bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Transcranial Motor Evoked Potential Monitoring During Traumatic Spinal Injury Surgery: A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research
Authors: Ushirozako Hiroki , Yoshida Go , Imagama Shiro , Machino Masaaki , Ando Muneharu , Kawabata Shigenori , Yamada Kei , Kanchiku Tsukasa , Fujiwara Yasushi , Taniguchi Shinichirou , Iwasaki Hiroshi , Shigematsu Hideki , Tadokoro Nobuaki , Takahashi Masahito , Wada Kanichiro , Yamamoto Naoya , Funaba Masahiro , Yasuda Akimasa , Hashimoto Jun , Morito Shinji , Takatani Tsunenori , Kobayashi Kazuyoshi , Nakanishi Kazuyoshi , Kurosu Kenta , Matsuyama Yukihiro 
Published: March 2023

Study Design.
Prospective multicenter observational cohort study

Objective.
This study aimed to investigate the role of transcranial motor evoked potential (TcMEP) monitoring during traumatic spinal injury surgery, the timing of TcMEP alerts, and intervention strategies to avoid intraoperative neurological complications.

Summary of Background Data.
Intraoperative neuromonitoring, including TcMEP monitoring, is commonly used in high-risk spinal surgery to predict intraoperative spinal cord injury; however, little information is available on its use in traumatic spinal injury surgery.

Methods.
The TcMEP monitoring data of 350 consecutive patients who underwent traumatic spinal injury surgery (mean age, 69.3 y) between 2017 and 2021 were prospectively reviewed. In this study, a TcMEP amplitude reduction ≥70% was established as a TcMEP alert. A rescue case was defined as a case with recovery of TcMEP amplitudes after certain procedures and without postoperative neurological complications.

Results.
Among the 350 patients who underwent traumatic spinal injury surgery (TcMEP derivation rate 94%), TcMEP monitoring revealed seven true-positive (TP) (2.0%), three rescue (0.9%; rescue rate 30%), 31 false-positive, one false-negative, and 287 true-negative cases, resulting in 88% sensitivity, 90% specificity, 18% positive predictive value, and 99% negative predictive value. The TP rate in patients with preoperative motor deficits (MDs) was 2.9%, which was higher than that in patients without preoperative MDs (1.1%). The most common timing of TcMEP alerts was during decompression (40%). During decompression, suspension of surgery with intravenous steroid injection was ineffective (rescue rate, 0%) and additional decompression was effective.

Conclusion.
Given the low prevalence of neurological complications (2.3%) and the low positive predictive value (18.4%), single usage of TcMEP monitoring during traumatic spinal injury surgery is not recommended. Further efforts should be made to reduce FP alert rates through better interpretation of multimodal IONMs and the incorporation of anesthesiology in order to improve the positive predictive value.

Level of Evidence.
III
Salvage Surgery: An Effective Therapy in the Management of Ileoanal Pouch Prolapse
Authors: Otero-Piñeiro Ana , Maspero Marianna , Holubar Stefan D. , Lightner Amy L. , Steele Scott R. , Hull Tracy , Turnbull Rupert B. 
Published: March 2023

BACKGROUND:
Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients requiring surgery for inflammatory bowel disease and, less frequently, for other pathologies. Pouch prolapse is a rare complication that compromises pouch function and negatively affects patients’ quality of life.

OBJECTIVE:
Describe our experience from a single high-volume center in this infrequent condition.

DESIGN:
Restrospective cohort study of a prospectively maintained, IRB-approved database.

SETTINGS/PATIENTS:
All consecutive eligible patients with ileal pouch-anal anastomosis and pouch prolapse were identified from 1990-2021. Patients with full-thickness prolapse treated by pouch pexy were included.

INTERVENTIONS:
Pouch pexy (with/without mesh).

MAIN OUTCOME MEASURES:
Success rate of pouch pexy, defined as no recurrence of prolapse.

RESULTS:
A total of 4,791 patients underwent ileal pouch-anal anastomosis; seven (0.1%) were diagnosed with full-thickness prolapse. Additional 18 ileal pouch-anal anastomosis patients were referred from outside institutions. Among 25 included patients, 16 (64.0%) were female and the overall mean age was 35.6+/-13.4 years. The time interval from initial pouch formation to prolapse was 4.2 (IQR 1.1-8.5) years. Nine (36.0%) patients underwent previous treatment for prolapse (physical therapy n=4, pouch pexies n=2, mesh pouch pexy n = 2, mucosal resection n = 1). All patients presented with symptoms and physical examination compatible with full-thickness prolapse. Twenty (80.0%) patients underwent surgical pouch pexy without mesh and five (20.0%) had pouch pexy with mesh placement. A diverting ileostomy was performed in one (4.0%) patient prior to pouch pexy, and in eight (32.0%) patients at the time of surgical prolapse correction. After surgery, recurrent prolapse was noted in three patients (12.0%) at a median of 6.9 (IQR 5.2-8.3) months.

