bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video-Assisted-Thoracoscopic-Surgery Pleural Decorticator for Emergency Empyema Surgery
Authors: Ariyaratnam Priyadharshanan , Tcherveniakov Peter , Milton Richard , Lodhia Joshil , Chaudhuri Nilanjan 
Published: February 2023

Background/need Pleural empyemas carry a high morbidity and mortality. Some can be managed with medical treatment but most require some form of surgery with the goals to remove the infected material from the pleural space and to help re-expand the collapsed lung. Keyhole surgery by Video Assisted Thoracoscopy Surgery (VATS) is rapidly becoming a common approach to deal with early stage empyemas to avoid larger, more painful thoracotomies that hinder recovery. However, the ability to achieve those aforementioned goals is often hindered by VATS surgery due to the instruments available. Methodology and device description We have developed a simple instrument called the “VATS Pleural Debrider” to achieve those goals in empyema surgery that can be used in keyhole surgery. Preliminary results We have used this device in over 90 patients with no peri-operative mortality and a low re-operation rate. Current status Used in routine urgent/emergency pleural empyema surgery across 2 cardiothoracic surgery centres.
Reconstruction of the accessory renal artery with autogenous vessels in aortic hybrid surgery: A case report
Authors: Zhou Kun , Duan Hui , Hu Hankui , Guo Qiang , Zhao Jichun 
Published: February 2023

Objective Accessory renal artery (ARA) is a common variant of renal vessels. Currently, there are some controversies about reconstruction strategy and few cases reported in the literature. Individualized treatment should be carried out according to preoperative renal function evaluation and technical level. Methods In this paper, a 50-year-old male patient was reported, who developed a dissecting aneurysm after thoracic endovascular aortic repair (TEVAR) and needed further intervention. Imaging showed that the left kidney was supplied by bilateral renal artery (false lumens), and there were left renal malperfusion complicated with abnormal renal function. Results Autologous blood vessels were used to successfully reconstruct ARA with during hybrid surgery. Renal perfusion and renal function recovered rapidly after operation. There was no abnormality in renal indexes after 3 months follow-up. Conclusion It is beneficial and necessary to reconstruct ARA for patients with renal malperfusion or abnormal renal function before operation.
A retrospective case–control study for the comparison of 5-year survival rates: the role of adjuvant and neoadjuvant chemotherapy in craniofacial bone sarcoma in adults
Authors: Hofmann Elena , Preissner Saskia , Hertel Moritz , Preissner Robert , Rendenbach Carsten , Flörcken Anne , Heiland Max 
Published: February 2023

Background: The impact of adjuvant or neoadjuvant chemotherapy in the treatment of craniofacial bone sarcomas has not been clarified. This study aimed to assess whether survival outcomes differed between patients who underwent adjuvant or neoadjuvant chemotherapy. Methods: A retrospective search for adult patients diagnosed with malignant neoplasms of the craniofacial bones (International Classification of Diseases 10 codes C41.0–C41.1), within the past 20 years from the access date 28 April 2022, was conducted using the TriNetX network (TriNetX, Cambridge, MA, USA). Cohort I included patients who underwent adjuvant chemotherapy and cohort II included patients with neoadjuvant chemotherapy. A refined search for individuals that received common chemotherapeutic agents, such as methotrexate, doxorubicin, cisplatin, and/or ifosfamide, was conducted and patients were assigned to cohort A (adjuvant chemotherapy) and cohort B (neoadjuvant chemotherapy). Following matching for age and sex, Kaplan–Meier analysis was performed, and risk ratio, odds ratio (OR), and hazard ratio were calculated. Results: Patients were assigned to two cohorts, with 181 patients each after matching. In cohorts I and II, 55 and 41 patients died, respectively. No significant differences were found between the two cohorts regarding the 5-year survival probability (I: 59.87% versus II: 68.45%; p = 0.076; log-rank test), or the risk of dying (I: 0.304 versus II: 0.227; risk difference: 0.077; p = 0.096). The risk analysis before matching for age and sex showed a significant survival benefit in cohort II (OR: 1.586; p = 0.0295; risk difference: 0.093). After a refined query to identify patients treated with methotrexate, doxorubicin, cisplatin, and/or ifosfamide, the two cohorts included 47 patients, respectively. In cohort A (adjuvant chemotherapy), 19 patients died, whereas 12 patients died in cohort B (neoadjuvant chemotherapy) within 5 years after diagnosis. Further analysis indicated a greater survival in cohort B, but the survival probability between the cohorts did not differ significantly (A: 43.55% versus B: 54.49%; p = 0.171). Conclusion: The use of neoadjuvant chemotherapy may improve survival rates in patients with surgically treated craniofacial bone sarcomas. Due to the retrospective nature of this study, randomized controlled studies are required to derive treatment recommendations.
Perioperative Complications Following Spine Surgery in Adult Patients with Achondroplasia
Authors: Chan Julie L. , Quintero-Consuegra Miguel D. , Kanim Linda E.A. , Kropf Michael A. , Bernstein Robert , Perry Tiffany G. , Walker Corey T. , Danielpour Moise , Tuchman Alexander 
Published: February 2023

