bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the posterior corneal surface after femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) performed into a pocket (SMI-LIKE) or under a flap (FS-LIKE)
Authors: Liu Shengtao , Yu Lanhui , Zhao Yu , Zhou Xingtao 
Published: May 2023

Abstract
Background
To compare the changes in posterior corneal surface after small-incision lenticule intrastromal keratoplasty (SMI-LIKE) and femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) for hyperopia correction.

Methods
In this prospective comparative randomized study, 23 eyes with hyperopia were recruited. Eyes were categorized into two groups—SMI-LIKE group (11 eyes) and FS-LIKE group (12 eyes). Lenticules from myopia small incision lenticule extraction were implanted into a pocket (SMI-LIKE group) or at a depth of 100 µm under a flap (FS-LIKE group). Posterior corneal elevations in the center, mid-periphery, and periphery, as well as mean keratometry of the posterior corneal surface (Kmb) were measured using a Pentacam over a three-month follow-up.

Results
All surgeries were completed successfully and no complications occurred. At one day postoperatively, there was a slight backward change with SMI-LIKE and a forward change with FS-LIKE in the central region of the posterior corneal elevation. Conversely, the peripheral area showed forward displacement in SMI-LIKE and an apparent backward change in FS-LIKE. The mid-peripheral regions manifested a backward change after the procedure throughout the entire follow-up in both groups. Kmb exhibited flattening at one month postoperatively and subsequently returned to its original level at three months after SMI-LIKE while in FS-LIKE, Kmb steepened after lenticule implantation with a significant change noted at one day postoperatively (P = 0.001).

Conclusions
Posterior corneal surface after SMI-LIKE and FS-LIKE exhibited different change patterns in various corneal regions, with the most prominent change occurring at one day postoperatively during the three-month follow-up.
Trial registration: Chinese Clinical Trial Registry: ChiCTR-ONC-16008300. Registered on Apr 18th, 2016. http://www.chictr.org.cn/edit.aspx?pid=14090&htm=4
Association of antithrombotic therapy with postoperative rebleeding in patients with cerebral amyloid angiopathy
Authors: Yanagawa Taro , Sato Hiroki , Suzuki Kaima , Ooigawa Hidetoshi , Takao Masaki , Kurita Hiroki 
Published: May 2023

Abstract
Background
Cerebral amyloid angiopathy is a common cause of subcortical hemorrhage in older adults. Although open hematoma removal may be performed for severe subcortical hemorrhage, its safety in patients with cerebral amyloid angiopathy has not been established, and postoperative rebleeding may occur. Therefore, this study aimed to investigate factors associated with postoperative rebleeding.

Methods
Out of 145 consecutive patients who had undergone craniotomy for surgical removal of subcortical intracerebral hemorrhage between April 2010 and August 2019 at a single institution in Japan, we examined 109 patients with subcortical hemorrhage who met the inclusion criteria. After excluding 30 patients whose tissue samples were unsuitable for the study, the final study cohort comprised 79 patients.

Results
Of the 79 patients, 50 (63%) were diagnosed with cerebral amyloid angiopathy (cerebral amyloid angiopathy group) and 29 (37%) were not diagnosed with noncerebral amyloid angiopathy (noncerebral amyloid angiopathy group). Postoperative rebleeding occurred in 12 patients (24%) in the cerebral amyloid angiopathy group and in 2 patients (7%) in the noncerebral amyloid angiopathy group. Preoperative prothrombin time–international normalized ratio and intraoperative bleeding volume were significantly associated with postoperative rebleeding in the cerebral amyloid angiopathy group (odds ratio = 42.4, 95% confidence interval = 1.14–1578; p = 0.042 and odds ratio = 1.005, 95% confidence interval = 1.001–1.008; p = 0.007, respectively).

Conclusions
Patients with cerebral amyloid angiopathy-related cerebral hemorrhage who are receiving antithrombotic therapy, particularly warfarin therapy, are at a high risk of postoperative rebleeding.

Trial registration
Registry and Registration Number of the study: 19–220, 2019/12/23, retrospectively registered.
Leave-one-out cross-validation, penalization, and differential bias of some prediction model performance measures—a simulation study
Authors: Geroldinger Angelika , Lusa Lara , Nold Mariana , Heinze Georg 
Published: May 2023

Abstract
Background
The performance of models for binary outcomes can be described by measures such as the concordance statistic (c-statistic, area under the curve), the discrimination slope, or the Brier score. At internal validation, data resampling techniques, e.g., cross-validation, are frequently employed to correct for optimism in these model performance criteria. Especially with small samples or rare events, leave-one-out cross-validation is a popular choice.

