bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Transverse Arch in Progressive Collapsing Foot Deformity
Authors: Schmidt Eli , Lalevée Matthieu , Kim Ki Chun , Carvalho Kepler Alencar Mendes de , Dibbern Kevin , Lintz Francois , Barbachan Mansur Nacime Salomao , de Cesar Netto Cesar 
Published: October 2023

Background: The transverse arch (TA) has recently been shown to significantly increase the intrinsic stiffness of the midfoot when coupled with the medial longitudinal arch (MLA). Progressive collapsing foot deformity (PCFD) is a complex deformity that ultimately results in a loss of stiffness and collapse of the MLA. The role of the TA has not been investigated in patients diagnosed with this disorder using weightbearing CT (WBCT). Therefore, this study aims to answer the following questions: (1) Is the curvature of the TA decreased in PCFD? (2) Where within the midfoot does TA curvature flattening happen in PCFD? Methods A retrospective review of weightbearing CT images was conducted for 32 PCFD and 32 control feet. The TA curvature was assessed both indirectly using previously described methods and directly using a novel measurement termed the transverse arch plantar (TAP) angle that assesses the angle formed between the first, second, and fifth metatarsals in the coronal plane. Location of TA collapse was also assessed in the coronal plane. Results: The TAP angle was significantly higher in PCFD (mean 115.2 degrees, SD 10.7) than in the control group (mean 100.8 degrees, SD 7.9) ( P < .001). No difference was found using the calculated normalized TA curvature between PCFD (mean 17.1, SD 4.8) and controls (mean 18.3, SD 4.0) ( P = .266). Location of collapse along the TA in PCFD was most significant at the second metatarsal and medial cuneiform. Conclusion: The TA is more collapsed in PCFD compared to controls. This collapse was most substantial between the plantar medial cuneiform and the plantar second metatarsal. This may represent a location of uncoupling of the TA and MLA. Level of Evidence: Level III, retrospective case control.
The Clinical Implementation of CYP2C19 Genotyping in Patients with an Acute Coronary Syndrome: Insights From the FORCE-ACS Registry
Authors: Azzahhafi Jaouad , Broek Wout W. A. van den , Chan Pin Yin Dean R. P. P. , Harmsze Ankie M. , van Schaik Ron H. N. , ten Berg Jurriën M. 
Published: October 2023

Background Guidelines recommend prasugrel or ticagrelor for acute coronary syndrome (ACS) patients. However, these P2Y12 inhibitors increase bleeding risk compared to clopidogrel. Although genotype-guided P2Y12-inhibitor selection has been shown to reduce bleeding risk, data on its clinical implementation is lacking. Methods The study included ACS patients receiving genotype-guided antiplatelet therapy, utilising either a point-of-care (POC) device or laboratory-based testing. We aimed to collect qualitative and quantitative data on genotyping, eligibility for de-escalation, physician adherence to genotype results, time to de-escalation and cost reduction. Results Of the 1,530 patients included in the ACS registry from 2021 to 2023, 738 ACS patients treated with ticagrelor received a CYP2C19 genotype test. The median turnover time of genotyping was 6.3 hours (interquartile range [IQR], 3.2-16.7), with 82.3% of the genotyping results known within 24 hours after admission. POC genotyping exhibited significantly shorter turnaround times compared to laboratory-based testing (with respective medians of 5.7 vs 47.8 hours; P < .001). Of the genotyped patients, 81.7% were eligible for de-escalation which was carried out within 24 hours in 70.9% and within 48 h in 93.0%. The time to de-escalation was significantly shorter using POC (25.4 hours) compared to laboratory-based testing (58.9 hours; P < .001). Implementing this strategy led to a reduction of €211,150.50 in medication costs. Conclusions CYP2C19 genotype-guided-de-escalation in an all-comers ACS population is feasible. POC genotyping leads to shorter turnaround times and quicker de-escalation. Time to de-escalation from ticagrelor to clopidogrel in noncarriers was short, with high physician adherence to genotype results.
Impact of New Onset Atrial Fibrillation in Hospitalized Patients with COVID-19. Results of the “ACO-VID” Registry
Authors: Cerezo Manchado Juan José , Iturbe Hernández Teodoro , Martínez Pacheco María del Carmen , Gil Ortega Ignacio , Campoy Desirée , Canals Pernas Tania , Martinez Serra Laia , Flores Aparco Katia Jessica , Velasquez Escandon Cesar Andres , García de Guadiana-Romualdo Luis , Martinez Frances Antonio , Olivera Pavel 
Published: October 2023

