bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Economic Cost Analysis for Percutaneous Bone Conduction Devices: The Minimally Invasive Ponto Surgery Versus Linear Incision Technique with Tissue Preservation
Authors: Strijbos Ruben M. , Straatman Louise V. , Stegeman Inge , Holmberg Marcus , Johansson Martin L. , Stokroos Robert J. 
Published: July 2023

Objectives
To identify differences in mean cost per patient between the Minimally Invasive Ponto Surgery (MIPS) and the linear incision technique with tissue preservation (LITT-P).

Study design
Health economic cost analysis.

Setting
The analysis was performed in a randomized multicenter controlled trial cohort.

Patients
Adult patients eligible for unilateral bone conduction device surgery.

Interventions
MIPS versus LITT-P surgery for bone conduction device implantation.

Main outcome measures
Perioperative and postoperative costs were identified and compared.

Results
The difference in mean cost per patient between both techniques was €77.83 in favor of the MIPS after 22 months follow-up. The mean costs per patient were lower in the MIPS cohort for surgery (€145.68), outpatient visits (€24.27), systemic antibiotic therapy with amoxicillin/clavulanic acid (€0.30) or clindamycin (€0.40), abutment change (€0.36), and abutment removal (€0.18). The mean costs per patient were higher for implant and abutment set (€18.00), topical treatment with hydrocortison/oxytetracycline/polymyxine B (€0.43), systemic therapy with azithromycin (€0.09) or erythromycin (€1.15), local revision surgery (€1.45), elective explantation (€1.82), and implant extrusion (€70.42). Additional analysis of scenarios in which all patients were operated under general or local anesthesia or with recalculation when using current implant survival rates showed that differences in mean cost per patient were also in favor of the MIPS.

Conclusion
The difference between the MIPS and the LITT-P in mean cost per patient was €77.83 in favor of the MIPS after 22 months of follow-up. The MIPS is an economically responsible technique and could be promising for the future.
Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis
Authors: Wong Zhi Yong , Park Yoon Soo , Mann Gagandeep Singh 
Published: July 2023

Objectives
To compare postoperative tympanoplasty outcomes between active versus inactive otitis media (OM) patients with tympanic membrane perforation.

Databases Reviewed
Medline via PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for studies published from inception to March 1, 2023.

Methods
Studies of 15- to 60-year-old patients undergoing microscopic/endoscopic myringoplasty using underlay/overlay technique with reported postoperative mean hearing gain and graft uptake were included. Studies requiring simultaneous surgical procedures, reporting patients with comorbidities and with non-English full text articles were excluded. Articles were independently screened by two researchers with data extracted according to a predetermined proforma in Microsoft Excel. Cochrane risk-of-bias assessment was used for risk of bias evaluation of randomized studies and Risk of Bias in Nonrandomized Studies of Interventions for nonrandomized studies. Similar studies were pooled for meta-analysis using the inverse variance random effects model to calculate the mean difference and corresponding 95% confidence interval (CI) for mean hearing gain and DerSimonian and Laird random effects model for graft uptake.

Results
Thirty-three studies comprising 2,373 patients met the inclusion/exclusion criteria, seven were pooled for meta-analysis. Included articles showed inactive OM patients have higher average postoperative mean hearing gain of 10.84 dB and graft uptake of 88.7% compared to active OM patients (9.15 dB and 84.2%). Meta-analysis of mean hearing gain (MD, –0.76 dB; 95% CI, −2.11 to 0.60; p = 0.27, moderate certainty) and graft uptake (OD, 0.61; 95% CI, 0.34–1.09; p = 0.10, moderate certainty) have an overall p value >0.05.