Methods
Using simulations and a real data example, we compared the effect of different resampling techniques on the estimation of c-statistics, discrimination slopes, and Brier scores for three estimators of logistic regression models, including the maximum likelihood and two maximum penalized likelihood estimators.

Results
Our simulation study confirms earlier studies reporting that leave-one-out cross-validated c-statistics can be strongly biased towards zero. In addition, our study reveals that this bias is even more pronounced for model estimators shrinking estimated probabilities towards the observed event fraction, such as ridge regression. Leave-one-out cross-validation also provided pessimistic estimates of the discrimination slope but nearly unbiased estimates of the Brier score.

Conclusions
We recommend to use leave-pair-out cross-validation, fivefold cross-validation with repetitions, the enhanced or the .632+ bootstrap to estimate c-statistics, and leave-pair-out or fivefold cross-validation to estimate discrimination slopes.
Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study
Authors: Mongkolchaiarunya Jarukit , Wongthanee Antika , Kasitanon Nuntana , Louthrenoo Worawit 
Published: May 2023

Abstract
Background
Several studies have compared the clinical features and outcomes of late- and early-onset systemic lupus erythematosus (SLE) patients. However, these previous studies were uncontrolled. The current study aimed to compare late- and early-onset SLE patients while controlling for sex and year at diagnosis (± 1 year).

Methods
The medical records of SLE patients in a lupus cohort from January 1994 to June 2020 were reviewed. Late-onset patients were identified as those with an age at diagnosis ≥ 50 years. The early-onset patients (age at diagnosis < 50 years) were matched by sex and year at diagnosis with the late-onset patients at a ratio of 2:1. Clinical manifestations, disease activity (mSLEDAI-2K), organ damage scores, treatment, and mortality were compared between the two groups.

Results
The study comprised 62 and 124 late- and early-onset patients, respectively, with a mean follow-up duration of 5 years. At disease onset, when comparing the early-onset patients with the late-onset patients, the latter group had a higher prevalence rate of serositis (37.0% vs. 14.5%, p < 0.001) and hemolytic anemia (50.0% vs. 33.9%, p = 0.034) but lower prevalence rate of malar rash (14.5% vs. 37.1%, p = 0.001), arthritis (41.9% vs. 62.1%, p = 0.009), leukopenia (32.3% vs. 50.0%, p = 0.022) and lymphopenia (50.0% vs. 66.1%, p = 0.034). The groups had similar SLE disease activity (7.41 vs. 7.50), but the late-onset group had higher organ damage scores (0.37 vs. 0.02, p < 0.001). The rates of treatment with corticosteroids, antimalarial drugs, or immunosuppressive drugs were not different. At their last visit, the late-onset patients still had the same pattern of clinically significant differences except for arthritis; additionally, the late-onset group had a lower rate of nephritis (53.2% vs. 74.2%, p = 0.008). They also had a lower level of disease activity (0.41 vs. 0.57, p = 0.006) and received fewer antimalarials (67.7% vs. 85.5%, p = 0.023) and immunosuppressive drugs (61.3% vs. 78.2%, p = 0.044), but they had higher organ damage scores (1.37 vs. 0.47, p < 0.001) and higher mortality rates/100-person year (3.2 vs. 1.1, p = 0.015). After adjusting for disease duration and baseline clinical variables, the late-onset patients only had lower rate of nephritis (p = 0.002), but still received fewer immunosuppressive drugs (p = 0.005) and had a higher mortality rate (p = 0.037).

