bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of preoperative IL-6 levels with overt HE in patients with cirrhosis after TIPS
Authors: Li JinYu , Liu Yang , Li ManBiao , Rong XueTong , Yuan Zhen , Ren Chao , Liu Shuai , Li Lei , Zhao Chao , Gao Long , Feng DuiPing 
Published: April 2023

Background:
HE is a common and dangerous complication after TIPS. The relationship between IL-6 levels and overt HE (OHE) after TIPS is rarely reported.We aimed to explore the relationship between the preoperative serum IL-6 levels and OHE risk after TIPS, and to evaluate its value in predicting the OHE risk.

Methods:
This prospective cohort study included 125 participants with cirrhosis who received TIPS. Logistics regression analyses were performed to explore the relationship between IL-6 and OHE risk, and the receiver operating characteristic analysis was used to compare the predictive power of IL-6 and other indexes.

Results:
Among 125 participants, 44 (35.2%) participants developed OHE after TIPS. Logistics regression showed preoperative IL-6 was associated with a higher OHE risk after TIPS in different models (all p < 0.05). Participants with IL-6 > 10.5 pg/mL had a higher cumulative incidence of OHE after TIPS than those with IL-6 ≤ 10.5 pg/mL (log-rank = 0.0124). The predictive power of IL-6 (AUC = 0.83) for the OHE risk after TIPS was higher than that of other indexes. Age (RR = 1.069, p = 0.002) and IL-6 (RR = 1.154, p < 0.001) were independent risk factors for OHE after TIPS. IL-6 was also a risk factor for the occurrence of coma in patients with OHE (RR = 1.051, p = 0.019).

Conclusion:
Preoperative serum IL-6 levels are closely related to the occurrence of OHE in patients with cirrhosis after TIPS. Patients with cirrhosis with high serum IL-6 levels following TIPS were at a higher risk of developing severe HE.
Efficacy and Safety of Intranasal Betahistine in the Treatment of Surgery-Induced Acute Vestibular Syndrome: A Double-Blind, Randomized, Placebo-Controlled Phase 2 Study
Authors: Van de Heyning Paul , Betka Jan , Chovanec Martin , Devèze Arnaud , Giannuzzi Anna Lisa , Krempaská Silvia , Przewoźny Tomasz , Scheich Matthias , Strupp Michael , Van Rompaey Vincent , Meyer Thomas 
Published: April 2023

Objective
To evaluate the safety and efficacy of AM-125 nasal spray (intranasal betahistine) in the treatment of surgery-induced acute vestibular syndrome (AVS).

Study Design
Prospective, double-blind, randomized, placebo-controlled exploratory phase 2 study with dose escalation (part A) followed by parallel dose testing (part B); open-label oral treatment for reference.

Setting
Twelve European study sites (tertiary referral centers).

Patients
One hundred and twenty-four patients 18 to 70 years old undergoing surgery for vestibular schwannoma resection, labyrinthectomy or vestibular neurectomy with confirmed bilateral vestibular function presurgery and acute peripheral vertigo postsurgery.

Interventions
AM-125 (1, 10, or 20 mg) or placebo or betahistine 16 mg p.o. t.i.d. for 4 weeks, starting 3 days postsurgery; standardized vestibular rehabilitation.

Main Outcome Measures
Tandem Romberg test (TRT) for primary efficacy, standing on foam, tandem gait, subjective visual vertical and spontaneous nystagmus for secondary efficacy, Vestibular Rehabilitation Benefit Questionnaire (VRBQ) for exploratory efficacy; nasal symptoms and adverse events for safety.

RESULTS
At treatment period end, mean TRT improvement was 10.9 seconds for the 20-mg group versus 7.4 seconds for the placebo group (mixed model repeated measures, 90% confidence interval = 0.2 to 6.7 s; p = 0.08). This was corroborated by nominally higher frequency of complete spontaneous nystagmus resolution (34.5% vs. 20.0% of patients) and improvement in the VRBQ; the other secondary endpoints showed no treatment effect. The study drug was well tolerated and safe.