Conclusion
There were no statistically significant differences in postoperative mean hearing gain and graft uptake between active and inactive OM patients undergoing tympanoplasty. Hence, tympanoplasty procedures should not be postponed solely because of patients' preoperative ear discharge status.
Diagnostic Role of Combined Electrocochleography and Pure-Tone Audiometry Monitoring During Dehydrating Test in Ménière's Disease: A Case Series
Authors: Immordino Angelo , Sireci Federico , Lorusso Francesco , La Gumina Rosario , Montalbano Calogero , Alfarghal Mohamad , Immordino Palmira , Dispenza Francesco 
Published: July 2023

Objectives
To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease.

Study Design
Prospective case series.

Settings
University hospital, secondary referral center.

Patients
Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification.

Intervention
Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone.

Main Outcome Measure
Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed.

Results
After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted.

Conclusions
The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.
Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review
Authors: Tran Vinh Vuong The , Jin Xian , Hong Ki Yong , Chang Hak 
Published: July 2023

Background:
Since nanofat was first introduced by Tonnard in 2013, numerous studies have reported positive findings with its use; however, concerns exist regarding its effects and mechanisms, and the various methods used to generate nanofat also remain unclear. The authors conducted a systematic review to evaluate the efficacy of nanofat grafting alone in plastic and reconstructive surgery.

Methods:
The MEDLINE, Embase, Cochrane Central, Web of Science, and Scopus databases were searched for studies related to the use of nanofat grafting alone in plastic and reconstructive surgery. Outcomes of interest were all clinical results in humans or animals.

Results:
Twelve studies were included. No meta-analysis was conducted due to the clinical heterogeneity of the studies. In general, included studies had a low level of evidence. Six studies (n = 253 patients) showed significant improvements in scar characteristics based on Patient and Observer Scar Assessment Scale, FACE-Q scale, physician assessment, patient satisfaction, and Vancouver Scar Scale scores. Four studies described the benefits of nanofat in skin rejuvenation (wrinkles, fine rhytides, pigmentation, and discoloration) through photographs, questionnaires, and indentation indices. Histologic evaluation illustrated overall increases in skin thickness, collagen, and elastic fibers. Three experimental studies showed the beneficial effects of nanofat on fat grafting, diabetic wound healing, and hair growth, with compelling histological evidence. No severe complication was reported.

Conclusions:
Nanofat grafting shows potential benefits in scar and antiaging treatments, with conclusive histological evidence. Clinical studies of fat grafting, wound healing, and hair growth should be conducted, based on the results of this systematic review. Nanofat grafting could be a practical and safe procedure.
Clinical Predictors of C5 Spinal Nerve Viability in Pan−Brachial Plexus Injuries
Authors: Wu Kitty Y. , Asserson Derek B. , Loosbrock Michelle F. , Bishop Allen T. , Spinner Robert J. , Shin Alexander Y. 
Published: July 2023

Background:
In pan–brachial plexus injury, distinguishing between preganglionic and postganglionic injuries is crucial to reconstructive planning. This study aimed to identify preoperative factors that would accurately predict a reconstructible C5 spinal nerve.

Methods:
Patients with pan–brachial plexus injury from a single institution between 2001 and 2018 were reviewed. Patient demographics, clinical examination, diagnostic imaging, and electrodiagnostic results were recorded. C5 viability was determined based on supraclavicular exploration and intraoperative electrophysiologic testing. Univariate analysis identified significant factors for regression analysis. A multivariable parsimonious model was created using stepwise high-performance logistic regression.

Results:
A total of 311 patients (mean age, 29.9 years; 46 women and 265 men; mean Injury Severity Score, 17.2) were included. A total of 134 patients (43%) had a viable C5 nerve, and 50 patients (12%) had a viable C6 nerve. Intact C5 spinal nerve on computed tomographic (CT) myelogram (OR, 5.4), positive Tinel test (OR, 2.6), muscle strength greater than or equal to 4 (according to the modified British Medical Research Council scale) for the rhomboid (OR, 1.3) or greater than or equal to 4 for the serratus anterior (OR, 1.4), and rhomboid needle electromyography (OR, 1.8) were predictive of having a viable C5 spinal nerve. The multivariable parsimonious stepwise model (area under the curve, 0.77) included four factors: positive Tinel test, intact C5 spinal nerve on CT myelogram, hemidiaphragmatic elevation, and midcervical paraspinal fibrillations.