LIMITATIONS:
Retrospective study, small sample size thus prone to selection and referral biases which may limit the generalizability of our findings.

CONCLUSION:
Pouch prolapse can be effectively treated with salvage surgery. Surgical intervention is safe and provides acceptable outcomes.
Mohs Surgeons Dominate Cutaneous Reconstructions in Cosmetically and Functionally Sensitive Sites: Medicare Trends From 2013 to 2019
Authors: Tan Andrea , Castner Nicholas B. , Slutsky Jordan B. 
Published: March 2023

BACKGROUND
Although dermatologists perform more cutaneous reconstructions than any other specialists for the Medicare population, the perception of dermatologists as surgeons may not be as fully recognized. Mohs surgeons are trained in complex reconstructions of cosmetically and functionally sensitive (CFS) sites, although the proportion they account for is unknown.

OBJECTIVE
To quantify the proportion of cutaneous reconstructions in CFS sites performed by Mohs surgeons compared with other specialists, and to identify trends from 2013 to 2019.

METHODS
A cross-sectional analysis was performed using the Medicare Public Use Files for 2013 to 2019. Data were stratified by physician specialty, with dermatologists further subdivided into Mohs surgeons and non-Mohs dermatologists.

RESULTS
Mohs surgeons performed 75.3% of all reconstructions in 2019, a significant increase from 2013 (p < .0001). Mohs surgeons dominated nearly every type of CFS cutaneous reconstruction, with significant increases in proportion (p < .0001) from 2013 to 2019 for every category except interpolation flaps. Complex repairs were the most commonly performed cutaneous reconstruction type.

CONCLUSION
Mohs surgeons perform far more cutaneous reconstructive surgeries in CFS sites than any other specialty for the Medicare population, with significant increases in their lead over the study period.
Costunolide Protects Myocardium From Ischemia Reperfusion Injury by Inhibiting Oxidative Stress Through Nrf2/Keap1 Pathway Activation
Authors: Li Weixin , Luo Yue , Huang Zhuqi , Shen Siyuan , Dai Chengyi , Shen Sirui , Qi Xiaoxiao , Liang Guang , Luo Wu 
Published: March 2023

Abstract:
Costunolide (Cos) is a naturally occurring sesquiterpene lactone that exhibits antioxidative properties. In this study, we demonstrate the protective mechanism of Cos against ischemia/reperfusion (I/R)-induced myocardial injury. Cos significantly decreased levels of reactive oxygen species and ameliorated apoptosis of I/R cardiomyocytes both in vitro and in vivo. Further investigation revealed that Cos increased expression of the antioxidant proteins HO-1 and NQO-1 and decreased the Bax/Bcl-2 ratio, thus protecting cardiac cells. NF-E2–related factor 2 (Nrf2) silencing significantly attenuated the protective effects of Cos in tert-butyl hydroperoxide (TBHP)-treated H9C2 cells. Additionally, Cos significantly intensified the I/R- or TBHP-induced dissociation of the Kelch-like ECH-associated protein 1 (Keap1)/Nrf2 complex both in vitro and in vivo. These results suggest that activation of Nrf2/Keap1 using Cos may be a therapeutic strategy for myocardial I/R injury.
Evaluating posttransurethral resection of prostate hematuria severity using two methods: A cross-sectional study
Authors: Hsu Chen-Hung , Wu Shin-Hsin , Lin Cheng-Chia 
Published: March 2023

Abstract

Background
Following transurethral resection of the prostate, postprocedure macroscopic hematuria must be evaluated. We developed a five-color table hematuria grading scale with visualized color references for health care workers to evaluate postprocedure hematuria severity and compared it with assessments made using the text hematuria grading scale.

Methods
Thirty hematuria samples from patients who had undergone transurethral resection of the prostate were evaluated twice by 17 doctors and 13 nurses. The main outcome was the postprocedure macroscopic hematuria severity, measured using the means obtained from the two hematuria grading methods (Meantext and Meanfive-color). Furthermore, we investigated the association between demographic factors including occupation, training years, and whether a urologist was involved in hematuria evaluation.