Study Design Retrospective cohort study Objectives To describe the common types of complications and their risk factors during spine surgery in patients with achondroplasia. Methods A retrospective review was performed of medical records of adult achondroplasia patients who underwent spine surgery at our institution between 2007 and 2021. Inclusion criteria were achondroplasia and age >16 years. Surgical encounters were evaluated for durotomy, postoperative neurologic deficit, wound compromise, medical complications, and return to the operating room. Statistical analysis included evaluation of relationships across complications and fisher exact test applied to bivariate/categorical variables and t-test/ANOVA for continuous variables. Multivariable analysis using logistic regression was performed to account for patient characteristics Results Fifty-five patients with achondroplasia underwent 95 surgeries. Forty-nine percent of the surgeries involved a complication. These included durotomy (33.7%), neurologic deficit (11.6%), wound compromise (6.3%), and other medical complications (6.3%). Thirteen percent of surgeries required return to the operating room. The greatest number of complications occurred in thoracolumbar region (60.0%) compared to cervicothoracic (18.2%) and craniocervical junction (33.3%). Chronologically later surgical encounters had decreased complications and durotomies only occurred in thoracolumbar surgeries (45.7%). Conclusions Adult patients with achondroplasia undergoing surgery chronologically later in this set of consecutive patients were at a decreased risk for complications. Thoracolumbar surgeries were at the greatest risk for durotomies. Male sex was a risk factor for durotomy, while age was a risk factor for neurologic deficit. The potential for adverse surgical events should be considered when evaluating patients with achondroplasia for spine surgery.
Effective removal of hexavalent chromium with magnetically reduced graphene oxide bentonite
Authors: Cao Shoufa , Guo Jingmao , Ma Jianchao , Chen Enqing , Pang Jin , Zhang Siyu , Hao Haidong , Wu Danlei , Wang Shaobin 
Published: February 2023

AbstractWater pollution by hexavalent chromium (Cr(VI)) is widespread and problematic. As a result, more research into economic Cr(VI) removal is needed. In this study, we created and employed an adsorption–reduction mechanism to remove Cr(VI). Magnetically reduced graphene oxide bentonite (MrGO-BT) is acid resistant and can undergo magnetic separation. The hydroxyl group of chitosan (CS) condensed with the functional groups on the surface of bentonite (BT), and the MrGO-BT sandwich has been fabricated and constructed from an Fe3O4 core layer sandwiched by reduced graphene oxide (rGO) and a BT shell, with CS acting as a crosslinker. Cr(VI) elimination by MrGO-BT was exothermic and spontaneous according to thermodynamic analyses. The adsorption kinetics and adsorption isotherms were characterized by the pseudo-second order kinetic theory and the Langmuir model, respectively. Regarding the elimination of Cr(VI), the greatest adsorption ability for Cr(VI) elimination achieved was 91.5 mg g–1. Fourier-transform infrared spectroscopy and X-ray photoelectron spectroscopy suggested that Cr(VI) was reduced by C–O–H on MrGO-BT to produce Cr(III) and H–C=O, and that Cr(III) chelated with amino groups or exchanged with BT after intercalation. In addition, the introduction of Cu2+ increased the positive charge of MrGO-BT and amplified the electrostatic interaction between Cr2O72− and HCrO4–, which is what caused Cr(VI) to be eliminated. Cu2+ and reduced Cr(III) combined with -NH2 on the surface of MrGO-BT to form -NH-Cr(III) or -NH-Cu2+, and Cr(VI) elimination via chelation and ion exchange was confirmed. MrGO-BT is shown to be an adsorbent with high acid resistance and good magnetic responsiveness and stability.
Effects of process changes on emergency department crowding in a changing world: an interrupted time-series analysis
Authors: Van Der Linden M. Christien , Van Loon-Van Gaalen Merel , Richards John R. , Van Woerden Geesje , Van Der Linden Naomi 
Published: February 2023