Objective To assess the impact of new-onset atrial fibrillation (AF) on patients hospitalized with coronavirus disease 2019 (COVID-19). Methods Multicenter and retrospective study that included subjects >55 years hospitalized with COVID-19 from March to October 2020 in Spanish hospitals. Patients were divided into 3 groups (no AF, new-onset AF, and preexisting AF) and followed-up to 90 days. Results A total of 668 patients were included, of whom 162 (24.3%) had no AF, 107 (16.0%) new-onset AF and 399 (59.7%) preexisting AF. Compared to patients without AF, those patients with new-onset AF were older and had more comorbidities, but without differences with preexisting AF. During hospitalization, in the univariate analysis, compared to patients without AF, major bleeding and cardiovascular mortality were more frequent in patients with new-onset AF (10.3% vs 0.6%; P < .001; 2.8% vs 0.6%; P = .025, respectively), with a trend toward more stroke (1.9% vs 0%; P = .085). Outcomes were similar between AF groups, but the length of stay was greater in preexisting AF patients. Among patients with new-onset AF taking reduced doses of anticoagulant treatment was associated with higher risks of stroke and major bleeding. Conclusions In COVID-19 hospitalized patients, new-onset AF may be associated with worse outcomes, but influenced by the dose of anticoagulants.
Liver toxicity with ribociclib in a patient with metastatic hormone receptor positive postmenopausal breast cancer
Authors: Sozer Karadagli Sumru , Gursoy Pınar 
Published: October 2023

Introduction In recent years, highly selective reversible CDK4/6 inhibitors have been combined with aromatase inhibitors for their efficacy and ease of application in the treatment of advanced stage of hormone-responsive breast cancers. Oral use of these drugs facilitates patient compliance. However, adverse drug reactions are reported due to these drugs, in the literature. Diverse adverse reactions such as skin reactions, liver toxicity, and vitiligo with ribociclib have been reported. Case report In this study, we present of liver toxicity due to the use of ribociclib in a case of advanced breast cancer with metastases. It is noteworthy that the patient did not have any other concomitant disease and did not take any other medication. Management and outcome After the 600 mg initial dose of ribociclib, neutropenia occurred at the beginning of the therapy, the dose was reduced to 400 mg, and liver enzymes started to rise in the second month of the therapy. In the fifth month of the intermittent treatment period, liver toxicity was grade 3. Discussion Liver adverse reaction occurred due to ribociclib use in the patient who had no history of any other disease. The Naranjo algorithm score was evaluated as 9. Considering the excretion of ribociclib by sulfation, cysteine conjugation, and glucuronidation, which are phase II reactions, n-acetyl cysteine (NAC) treatment (600 mg/day) was started for the patient. NAC therapy is recommended to reduce elevated liver enzymes in the case. The patient's treatment has been continuing with palbociclib for 5 months. No increase in liver enzymes was observed.
Design and structural testing of 3D printed honeycomb cores with optimised integrated blended inserts
Authors: Dumitrescu Adrian , Walker Scott J. I. , Romei Federico , Bhaskar Atul 
Published: October 2023

The integration of inserts into sandwich panel constructions is a complex multi-step process with significant human intervention that also limits the geometrical freedom of the insert design. In a standard sandwich construction, the panel core is made up of multiple materials across its main components: insert, potting and core. This multi-material assembly is not only difficult to manufacture, but it also promotes stress jumps at the insert-core interface, leading to a sub-optimal load distribution from the bolt to the panel core. Additive manufacturing (AM) can lead to a single-part core and insert assembly with more optimised insert geometries that can better transmit the loads applied to the panel. Previous work by the authors has explored the manufacturing limits and the failure modes of AM inserts integrated in cores printed out of sintered AlSi10Mg. The conclusions were that the core walls and insert elements should have a minimum design thickness of 0.5 mm to survive the tapping process without facesheets attached and it was found that the main failure mode of the geometries tested in pull-out was buckling of the insert walls. Based on these results, the paper proposes a novel insert design philosophy that can delay the buckling of 3D printed inserts and move the failure point of the insert away from the bolt. A set of inserts that follow this design direction is manufactured and tested under normal pull-out loads and the optimised designs outperform standard printed insert geometries by a factor of three. The design philosophy can be further developed to offer a suitable alternative to the current insert standard.
Effectiveness of Duloxetine on Oxaliplatin-induced Allodynia and Hyperalgesia in Rats
Authors: Wagner Monica A. , Smith Ellen M. Lavoie , Ayyash Naji , Toledo Josue , Rasheed Zainab , Holden Janean E. 
Published: October 2023