Results
The Meantext for 30 patients was 2.2489 ± 1.96*0.76862, whereas the Meanfive-color was 2.4222 ± 1.96*0.91268. The paired t test revealed a significant difference between Meantext and Meanfive-color (P = 0.00), meaning that the severity observed by medical staff was significantly milder using the text compared with the five-color hematuria grading scale. The Wilcoxon signed rank test between the variances of the two hematuria grading scales showed a Z score of −1.127 and p value of 0.026 without significant difference.

Conclusions
Our findings reveal that hematuria grading is method-dependent. Hematuria severity in patients who had undergone transurethral resection of the prostate with macroscopic hematuria assessed using a hematuria grading scale without visualized color references may be underestimated in clinical practice. With visualized color references, consistent counts did not negatively correlate to fewer years of experience in the surgery department.
Hepatocellular carcinomas, exhibiting intratumor fibrosis, express cancer-specific extracellular matrix remodeling and WNT/TGFB signatures, associated with poor outcome
Authors: Desert Romain , Chen Wei , Ge Xiaodong , Viel Roselyne , Han Hui , Athavale Dipti , Das Sukanta , Song Zhuolun , Lantvit Daniel , Cano Luis , Naba Alexandra , Musso Orlando , Nieto Natalia 
Published: March 2023

Background and Aims:
HCC, the third leading cause of cancer-related death, arises in the context of liver fibrosis. Although HCC is generally poorly fibrogenic, some tumors harbor focal intratumor extracellular matrix (ECM) deposits called “fibrous nests.” To date, the molecular composition and clinical relevance of these ECM deposits have not been fully defined.

Approach and Results:
We performed quantitative matrisome analysis by tandem mass tags mass spectrometry in 20 human cancer specific matrisome (HCCs) with high or low-grade intratumor fibrosis and matched nontumor tissues, as well as in 12 livers from mice treated with vehicle, carbon tetrachloride, or diethylnitrosamine. We found 94 ECM proteins differentially abundant between high and low-grade fibrous nests, including interstitial and basement membrane components, such as several collagens, glycoproteins, proteoglycans, enzymes involved in ECM stabilization and degradation, and growth factors. Pathway analysis revealed a metabolic switch in high-grade fibrosis, with enhanced glycolysis and decreased oxidative phosphorylation. Integrating the quantitative proteomics with transcriptomics from HCCs and nontumor livers (n = 2,285 samples), we identified a subgroup of fibrous nest HCCs, characterized by cancer-specific ECM remodeling, expression of the WNT/TGFB (S1) subclass signature, and poor patient outcome. Fibrous nest HCCs abundantly expressed an 11-fibrous-nest–protein signature, associated with poor patient outcome, by multivariate Cox analysis, and validated by multiplex immunohistochemistry.

Conclusions:
Matrisome analysis highlighted cancer-specific ECM deposits, typical of the WNT/TGFB HCC subclass, associated with poor patient outcomes. Hence, histologic reporting of intratumor fibrosis in HCC is of clinical relevance.
Persistent mTORC1 activation due to loss of liver tuberous sclerosis complex 1 promotes liver injury in alcoholic hepatitis
Authors: Chao Xiaojuan , Wang Shaogui , Ma Xiaowen , Zhang Chen , Qian Hui , Williams Sha Neisha , Sun Zhaoli , Peng Zheyun , Liu Wanqing , Li Feng , Sheshadri Namratha , Zong Wei-Xing , Ni Hong-Min , Ding Wen-Xing 
Published: March 2023

Background and Aims:
The aim of the study was to investigate the role and mechanisms of tuberous sclerosis complex 1 (TSC1) and mechanistic target of rapamycin complex 1 (mTORC1) in alcohol-associated liver disease.

Approach and Results:
Liver-specific Tsc1 knockout (L-Tsc1 KO) mice and their matched wild-type mice were subjected to Gao-binge alcohol. Human alcoholic hepatitis (AH) samples were also used for immunohistochemistry staining, western blot, and quantitative real-time PCR (q-PCR) analysis. Human AH and Gao-binge alcohol-fed mice had decreased hepatic TSC1 and increased mTORC1 activation. Gao-binge alcohol markedly increased liver/body weight ratio and serum alanine aminotransferase levels in L-Tsc1 KO mice compared with Gao-binge alcohol-fed wild-type mice. Results from immunohistochemistry staining, western blot, and q-PCR analysis revealed that human AH and Gao-binge alcohol-fed L-Tsc1 KO mouse livers had significantly increased hepatic progenitor cells, macrophages, and neutrophils but decreased HNF4α-positive cells. Gao-binge alcohol-fed L-Tsc1 KO mice also developed severe inflammation and liver fibrosis. Deleting Tsc1 in cholangiocytes but not in hepatocytes promoted cholangiocyte proliferation and aggravated alcohol-induced ductular reactions, fibrosis, inflammation, and liver injury. Pharmacological inhibition of mTORC1 partially reversed hepatomegaly, ductular reaction, fibrosis, inflammatory cell infiltration, and liver injury in alcohol-fed L-Tsc1 KO mice.