Conclusions:
In this cohort of pan–brachial plexus patients with major polytrauma, there was a 43% incidence of viable C5 spinal nerve. A positive Tinel test (OR, 2.1) and intact C5 spinal nerve on CT myelogram (OR, 4.9) predicted a viable C5 nerve. In contrast, hemidiaphragmatic elevation (OR, 3.1) and midcervical paraspinal fibrillations (OR, 2.92) predicted root avulsion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Medial Plantar Artery Perforator Kiss Flap for Salvage of Extensive Palmar Skin Defect
Authors: Zheng Youmao , Zhang Shunuo , Hong Joon Pio , Hallock Geoffrey G. , Levin L. Scott , Zhang Yixin , Min Peiru 
Published: July 2023

Background:
Flaps based on the medial plantar artery (MPA) accomplish favorable surgical outcomes in palmar resurfacing because of their outstanding texture, pliability, and contour, but primary closure cannot be achieved at the donor site when the flap is designed to be relatively large. In this study, the kiss technique was used for the reconstruction of extensive palmar defects, which minimized donor-site morbidity.

Methods:
A modified flap surgical strategy was systemically developed based on the perforator distribution of the MPA through a cadaver study. Two or three narrow, small skin paddles based on the MPA were raised and resembled at the recipient site as a larger flap. Static two-point discrimination, hypersensitivity and range of motion, QuickDASH, gait, and patient satisfaction were evaluated 6 months to 12 months after the operation.

Results:
From June of 2015 to July of 2021, 20 cases of reconstruction using the MPA perforator kiss flap were performed for the resurfacing of palmar skin defects. All flaps survived uneventfully, with coverage matching the texture and color of the recipients, except one flap that exhibited venous congestion and recovered after revision. Twelve flaps (60%) were double-paddled, and eight flaps (40%) were triple-paddled, with a resurfacing area of 27.19 cm2 and 41.1 cm2, respectively. All donor sites achieved primary closure without major complications.

Conclusions:
Versatile kiss flap combinations were developed based on further understanding of the MPA system. Durable and pliable characteristics of the MPA perforator flap provide excellent reconstruction for extensive palmar defects while minimizing donor-site complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Comparison of 2 Regenerative Peripheral Nerve Interface Techniques for the Treatment of Rat Neuroma Pain
Authors: Senger Jenna-Lynn , Thorkelsson Aline , Wang Bonnie Y. , Chan K. Ming , Kemp Stephen W. P. , Webber Christine A. 
Published: July 2023

Summary:
Treatment of painful neuromas has long posed a significant challenge for peripheral nerve patients. The regenerative peripheral nerve interface (RPNI) provides the transected nerve with a muscle graft target to prevent neuroma formation. Discrepancies in RPNI surgical techniques between animal models (“inlay” RPNI) and clinical studies (“burrito” RPNI) preclude direct translation of results from bench to bedside and may account for variabilities in patient outcomes. The authors compared outcomes of these 2 surgical techniques in a rodent model. Animals treated with burrito RPNI after tibial nerve neuroma formation demonstrated no improvement in pain assessment, and tissue analysis revealed complete atrophy of the muscle graft with neuroma recurrence. By contrast, animals treated with inlay RPNI had significant improvement in pain with viable muscle grafts. The results suggest superiority of the inlay RPNI surgical technique for the management of painful neuroma in rodents.