Development of painful oxaliplatin-induced peripheral neuropathy (OIPN) is a major problem in people who receive oxaliplatin as part of cancer treatment. The pain experienced by those with OIPN can be seriously debilitating and lead to discontinuation of an otherwise successful treatment. Duloxetine is currently the only recommended treatment for established painful OIPN recommended by the American Society of Clinical Oncology, but its preventative ability is still not clear. This study examined the ability of duloxetine to prevent signs of chronic OIPN in female (n = 12) and male (n = 21) rats treated with the chemotherapeutic agent oxaliplatin. Using an established model of OIPN, rats were started on duloxetine (15 mg) one week prior to oxaliplatin administration and continued duloxetine for 32 days. Behavioral testing for mechanical allodynia and mechanical hyperalgesia was done with selected von Frey filaments. Significant posttreatment differences were found for allodynia in female ( p = .004), but not male rats. Duloxetine was associated with significant differences for hyperalgesia in both female ( p < .001) and male ( p < .001) rats. These findings provide preliminary evidence of the preventative effects of duloxetine on both oxaliplatin-induced allodynia and hyperalgesia in male and female rats, with a difference noted in response between the sexes.
Tunneled femoral dialysis catheters and factors affecting their outcome: a single institution experience
Authors: Pokala Naveen Kumar , Mesick Matthew , Kim Seung Kwon , Kavali Pavan Kumar , Mani Naganathan B 
Published: October 2023

Background: To assess a single-center experience with tunneled femoral dialysis catheter usage and outcomes and to identify any operator-dependent factors related to risk of premature catheter failure. Methods: Retrospective review of the institutional radiology information system for tunneled femoral dialysis catheter placement from 2010 to 2017 was performed. Patients for whom the catheter was placed for an indication other than dialysis or who were less than 18 years of age at the time of catheter placement were excluded. Premature catheter failure rate, cause of premature failure, catheter patency (in days) and infection rate were assessed. Operator/placement characteristics, including laterality, catheter tip placement, and catheter length were also assessed. Results: A total of 101 patients were included in the study. This included n = 116 catheter placements. Thirty-four percent of patients ( n = 40) were lost to follow-up, resulting in n = 61 patients and n = 76 catheters analyzed. Premature catheter failure rate was 48% ( n = 36), with low flows being the foremost cause of failure (64%, n = 23). Average primary patency of these catheters was 82.4 days (1–328 days). About 8% of catheters ( n = 3) were complicated by infection, resulting in an infection rate of 0.4/1000 catheter days. None of the operator-dependent factors analyzed, including catheter laterality, catheter tip placement, and catheter length, demonstrated a significant association with premature catheter failure. Conclusions: Institutional primary access patency rates are comparable to or higher than previously published data, while infection rates are similar to or lower than those reported in the literature. None of the operator-dependent factors related to placement was shown to significantly decrease the risk of premature catheter failure. These findings suggest that while femoral dialysis catheters do not function well in the long term relative to internal jugular vein dialysis catheters, prior literature may undervalue their utility and function, particularly given that these catheters are used as a “last resort” for many patients.
Prehospital stroke scales outperform National Institutes of Health Stroke Scale in predicting large vessel occlusion in a large academic telestroke network
Authors: English Stephen W , Chhabra Nikita , Hanus Abigail E , Basharath Rida , Miller Monet , Butterfield Richard J , Zhang Nan , Demaerschalk Bart M 
Published: October 2023