Conclusions:
Our findings indicate that persistent activation of mTORC1 due to the loss of cholangiocyte TSC1 promotes liver cell repopulation, ductular reaction, inflammation, fibrosis, and liver injury in Gao-binge alcohol-fed L-Tsc1 KO mice, which phenocopy the pathogenesis of human AH.
Effects of EEG burst suppression on cerebral oxygen metabolism and postoperative cognitive function in elderly surgical patients: A randomized clinical trial
Authors: Liu Min , Wang Qi-Qi , Lin Wen-Xin , Ma Bao-Xin , Lin Quan-Yang 
Published: March 2023

Background:
This randomized clinical trial determined the effects of electroencephalographic burst suppression on cerebral oxygen metabolism and postoperative cognitive function in elderly surgical patients.

Methods:
The patients were placed into burst suppression (BS) and non-burst suppression (NBS) groups. All patients were under bispectral index monitoring of an etomidate target-controlled infusion for anesthesia induction and intraoperative combination sevoflurane and remifentanil for anesthesia maintenance. The cerebral oxygen extraction ratio (CERO2), jugular bulb venous saturation (SjvO2), and difference in arteriovenous oxygen (Da-jvO2) were measured at T0, T1, and T2. One day before surgery, and 1, 3, and 7 days after surgery, postoperative cognitive dysfunction was assessed using the mini-mental state examination (MMSE).

Results:
Compared with T0, the Da-jvO2 and CERO2 values were decreased, and SjvO2 was increased in the 2 groups at T1 and T2 (P < .05). There was no statistical difference in the SjvO2, Da-jvO2, and CERO2 values between T1 and T2. Compared with the NBS group, the SjvO2 value increased, and the Da-jvO2 and CERO2 values decreased at T1 and T2 in the BS group (P < .05). The MMSE scores on the 1st and 3rd days postoperatively were significantly lower in the 2 groups compared to the preoperative MMSE scores (P < .05). The MMSE scores of the NBS group were higher than the BS group on the 1st and 3rd days postoperatively (P < .05).

Conclusion:
In elderly patients undergoing surgery, intraoperative BS significantly reduced cerebral oxygen metabolism, which temporarily affected postoperative neurocognitive function.
Comparative evaluation of rapidity of action of benzydamine hydrochloride 0.3% oromucosal spray and benzydamine hydrochloride 3 mg lozenges in patients with acute sore throat: A phase IV randomized trial
Authors: Valerio Carmelina , Di Loreto Giorgio , Salvatori Enrica , Cattaneo Agnese 
Published: March 2023

Background:
Acute sore throat (ST) can occur as part of a common cold of viral origin or caused by pharyngeal bacterial pathogens. The majority of patients with acute ST complain of pain on swallowing and dry scratchiness which can have a negative impact on the quality of life (QoL). This study aimed to evaluate the time to pain relief in patients with acute ST, following a single administration of benzydamine hydrochloride (HCl) 0.3% oromucosal spray or benzydamine HCl 3 mg lozenges.

Methods:
This multicenter, randomized, active-controlled, open label, parallel-group, international phase IV study was conducted at 12 investigational centers in Poland, Hungary, and Russian Federation. The study population consisted of 363 adult patients with recent onset (≤3 days) of ST and a diagnosis of tonsillopharyngitis. The primary endpoint was to assess the efficacy of benzydamine HCl in ST pain relief at 2 minutes after a single-dose administration. Secondary endpoints included, among others, the assessment of a first perceived ST relief at 1 minute after a single-dose administration of benzydamine HCl spray or lozenge.

Results:
Both the spray and lozenges are effective in providing a ST relief starting already at 2 minutes after a single administration, with an effect lasting up to up to 4 hours. Clinical efficacy after 7 days of treatment and a good safety profile were also demonstrated.

Conclusion:
Anesthetic and analgesic properties of benzydamine spray and lozenges effectively addressed the patient priority of a rapid relief of symptoms of upper respiratory tract infections (URTI).
Malignant transformation of meningioma: Case report
Authors: Qu Xiaoqin , Jiang Jingcheng , Wang Han , Zhang Chao , Deng Qingshan , Xu Xiaoping , Zhou Shijun , Yi Yong , Qiu Lihua 
Published: March 2023

Rationale:
Meningiomas are mostly benign brain tumors with minimal malignant cases. Anaplastic meningioma has malignant morphological characteristics and a World Health Organization grade of III.

