bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centripetal Nystagmus, Slow Saccades, Cerebellar Ataxia, and Parkinsonism in a Patient With Anti-GAD65-Associated Stiff Person Syndrome Spectrum Disorder
Authors: Hac Nicholas E. F. , Murphy Olwen C. , Butala Ankur A. , Newsome Scott D. , Gold Daniel R. 
Published: February 2023

Abstract:
A 68-year-old woman with positional dizziness and progressive imbalance presented for vestibular evaluation. Examination was notable for spontaneous downbeat nystagmus (DBN), horizontal and vertical gaze-evoked nystagmus (GEN) with centripetal and rebound nystagmus, and positional apogeotropic nystagmus. There was also mild–moderate slowing of saccades horizontally and vertically and poor fast phases with an optokinetic stimulus. Further consultation by a movement disorder specialist uncovered asymmetric decrementing bradykinesia and rigidity, masked facies, and a wide-based stance without camptocormia. Screening serum laboratory results for metabolic, rheumatologic, infectious, heavy metal, endocrine, or vitamin abnormalities was normal. Surveillance imaging for neoplasms was unremarkable, and cerebrospinal fluid (CSF) analysis was negative for 14-3-3 and real-time quaking-induced conversion (RT-QuIC). However, her anti-glutamic acid decarboxylase-65 (GAD65) immunoglobulin G (IgG) level was markedly elevated in serum to 426,202 IU/mL (reference range 0–5 IU/mL) and in CSF to 18.1 nmol/L (reference range <0.03 nmol/L). No other autoantibodies were identified on the expanded paraneoplastic panel. The patient was referred to neuroimmunology, where torso rigidity, spasticity, and significant paravertebral muscle spasms were noted. Overall, the clinical presentation, examination findings, and extensive workup were consistent with a diagnosis of anti-GAD65-associated stiff person syndrome-plus (musculoskeletal plus cerebellar and/or brainstem involvement). She was subsequently treated with intravenous immunoglobulin (IVIg) and has been stable since commencing this therapy. In patients with centripetal nystagmus, especially in association with other cerebellar findings, an autoimmune cerebellar workup should be considered.
Sympathetic Skin Response in Ulnar Neuropathy at the Elbow
Authors: Mondelli Mauro , Aretini Alessandro 
Published: February 2023

Introduction:
The sympathetic skin response (SSR) reflects the function of sudomotor sympathetic unmyelinated fibers. This study evaluates SSR abnormalities in ulnar neuropathy at the elbow (UNE).

Methods:
Sympathetic skin response was obtained after electrical stimulation of the glabella recording simultaneously from the hand palm (P), third digit (M3) and fifth digit ipsilateral (U5) and contralateral (cU5) to the side of UNE. Ten consecutive SSRs were recorded from each recording side of all participants.

Results:
The authors enrolled 31 patients (mean age 54.3 ± 11.4 years) and 25 subjects of a control group (mean age 52.6 ± 11.3 years). The mean of the areas and the area of the largest response of U5-SSR were significantly lower in the patients (106.9 ± 68.9 and 127.8 ± 79.7 μV/s, respectively) than in control group (161.8 ± 116.6 and 197.2 ± 143.3 μV/s, respectively) and in the affected than in the unaffected sides of the patients (155.3 ± 84.8 and 197.7 ± 103.3 μV/s, respectively); there were no differences in U5-SSR latencies and P-SSR and M3-SSR parameters. U5-SSR mean areas and U5-SSR largest area were reduced in 29% and 26% of patients, respectively. The differences between patients and control group and the number of patients with U5-SSR abnormalities increased when the ratios of M3/U5-SSR and U5/cU5-SSR areas were considered. U5-SSR area was related to UNE clinical severity and to some parameters of the ulnar nerve conduction velocity and cutaneous silent period.

Conclusions:
Sympathetic skin response is useful to demonstrate abnormalities of sympathetic fibers even if UNE patients do not complain for sympathetic symptoms. The SSR abnormalities were evident only if electrophysiological damage of myelinated fibers was moderate or severe.
A Stable EEG Epilepsy Network Spans From Infraslow to Ripple and From Interictal to Ictus
Authors: Ghimire Sushma , Dhamala Mukesh , Epstein Charles M. 
Published: February 2023

Purpose:
To characterize the epilepsy network as reflected in intracranial electroencephalography (iEEG) across the full spectrum of iEEG frequencies and different phases of epilepsy, using a single, conceptually straightforward mathematical measure.