Conclusions
In this sex- and year at diagnosis-matched controlled study, after adjusting for disease duration and baseline clinical variables, the late-onset SLE patients had less renal involvement and received less aggressive treatment, but had a higher mortality rate than the early-onset patients.
DLP: towards active defense against backdoor attacks with decoupled learning process
Authors: Ying Zonghao , Wu Bin 
Published: May 2023

AbstractDeep learning models are well known to be susceptible to backdoor attack, where the attacker only needs to provide a tampered dataset on which the triggers are injected. Models trained on the dataset will passively implant the backdoor, and triggers on the input can mislead the models during testing. Our study shows that the model shows different learning behaviors in clean and poisoned subsets during training. Based on this observation, we propose a general training pipeline to defend against backdoor attacks actively. Benign models can be trained from the unreliable dataset by decoupling the learning process into three stages, i.e., supervised learning, active unlearning, and active semi-supervised fine-tuning. The effectiveness of our approach has been shown in numerous experiments across various backdoor attacks and datasets.
Increasing trend toward joint-preserving procedures for hip osteonecrosis in the United States from 2010 to 2019
Authors: Ng Mitchell K. , Kobryn Andriy , Golub Ivan J. , Piuzzi Nicolas S. , Wong Che Hang Jason , Jones Lynne , Mont Michael A. 
Published: May 2023

Abstract
Introduction
The incidence of osteonecrosis of the femoral head is estimated at about 10 to 20,000 patients annually, and, when left untreated, 80% or more of cases progress to femoral head collapse. A series of joint-preserving procedures have been developed to prevent/delay the need for hip arthroplasty. The aim of this study was to provide a five-year update: (1) evaluating temporal trends of arthroplasty vs. joint-preservation techniques such as core decompression, bone grafting, osteotomies, and arthroscopy; (2) determining proportions of procedures in patients aged less than vs. over 50 years; and (3) quantifying rates of specific operative techniques.

Methods
A total of 10,334 patients diagnosed with osteonecrosis of the femoral head and having received hip surgery were identified from a nationwide database between 1 January 2010 and 31 December 2019, by using the International Classification of Disease, the Ninth/Tenth revision (ICD-9/10) codes. The percentage of patients managed by each operative procedure was calculated annually. To identify trends, patients were grouped by age under/over 50 years and divided into a joint-preserving and a non-joint-preserving (arthroplasty) group. Chi-squared tests were performed to compare the total number of procedures per year.

Results
Rates of arthroplasty far exceeded those for joint-preserving procedures. However, from 2015 to 2019, significantly more joint-preserving procedures were performed than in 2010 to 2014 (4.3% vs. 3.0%, P < 0.001). Significantly more joint-preserving procedures were performed in patients aged < 50 years relative to those ≥ 50 years (7.56% vs. 1.86%, P < 0.001). Overall, total hip arthroplasty was the most common procedure (9,814; 94.97%) relative to core decompression (331; 3.20%), hemiarthroplasty/resurfacing (102; 0.99%), bone grafting (48; 0.46%), and osteotomy (5; 0.05%).

Conclusion
Management of patients who have osteonecrosis of the femoral head continues to be predominantly arthroplasty procedures, specifically, total hip arthroplasty. Our findings suggest a small, but significant trend toward increased joint-preserving procedures, especially in patients under 50 years. In particular, the proportion of patients receiving core decompression has increased significantly from 2015 to 2019 relative to prior years.
Would a complete electrophysiological study allow us to make a correct diagnosis? Case report
Authors: Chávez-González Elibet , Carmona-Puerta Raimundo , Rodríguez-González Fernando , Cruz-Elizundia Juan Miguel , Torres-Acosta Cynthia 
Published: May 2023

Abstract
Background
Oblique course of some left accessory pathways is rare An incomplete electrophysiological study may confuse us between an oblique accessory pathway or the presence of two accessory pathways. The proximity of all atrial and ventricular electrograms, at each pole of the catheter, within the coronary sinus may be a novel finding.

Case presentation
A 68-year-old woman patient presented arrhythmias with hypotension requiring electrical cardioversion. Her electrocardiogram (ECG) was interpreted as atrial fibrillation by accessory pathway. We performed with the protocol of ablation stablished in our laboratory: two punctures on the right femoral vein with placement of introducers (8F and 7F) by Seldigner technique and one puncture on the left femoral vein (7F). The study was performed with BIOTRONIK technology (Multicath study catheter), a non-deflectable 7F quadripolar catheter with 2 mm tip electrode to record the His electrogram, a non-deflectable decapolar catheter with 5 pairs of coronary sinus (CS) electrodes. Accessory pathway mapping was performed in right and left cavities and within the CS. All electrograms into CS showed short AV from proximal to distal CS. Finally, ablation of two accessory pathway recordings was achieved at two distant epicardial points within the CS.

