injustice can mitigate polarization in a conversation about cultural, ethnic, and racial categorizations
Authors: Åberg Ingvill Bjørnstad 
Published: October 2023

ABSTRACT
It is a common contention that education done uncritically and unreflectively may serve to sustain and justify the status quo, in terms of mechanisms of cultural or racial privileging and marginalization. This article explores an argument made from within anti-oppressive education theory and advocated by theorist Kevin Kumashiro, namely that transformative education must entail altering harmful citational practices. I see two shortcomings in relation to this argument: first, its focus on discursive practice entails a prerequisite of high discursive literacy. Second, it may lead to a failure to give credit to people’s intentions, risking a conflation of honest mistakes and wilful ignorance, and depriving us of theoretical nuance. While a well-argued and important call, I argue in this article that both shortcomings lead to the risk of a polarized conversation. Focusing on cultural, ethnic, and racial categorization, and using social studies as an illustration, it is suggested that applying notions from the theoretical concept of epistemic injustice may open up a space for granting nuanced credit to people’s intentions, thereby mitigating the risk of polarization. Rather than viewing attention to outcome and attention to intention as oppositional to one another, it is argued that both theoretical perspectives may benefit from the insights of the other. By applying needed context-specificity and nuance to categorizations of dominance and marginalization in individual discursive exchange, this can be done without granting priority to the experience of dominantly situated knowers.
Mutation of the gene encoding the PHD-type transcription factor SAB23 confers submergence tolerance in rice
Authors: Duan Ao , Liu Rui , Liu Changchang , Wu Fei , Su Hang , Zhou Shuangzhen , Huang Min , Tian Xiaohai , Jia Haitao , Liu Ya , Li Manfei , Du Hewei 
Published: October 2023

Abstract
Submergence is a major constraint on rice production in South and Southeast Asia. In this study, we determined that a gene of the Sub1A-binding protein family, SAB23, encodes a plant homeodomain (PHD)-type transcription factor that has a novel function of negatively regulating submergence tolerance in rice. The T-DNA insertion mutant sab23 displayed reduced plant height, delayed seed maturation, and lower percentage seed set. Importantly, this mutant also exhibited enhanced submergence tolerance. In addition, CRISPR/Cas9 knock out of SAB23 resulted in a significant reduction in the content of the gibberellin GA4 and a dramatic increase in the content of GA1 in the plants. SAB23 binds to the promoter of CYTOCHROME P450 714B2 (CYP714B2), which encodes a GA13-oxidase that catalyses the conversion of GA53 to GA19. Disruption of SAB23 function led to increased CYP714B2 transcription, and overexpression of CYP714B2 produced phenotypes similar to those of the SAB23-knockout plants. Taken together, our results reveal that SAB23 negatively regulates rice submergence tolerance by modulating CYP714B2 expression, which has significant potential for use in future breeding.
Identification of Chemicals That Abrogate Folate-Dependent Inhibition of Starch Accumulation in Non-Photosynthetic Plastids of Arabidopsis
Authors: Kawada Yoshihiro , Hayashi Eriko , Katsuragi Yuya , Imamura-Jinda Aya , Hirokawa Takatsugu , Mizukami Tamio , Hayashi Makoto 
Published: October 2023

Abstract
Folate, also known as vitamin B9, is an essential cofactor for a variety of enzymes and plays a crucial role in many biological processes. We previously reported that plastidial folate prevents starch biosynthesis triggered by the influx of sugar into non-starch-accumulating plastids, such as etioplasts, and chloroplasts under darkness; hence the loss of plastidial folate induces the accumulation of starch in plastids. To understand the molecular mechanism underlying this phenomenon, we screened our in-house chemical library and searched their derivatives to identify chemicals capable of inducing starch accumulation in etioplasts. The results revealed four chemicals, compounds #120 and #375 and their derivatives, compounds #120d and #375d, respectively. The derivative compounds induced starch accumulation in etioplasts and suppressed hypocotyl elongation in dark-grown Arabidopsis seedlings. They also inhibited the post-germinative growth of seedlings under illumination. All four chemicals contained the sulfonamide group as a consensus structure. The sulfonamide group is also found in sulfa drugs, which exhibit antifolate activity, and in sulfonylurea herbicides. Further analyses revealed that compound #375d induces starch accumulation by inhibiting folate biosynthesis. By contrast, compound #120d neither inhibited folate biosynthesis nor exhibited the herbicide activity. Protein and metabolite analyses suggest that compound #120d abrogates folate-dependent inhibition of starch accumulation in etioplasts by enhancing starch biosynthesis.
Why Has the Franco-American Security Relationship Been so Semi—Hostile for so Long?
Authors: Williams Andrew J 
Published: October 2023

