bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fabrication and characterization of PEKK nanocomposites: An in vitro study
Authors: Al-Samaray Manar E , Fatalla Abdalbseet A 
Published: August 2023

Although the number of implants has increased gradually and consistently over the years to around one million per year globally, there is still far more potential for advancement in the field of dental implantology which is typically growing quickly. This study investigates the effect of nanofiller reinforcement high-performance polymer matrix to enhance mechanical and physical characteristics. Calcium silicate (CS)/Polyetherketoneketone (PEKK) biomedical composite (G0 as a control group) is reinforced with different weight percentages (G1-G4) of tellurium dioxide nanoparticles (TeO2 NPs) ( n = 5). This research uses ethanol as a binder for mixing various weight percentages (wt%) of TeO2 NPs with CS/PEKK biomedical composite. The combination is then dried at 120°C in a forced convection oven before being put into special molds and compressed for 20 min Holding period at 310°C and 15 MPa. The composites were prepared via the compression molding technique. Morphological, mechanical, and physical characteristics were studied. The findings of this study suggested improvement in the interfacial interaction between TeO2 NPs (G1 and G2) and CS/PEKK bioactive composite resulting in better mechanical and physical properties, especially at 1 w% of TeO2 NPs (G2).
Stretch or Suppress: Role of Owners and Nominee Directors in Financial Distress
Authors: Chada Swechha , Banerjee Sumit 
Published: August 2023

This study investigates the effect of various firm-level corporate governance mechanisms on the likelihood of financial distress in India. We analyze the competing hypotheses of interest alignment and agency theory, examining how controlling shareholders affect the probability of financial distress. Additionally, we assess the potential impact of institutional investor shareholding and bank-appointed directors on the likelihood of financial distress. Our findings suggest that increasing controlling shareholder ownership decreases the probability of distress. However, the effects of institutional investors and bank-appointed directors vary and also depend on the quantum of shareholding of institutional investors and affiliation with business groups. Our results offer insights into improving governance in economies with higher ownership concentration, weaker institutional frameworks, and greater bank participation in credit facilitation. JEL Codes: G32, G33, G34
The First Population-Level Description of Women Diagnosed With Invasive Breast Cancer in Costa Rica From 2008 to 2012: A Cross-Sectional Study
Authors: Aparicio Amada , Guzman Percy , Morera Melvin , Calvo Yoleni , Obando Marjorie , Landaverde Denis , González Ileana , Ramirez-Pena Esmeralda 
Published: August 2023

Introduction Breast cancer is the leading cause of cancer-related deaths among women worldwide. In Costa Rica, it ranks first in incidence and fourth in terms of mortality. However, there is a lack of comprehensive information on treatment patterns and outcomes for breast cancer patients in Costa Rica. Methods This study utilized data from the National Tumor Registry, which was merged with the Costa Rica Social Security Fund (CCSS) to ensure comprehensive access to clinical information. The study is prospective and focused on patients diagnosed with breast cancer between January 2008 and December 2012. This combined dataset allowed for a more comprehensive analysis of patient characteristics, treatment patterns, and outcomes related to breast cancer in Costa Rica. Results Among the 4775 patients diagnosed during this period, 3160 met the inclusion criteria for our study. The average age at diagnosis was 59.1 years, with 32.5% of patients being over the age of 65. Most of the patients (55.4%) identified themselves as homemakers, while 46.5% underwent core needle biopsy for diagnosis. Approximately 60% of women were diagnosed with early-stage disease (IA, IIA, and IIB), while 1.7% had metastatic disease, mainly affecting the bone. The mean interval between diagnosis and surgery was 72 days. Most patients (88.7%) received surgery as their initial treatment, and over half (54.4%) received some form of adjuvant therapy. Additionally, 85.6% of patients completed their prescribed treatment. Conclusion This study provides a comprehensive and detailed description of the characteristics and treatment patterns among breast cancer patients in Costa Rica. The findings contribute to our understanding of the disease in this population and can serve as a foundation for further research and improvement in breast cancer management and care.
Health economic impact of Nerinetide in addition to mechanical thrombectomy without concurrent alteplase
Authors: Ospel Johanna M , Adams Corey , Tymianski Michael , Goyal Mayank , Hill Michael 
Published: August 2023

