bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary flow capacity and survival prediction after revascularization: physiological basis and clinical implications
Authors: Gould K Lance , Johnson Nils P , Roby Amanda E , Bui Linh , Kitkungvan Danai , Patel Monica B , Nguyen Tung , Kirkeeide Richard , Haynie Mary , Arain Salman A , Charitakis Konstantinos , Dhoble Abhijeet , Smalling Richard , Nascimbene Angelo , Jumean Marwan , Kumar Sachin , Kar Biswajit , Sdringola Stefano , Estrera Anthony , Gregoric Igor , Lai Dejian , Li Ruosha , McPherson David , Narula Jagat 
Published: August 2023

Abstract

Background and Aims
Coronary flow capacity (CFC) is associated with an observed 10-year survival probability for individual patients before and after actual revascularization for comparison to virtual hypothetical ideal complete revascularization.

Methods
Stress myocardial perfusion (mL/min/g) and coronary flow reserve (CFR) per pixel were quantified in 6979 coronary artery disease (CAD) subjects using Rb-82 positron emission tomography (PET) for CFC maps of artery-specific size-severity abnormalities expressed as percent left ventricle with prospective follow-up to define survival probability per-decade as fraction of 1.0.

Results
Severely reduced CFC in 6979 subjects predicted low survival probability that improved by 42% after revascularization compared with no revascularization for comparable severity (P = .0015). For 283 pre-and-post-procedure PET pairs, severely reduced regional CFC-associated survival probability improved heterogeneously after revascularization (P &lt; .001), more so after bypass surgery than percutaneous coronary interventions (P &lt; .001) but normalized in only 5.7%; non-severe baseline CFC or survival probability did not improve compared with severe CFC (P = .00001). Observed CFC-associated survival probability after actual revascularization was lower than virtual ideal hypothetical complete post-revascularization survival probability due to residual CAD or failed revascularization (P &lt; .001) unrelated to gender or microvascular dysfunction. Severely reduced CFC in 2552 post-revascularization subjects associated with low survival probability also improved after repeat revascularization compared with no repeat procedures (P = .025).

Conclusions
Severely reduced CFC and associated observed survival probability improved after first and repeat revascularization compared with no revascularization for comparable CFC severity. Non-severe CFC showed no benefit. Discordance between observed actual and virtual hypothetical post-revascularization survival probability revealed residual CAD or failed revascularization.
Instantaneous wave free ratio vs. fractional flow reserve and 5-year mortality: iFR SWEDEHEART and DEFINE FLAIR
Authors: Eftekhari Ashkan , Holck Emil Nielsen , Westra Jelmer , Olsen Niels Thue , Bruun Niels Henrik , Jensen Lisette Okkels , Engstrøm Thomas , Christiansen Evald Høj 
Published: August 2023

Abstract

Background and Aims
Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038).

Methods
Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan–Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA).

Results
In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [n = 1128 (50.0%)] vs. the FFR group [n = 1021 (45.2%); P = .001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32].

Conclusions
Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups.
What is Federalism? Some Definitional Clarification
Authors: Fenna Alan , Schnabel Johanna 
Published: August 2023

Abstract
The most prominent conceptualization of federalism is as a political organization combining “self-rule” with “shared rule”. The abstractness that makes this formula so attractive has, however, opened the door to misinterpretation and, in turn, encouraged misconceptions about the essential nature of federalism. “Shared rule” has been misinterpreted as meaning participation of the constituent units in central-government decision-making, or co-determination. This confuses common aspects of federal design, such as bicameralism, or important elements of federal practice, such as intergovernmental relations, with the essential or defining features of a federal system. The analysis here clarifies the meaning of shared rule and confirms that the existence of two constitutionally guaranteed orders of government, each enjoying a direct relationship with the people and exercising meaningful powers, is both necessary and sufficient for a political system to be characterized as a federation.
Asset Complexity and the Return Gap
Authors: Gao Pengjie , Hu Allen , Kelly Peter , Peng Cameron , Zhu Ning 
Published: August 2023