Abstract
Many people assume that Franco-American relations since 1776 have been far more harmonious than those of the United States’ relationship with Great Britain. After all, France fought on the side of the new aspiring republic in the American War of Independence against a colonial power. Although still a country ruled by a king, France itself became a republic shortly after the American Declaration of Independence was ratified. But in fact, France and the United States (and the colonies that preceded them) have often had poor relations. In his book Sister Republics: Security Relations between America and France, David Haglund asks why security relations between France and the United States been so fractious since the beginning of the American republic, and even well before it. He debunks the generally accepted mythology and its attendant symbology of two sister republics. The French-built and donated Statue of Liberty in New York Harbor and the statue of General Lafayette on the Seine opposite the Quai d’Orsay in Paris are misleading. In truth any special relationship between France and the United States has been special on the whole in its lack of mutual liking, even respect. Haglund traces this difficult, even suboptimal, relationship over three centuries and shows how the weight of history still continues to upset Franco-American relations regularly.
Codesigning Policy-Based Solutions to Discrimination and Harassment in Academic Medicine: An Inclusive Approach
Authors: Sukhera Javeed , Goez Helly , Brown Allison , Haddara Wael , Razack Saleem 
Published: October 2023

Abstract
Academic medicine institutions have historically employed policies as a means to tackle various types of discrimination and harassment within educational and professional settings, thereby affirming their dedication to promoting diversity, equity, and inclusion. However, the implementation and effectiveness of policies are constrained by limitations, including a lack of awareness and barriers to reporting. Due to concerns about accountability and transparency, many groups and individuals experiencing discrimination have lost trust in policy-based solutions to address equity in academic medicine. To address such challenges, the authors offer an evidence-informed policy framework with actionable recommendations. First, policy should be cowritten through meaningful and participatory engagement. Second, organizations should publicly report on metrics of policy effectiveness. Third, to ensure accountability, external organizations or adjudicators should be involved in oversight of policy-based processes. Fourth, leadership commitment is essential for success. Overall, policy can be an effective mechanism to address discrimination and harassment; however, a more inclusive approach is needed.
Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors
Authors: Henschen Bruce L. , Pascoe Jennifer , Kisielewski Michael , Duca Nicholas S. , Lang Valerie J. , Levine Diane , Jasti Harish , Blatt Amy 
Published: October 2023

Abstract

Purpose
Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment.

Method
In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership.

Results
Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 1–4; range, 0–50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were “always” aware of the outcome of bias reports.

Conclusions
Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting.
Practical, Privacy and Ethical, and Philosophical Considerations for Using Big Data in Medical Education
Authors: Amiel Jonathan M. 
Published: October 2023

Abstract
In this issue of Academic Medicine, Thelen and colleagues present a thoughtful perspective on the emerging opportunity to use longitudinal educational data to improve graduate medical education and optimize the education of individual residents, and call for the accelerated development of large interinstitutional data sets for this purpose. Such applications of big data to medical education hold great promise in terms of informing the teaching of individuals, enhancing transitions between phases of training and between institutions, and permitting better longitudinal education research. At the same time, there is a tension between whose data they are and consequently how they ought to be used. This commentary proposes some practical, privacy and ethical, and philosophical considerations that need to be explored as early efforts to aggregate data across the medical education continuum mature and new efforts are undertaken.
Causal Associations of Genetically Determined Tinnitus With Neuroimaging Traits: Evidence From a Mendelian Randomization Study
Authors: Sun Jing , Wang Xinghao , Li Jia , Zhang Tingting , Chen Qian , Liu Wenjuan , Cai Linkun , Zhao Pengfei , Yang Zhenghan , Pan Junhua , Wang Zhenchang , Lv Han 
Published: October 2023

Objectives:
Potential reverse causality and unmeasured confounding factors are common biases in most neuroimaging studies on tinnitus and central correlates. The causal association of tinnitus with neuroimaging features also remains unclear. This study aimed to investigate the causal relationship of tinnitus with neuroplastic alterations using Mendelian randomization.

Design:
Summary-level data from a genome-wide association study of tinnitus were derived from UK Biobank (n = 117,882). The genome-wide association study summary statistics for 4 global-brain tissue and 14 sub-brain gray matter volumetric traits were also obtained (n = up to 33,224). A bidirectional Mendelian randomization analysis was conducted to explore the causal relationship between tinnitus and neuroanatomical features at global-brain and sub-brain levels.

Results:
Genetic susceptibility to tinnitus was causally associated with increased white matter volume (odds ratio [OR] = 2.361, 95% confidence interval [CI], 1.033 to 5.393) and total brain volume (OR = 2.391, 95% CI, 1.047 to 5.463) but inversely associated with cerebrospinal fluid volume (OR = 0.362, 95% CI, 0.158 to 0.826). A smaller gray matter volume in the left Heschl’s gyrus and right insular cortex and larger gray matter volume in the posterior division of the left parahippocampal gyrus may lead to an increased risk for tinnitus (OR = 0.978, 95% CI, 0.961 to 0.996; OR = 0.987, 95% CI, 0.976 to 0.998; and OR = 1.015, 95% CI, 1.001 to 1.028, respectively).