Methods:
The authors applied the spectral Granger causality techniques to intracranial electroencephalography recordings and computed contact-by-contact inward, outward, and total causal flow across frequencies and seizure phases in a selected group of three patients with well-defined, nonlesional seizure foci and prolonged responses to invasive procedures. One seizure and one interictal sample were analyzed per subject.

Results:
A prominent intracranial electroencephalography network was identified by Granger causality at both high and low frequencies. This network persists during the preictal and interictal phases of epilepsy and closely matches the visible seizure onset. The causal inflow network corresponded to seizure onset electrode contacts in 8 of 12 conditions, including ripple, infraslow, preictal, and interictal phases of epilepsy. Its most striking feature is the consistent dominance of causal inflow rather than outflow in the vicinity of the seizure onset zone.

Conclusions:
Findings of this study indicate that a stable intracranial electroencephalography epilepsy network persists, and it can be characterized by a single Granger causality measure from infraslow to ripple frequencies and from the interictal to the immediate preictal phases of epilepsy.
Technique for Robotic Pancreaticojejunostomy
Authors: Erstad Derek J , Hatanaka Yuji , Cass Samuel , Maxwell Jessica , Tran Cao Hop , Kim Michael , Tzeng Ching-Wei , Lee Jeffrey E , Katz Matthew , Ikoma Naruhiko 
Published: February 2023

Background:
Minimally invasive, robotic techniques for hepatobiliary procedures offer the potential for accelerated recovery and reduced opioid usage. Robotic pancreaticoduodenectomy is a technically challenging procedure with a complex reconstruction. In this regard, standardization of the pancreaticojejunostomy technique is critical for safe adoption of robotic technology in pancreatic surgery.

Study Design:
We demonstrate the primary steps and associated principles to perform a robotic pancreaticojejunostomy using a modified Blumgart/Nagakawa technique.

Results:
Key steps to this procedure include: 1) exposure and positioning of the pancreatic remnant and jejunal limb; 2) transpancreatic suture placement using augmented sutures with bulldog clamps for organization; 3) duct-to-mucosa anastomosis with well-defined order of suture placement and knot-tying for optimal exposure, tissue handling, and technical ease; 4) completion of the anterior row of transpancreatic sutures using Lapra-TY clips for gentle, but firm tissue apposition; and 5) placement of omental flap and surgical drains in proximity to the reconstruction.

Conclusion:
We described our technique for performing a robotic pancreaticojejunostomy, which compensates for the technical limitations of the robotic approach. These adjustments in combination with the magnified surgical vision and augmented skill associated with the robotic platform allow for safe and reliable performance of the pancreaticojejunostomy technique.
Use of Thromboelastography with Platelet Mapping to Identify Prothrombotic Coagulation Profiles in Patients with History of Cardiac Intervention Undergoing Lower Extremity Revascularization
Authors: Hall Ryan , Majumdar Monica , Cassidy Ryan , Feldman Zachary , Suarez Sasha , Goudot Guillaume , Bellomo Tiffany , Jessula Samuel , Kirshkaln Amanda , Dua Anahita 
Published: February 2023

Background:
Patients with concomitant peripheral and coronary artery disease (CAD and PAD) are at significant risk for major adverse limb events (MALE). Prevention of thrombosis in this population is of paramount importance. Identifying prothrombotic coagulation profiles in this cohort may facilitate targeted thromboprophylaxis. We compared coagulation profiles of those with CAD and PAD to those with PAD alone during the perioperative period of lower extremity revascularization.

Study Design:
Patients undergoing lower extremity revascularization underwent thromboelastography-platelet mapping (TEG-PM) analysis preoperatively and at serial intervals for up to 6 months. Coagulation profiles of patients with significant CAD (defined as history of coronary artery bypass graft or percutaneous coronary intervention) and PAD were compared to those with PAD alone. MALE in the post-operative period was recorded.