Introduction Prehospital telestroke evaluations may improve stroke triage compared to paramedic-applied large vessel occlusion scales, but ambulance-based video National Institutes of Health Stroke Scale assessments are challenging. The accuracy of telestroke-administered large vessel occlusion scales has not been investigated, so we sought to evaluate this further. Methods This retrospective study included all in-hospital telestroke encounters in a large academic telestroke network from 2019 to 2020. We retrospectively calculated seven large vessel occlusion scales using the in-hospital telestroke National Institutes of Health Stroke Scale (Rapid Arterial oCclusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Field Assessment Stroke Triage for Emergency Destination, 3-Item Stroke Scale, Prehospital Acute Stroke Severity, Vision-Aphasia-Neglect, and Gaze-Face-Arm-Speech-Time). Diagnostic performance was assessed via sensitivity, specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and accuracy using established scale thresholds. These results were compared to the National Institutes of Health Stroke Scale at thresholds of 6, 8, and 10. The area under curve was calculated using c-statistics by treating scales as continuous variables. Results A total of 625 patients were included; 111 (17.8%) patients had an anterior large vessel occlusion, 118 (18.9%) patients had any large vessel occlusion, and 182 (29.1%) patients had stroke mimic diagnosis. The mean age (SD) was 67.9 (15.9), 48.3% were female, and 93.4% were white. The Mean National Institutes of Health Stroke Scale (SD) was 14.9 (8.4) for patients with anterior large vessel occlusion, 4.7 (5.0) for patients with non-large vessel occlusion ischemic stroke, and 4.4 (5.8) for stroke mimic ( p < 0.001). Compared to the National Institutes of Health Stroke Scale, Field Assessment Stroke Triage for Emergency Destination, and Rapid Arterial oCclusion Evaluation scales demonstrated higher accuracy and area under curve for large vessel occlusion detection. Discussion Both the Field Assessment Stroke Triage for Emergency Destination and Rapid Arterial oCclusion Evaluation scales outperformed the National Institutes of Health Stroke Scale for large vessel occlusion detection in patients evaluated by in-hospital telestroke. These scales may be valid alternatives to the National Institutes of Health Stroke Scale examination in this setting.
Patterns of physical activity and sedentary behavior in child and adolescent cancer survivors assessed using wrist accelerometry: A cluster analysis approach
Authors: Ha Lauren , Wakefield Claire E. , Diaz Claudio , Mizrahi David , Signorelli Christina , Yacef Kalina , Simar David 
Published: October 2023

Physical activity levels among childhood cancer survivors are typically quantified as a total amount using time spent in various intensities. Yet, most analyses do not consider the transitory nature of children’s behaviors and a more detailed approach could provide complimentary information. We aimed to explore various behavior profiles of survivors’ daily and hourly physical activity patterns. We measured 8-18-year-old survivors’ activity levels over 7 days using wrist accelerometry and cluster analysis. Of the 37 participant datasets, survivors engaged in mean (SD) 36.3 (19.0) min/day of MVPA and 4.1 (1.9) hrs/day of sedentary activity. The cluster analysis revealed five daily movement patterns: ‘most active’ (prevalence 11%), ‘active’ (22%), ‘moderately active + moderately sedentary’ (35%), ‘moderately active + high sedentary’ (5%) and ‘least active’ (27%). Younger survivors and those with less time since treatment completion were more likely to be in the active clusters. Hourly behaviors were characterized by short bursts of MVPA and moderate bouts of sedentary activity. Our approach provides an insightful analysis into the nature and timing of childhood cancer survivors’ movement behaviours. Our findings may assist in the development of targeted interventions to improve physical activity levels.
Physician-Modified Endografts for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch
Authors: Wen Qinshu , Wu Guangyan , Ji Ye , Yang Guangmin , Zhang Yepeng , Li Wendong , Du Xiaolong , Li Xiaoqiang , Zhou Min 
Published: October 2023