Conclusions:
Genetic susceptibility to tinnitus was causally associated with increased white matter volume and total brain volume. Volume alteration in several cortical regions may indicate a higher tinnitus risk, and further research is recommended for causality inference at the level of sub-brain regions. Our findings provide genetic evidence for elucidating the underlying pathophysiological mechanisms of tinnitus-related neuroanatomical abnormalities.
Nylon cable ties–assisted delay primary closure of fasciotomy wound in patients of forearm compartment syndrome
Authors: Hsieh Chiung Hui , Ho Chun Yee , Roan Tyng Luen , Chang Che Wei 
Published: October 2023

Abstract

Background
Forearm compartment syndrome is a rare condition that requires forearm fasciotomy to release compartment pressure. In most cases, there is little to no skin damage initially, but after the fasciotomy, the skin flap may gradually retract. Traditional methods for reconstructing fasciotomy wounds, such as skin grafts or flaps, often result in an unpleasant appearance and require donor sites.

Materials and Methods
We present a method using nylon cable ties for delayed primary closure of forearm fasciotomy wounds. We retrospectively reviewed patients who underwent fasciotomy of forearms for compartment syndrome and nylon cable ties–assisted closure in a medical center from January 2017 to December 2022.

Results
Of the 7 eligible patients, 4 suffered from compartment syndrome of the forearm because of iatrogenic vascular rupture after procedures, whereas the other reasons included open-type fracture and fasciitis. For all the patients, nylon cable ties were applied for delayed primary wound closure after emergent fasciotomy. Six of them achieved successful wound closure by nylon cable ties without skin grafts or flaps on median day 12 (days 6–19). Only 1 patient required skin graft reconstruction after the application of nylon cable ties for 10 days.

Conclusions
Nylon cable ties, which are inexpensive and readily available, can be adjusted according to the different tension along the wound edges. They provide a simple, effective, and safe way to close difficult forearm fasciotomy wounds, which often result in a retracting skin flap after the procedure.
Robotic versus open surgery for simultaneous resection of rectal cancer and liver metastases: a randomized controlled trial
Authors: Chang Wenju , Ye Qinghai , Xu Donghao , Liu Yu , Zhou Shizhao , Ren Li , He Guodong , Zhou Guofeng , Liang Fei , Fan Jia , Wei Ye , Wang Xiaoying , Xu Jianmin 
Published: October 2023

Objective:
This study aimed to compare the short-term and long-term outcomes between robotic-assisted simultaneous resection and open surgery in patients with rectal cancer and liver metastases.

Background:
Open simultaneous resection of colorectal cancer and synchronous liver metastases is widely performed and the potential cure for eligible patients. However, the feasibility of robotic simultaneous resection of primary and secondary liver lesions has not been established as a treatment option for metastatic rectal cancer.

Patients and methods:
A single-center randomized controlled trial was conducted at a hospital in China. Enrolling patients were aged from 18 to 75 years and diagnosed with surgically resectable metastatic rectal cancer (distal extension to ≤15 cm from the anal margin). Patients selected for simultaneous resection were randomly assigned to have robotic or open surgery at a 1:1 ratio. The primary endpoint was the incidence rate of complications within 30 days after surgery. Secondary endpoints were bladder, sexual function, 3-year disease-free survival and overall survival.

Results:
A total of 171 patients were enrolled in this trial with 86 in the robotic group and 85 in the open group. As a result, patients in the robotic group demonstrated fewer complications within 30 days after surgery than those in the open group (31.4% vs. 57.6%, P=0.014) and no mortality seen in either group. Patients in the robotic group had less blood loss (mean [SD], 125.5 [38.3] vs. 211.6 [68.7] mL; P<0·001), faster bowel function recovery (mean [SD], 63.7 [27.4] vs. 93.8 [33.5] hours) P<0·001) and shorter hospital stay (mean [SD], 8.0 [2.2] vs. 10.7 [5.4] days; P<0·001) compared with those in the open group. The robotic group had faster recovery of bladder and sexual function at 3 months after surgery than that of the open group. The 3-year disease-free survival rate (39.5% vs. 35.3%, P=0.739) and the 3-year overall survival rate (76.7% vs. 72.9%, P=0.712) were not statistically significant between the two groups.

Conclusions:
In our randomized clinical trial, robotic simultaneous resection treatment of patients with rectal cancer and liver metastases resulted in fewer surgical complications, and faster recovery to those of open surgery. Oncological outcomes showed no significant difference between two groups.