CONCLUSIONS
Intranasal betahistine may help accelerate vestibular compensation and alleviate signs and symptoms of vestibular dysfunction in surgery-induced AVS. Further evaluation in a confirmatory manner appears warranted.
Ergonomic Analysis of Otologic Surgery: Comparison of Endoscope and Microscope
Authors: Arrighi-Allisan Annie E. , Fan Caleb J. , Wong Kevin , Wong Anni , Garvey Katherine L. , Schwam Zachary G. , Filip Peter , Jategaonkar Ameya A. , Perez Enrique , Wanna George B. , Govindaraj Satish , Iloreta Alfred-Marc , Cosetti Maura K. 
Published: April 2023

Objective
The comparative postural health of surgeons performing endoscopic and microscopic otologic surgeries has been a topic of active debate, with many nascent or anecdotal reports suggesting the latter encourages suboptimal ergonomics. Using inertial body sensors to measure joint angles, this study sought to objectively evaluate and compare the ergonomics of surgeons during endoscopic and microscopic otologic surgeries.

Study Design
Prospective pilot trial.

Setting
Large, multicenter, academic hospital system. Performed 21 otologic operations (10 endoscopic and 11 microscopic) in November 2020 and January 2021. All attendings were fellowship trained in otology/neurotology.

Subjects
Eight otolaryngologists (four attendings and four residents) performing 21 otologic surgeries (11 microscopic and 10 endoscopic).

Intervention
Approach to otologic surgery: endoscope or microscope.

Main Outcome Measures
Surgeons’ neck and back angles while wearing ergonomic sensors affixed to either side of each major joint, mental and physical burdens and pain after each surgery (via modified NASA Task Load Index).

Results
Residents’ necks (9.54° microscopic vs. −4.79° endoscopic, p = 0.04) and backs (16.48° microscopic vs. 3.66° endoscopic, p = 0.01) were significantly more flexed when performing microscopic surgery than when performing endoscopic surgery, although attending neck and back flexion were comparable during microscopic and endoscopic surgeries. Attendings reported significantly higher pain levels after operating microscopically than after operating endoscopically (0.13 vs. 2.76, p = 0.01).

Conclusions
Residents were found to operate with significantly higher risk back and neck postures (as defined by the validated ergonomic tool, Rapid Entire Body Assessment) when operating microscopically. Attendings reported significantly higher levels of pain after operating microscopically versus endoscopically, suggesting that the suboptimal microscopic postures adopted earlier in training may pose an indelible risk later in a surgeon’s career.
Transcanal Endoscopic Stapedial and Tensor Tympani Tenotomy for Middle Ear Myoclonus: A Retrospective Case Series of Surgical Outcomes
Authors: Moon Seoungjun , Yeon Eun-Kyeong , Son Hyo One , Choi Jin Woong 
Published: April 2023

Objective
To describe and analyze the surgical outcomes of transcanal endoscopic resection of the stapedial tendon (ST) and tensor tympani tendon (TT) in the management of middle ear myoclonus (MEM).

Study Design
A retrospective case series.

Setting
Tertiary academic center.

Patients
Seven consecutive patients (seven ears) with tinnitus were diagnosed with MEM.

Intervention
Transcanal endoscopic resection of both the ST and TT using either microinstruments or a laser.

Main Outcome Measures
The symptom of tinnitus, based on visual analog scale and Tinnitus Handicap Inventory scores, was analyzed preoperatively and postoperatively for each patient. The intraoperative findings and postoperative complications were also evaluated.

Results
Amelioration of objective tinnitus with significant improvement in visual analog scale and Tinnitus Handicap Inventory scores was noted in all seven patients. The ST and TT were easily identified in the same endoscopic field, with minimal or no removal of the scutum. There was no need to perform an anterior tympanotomy to expose the TT. Resection of both the ST and TT and creating a gap between the cut edges were achieved by using either microinstruments or a laser under an endoscopic field. Conversion to or conjunction with the microscopic approach was unnecessary for any of the seven patients. No hearing loss or hyperacusis occurred postoperatively.