Background and purpose The ESCAPE-NA1 trial has shown that intravenous Nerinetide improves clinical outcomes in acute ischemic stroke patients with large vessel occlusion undergoing endovascular treatment without concurrent intravenous alteplase. We assessed the health economic impact of intravenous Nerinetide as an adjunctive treatment in endovascular treatment patients who do not receive concurrent intravenous alteplase. Methods Data are from the ESCAPE-NA1 trial, in which acute ischemic stroke with large vessel occlusion endovascular treatment patients were randomized to receive intravenous Nerinetide or placebo. Only those patients not treated with concurrent intravenous alteplase were included in this analysis. We used a Markov state transition model (12 months cycle length) to estimate expected lifetime costs and outcomes, assuming Nerinetide cost being zero for the purpose of this analysis. We calculated incremental cost-effectiveness ratios and derived mean net monetary benefits with 95% prediction intervals from a probabilistic sensitivity analysis. Upper, middle, and lower willingness-to-pay thresholds were set at $50,000,$100,000, and $150,000. Results The incremental cost-effectiveness ratio for Nerinetide in addition to endovascular treatment was $13,721/quality-adjusted life year (healthcare perspective) and $14,453/quality-adjusted life year (societal perspective). At the upper willingness-to-pay threshold, Nerinetide in addition to endovascular treatment resulted in a higher mean net monetary benefit compared to endovascular treatment alone, both from a healthcare perspective (449,526 [95% prediction interval: 448,627–450,425] vs. 382,584 [381,781–383,386]) and a societal perspective (350,750 [349,842–351,658] vs. 282,896 [282,068–283,725]). Mean net monetary benefits were also higher for Nerinetide in addition to endovascular treatment at the middle and lower willingness-to-pay thresholds. Conclusion Treating patients with a cerebroprotectant, such as Nerinetide, in addition to endovascular treatmentl in patients who cannot receive intravenous alteplase may be beneficial from a health-economic standpoint.
Evaluation of a novel polymer coil for endovascular occlusion of intracranial aneurysms in a rabbit model
Authors: Bisharat David-R , Johnson Jed , Mühl-Benninghaus Ruben , Tomori Toshiki , Lago James , Virmani Renu , Reith Wolfgang , Simgen Andreas 
Published: August 2023

Background and Purpose The results of the preclinical study of a novel polymer coil in treatment of elastase induced aneurysms will be presented in this paper. Material and Methods We induced 16 aneurysms in 16 New Zealand white rabbits at the origin of the right common carotid artery at the brachiocephalic trunk. Newly developed polymer coils in both groups for six aneurysms each and platinum coils for two aneurysms each were used. Control angiographies followed in both groups immediately after coiling as well as in the first eight animals 30 days after intervention (30 days group) and in the other eight animals 90 days after (90 days group). An explanation and histological evaluation of the treated aneurysms followed. Results The 12 animals in which the aneurysms were treated with polymer coils showed a complete occlusion (grade IV) in only 6 out of 12 aneurysms (50%), an almost complete occlusion (grade III) in 5 out of 12 (42%) and an incomplete occlusion in the treatment of one aneurysm (8%). Histologically, we observed a significantly more pronounced inflammatory response and neoangiogenesis in aneurysms treated with polymer coils only in the 30 days group. Conclusion Most difficulties and concerns with the polymer coils were related to the flexibility and detachment behaviour. Therefore, and due to the technical challenges of delivery, the novel polymer coil cannot be considered an alternative to the current platinum coils.
Predicting Time to Evaluation After Pediatric Concussion: Factors Affecting Specialty Concussion Care
Authors: Wingerson Mathew J. , Magliato Samantha N. , Smulligan Katherine L. , Wilson Julie C. , Little Casey C. , Howell David R. 
Published: August 2023