Objective: This study aimed to evaluate the outcomes of physician-modified endografts (PMEGs) for the treatment of thoracic aortic pathologies involving the aortic arch. Methods: A retrospective single-center study was performed on consecutive patients with thoracic aortic pathologies treated by PMEGs between February 2018 and May 2022. Data on baseline characteristics, operative procedure, and follow-up information were collected. The endpoints included technical success, complications, mortality, overall survival, re-intervention, and target vessel instability. Results: This study comprised 173 patients (mean age=58±13, range=28–83, 148 men) with thoracic aortic pathologies, including 44 thoracic aortic aneurysms, 113 aortic dissections (9 type A, 4 residual type A, 75 type B, 32 non-A non-B), 3 aortic intramural hematomas, and 13 penetrating aortic ulcers. Thirty-five of the patients had PMEGs with 3 fenestrations, 32 had 2 fenestrations, and 106 had 1 single fenestration. Technical success was 98% (170/173), and the 30-day mortality was 2% (3/173). Perioperative complications included stroke (n=3, 2%), retrograde type A dissection (RTAD; n=3, 2%) and renal injury (n=3, 2%). Seven deaths (4%) were noted during a median follow-up of 11 (range=1–52) months. Eleven cases of re-intervention were stent-related. There were 5 type Ia endoleaks (3%), 2 type III endoleaks (1%) from the innominate artery (IA), and 3 type Ic endoleaks (2%) from the left subclavian arteries. One case of IA stent-graft (SG) stenosis was noted because of mural thrombus. Estimate rates of overall survival, freedom from secondary intervention, and freedom from target vessel instability at 2 years were 93.4% (95% confidence interval [CI]=88.7%–98.1%), 80.7% (95% CI=73.3%–88.1%), and 89.0% (95% CI=80.4%–97.6%), respectively. Conclusions: Physician-modified endografts showed promising immediate therapeutic results in the treatment of thoracic aortic pathologies involving the aortic arch. Our study demonstrates that the technique is feasible and produces acceptable results. Long-term outcomes are required for further refinement of this technical approach to confirm technical success and durability over time as a valuable option for endovascular aortic arch repair in specialized centers. Clinical impact Our short- and mid-term outcomes of physician-modified endografts in 173 patients showed promising results compared to other branched/fenestrated techniques and backed up the endovascular repair of the aortic arch. Meanwhile, the technical expertise pointed out in our manuscript, including preloaded guidewire, diameter-reducing wire and inner mini-cuffs, provided reference and technical guidance for our peers. Most importantly, it demonstrated that the PMEG, as a device whose components were all commercially available, might be a better option for emergency surgery and for centers who had no access to custom-made devices.
Artificial Intelligence–Assisted Sac Diameter Assessment for Complex Endovascular Aortic Repair
Authors: Wegner Moritz , Fontaine Vincent , Nana Petroula , Dieffenbach Bryan V. , Fabre Dominique , Haulon Stéphan 
Published: October 2023

Purpose: Artificial intelligence (AI) using an automated, deep learning–based method, Augmented Radiology for Vascular Aneurysm (ARVA), has been verified as a viable aide in aneurysm morphology assessment. The aim of this study was to evaluate the accuracy of ARVA when analyzing preoperative and postoperative computed tomography angiography (CTA) in patients managed with fenestrated endovascular repair (FEVAR) for complex aortic aneurysms (cAAs). Materials and Methods: Preoperative and postoperative CTAs from 50 patients (n=100 CTAs) who underwent FEVAR for cAAs were extracted from the picture archiving and communication system (PACS) of a single aortic center equipped with ARVA. All studies underwent automated AI aneurysm morphology assessment by ARVA. Appropriate identification of the outer wall of the aorta was verified by manual review of the AI-generated overlays for each patient. Maximum outer-wall aortic diameters were measured by 2 clinicians using multiplanar reconstruction (MPR) and curved planar reformatting (CPR), and among studies where the aortic wall was appropriately identified by ARVA, they were compared with ARVA automated measurements. Results: Identification of the outer wall of the aorta was accurate in 89% of CTA studies. Among these, diameter measurements by ARVA were comparable to clinician measurements by MPR or CPR, with a median absolute difference of 2.4 mm on the preoperative CTAs and 1.6 mm on the postoperative CTAs. Of note, no significant difference was detected between clinician measurements using MPR or CPR on preoperative and postoperative scans (range 0.5–0.9 mm). Conclusion: For patients with cAAs managed with FEVAR, ARVA provides accurate preoperative and postoperative assessment of aortic diameter in 89% of studies. This technology may provide an opportunity to automate cAA morphology assessment in most cases where time-intensive, manual clinician measurements are currently required. Clinical Impact In this retrospective analysis of preoperative and postoperative imaging from 50 patients managed with FEVAR, AI provided accurate aortic diameter measurements in 89% of the CTAs reviewed, despite the complexity of the aortic anatomies, and in post-operative CTAs despite metal artifact from stent grafts, markers and embolization materials. Outliers with imprecise automated aortic overlays were easily identified by scrolling through the axial AI-generated segmentation MPR cuts of the entire aorta.This study supports the notion that such emerging AI technologies can improve efficiency of routine clinician workflows while maintaining excellent measurement accuracy when analyzing complex aortic anatomies by CTA.