Abstract
Background
During a 6-year period, several process changes were introduced at the emergency department (ED) to decrease crowding, such as the implementation of a general practitioner cooperative (GPC) and additional medical staff during peak hours. In this study, we assessed the effects of these process changes on three crowding measures: patients’ length of stay (LOS), the modified National ED OverCrowding Score (mNEDOCS), and exit block while taking into account changing external circumstances, such as the COVID-19 pandemic and centralization of acute care.

Methods
We determined time points of the various interventions and external circumstances and built an interrupted time-series (ITS) model per outcome measure. We analyzed changes in level and trend before and after the selected time points using ARIMA modeling, to account for autocorrelation in the outcome measures.

Results
Longer patients’ ED LOS was associated with more inpatient admissions and more urgent patients. The mNEDOCS decreased with the integration of the GPC and the expansion of the ED to 34 beds and increased with the closure of a neighboring ED and ICU. More exit blocks occurred when more patients with shortness of breath and more patients > 70 years of age presented to the ED. During the severe influenza wave of 2018–2019, patients’ ED LOS and the number of exit blocks increased.

Conclusions
In the ongoing battle against ED crowding, it is pivotal to understand the effect of interventions, corrected for changing circumstances and patient and visit characteristics. In our ED, interventions which were associated with decreased crowding measures included the expansion of the ED with more beds and the integration of the GPC on the ED.
Spinal injury with spinal ankylosing disorders as a primary cause of death: report of two cases
Authors: Miyake Takahito , Okada Hideshi , Kanda Norihide , Mizuno Yosuke , Suzuki Kodai , Doi Tomoaki , Yoshida Takahiro , Yoshida Shozo , Ogura Shinji 
Published: February 2023

Abstract
Background
Spinal ankylosing disorders (SADs) refer to a group of conditions resulting in spontaneous or postsurgical ossification and fusion of the spinal segments. The spine becomes increasingly susceptible to injury over time such that even low-energy trauma can cause a spinal injury. We report two cases of SADs, associated with massive thoracic hemorrhage.

Case presentation
The first patient was an 85-year-old male, who suffered from a vehicular crash. He was diagnosed with a fracture of the first lumbar vertebra, accompanied by SADs. Intubation was required, and thoracic drainage tubes were inserted. The patient underwent a massive transfusion and thoracotomy with packing. Despite prompt treatment, the hemorrhage from the vertebral fracture was uncontrolled, and the patient died 180 min after the injury.
The second case features an 88-year-old male who fell from a height. He was diagnosed with flail chest, hemothorax, pneumothorax, and a fracture of the eighth thoracic vertebra with SADs. After intubation, four thoracic drainage tubes were placed, and a massive transfusion was conducted. He died after 3 days due to hypoxemia secondary to persistent bleeding of the vertebral fracture for 24 h.