Background: The timing of clinical evaluation after pediatric concussion represents an important and potentially modifiable clinical milestone for diagnosis, selection of appropriate treatment pathways, and recovery prognosis. Patient demographics, socioeconomic status, or medical history may affect the time to the initial evaluation and subsequently influence recovery outcomes. Purpose/Hypothesis: The purpose of this investigation was to evaluate the association of patient characteristics with the time to specialty evaluation after a concussion. It was hypothesized that patients with a history of concussion, a preexisting relationship with our specialty concussion program, or a higher ZIP code–based income estimate would present for care more quickly after a concussion than patients without these characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were patients with a concussion between 6 and 18 years old who were seen for care at a single sports medicine center between January 1 and December 31, 2019. Patient demographic, socioeconomic, injury, and clinical characteristics were collected through a retrospective review of the medical records. The primary outcome was the number of days between the date of the concussion and the patient’s initial specialty evaluation. Results: Overall, 220 patients (mean age, 14.4 ± 2.5 years; 46% female) were seen for care at a mean of 9.7 ± 5.6 days (range, 1-21 days) after concussion. A shorter time to specialty evaluation was associated with a history of concussion (β = –1.72 [95% CI, –3.24 to –0.20]; P = .03) and a prior clinical relationship with the treating clinical department (β = –1.85 [95% CI, –3.52 to –0.19]; P = .03). Referral by a primary care provider was associated with a longer time to evaluation (β = 3.86 [95% CI, 2.39-5.33]; P < .0001). Conclusion: A history of concussion and having a preexisting clinical relationship with the deparment were associated with a shorter time to evaluation after concussion. Referral from a primary care physician was associated with a longer time to evaluation. Issues may exist in the propensity to access care after an injury, resulting in delays for initiating early treatment.
Concomitant Injuries Associated With ACL Rupture in Elite Professional Alpine Ski Racers and Soccer Players: A Comparative Study With Propensity Score Matching Analysis
Authors: Farinelli Luca , Csapo Robert , Meena Amit , Abermann Elisabeth , Hoser Christian , Fink Christian 
Published: August 2023

Background: For elite professional soccer players and alpine skiers, injuries associated with anterior cruciate ligament (ACL) rupture, such as meniscal, cartilage, or collateral ligament lesions, could result in a delayed return to sport compared with isolated ACL injury. Purpose/Hypothesis: The purpose of the study was to provide a detailed description of associated injuries at the time of primary ACL reconstruction in elite soccer players and alpine skiers. It was hypothesized that soccer players and skiers would present different typical injury patterns due to different injury mechanisms. Study Design: Cohort study; Level of evidence, 3. Methods: Surgical reports and arthroscopic images of elite professional soccer players and alpine skiers who underwent primary ACL reconstruction at a single institution between January 2010 and June 2022 were analyzed retrospectively. The presence and location of multiligamentous injury, meniscal tears, and chondral lesions were compared between the athlete groups. A propensity score matching analysis with 1:1 ratio was performed between skiers and soccer players to limit the effect of selection bias. Results: Included were ACL reconstruction data representative of 37 soccer players and 44 alpine skiers. Meniscal pathology was found in 32 (86%) soccer players and 30 (68%) skiers. Chondral injuries were reported in 11 (30%) soccer players and 15 (34%) skiers. Results of the propensity score matching analysis in 15 pairs of soccer players and skiers indicated that soccer players had a significantly higher rate of medial meniscal injuries (73% vs 27%; P = .03) and lateral posterior root tears (33% vs 0%; P = .04) compared with skiers. Conclusion: A higher prevalence of combined chondral and meniscal injuries versus isolated ACL injuries was observed in both groups of athletes. Professional soccer players were characterized by higher prevalence of medial meniscal tears and lateral posterior root lesions compared with professional alpine skiers.
Characterization of Regional Morphological Changes in Metopic Craniosynostosis Following Endoscopic Strip Craniectomy With Postoperative Helmeting: Predictors for Success
Authors: Cepeda Alfredo , Nguyen Huan T. , Obinero Chioma , Washington George N. , Littlefield Tim , Greives Matthew R. , Nguyen Phuong D. 
Published: August 2023