Patient concerns:
The present study reports a case of an occipital meningioma in a patient who initially chose observation and follow-up after diagnosis. The patient ultimately underwent surgery due to the enlargement of the tumor and the development of visual field defects after a decade of imaging follow-up. The postoperative pathology slides indicated the presence of an anaplastic meningioma (World Health Organization-grade III).

Diagnoses:
The patient’s diagnosis was established through cranial magnetic resonance imaging, which revealed an irregular mixed mass in the right occipital region with isointense T1 and hypointense T2 signal, irregular lobulation, and a maximum diameter of approximately 5.4 cm. Heterogenous enhancement was observed in the contrast-enhanced scan.

Interventions:
The patient opted for surgical intervention to remove the tumor, and the pathology slides of the tumor sample confirmed the diagnosis of anaplastic meningioma. The patient also received radiotherapy (40Gy/15fr).

Outcomes:
No recurrence was observed during the 9-month follow-up.

Lessons:
This case highlights the potential for low-grade meningiomas to undergo malignant transformation, particularly in the presence of irregular lobulation, peritumoral brain edema, and heterogeneous enhancement on contrast-enhanced scans. Total excision (Simpson grade I) is the preferred treatment option, and long-term imaging follow-up is recommended.
Successful treatment of a gravida with acute type A aortic dissection in the third trimester: A case report
Authors: Wang Yue , Hong Jianmao , Xu Bijun , Wang Shiqiang , He Fan 
Published: March 2023

Rationale:
Acute type A aortic dissection is a rare and catastrophic complication of pregnancy with a very high mortality rate for both the mother and the fetus.

Patient concerns:
A 40-year-old female who was 31 weeks pregnant was transferred to our hospital due to “chest and back pain for 7 hours.” Enhanced computed tomography (CT) of the aorta revealed a Standford A dissection, involving 3 branches of the aortic arch and the opening of the right coronary artery. The aortic root and ascending aorta were significantly widened.

Diagnoses:
Acute type A aortic dissection.

Interventions:
After multidisciplinary discussions, we decided to perform cesarean section first and then cardiac surgery. A live male infant was delivered successfully by Obstetrician and Gynecologist. And then, we performed the Betalls procedure with the use of a mechanical 23# aortic-valve vessel for the patient. The innominate artery openings were reinforced with felt pads.

Outcomes:
The procedure was successful. CT examination at 2 months after operation showed that the true lumen of the aorta was enlarged, and no dissection was found in the 3 branches of the aortic arch.

Lessons:
Type A aortic dissection during pregnancy is a rare event that carries a high risk of death for both mother and fetus. An optimal outcome can be achieved through early and accurate diagnosis, safe imaging techniques, timely and effective multidisciplinary discussion, and precise and individualized treatment.
Assessment of Veterans Affairs Case Management Leadership
Authors: Perla Lisa Y. , Beck Lucille B. , Grunberg Neil E. 
Published: March 2023

Purpose/Objectives:
The critical work of Veterans Affairs (VA) case managers is to assist and advocate for veterans navigating the VA and civilian health care systems, aligning services, developing integrated care plans, and supporting team-based care (Hunt & Burgo-Black, 2011). The article reviews publications regarding VA case management leadership because case managers who function as leaders are likely to better coordinate health care services for veterans.

Primary Practice Setting:
VA case managers adhere to the Commission for Case Managers (CCM) scope of practice through patient advocacy, education, and resource management, while ensuring the care is safe, effective, and equitable. VA case managers are competent in veteran health care benefits, health care resources, military service, and the prevailing military culture. They work in a variety of clinical settings including more than 1,400 facilities throughout the United States.

Findings/Conclusions:
The present literature review indicates that few published articles address leadership among VA case managers. Several publications suggest that VA case managers lead, as well as manage, without indicating the extent to which they function as leaders. The literature reviewed indicates an association between unsuccessful program implementation and a lack of staff adaptability, a lack of necessary resources, a lack of ongoing involvement of senior leaders, and a fear of reprisal.

Implications for Case Management Practice:
Because of the 2018 MISSION Act, the number of veterans seeking services in the community has increased and further complicated the coordination of services for VA case managers. Understanding the leadership elements influencing successful care coordination processes is important for veterans to receive high-quality health care services.