Conclusions
The patients died of persistent thoracic hemorrhage, and the sources of bleeding were the fracture site of the spine fractures. Controlling spinal hemorrhage is difficult due to the absence of a bleeding artery, which is managed via trans-arterial embolization. This report emphasized that fracture of SADs could be a fatal disease that requires prompt intervention.
Analysis of genetically determined gene expression suggests role of inflammatory processes in exfoliation syndrome
Authors: Hirbo Jibril B. , Pasutto Francesca , Gamazon Eric R. , Evans Patrick , Pawar Priyanka , Berner Daniel , Sealock Julia , Tao Ran , Straub Peter S. , Konkashbaev Anuar I. , Breyer Max A. , Schlötzer-Schrehardt Ursula , Reis André , Brantley Milam A. , Khor Chiea C. , Joos Karen M. , Cox Nancy J. 
Published: February 2023

Abstract
Background
Exfoliation syndrome (XFS) is an age-related systemic disorder characterized by excessive production and progressive accumulation of abnormal extracellular material, with pathognomonic ocular manifestations. It is the most common cause of secondary glaucoma, resulting in widespread global blindness. The largest global meta-analysis of XFS in 123,457 multi-ethnic individuals from 24 countries identified seven loci with the strongest association signal in chr15q22–25 region near LOXL1. Expression analysis have so far correlated coding and a few non-coding variants in the region with LOXL1 expression levels, but functional effects of these variants is unclear. We hypothesize that analysis of the contribution of the genetically determined component of gene expression to XFS risk can provide a powerful method to elucidate potential roles of additional genes and clarify biology that underlie XFS.

Results
Transcriptomic Wide Association Studies (TWAS) using PrediXcan models trained in 48 GTEx tissues leveraging on results from the multi-ethnic and European ancestry GWAS were performed. To eliminate the possibility of false-positive results due to Linkage Disequilibrium (LD) contamination, we i) performed PrediXcan analysis in reduced models removing variants in LD with LOXL1 missense variants associated with XFS, and variants in LOXL1 models in both multiethnic and European ancestry individuals, ii) conducted conditional analysis of the significant signals in European ancestry individuals, and iii) filtered signals based on correlated gene expression, LD and shared eQTLs, iv) conducted expression validation analysis in human iris tissues. We observed twenty-eight genes in chr15q22–25 region that showed statistically significant associations, which were whittled down to ten genes after statistical validations. In experimental analysis, mRNA transcript levels for ARID3B, CD276, LOXL1, NEO1, SCAMP2, and UBL7 were significantly decreased in iris tissues from XFS patients compared to control samples. TWAS genes for XFS were significantly enriched for genes associated with inflammatory conditions. We also observed a higher incidence of XFS comorbidity with inflammatory and connective tissue diseases.

Conclusion
Our results implicate a role for connective tissues and inflammation pathways in the etiology of XFS. Targeting the inflammatory pathway may be a potential therapeutic option to reduce progression in XFS.
Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery
Authors: Döhler Ida , Röder Daniel , Schlesinger Tobias , Nassen Christian Alexander , Germer Christoph-Thomas , Wiegering Armin , Lock Johan Friso 
Published: February 2023

Abstract
Background
Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events.

Methods
We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality.

Results
A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed.

Conclusion
It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low.
Phenylacetyl glutamine: a novel biomarker for stroke recurrence warning
Authors: Ma Li , Fu Guoping , Liu Rongrong , Zhou Feng , Dong Shiye , Zhou Yang , Lou Jingwei , Wang Xinjun 
Published: February 2023

Abstract
Background
Stroke is the second leading cause of disease-related death and the third leading cause of disability worldwide. However, how to accurately warn of stroke onset remains extremely challenging. Recently, phenylacetyl glutamine (PAGln) has been implicated in the onset of stroke, but evidences from cohort studies of onset are lacking, especially in patients with first-onset or recurrent. It is necessary to deeply demonstrate the effectiveness of PAGln level on warning stroke onset.

Methods
One hundred fifteen first onset stroke patients, 33 recurrent stroke patients, and 135 non-stroke controls were included in the analysis. Risk factors associated with stroke attacking were evaluated, and plasma PAGln levels were detected via HPLC-MS based method. LASSO regression, Pearson correlation analysis, and univariate analysis were carried out to demonstrate the associations between PAGln levels and risk factors of stroke. Random forest machine learning algorithm was used to build classification models to achieve the distinction of first-onset stroke patients, recurrent stroke patients, and non-stroke controls, and further demonstrate the contribution of PAGln levels in the distinction of stroke onset.