Background: Metopic craniosynostosis (MC) represents 10% to 25% of craniosynostosis cases. Endoscopic-assisted strip craniectomy (ESC) with orthotic molding therapy provides a minimally invasive alternative to open fronto-orbital advancement. Herein, we describe a 3D photogrammetry methodology for measurement of regional cranial growth and inter-frontal angle (IFA) as well as examine factors that may contribute to successful outcomes after ESC. Methods: A retrospective review was performed on patients with MC treated with ESC and band therapy from 2015 to 2019. Patients obtained 3D photogrammetry preoperatively, postoperatively, and post-helmet therapy. A survey was administered to 14 independent raters, who were asked to determine treatment success based on subjective visual assessment of preoperative and post-banding images. Patients were considered to have successful therapy when ≥75% of raters were in agreeance. Results: Thirteen patients met inclusion criteria. Average age at surgery was 3.5 months, with 53.9% of these patients deemed as a successful outcome on aggregate reviewer scores. For patients with successful treatment, there was a trend toward younger at surgery (2.9 months vs 4.2 months, P = .09) and at initiation of helmeting (3.3 months vs 4.8 months, P = .07). Regional root mean square identified significant differences between frontal and temporal (14.04 mm vs 7.39 mm, P = .02) and temporal and parietal (7.39 mm vs 15.37 mm, P = .002) regions. Average postoperative IFA was significantly improved compared to preoperative values (128.19° vs 117.9°, P = .02). Logistic regression modeling found no significant predictors of success. Discussion: Though not statistically significant, patients with MC with successful outcomes following ESC and banding were younger at surgery and time of helmeting. Our analysis of regional cranial growth and IFA demonstrated significant differences, which coincide with expected morphologic changes in this patient population. Our results demonstrate the potential for this technology in surgical evaluation and support the importance of early diagnosis and treatment by craniofacial surgeons.
Relations of Microstructural Attributes and Strength-Ductility of Zirconium Alloys with Hydrides
Authors: Fang Chao , Guo Xiang , Li Jianghua , Chen Gang 
Published: August 2023

AbstractAs the first safety barrier of nuclear reactors, zirconium alloy cladding tubes have attracted extensive attention because of its good mechanical properties. The strength and ductility of zirconium alloy are of great significance to the service process of cladding tubes, while brittle hydrides precipitate and thus deteriorate the overall performance. Based on the cohesive finite element method, the effects of cohesive strength, interfacial characteristics, and hydrides geometric characteristics on the strength and ductility of two-phase material (zirconium alloy with hydrides) are numerically simulated. The results show that the fracture behavior is significantly affected by the cohesive strength and that the overall strength and ductility are sensitive to the cohesive strength of the zirconium alloy. Furthermore, the interface is revealed to have prominent effects on the overall fracture behavior. When the cohesive strength and fracture energy of the interface are higher than those of the hydride phase, fracture initiates in the hydrides, which is consistent with the experimental phenomena. In addition, it is found that the number density and arrangement of hydrides play important roles in the overall strength and ductility. Our simulation provides theoretical support for the performance analysis of hydrogenated zirconium alloys during nuclear reactor operation.
Effects of remote ischemic preconditioning on coronary blood flow and microcirculation
Authors: Zhao Zhen-Zhou , Li En , Li Xue-Jie , Guo Quan , Shi Qing-Bo , Li Mu-Wei 
Published: August 2023

AbstractThis study aimed to determine the effect of short-term remote ischemic preconditioning (RIPC) on coronary blood flow and microcirculation function using the quantitative flow ratio (QFR) and index of microcirculatory resistance (IMR). We randomly divided 129 patients undergoing coronary angiography (CAG) into RIPC and control groups. Following the first CAG, we randomly divided the patients further into the unilateral upper limb and lower limb groups for four cycles of ischemia/reperfusion circulation; subsequently, we performed the second CAG. During each CAG, contrast-flow QFR (cQFR), fixed-flow QFR (fQFR), and IMR (in patients with cardiac syndrome X) were calculated and compared. We measured 253 coronary arteries in 129 patients. Compared to the control group, the average cQFR of the RIPC group increased significantly after RIPC. Additionally, 23 patients with cardiac syndrome X (IMR > 30) were included in this study. Compared to the control group, IMR and the difference between cQFR and fQFR (cQFR-fQFR) both decreased significantly after receiving RIPC. The application of RIPC can increase coronary blood flow and improve coronary microcirculation function.
An optimized optical-flow-based method for quantitative tracking of ultrasound-guided right diaphragm deformation
Authors: Zhang Qi , Yang Dawei , Zhu Yu , Liu Yatong , Ye Xiong 
Published: August 2023