Results:
477 TEG-PM samples from 114 patients were analyzed. 28.1% had a history of significant CAD. The incidence of atrial fibrillation was higher in this group. The significant CAD group had lower ADP-platelet inhibition, higher ADP-platelet aggregation and greater maximum clot strength compared to patients with PAD alone. Patients with significant CAD were more frequently on full dose anticoagulation, but less frequently on dual-antiplatelet therapy. 28.1% of patients with significant CAD developed post-operative MALE compared to 22.9% of patients with PAD alone (p=.40). For both groups, patients who developed post-operative MALE demonstrated greater ADP-platelet aggregation and lower ADP-platelet inhibition.

Conclusion:
Patients with a history of significant CAD undergoing lower extremity revascularization demonstrated prothrombotic TEG-PM profiles, less frequent use of DAPT, and greater rates of full dose anticoagulation. Decreased platelet inhibition was also associated with postoperative MALE. This study underscores the potential utility of viscoelastic assays for coagulation profiling in complex cardiovascular patients.
Does Access to Point-of-Care Medical Information Improve Trauma and General Surgeons’ Clinical Knowledge in a Middle-Income Country? A Mixed-Methods Study with Random Assignment
Authors: Noble Helen , Neumann Ordoñez Willy Jesús , Wong Gabriela Zavala , Rodríguez Manuel J , Checa David Ortega , Warne Maria , Senturia Kirsten , Jin Ying , Peterson Ryan , LaGrone Lacey Nicole 
Published: February 2023

Background:
Investing in continued medical education (CME) strengthens surgical systems. This study assessed the effectiveness of an evidence-based practice (EBP) tutorial and access to UpToDate (UTD) to improve EBP, and understand how and why providers practice using evidence.

Study Design:
A mixed-methods, implementation study at nine public hospitals in Peru consisting of didactic session for surgeons on EBP and Google Translate (GT), and support of applications for UTD access. Change in clinical knowledge scores (CKS), access and use of UTD and impact of language pre- and post-intervention were measured. Qualitative interviews uncovered reasons for these changes.

Results:
Intervention participants had lower CKS at follow-up compared to baseline (odds ratio (OR) of higher score: 0.41 [0.18,0.98]; p=0.044), and this effect was modified (p=0.003) to the extent that the reverse was true for control participants (OR: 2.30 [1.13,4.71]; p=0.022). Participants with 1-20 years’ experience had significantly improved CKS compared to students/residents (1-10 years: OR 4.5 [1.1,18]; 11-20 years: OR 4.9 [1.4,17]); there was no evidence of a different CKS between providers with >20 years’ experience compared to students/residents (OR 1.3 [0.5,3.7]). Administrative disconnect, usability, motivation, education, time, resources, and age influenced POCMIS impact on knowledge and EBP. Participants reporting low English proficiency translated medical literature mostly used GT. Those with low/no English reading proficiency had higher odds of reporting a negative impact on research compared to those with working (p=0.007) or professional (p<0.001) proficiency.

Conclusion:
Providing education on EBP, free UTD access and translation solutions did not correlate with increased CKS due to complex barriers to using POCMIS.
Low Muscle Mass and Radiodensity Associate with Impaired Pulmonary Function and Respiratory Complications in Patients with Esophageal Cancer
Authors: Cameron Miles E , Ayzengart Alexander L , Oduntan Olusola , Judge Sarah M , Judge Andrew R , Awad Ziad T 
Published: February 2023

Background:
60% of patients with esophageal cancer display signs of cachexia at diagnosis. Changes in body composition are common, and muscle mass and quality are measurable through imaging studies. Cachexia leads to functional impairments that complicate treatments, including surgery. We hypothesize that low muscle mass and quality associate with pulmonary function testing parameters, highlighting ventilatory deficits and postoperative complications in patients receiving esophagectomy.

Study Design:
We performed a retrospective review of patients receiving esophagectomy between 2012 and 2021 at our facility. PET/CT scans were used to quantify skeletal muscle at the L3 and T4 levels. Patient characteristics were recorded, including pulmonary function testing parameters. Regression models were created to characterize predictive associations.

Results:
108 patients were identified. All were included in the final analysis. In linear regression adjusted for sex, age and COPD status, low L3 muscle mass independently associated with low FVC (p<0.005, β 0.354) and FEV1 (p<0.001, β 0.392). Similarly, T4 muscle mass independently predicted FVC (p<0.005, β 0.524) and FEV1 (p<0.01, β 0.480). L3 muscle quality correlated with TLC (R 0.2463, p<0.05). 26 patients had pleural effusions postoperatively, associated with low muscle quality on L3 images (p<0.05). Similarly, patients with hospitalization over two weeks presented with lower muscle quality (p<0.005).