Conclusions
Ablation at two distant sites, one on the ventricular side and the other on the mitral annulus, suggests the presence of an oblique accessory pathway and at the same time the differential diagnosis of the presence of two accessory pathways. In our point of view according the above, we consider this is a very rare case of oblique AP with epicardial trajectory. The sequence of electrograms (in this case) along the CS has not been seen before in the literature reviewed. It is important, regardless of the urgency, to follow diagnostic and therapeutic protocols in invasive electrophysiology.
Design optimization and production of a small-scale semi-trailer chassis for testing
Authors: Ibrahim Arafat M , Ali Ahmed M , Kamel Hisham 
Published: May 2023

AbstractThe automotive industry is placing a high priority on the design and optimization of articulated vehicles to minimize the risk of potential accidents or failures. Before mass production, field testing is a crucial step in the development process, requiring extensive dynamic tests to provide a secure design. However, these tests can be both expensive and time-consuming. This study presents the design process of a small-scale low-bed semi-trailer chassis, manufactured to simulate the structural response of an actual semi-trailer. The aim was to identify weak points through analysis under bending conditions and then optimize the thickness and width of the various cross-sections to increase strength while minimizing costs. After manufacturing and welding based on the optimized design, the equivalent chassis was subjected to two load cases for experimental testing. The test results confirmed the accuracy of the finite element analysis, with a deviation of 7.75 to 10.24% in stress levels compared to the numerical results. Overall, this study demonstrates an effective approach to optimize the design of low-bed semi-trailers for improved safety and cost-effectiveness.
A case of early reperfusion of celiac artery for type A acute aortic dissection with malperfusion
Authors: Izubuchi Ryo , Uchida Keiji , Yasuda Shota , Cho Tomoki , Matsumoto Atsushi , Kaneko Shotaro , Ikematsu Makoto , Kakuta Sho , Yamamoto Sousuke , Ogata Makoto 
Published: May 2023

AbstractMalperfusion of the celiac artery alone, with acute aortic dissection, rarely requires early intervention. A 57-year-old woman had thrombosed type A acute aortic dissection with celiac malperfusion, for which total arch replacement was performed after percutaneous balloon angioplasty of the celiac artery. The endovascular treatment minimized extensive hepatic infarction, which saved the patient's life.
Phase II Randomized Trial of Lenalidomide in Children With Pilocytic Astrocytomas and Optic Pathway Gliomas: A Report From the Children's Oncology Group
Authors: Warren Katherine E. , Vezina Gilbert , Krailo Mark , Springer Linda , Buxton Allen , Peer Cody J. , Figg William D. , William-Hughes Chris , Kessel Sandy , Fouladi Maryam , Gajjar Amar , Bowers Daniel 
Published: May 2023

PURPOSE Children with low-grade glioma often require long-term therapy and suffer from treatment morbidity. Although targeted agents are promising, tumor targets often encompass normal developmental pathways and long-term effects of inhibition are unknown. Lenalidomide is an immunomodulatory agent with wide-ranging properties. Phase I studies indicated greater tolerability of lenalidomide in children compared with adults and a potential dose-response effect. PATIENTS AND METHODS We performed a phase II trial of lenalidomide in children with pilocytic astrocytomas and optic pathway gliomas who failed initial therapy. Primary objectives included determination of objective response rate of children randomly assigned to regimen A, low-dose (20 mg/m2/dose), or regimen B, high-dose (115 mg/m2/dose) lenalidomide, and assessment for early progression. Secondary objectives included estimation of event-free survival, overall survival, incidence of toxic events, and assessment of plasma lenalidomide concentrations. Lenalidomide was administered once daily × 21 days of each 28-day cycle for each regimen. RESULTS Seventy-four eligible patients were enrolled (n = 37, each arm). The predefined activity level of interest was achieved for both arms. Four objective responses were observed in each arm, and the number of early progressors was low. Eighteen patients completed 26 cycles of therapy (regimen A, n = 12; regimen B, n = 6). The median number of cycles was 14 (range, 2-26) for regimen A and 11 for regimen B (range, 1-26). Of 74 eligible patients who received study drug, 30 required dose reduction for toxicity (regimen A, n = 6; regimen B, n = 24) and 16 discontinued because of toxicity (regimen A, n = 2; regimen B, n = 14). CONCLUSION Lenalidomide demonstrates a sufficient level of activity in children with low-grade glioma to warrant further exploration. Low-dose (20 mg/m2/dose administered once daily × 21 days of each 28-day cycle) lenalidomide appears to have better tolerability with comparable activity.
Ruxolitinib Versus Best Available Therapy for Polycythemia Vera Intolerant or Resistant to Hydroxycarbamide in a Randomized Trial
Authors: Harrison Claire N. , Nangalia Jyoti , Boucher Rebecca , Jackson Aimee , Yap Christina , O'Sullivan Jennifer , Fox Sonia , Ailts Isaak , Dueck Amylou C. , Geyer Holly L. , Mesa Ruben A. , Dunn William G. , Nadezhdin Eugene , Curto-Garcia Natalia , Green Anna , Wilkins Bridget , Coppell Jason , Laurie John , Garg Mamta , Ewing Joanne , Knapper Steven , Crowe Josephine , Chen Frederick , Koutsavlis Ioannis , Godfrey Anna , Arami Siamak , Drummond Mark , Byrne Jennifer , Clark Fiona , Mead-Harvey Carolyn , Baxter Elizabeth Joanna , McMullin Mary Frances , Mead Adam J. 
Published: May 2023