Clinical Relevance Statement:
RPNIs are currently being used to prevent and treat neuroma and phantom limb pain. This preclinical study suggests the superiority of one surgical technique over the other.
Exploratory Correlation of The Human Structural Connectome with Non-MRI Variables in Alzheimer’s Disease
Authors: Aganj Iman , Mora Jocelyn , Frau-Pascual Aina , Fischl Bruce ,   the Alzheimer’s Disease Neuroimaging Initiative
Published: July 2023

ABSTRACTINTRODUCTIONDiscovery of the associations between brain structural connectivity and clinical and demographic variables can help to better understand the vulnerability and resilience of the brain architecture to neurodegenerative diseases and to discover biomarkers.METHODSWe used four diffusion-MRI databases, three related to Alzheimer’s disease, to exploratorily correlate structural connections between 85 brain regions with non-MRI variables, while stringently correcting the significance values for multiple testing and ruling out spurious correlations via careful visual inspection. We repeated the analysis with brain connectivity augmented with multi-synaptic neural pathways.RESULTSWe found 85 and 101 significant relationships with direct and augmented connectivity, respectively, which were generally stronger for the latter. Age was consistently linked to decreased connectivity, and healthier clinical scores were generally linked to increased connectivity.DISCUSSIONOur findings help to elucidate which structural brain networks are affected in Alzheimer’s disease and aging and highlight the importance of including indirect connections.
T4SEpp: a pipeline integrated with protein language models effectively predicting bacterial type IV secreted effectors
Authors: Hu Yueming , Wang Yejun , Hu Xiaotian , Chao Haoyu , Li Sida , Ni Qinyang , Zhu Yanyan , Hu Yixue , Zhao Ziyi , Chen Ming 
Published: July 2023

AbstractMany pathogenic bacteria use type IV secretion systems(T4SSs) to deliver effectors (T4SEs) into the cytoplasm of eukaryotic cells, causeing diseases. The identification of effectors is a crucial step in understanding the mechanisms of bacterial pathogenicity, but this remains a major challenge. In this study, we used the full-length embedding features generated by six pre-trained protein language models to train classifiers predicting T4SEs, and compared their performance. An integrated model T4SEpp was assembled by a module searching full-length, signal sequence and effector domain homologs of known T4SEs, a machine learning module based on the hand-crafted features extracted from the signal sequences, and the third module containing three best-performing protein language pre-trained models. T4SEpp outperformed the other state-of-the-art (SOTA) software tools, achieving ∼0.95 sensitivity at a high specificity of ∼0.99, based on the assessment of an independent testing dataset. Additionally, we performed a comprehensive search among 8,761 bacterial species, leading to the discovery of 227 species belonging to 3 phyla and 117 genera that possess T4SSs. Furthermore, leveraging the power of T4SEpp, we successfully identified a grand total of 12,622 plausible T4SEs. Overall, T4SEpp provides a better solution to assist in the identification of bacterial T4SEs, and facilitates studies of bacterial pathogenicity. T4SEpp is freely accessible athttps://bis.zju.edu.cn/T4SEpp.
Decapitated body intelligence (DBI) in cricketGryllodes sigillatus
Authors: Xue Tongyao , Yang Hewei , Wu Wen , Wang Qinghao 
Published: July 2023

AbstractBackgroundintelligence is a highly complex problem. The decapitated insect exhibits various behaviors, indicating that they may have intelligence. Recent studies have reported organoid intelligence (OI) that lab-grown organoids also possess intelligence. This study investigated the response of decapitated crickets to different chemical stimuli to determine whether decapitated crickets have intelligence.MethodsWe used deionized water, NaCl, sucrose, and sodium hypochlorite to stimulate the front legs of the decapitated crickets and lesion the T1-T2 nerve connection of the thoracic ganglia. The behavioral response types of their forelegs were recorded. Reaction time, incidence rate, and total number of responses were calculated and analyzed.ResultsThe decapitated crickets exhibit four types of responses: leg extension, leg withdrawal, leg lift, and jump. The reaction time and incidence rate varied depending on the type and concentration of the stimulant solution. The total number of responses gradually increased with deionized water, NaCl, sucrose, and sodium hypochlorite. The lesion experiments further revealed that the only T1 thoracic ganglion can control stimulating behavior.ConclusionThe decapitated crickets possess the intelligence of perceiving stimuli and taking corresponding action. We called it decapitated body intelligence (DBI) or extrabrain intelligence (EI), which suggests that intelligence is not localized exclusively in the brain but also resides in insect ganglia. This finding opens up new ideas and avenues for the study of intelligence and the brain.
Juvenile niches select between two distinct development trajectories and symbiosis modes in vent shrimps
Authors: Methou Pierre , Guéganton Marion , Copley Jonathan T. , Watanabe Hiromi Kayama , Pradillon Florence , Cambon-Bonavita Marie-Anne , Chen Chong 
Published: July 2023