Conclusions
Transcanal endoscopic resection of the ST and TT successfully ameliorated the symptom of tinnitus in patients with MEM. A transcanal endoscopic approach provides an alternative method to manage MEM, providing excellent visualization and minimal invasiveness.
Effectiveness of prophylactic antimicrobial levofloxacin against postureteroscopic lithotripsy infection: A multicenter prospective open-label randomized controlled trial
Authors: Du Zhen , Sun Hui , Zhang Yong , Cui Liang , Hou Jianping , Chen Jun , Chen Shan , Qiao Ludong 
Published: April 2023

Background:To verify the appropriate prophylactic agent to prevent ureteroscopic lithotripsy infection, which is safe, effective, convenient, reasonable, and with best pharmacoeconomic benefit ratio, to provide evidence for clinical practice.Methods:This study is a multicenter, open-label, randomized, positive drug-controlled trial design. From January 2019 to December 2021, patients with ureteral calculi who were going to undergo retrograde flexible ureteroscopic lithotripsy were selected from urology departments in 5 research centers. The patients enrolled were randomly divided into the experimental group and the control group according to the random number table by blocking randomization. In the experimental group (Group A), 0.5 g levofloxacin was given 2 to 4 hours before surgery. In the control group (Group B), cephalosporin was injected 30 minutes before surgery. The infectious complications, the incidence of adverse drug reactions and the economic benefit ratio were compared between the 2 groups.Results:A total of 234 cases were enrolled. There was no statistically significant difference between the 2 groups at baseline. Postoperative infection complications were 1.8% in the experimental group, which was significantly lower than 11.2% in control group. The type of infection complication in both groups was asymptomatic bacteriuria. The cost of drugs in the experimental group was 19.89 ± 13.11 yuan, which was significantly lower than cost of drugs in the control group of 41.75 ± 30.12 yuan. The levofloxacin application had favorable cost-effectiveness ratio. The difference in safety between 2 groups was not significant.Conclusion:The application of levofloxacin is safe, effective, and low-cost regimen for postureteroscopic lithotripsy infection prevention.
Prognostic value of O6-methylguanine-DNA methyltransferase hypermethylation and expression in head and neck cancer: A systematic review and meta-analysis
Authors: Yang Huiwen , Zhou Liuqing , Yang Fan , Chen Jingcai , Wang Yanjun 
Published: April 2023

Background:
O6-methylguanine-DNA methyltransferase (MGMT) is a DNA repair enzyme that maintains the stability of genetic information. MGMT is a strong prognostic biomarker in patients with glioblastoma. However, the effect of its gene hypermethylation and expression on the survival rate of head and neck cancer (HNC) patients is still disputed. Therefore, we conducted a meta-analysis to evaluate the prognostic value of MGMT hypermethylation and expression in HNC patients.

Methods:
This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered at the International Prospective Register of Systematic Reviews (CRD42021274728). Literature related to the survival rate of HNC patients and MGMT was systematically searched in PubMed, Embase, The Cochrane Library and Web of Science electronic databases (published from inception to February 1, 2023). The association was evaluated by the combined hazard ratio (HR) and related 95% confidence interval (CI). Two authors independently screened all records and extracted the data. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. All of the statistical tests used in this meta-analysis were conducted with Stata 12.0 software.

Results:
We included 5 studies with 564 HNC patients for the meta-analysis. All of the included patients were primary tumors and underwent surgical resection without prior radiotherapy or chemotherapy therapy. No significant heterogeneity was noted between MGMT and overall survival, MGMT and disease-free survival, and a fixed-effects model was used. HNC patients with MGMT hypermethylation and low expression had a poor prognosis, with pooled HR for overall survival (HR = 1.23, 95% CI: 1.10–1.38, P < .001) and disease-free survival (HR = 2.28, 95% CI: 1.45–3.58, P < .001). Subgroup analysis stratified by molecular abnormalities, such as hypermethylation or low expression, showed similar results. The insufficient number of trials included in our study encountered high risk of bias and may increase the deviation of the final meta-analysis results.