Abstract
Objectives
To develop a quantitative analysis method for right diaphragm deformation. This method is based on optical flow and applied to diaphragm ultrasound imaging.

Methods
This study enrolls six healthy subjects and eight patients under mechanical ventilation. Dynamic images with 3–5 breathing cycles were acquired from three directions of right diaphragm by a portable ultrasound system. Filtering and density clustering algorithms are used for denoising Digital Imaging and Communications in Medicine (DICOM) data. An optical flow based method is applied to track movements of the right diaphragm. An improved drift correction algorithm is used to optimize the results. The method can automatically analyze the respiratory cycle, inter-frame/cumulative vertical and horizontal displacements, and strain of the input right diaphragm ultrasound image.

Results
The optical-flow-based diaphragm ultrasound image motion tracking algorithm can accurately track the right diaphragm during respiratory motion. There are significant differences in horizontal and vertical displacements in each section (p-values < 0.05 for all). Significant differences are found between healthy subjects and mechanical ventilation patients for both horizontal and vertical displacements in Section III (p-values < 0.05 for both). There is no significant difference in global strain in each section between healthy subjects and mechanical ventilation patients (p-values > 0.05 for all).

Conclusions
The developed method can quantitatively evaluate the inter-frame/cumulative displacement of the diaphragm in both horizontal and vertical directions, as well as the global strain in three different imaging planes. The above indicators can be used to evaluate diaphragmatic dynamics.
An artificial intelligence-based ecological index for prognostic evaluation of colorectal cancer
Authors: Chen Qicong , Cai Ming , Fan Xinjuan , Liu Wenbin , Fang Gang , Yao Su , Xu Yao , Li Qian , Zhao Yingnan , Zhao Ke , Liu Zaiyi , Chen Zhihua 
Published: August 2023

Abstract
Background and objective
In the tumor microenvironment (TME), the dynamic interaction between tumor cells and immune cells plays a critical role in predicting the prognosis of colorectal cancer. This study introduces a novel approach based on artificial intelligence (AI) and immunohistochemistry (IHC)-stained whole-slide images (WSIs) of colorectal cancer (CRC) patients to quantitatively assess the spatial associations between tumor cells and immune cells. To achieve this, we employ the Morisita-Horn ecological index (Mor-index), which allows for a comprehensive analysis of the spatial distribution patterns between tumor cells and immune cells within the TME.

Materials and methods
In this study, we employed a combination of deep learning technology and traditional computer segmentation methods to accurately segment the tumor nuclei, immune nuclei, and stroma nuclei within the tumor regions of IHC-stained WSIs. The Mor-index was used to assess the spatial association between tumor cells and immune cells in TME of CRC patients by obtaining the results of cell nuclei segmentation. A discovery cohort (N = 432) and validation cohort (N = 137) were used to evaluate the prognostic value of the Mor-index for overall survival (OS).

Results
The efficacy of our method was demonstrated through experiments conducted on two datasets comprising a total of 569 patients. Compared to other studies, our method is not only superior to the QuPath tool but also produces better segmentation results with an accuracy of 0.85. Mor-index was quantified automatically by our method. Survival analysis indicated that the higher Mor-index correlated with better OS in the discovery cohorts (HR for high vs. low 0.49, 95% CI 0.27–0.77, P = 0.0014) and validation cohort (0.21, 0.10–0.46, < 0.0001).

Conclusion
This study provided a novel AI-based approach to segmenting various nuclei in the TME. The Mor-index can reflect the immune status of CRC patients and is associated with favorable survival. Thus, Mor-index can potentially make a significant role in aiding clinical prognosis and decision-making.