Conclusion:
Cachexia and low muscle mass are common. Reduced muscle mass and quality independently associate with impaired FVC, FEV1 and TLC. We propose that respiratory muscle atrophy occurs with weight loss. Body composition analyses may aid in stratifying patients. Pulmonary function testing may also serve as a functional endpoint for clinical trials. These findings highlight the need to study mechanisms that lead to respiratory muscle pathology and dysfunction in tumor bearing hosts.
Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury
Authors: Zambetti Benjamin R , Patel Devanshi D , Stuber Jacqueline D , Zickler William P , Hosseinpour Hamidreza , Anand Tanya , Nelson Adam C , Stewart Collin , Joseph Bellal , Magnotti Louis J 
Published: February 2023

Background:
Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset.

Study Design:
Patients undergoing operative repair for IAI were identified from the Trauma Quality Improvement Program (TQIP) database over 5 years, ending in 2019. Age, gender, race, severity of injury, severity of shock, type of iliac repair (open and endovascular), mechanism, morbidity and mortality were recorded. Patients with IAI were stratified by both type of repair and mechanism and compared. Multivariable logistic regression (MLR) analysis was used to identify independent predictors of mortality.

Results:
Operative IAI was identified in 507 patients. Of these, 309 (61%) were penetrating and 346 (68.2%) involved the external iliac artery. The majority was male (82%) with a median age and ISS of 31 and 20, respectively. Endovascular repair was performed in 31% of cases. For patients with penetrating injuries, type of repair impacted neither morbidity nor mortality. For blunt-injured patients, endovascular repair was associated with lower morbidity (29.3 vs. 41.3%, p=0.082) and significantly reduced mortality (14.6 vs 26.7%, p=0.037) compared to open approach. MLR identified endovascular repair as the only modifiable risk factor associated with decreased mortality (OR 0.34, 95%CI 0.15-0.79, p=0.0116).

Conclusions:
Traumatic IAI causes significant morbidity and mortality. Endovascular repair was identified as the only modifiable predictor of decreased mortality in blunt-injured patients with traumatic IAI. Thus, for select patients with blunt iliac artery injuries, an endovascular repair should be the preferred approach.
Chromatin-Accessible miRNA Regulons Driving Thyroid Tumorigenesis and Progression
Authors: Toraih Eman A , Ruiz Emmanuelle , Ning Bo , Tortelote Giovane G , Hilliard Sylvia , Moroz Krzysztof , Hu Tony , Fawzy Manal S , Kandil Emad 
Published: February 2023

Background:
While papillary thyroid cancer (PTC) can remain indolent, associated lymph node metastases (LNM) and recurrence rates are approximately 50% and 20%, respectively. Omics-based medicine has led to the discovery of predictive biomarkers that can be used to predict tumor progression and clinical outcomes. We aimed to develop a non-invasive omics-driven blood test to allow accurate risk stratification and help tailor individual patient treatment plans.

Study design:
RNA-seq and miRNA-seq analysis of TCGA and GEO datasets were employed to identify an epigenetic prognostic panel. Integrated bulk ATAC-seq and RNA-seq experiments confirmed the results. Sixty-two paired tumor and adjacent control thyroid tissues and 67 blood samples (62 PTC and 5 controls) were analyzed for validation using sequencing and RT-PCR and correlated to clinical outcomes. Liposome-exosome fusion CRISPR-FDS miRNA assay was developed. A predictive risk nomogram was generated and tested for performance.

Results:
Our miRNA panel (miR-146b-5p and miR-221-3p) from tissue and blood was associated with aggressive features and was located within accessible chromatin regions. The miRNA risk score and prognostic nomogram showed higher accuracy in predicting LNM (miR-146b: AUC=0.816, sensitivity=76.9%; miR-221: AUC=0.740, sensitivity=79.5%) and recurrence (miR-146b: AUC=0.921, sensitivity=75.0%; miR-221: AUC=0.756, sensitivity=70.0%) (p<0.001) than staging and ATA risk stratification. CRISPR-based miRNA assays showed upregulation in the blood of cancer cohorts.