Conclusion:
HNC patients with MGMT hypermethylation and low expression were more likely to exhibit poorer survival. MGMT hypermethylation and low expression can predict survival in patients with HNC.
Important Factors to Expect the Outcome After Intracerebral Hemorrhage
Authors: Albakr Aishah , Almatar Ahmad , AlFajri Abdullah , Zafar Azra , Nazish Saima , Shahid Rizwana , AlJaafari Danah , Soltan Nehad , Alarfaj Zainab , Al Ghamdi Omar , Alfilw Suad , Abdelhady Ahmed , Albaker Waleed 
Published: April 2023

Background:
Intracerebral hemorrhage (ICH) has worse clinical outcomes than other stroke types. The risk factors contributing to ICH outcomes are not entirely understood, and published literature from Saudi Arabia on ICH outcomes is limited. Our goal was to study the specific clinical and imaging determinants of ICH outcomes.

Methods:
We retrospectively retrieved all patients with spontaneous ICH (SICH) from a prospective King Fahd Hospital University registry between 2017 and 2019. The clinical characteristics of ICH events and data on clinical outcomes (6 to 12 mo) were recorded. Groups of patients with a favorable modified Rankin Scale of 0 to 2 and nonfavorable outcomes of a modified Rankin Scale of 3 to 6 were investigated. The relationship between the clinical characteristics of the SICH event and its outcomes was assessed using linear and logistic regression analyses.

Results:
A total of 148 patients with a mean age of 60.3 years (±15.2) and a median follow-up of 9 months were included. Unfavorable outcomes were reported in 98 patients (66.2%). The ICH event variables associated with unfavorable outcomes were impaired renal function, Glasgow Coma Score <8, hematoma volume, hematoma expansion, and intraventricular extension (IVE).

Conclusions:
Our study demonstrated important clinical and radiologic features in patients with ICH that may affect their clinical long-term functional outcomes. A larger multicenter study is required to validate our results and evaluate the methods to improve health care in patients with SICH.
Acute Mania and Psychosis in the Context of Primary Adrenal Insufficiency: A Systematic Review of the Literature
Authors: Ovakimyan Andrew , Patel Neal A. , Brown Nolan J. , Reardon Taylor , Fote Gianna , Gendreau Julian 
Published: April 2023

Background:
Given the sparse nature of acute mania or psychosis in primary adrenal insufficiency (PAI), physicians may not be aware of the association of these two entities.

Objective:
To conduct a systematic review of the literature for the purpose of identifying all studies reporting mania and/or psychosis in individuals with PAI.

Method:
We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Embase, and Web of Science databases from June 22, 1970 to June 22, 2021, for the purpose of identifying all studies reporting instances of mania or psychosis associated with PAI.

Results:
We identified nine case reports featuring nine patients (Mage = 43.3 years, male = 44.4%) over eight countries that fit our inclusion/exclusion criteria. Eight (89%) of the patients had experienced psychosis. Manic and/or psychotic symptom resolution was achieved in 100% of the cases, of which steroid replacement therapy was efficacious in seven (78%) cases and was sufficient in six (67%).