PURPOSE Polycythemia vera (PV) is characterized by JAK/STAT activation, thrombotic/hemorrhagic events, systemic symptoms, and disease transformation. In high-risk PV, ruxolitinib controls blood counts and improves symptoms. PATIENTS AND METHODS MAJIC-PV is a randomized phase II trial of ruxolitinib versus best available therapy (BAT) in patients resistant/intolerant to hydroxycarbamide (HC-INT/RES). Primary outcome was complete response (CR) within 1 year. Secondary outcomes included duration of response, event-free survival (EFS), symptom, and molecular response. RESULTS One hundred eighty patients were randomly assigned. CR was achieved in 40 (43%) patients on ruxolitinib versus 23 (26%) on BAT (odds ratio, 2.12; 90% CI, 1.25 to 3.60; P = .02). Duration of CR was superior for ruxolitinib (hazard ratio [HR], 0.38; 95% CI, 0.24 to 0.61; P < .001). Symptom responses were better with ruxolitinib and durable. EFS (major thrombosis, hemorrhage, transformation, and death) was superior for patients attaining CR within 1 year (HR, 0.41; 95% CI, 0.21 to 0.78; P = .01); and those on ruxolitinib (HR, 0.58; 95% CI, 0.35 to 0.94; P = .03). Serial analysis of JAK2V617F variant allele fraction revealed molecular response was more frequent with ruxolitinib and was associated with improved outcomes (progression-free survival [PFS] P = .001, EFS P = .001, overall survival P = .01) and clearance of JAK2V617F stem/progenitor cells. ASXL1 mutations predicted for adverse EFS (HR, 3.02; 95% CI, 1.47 to 6.17; P = .003). The safety profile of ruxolitinib was as previously reported. CONCLUSION The MAJIC-PV study demonstrates ruxolitinib treatment benefits HC-INT/RES PV patients with superior CR, and EFS as well as molecular response; importantly also demonstrating for the first time, to our knowledge, that molecular response is linked to EFS, PFS, and OS.
Synthetic Studies on Cimiciduphytine
Authors: Ojima Ken-ichi , Ueda Hirofumi , Tokuyama Hidetoshi 
Published: May 2023

Abstract
Synthetic studies on a dimeric indole alkaloid, cimiciduphytine, were conducted based on modifying our synthesis of (+)-haplophytine. The key feature of this synthesis is the development of chemoselective deallylation of an N,O-diallyl derivative of a hydroxy aniline derivative, and copper sulfate-mediated oxidative lactonization via oxidation of the amino moiety. A highly convergent strategy led us to synthesize the originally proposed cimiciduphytine. However, the compound was unstable under air and underwent cyclization to generate a bridged derivative.
Familiarity is the Path to the Dark Side
Authors: Knopf Christina 
Published: May 2023

This paper considers depictions of politicians as servants of the Dark Side in political cartoons and political satire comic books from 2015-2020. Particular attention is given to images of Donald Trump as Darth Vader. The use of such pop culture references provides what Morris (1993) called “domestication” – the conversion of abstract ideas into concrete ones, unfamiliar people to familiar ones, and/or distant events to close ones. Guided by the interaction view of metaphor offered by the philosopher Max Black, this paper will discuss how different audiences may decode Dark Side allusions in political satire differently and, significantly, how the domestication of public figures like Donald Trump as Darth Vader and Darth Sidious may result in greater public acceptance of egregious political acts.