Abstract
Existing research finds that investors’ returns vary with their wealth and level of sophistication. We bring a new perspective from the supply side by showing that return heterogeneity can be magnified as assets offered by the market become more complex. Using detailed account-level data, we examine the trading of B funds—complex, structured products in the Chinese market. During a 3-year market cycle, the return gap between the naive and sophisticated is an order-of-magnitude greater when trading B funds than when trading simple, non-structured funds. In an event study, we confirm that this disparity is driven by differences in investors’ understanding of product complexity.
A mode of action-based probabilistic framework of dose-response assessment for nonmutagenic liver carcinogens: a case study of PCB-126
Authors: Zhou Yun , Chen Qiran , Klaunig James E , Shao Kan 
Published: August 2023

Abstract
A main function of dose-response assessment is to estimate a “safe” dose in the target population to support chemical risk assessment. Typically, a “safe” dose is developed differently for cancer and noncancer effects based on a 2-step procedure, ie, point of departure (POD) derivation and low-dose extrapolation. However, the current dose-response assessment framework is criticized for its dichotomized strategy without integrating the mode of action (MOA) information. The objective of this study was, based on our previous work, to develop a MOA-based probabilistic dose-response framework that quantitatively synthesizes a biological pathway in a dose-response modeling process to estimate the risk of chemicals that have carcinogenic potential. 3,3′,4,4′,5-Pentachlorobiphenyl (PCB-126) was exemplified to demonstrate our proposed approach. There were 4 major steps in the new modeling framework, including (1) key quantifiable events (KQEs) identification and extraction, (2) essential dose calculation, (3) MOA-based POD derivation, and (4) MOA-based probabilistic reference dose (RfD) estimation. Compared with reported PODs and traditional RfDs, the MOA-based estimates derived from our approach were comparable and plausible. One key feature of our approach was the use of overall MOA information to build the dose-response relationship on the entire dose continuum including the low-dose region. On the other hand, by adjusting uncertainty and variability in a probabilistic manner, the MOA-based probabilistic RfDs can provide useful insights of health protection for the specific proportion of population. Moreover, the proposed framework had important potential to be generalized to assess different types of chemicals other than nonmutagenic carcinogens, highlighting its utility to improve current chemical risk assessment.
In Vivo Comparison of Positive Microbial Culture by Wound Irrigation Methods
Authors: Kang Min-Seok , You Ki-Han , Hwang Jae-Yeun , Cho Tack-Geun , Yoon Joon-Hyeok , Lee Chong-Suh , Park Hyun-Jin 
Published: August 2023

Study Design.
Prospective cohort study.

Objective.
This study aimed to evaluate the risk factors and prevalence of intraoperative contamination (IoC) through the microbial culture of superficial and deep samples obtained during surgery.

Summary of Background Data.
Surgical site infection (SSI) in spinal surgery is a serious complication. The prevalence of IoC may differ based on surgical approach and technique, even in the setting of the same procedure.

Materials and Methods.
In this in vivo study, microbial cultivation was performed with superficial (ligamentum flavum, LF) and deep (nucleus pulposus, NP) surgical specimens to evaluate IoC in 132 patients undergoing single-level transforaminal lumbar interbody fusion (TLIF). Biportal endoscopic –TLIF was performed under continuous wound irrigation (group A, n=66), whereas open microscopic (OM) TLIF was performed under intermittent wound irrigation (group B, n=66). LF and NP specimens were homogenized, gram stained, and cultured in aerobic and anaerobic media for 14 days. Microbial culture results and the occurrence of SSI in the two groups were assessed. The χ2 test and Fisher exact test were used to determine significant differences among categorical variables. Logistic regression analysis was used to assess the influence of patient characteristics on the prevalence of positive microbial cultures.

Results.
Of the 132 patients, 34 (25.8%) had positive microbial cultures, and positive culture required an incubation period of 72 hours to 2 weeks in all these patients except for three. Overall, positive culture was significantly higher in group B than in group A (P=0.029). The subgroups of LF- and NP-positive cultures were 18.18% (n=24) and 12.88% (n=17), respectively; the SSI was 0.76% (n=1). Group A had a significantly lower subgroup of NP-positive culture than group B (P=0.035). OM technique was an independent risk factor associated with overall positive culture (P<0.05). The most common microorganism was Cutibacterium acnes (C. acnes).