Conclusion:
Acute mania and psychosis in the context of PAI is a very rare presentation of an already uncommon disease. Resolution of acute psychiatric change is reliably achieved with the correction of underlying adrenal insufficiency.
Impact of a High Observation Trauma Protocol on Patients with Isolated Traumatic Brain Injury
Authors: Hamlin Sean , Alexander Rosalyn , Hayes Kathryn , Szoke AnnMarie , Benton Adam , Wilde-Onia Rebecca , Castillo Roberto , Thomas Peter , Cipolla James , Braverman Maxwell A 
Published: April 2023

Background:
Nationally, the volume of geriatric falls with intracranial hemorrhage (ICH) is increasing. Our institution began observing patients with ICH, a GCS ≥ 14, and no midline shift or intraventricular hemorrhage with hourly neurologic examination outside the ICU in a high observation trauma (HOT) protocol. We first excluded patients on anticoagulants/antiplatelets (HOT I), then included antiplatelets and warfarin (HOT II) and finally included direct oral anticoagulants (HOT III). Our hypothesis is that HOT protocol safely reduces ICU utilization and creates cost savings in this patient population.

Study Design:
Our institutional trauma registry was retrospectively queried for all patients on HOT protocol. Patients were stratified based on date of admission: HOT I (2008-2014), HOT II (2015-2018) and HOT III (2019-2021). Demographics, anticoagulant use, injury characteristics, lengths of stay (LOS), incidence of neuro-intervention, and mortality.

Results:
Over the study period, 2343 patients were admitted, including HOT I (n=939), HOT II (n=794), and HOT III (n=610). Of these patients, 331 (35%), 554 (70%), and 495 (81%) were admitted to the floor under HOT protocol. HOT patients required neurointervention in 3.0%, 0.5% and 0.4% of cases over HOT I, II, and III, respectively. Mortality among HOT protocol patients was found to be 0.6% in HOT I, 0.9% in HOT II and 0.2% in the HOT III cohort (p=0.33).

Conclusion:
Across the study period, ICU utilization decreased without an increase in neurosurgical intervention or mortality indicating the efficacy of the HOT selection criteria in identifying appropriate candidates for stepdown admission and high observation trauma protocol.
Emergence of belief-like representations through reinforcement learning
Authors: Hennig Jay A. , Romero Pinto Sandra A. , Yamaguchi Takahiro , Linderman Scott W. , Uchida Naoshige , Gershman Samuel J. 
Published: April 2023

AbstractTo behave adaptively, animals must learn to predict future reward, or value. To do this, animals are thought to learn reward predictions using reinforcement learning. However, in contrast to classical models, animals must learn to estimate value using only incomplete state information. Previous work suggests that animals estimate value in partially observable tasks by first forming “beliefs”—optimal Bayesian estimates of the hidden states in the task. Although this is one way to solve the problem of partial observability, it is not the only way, nor is it the most computationally scalable solution in complex, real-world environments. Here we show that a recurrent neural network (RNN) can learn to estimate value directly from observations, generating reward prediction errors that resemble those observed experimentally, without any explicit objective of estimating beliefs. We integrate statistical, functional, and dynamical systems perspectives on beliefs to show that the RNN’s learned representation encodes belief information, but only when the RNN’s capacity is sufficiently large. These results illustrate how animals can estimate value in tasks without explicitly estimating beliefs, yielding a representation useful for systems with limited capacity.Author SummaryNatural environments are full of uncertainty. For example, just because my fridge had food in it yesterday does not mean it will have food today. Despite such uncertainty, animals can estimate which states and actions are the most valuable. Previous work suggests that animals estimate value using a brain area called the basal ganglia, using a process resembling a reinforcement learning algorithm called TD learning. However, traditional reinforcement learning algorithms cannot accurately estimate value in environments with state uncertainty (e.g., when my fridge’s contents are unknown). One way around this problem is if agents form “beliefs,” a probabilistic estimate of how likely each state is, given any observations so far. However, estimating beliefs is a demanding process that may not be possible for animals in more complex environments. Here we show that an artificial recurrent neural network (RNN) trained with TD learning can estimate value from observations, without explicitly estimating beliefs. The trained RNN’s error signals resembled the neural activity of dopamine neurons measured during the same task. Importantly, the RNN’s activity resembled beliefs, but only when the RNN had enough capacity. This work illustrates how animals could estimate value in uncertain environments without needing to first form beliefs, which may be useful in environments where computing the true beliefs is too costly.