AbstractMost animal species have a singular developmental pathway and adult ecology, but developmental plasticity is well-known in some like honeybees where castes display profoundly different morphology and ecology. An intriguing case is the Atlantic deep-sea hydrothermal vent shrimpRimicaris hybisae/chaceithat share dominant COI haplotypes but develops into either the symbiont-relianthybisaewith a hypertrophied head chamber (in the Mid-Cayman Spreading Centre) or the mixotrophicchaceiwith a narrow head chamber (on the Mid-Atlantic Ridge). Here, we use X-ray micro-computed tomography and fluorescentin situhybridization to show that key anatomical shifts in both occur between the juvenile-subadult transition, when those developing intohybisaehave fully established symbiosis but notchacei. On the Mid-Atlantic Ridge the diet ofR. chaceihas been hypothetically linked to competition with the obligatorily symbiotic congenerR. exoculata, and we find anatomical evidences thatR. exoculatais indeed better adapted for symbiosis – suggesting thechaceimorph could be an adaptation to prevent competitive exclusion. Our results suggest that the two distinct development trajectories are likely selected according to the diet available to the juveniles, determined by whether energetically sufficient symbiont colonisation has occurred before reaching subadult stage.
A continuous centennial Lateglacial-Early Holocene (15-10 cal kyr BP) palynological record from the Iberian Pyrenees and regional comparisons
Authors: Rull Valentí , Blasco Arnau , Calero Miguel Ángel , Blaauw Maarten , Teresa Vegas-Vilarrúbia 
Published: July 2023

AbstractThis paper presents the first continuous (gap-free) Lateglacial-Early Holocene (LGEH) pollen record for the Iberian Pyrenees resolved at centennial resolution. The main aims are (i) to provide a standard chronostratigraphic correlation framework, (ii) to unravel the relationships between vegetation shifts, climatic changes and fire, and (iii) to obtain a regional picture of LGEH vegetation for the Pyrenees and the surrounding lowlands. Seven pollen assemblage zones were obtained and correlated with the stadial/interstadial phases of the Greenland ice cores that serve as a global reference. Several well-dated datums were also derived for keystone individual taxa that are useful for correlation purposes. Four vegetation types were identified, two of them corresponding to conifer and deciduous forests (Cf, Df) and two representing open vegetation types (O1, O2) with no modern analogs, dominated byArtemisia-Poaceae andSaxifraga-Cichiroideae, respectively. Forests dominated during interstadial phases (Bølling/Allerød and Early Holocene), whereas O1 dominated during stadials (Oldest Dryas and Younger Dryas), with O2 being important only in the first half of the Younger Dryas stadial. The use of pollen-independent proxies for temperature and moisture allowed the reconstruction of paleoclimatic trends and the responses of the four vegetation types defined. The most relevant observation in this sense was the finding of wet climates during the Younger Dryas, which challenges the traditional view of arid conditions for this phase on the basis of former pollen records. Fire incidence was low until the early Holocene, when regional fires were exacerbated, probably due to the combination of higher temperatures and forest biomass accumulation. These results are compared with the pollen records available for the whole Pyrenean range and the surrounding lowlands within the framework of elevational, climatic and biogeographical gradients. Some potential future developments are suggested on the basis of the obtained results, with an emphasis on the reconsideration of the LGEH spatiotemporal moisture patterns and the comparison of the Pyrenees with other European ranges from different climatic and biogeographical regions.