Conclusions.
Biportal endoscopic–TLIF with continuous wound irrigation showed significantly lower overall and NP-positive cultures than OM-TLIF with intermittent irrigation. The most common strain of positive culture was C. acnes.

Level of Evidence:
2.
Effects of COL1A1 and SYTL2 on inflammatory cell infiltration and poor extracellular matrix remodeling of the vascular wall in thoracic aortic aneurysm
Authors: Xie Xinsheng , Yuan Ye , Huang Yulong , Hong Xiang , Hong Shichai , Chen Gang , Chen Yihui , Lin Yue , Lu Weifeng , Fu Weiguo , Wang Lixin 
Published: August 2023

Abstract

Background:
Thoracic aortic aneurysm (TAA) is a fatal cardiovascular disease, the pathogenesis of which has not yet been clarified. This study aimed to identify and validate the diagnostic markers of TAA to provide a strong theoretical basis for developing new methods to prevent and treat this disease.

Methods:
Gene expression profiles of the GSE9106, GSE26155, and GSE155468 datasets were acquired from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified using the "limma" package in R. Least absolute shrinkage and selection operator (LASSO), support vector machine-recursive feature elimination (SVM-RFE), random forest, and binary logistic regression analyses were used to screen the diagnostic marker genes. Single-sample gene set enrichment analysis (ssGSEA) was used to estimate immune cell infiltration in TAA.

Results:
A total of 16 DEGs were identified. The enrichment and functional correlation analyses showed that DEGs were mainly associated with inflammatory response pathways and collagen-related diseases. Collagen type I alpha 1 chain (COL1A1) and synaptotagmin like 2 (SYTL2) were identified as diagnostic marker genes with a high diagnostic value for TAA. The expression of COL1A1 and SYTL2 was considerably higher in TAA vascular wall tissues than in the corresponding normal tissues, and there were significant differences in the infiltration of immune cells between TAA and normal vascular wall tissues. Additionally, COL1A1 and SYTL2 expression were associated with the infiltration of immune cells in the vascular wall tissue. Single-cell analysis showed that COL1A1 in TAA was mainly derived from fibroblasts and SYTL2 mainly from cluster of differentiation (CD)8+ T cells. In addition, single-cell analysis indicated that fibroblasts and CD8+ T cells in TAA were significantly higher than those in normal arterial wall tissue.

Conclusions:

COL1A1 and SYTL2 may serve as diagnostic marker genes for TAA. The upregulation of SYTL2 and COL1A1 may be involved in the inflammatory infiltration of the vessel wall and poor extracellular matrix remodeling, promoting the progression of TAA.
Primary Cutaneous Mucinous Carcinoma: A Review of the Literature
Authors: Freeman Timothy , Russell Aaron J. , Council M. Laurin 
Published: August 2023

BACKGROUND
Primary cutaneous mucinous carcinoma (PCMC) is an exceedingly rare, low-grade tumor that histologically resembles mucinous carcinoma from other primary sites, such as the breast, gastrointestinal tract, and lungs.

OBJECTIVE
The purpose of this article was to review the current literature on PCMC as it relates to epidemiology, clinical presentation, histopathology, immunohistochemistry, treatment, and prognosis.

MATERIALS AND METHODS
An extensive literature review was conducted using PubMed and Ovid MEDLINE to identify articles related to PCMC.

RESULTS
Several hundred cases have been reported in the medical literature, and surgical resection, whenever feasible, is the standard of care.

CONCLUSION
The diagnosis of primary cutaneous mucinous carcinoma is one of exclusion, requiring a metastatic work-up to rule out distant primary. Mohs micrographic surgery is a tissue sparing technique that allows complete margin control of these rare neoplasia.
Assessment of self-medication status among international students in different universities in Pakistan; a cue to the rational use of medicines: a cross-sectional study
Authors: Khadka Sitaram , Yadav Gopal K. , Gupta Ravi Prasad , Aryal Pallav , Saleem Mohammad , Sharma Arun , Amgain Kapil , Adnan Muhammad Abdul Jabar 
Published: August 2023

Background:
Self-medication is a global phenomenon that can lead to adverse consequences. This study was conducted to assess the self-medication status among international students in Pakistan so that rational use of medicines (RUM) can be assured with effective interventions.