Results
The median level of PAGln in the first-onset stroke group, recurrent stroke group, and non-stroke group was 933 ng/mL, 1014 ng/mL, and 556 ng/mL, respectively. No statistical correlation was found between PAGln level and subject’s living habits, eating preferences, and concomitant diseases (hypertension, hyperlipidemia, and diabetes). Stroke severity indicators, mainly age and NIHSS score, were found associate with the PAGln levels. Machine learning classification models confirmed that PAGln levels, as the main contributing variable, could be used to distinguish recurrent stroke patients (but not first-onset stroke patients) from non-stroke controls.

Conclusion
PAGln may be an effective indicator to monitor the recurrence in stroke patients.
Direct standardization method according to Robson classification for comparison of cesarean rates
Authors: Campos Marcelle Gonçalves , Franco-Sena Ana Beatriz , Rebelo Fernanda 
Published: February 2023

Abstract
Background
Compare cesarean section rates between populations or within a population over time using the crude measure is biased mainly due to differences in the characteristics of the obstetric population. The Robson Ten Group Classification (RTGC) is being widely used all over the world based on a few basic obstetrics variables.

Objectives
Propose a method of direct standardization according to RTGC to make the overall rates of cesarean sections comparable between different populations or within the same population over time.

Methods
We used data from the WHO Global Maternal and Perinatal Health Survey (WHOGS) conducted between 2004 and 2008 and data from the WHO Multinational Survey on Maternal and Neonatal Health (WHOMCS) conducted between 2010 and 2011, covering information from obstetric population of 21 countries. The standard population was based in the average size of Robson Groups in WHOMCS. The crude and standardized rates, their differences intra and inter populations, and its respective confidence intervals were calculated.

Results
The impact and importance of the method were demonstrated. The five leading countries list on cesarean rates was completely modified and changes of cesarean rates over time in the same country varied in both directions by the standardization.

Conclusion
This method is useful to compare overall rates as an additional information when RTGC Report Table is been used or, for some type of studies as analytical ecologic studies with multiple groups, where leading with the report tables are laborious and hard to interpret. The use of Robson Ten Group Classification for direct standardization of cesarean rates is easy to apply and interpret.
Development of a nomogram prediction model for early identification of persistent coronary artery aneurysms in kawasaki disease
Authors: Gong Xue , Tang Liting , Wu Mei , Shao Shuran , Zhou Kaiyu , Hua Yimin , Wang Chuan , Li Yifei 
Published: February 2023

Abstract
Background
Coronary artery aneurysms (CAA) persistence prediction is critical in evaluating Kawasaki disease (KD). This study established a nomogram prediction system based on potential risk factors for assessing the risk of CAA persistence in a contemporary cohort of patients with KD.

Methods
This cohort comprised 105 patients with KD who had been diagnosed with CAA during the acute or subacute phase by echocardiography. The follow-up duration was at least 1 year. The clinical and laboratory parameters were compared between the CAA regression and persistence groups. Multivariable logistic regression analysis was used to identify the independent risk factors for CAA persistence, which were subsequently used to build the nomogram predictive model. Decision curve analysis was used to assess the net benefits of different nomogram scores.

Results
Of these patients with CAA, 27.6% of patients presented with persistent lesions. The incidences of CAA persistence were 14.1%, 81.3%, and 100.0% in patients with small, medium, and large aneurysms, respectively. The ratio of neutrophils to lymphocytes, γ-GT, and CAA size at diagnosis were considered as the independent risk factors for CAA persistence in patients with KD. The nomogram predictive models yielded a high capability in predicting CAA persistence, based on either univariable or multivariable analyses-identified parameters, compared with using CAA size as a single predictor.

Conclusion
The initial ratio of neutrophils to lymphocytes, γ-GT, and CAA size were the independent risk factors for CAA persistence in patients with KD. Nomogram scores could help elevate predictive efficacy in detecting CAA persistence.