Conclusion:
CRISPR-based detection of miR-146b and miR-221 in the blood of TC patients is a reliable and non-invasive tool for real-time assessment and prognostication that has great potential to provide a direct impact on the care of these patients.
Multilevel Intervention to Improve Racial Equity in Access to Kidney Transplant
Authors: Taber David J , Su Zemin , Gebregziabher Mulugeta , Mauldin Patrick D , Morinelli Thomas A , Mahmood Ammar O , Magwood Gayenell S , Casey Michael J , Scalea Joseph R , Kavarana Sam M , Baliga Prabhakar K , Rodrigue James R , DuBay Derek A 
Published: February 2023

Background:
African Americans (AAs) have reduced access to kidney transplant (KTX). Our center undertook a multilevel quality improvement endeavor to address KTX access barriers, focused on vulnerable populations. This program included dialysis center patient/staff education, embedding telehealth services across South Carolina, partnering with community providers to facilitate testing/procedures, and increased use of high-risk donors.

Methods:
This was a time series analysis from 2017 to 2021 using autoregression to assess trends in equitable access to KTX for AAs. Equity was measured using a modified version of the Kidney Transplant Equity Index (KTEI), defined as the proportion of AAs in South Carolina with end-stage kidney disease (ESKD) versus the proportion of AAs initiating evaluation, completing evaluation, waitlisting, and undergoing KTX. A KTEI of 1.00 is considered complete equity; KTEI < 1.00 is indicative of disparity.

Results:
From January 2017 to September 2021, 11,487 ESKD patients (64.7% AA) were referred, 6,748 initiated an evaluation (62.8% AA), 4,109 completed evaluation (59.7% AA), 2,762 were waitlisted (60.0% AA), and 1,229 underwent KTX (55.3% AA). The KTEI for KTX demonstrated significant improvements in equity. The KTEI for initiated evaluations was 0.89 in 2017, improving to 1.00 in 2021 (p=0.0045). Completed evaluations KTEI improved from 0.85 to 0.95 (p=0.0230), while waitlist additions KTEI improved from 0.83 to 0.96 (p=0.0072). The KTEI for KTX also improved from 0.76 to 0.91, which did not reach statistical significance (p=0.0657).

Conclusion:
A multilevel intervention focused on improving access to vulnerable populations was significantly associated with reduced disparities in AAs.
Recipient Survival after Orthotopic Liver Transplantation: Interpretable Machine Learning Survival Tree Algorithm for Patient Specific Outcomes
Authors: Rogers Michael P , Janjua Haroon M , Read Meagan , Cios Konrad , Kundu Madan G , Pietrobon Ricardo , Kuo Paul C 
Published: February 2023

Background:
Elucidating contributors affecting liver transplant survival is paramount. Current methods offer crude global group outcomes. To refine patient-specific mortality probability estimation and determine covariate interaction using recipient and donor data, we generated a survival tree algorithm (ReSOLT) using UNOS transplant data.

Study Design:
The UNOS database was queried for liver transplants in patients ≥18 years old between 2000-2021. Pre-operative factors were evaluated with stepwise logistic regression; 43 significant factors were used in survival tree modeling. Graft survival <7 days was excluded. Data were split into training and testing sets and further validated with ten-fold cross validation. Survival tree pruning and model selection was achieved based on AIC and log-likelihood values. Log-rank pairwise comparisons between subgroups and estimated survival probabilities were calculated.

Results:
A total of 122,134 liver transplant patients were included for modeling. Multivariable logistic regression (AUC = 0.742, F1 = 0.822) and survival tree modeling returned 8 significant recipient survival factors: recipient age, donor age, recipient primary payment, recipient Hepatitis C status, recipient diabetes, recipient functional status at registration and at transplantation, and deceased donor pulmonary infection. Twenty subgroups consisting of combinations of these factors were identified with distinct Kaplan-Meier survival curves (p<0.001 among all by log rank test) with five-year and ten-year survival probabilities.

Conclusions:
Survival trees are a flexible and effective approach to understand the effects and interactions of covariates on survival. Individualized survival probability following liver transplant is possible with ReSOLT, allowing for more coherent patient and family counseling and prediction of patient outcome using both recipient and donor factors.