Methods:
A web-based cross-sectional survey was conducted among 317 international students in different universities in Pakistan. The original Bloom’s cutoff point was utilized to categorize the participants’ overall knowledge, attitude, and practice. The χ2 test was used to test for group differences. For binary logistic regression analyses, the odds ratio (OR) was calculated at 95% CI. Spearman rank correlation coefficient test was used to assess the relationships among the knowledge, attitude, and/or practice scores.

Results:
The participants demonstrated overall good knowledge (85.5%), positive attitude (83.9%), and good practice (78.5%) towards self-medication. None of the demographic parameters were found statistically significant with knowledge, attitude, and practice about self-medication. The participants with good knowledge and positive attitude had more than 7 and 30 times high odds of good practice (OR: 7.97, 95% CI: 4.06–15.65, P < 0.001 and OR: 30.91, 95% CI: 14.26–67.00, P < 0.001) than those without good knowledge and positive attitude, respectively.

Conclusion:
Good knowledge, positive attitude, and good practice towards self-medication show the value of education and awareness towards RUM. The interventions to halt the irrational practice of self-medication, expanding awareness, and executing legislation to upgrade the judicious use of self-medication practices are indicated for the RUM at the national level.
Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile
Authors: Koulenti Despoina , Papathanakos Georgios , Blot Stijn 
Published: August 2023

Purpose of reviewIn the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades.Recent findingsIn the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA.SummaryThe classic risk profile (‘host factors’) reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.
Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?
Authors: Lyons Patrick G. , McEvoy Colleen A. , Hayes-Lattin Brandon 
Published: August 2023

Purpose of reviewCare and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures.Recent findingsThe prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation – including ICU, hospital, and 28-day mortality – across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement.SummaryImproving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.
Central line associated and primary bloodstream infections
Authors: Stewart Adam G. , Laupland Kevin B. , Tabah Alexis 
Published: August 2023

Purpose of reviewPrimary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU.Recent findingsIn critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19.7–40.7% and 26.4–37.3% of all BSIs, respectively. Failure to achieve source control (i.e., removal of catheter in CA-BSI) is associated with higher mortality. Higher severity scores and durations of ICU stay and catheter insertion are well established risk factors for CA-BSI. The use of prevention bundles when inserting a central venous line is able to reduce CA-BSI incidence from 4 to 1.6 episodes per 1000 central venous catheter days. Differential time-to-positivity of paired blood cultures may assist in the diagnosis of CA-BSI.SummaryPrimary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.
Breath of fresh insight: unraveling the evolution of our understanding of cystic fibrosis pulmonary exacerbations
Authors: Somayaji Ranjani , Quon Bradley S. 
Published: August 2023

Purpose of review
Pulmonary exacerbations are critical events with significant negative impacts in persons with cystic fibrosis, but their diagnosis and management are highly variable. Highly effective modulator therapies have greatly improved health and reduced exacerbation events, but have also reshaped how they present. This review discusses the complexities of the diagnosis and management of pulmonary exacerbations as well as the emerging work and evidence in this area.

Recent findings
The shifting epidemiology and our understanding of risk factors for pulmonary exacerbations are discussed. As symptoms may be more subtle in the modulator context, novel technologies including studies of remote monitoring are presented. The continued relevance of pulmonary exacerbations, the heterogeneity in their management, as well as current and forthcoming clinical trials to optimize treatment approaches are detailed.

Summary
In spite of the dramatic reductions in pulmonary exacerbations, airway infections persist, a proportion of persons with cystic fibrosis either on or off modulator therapies continue to experience exacerbation events, and long-term data is lacking. Innovative approaches and studies will be crucial to enable standardized and generalizable strategies to improve outcomes in persons with cystic fibrosis.