bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-293 TROMS (TRAINEE-REPORTED OUTCOME MEASURES): THE NEW FOCUS OF TRAINING IN ENDOCRINE SURGERY
Authors: Lorente-Poch L , Alonso S , Martínez-Santos C , Mercader-Cidoncha E , Gómez-Ramírez J , Arranz-Jiménez R , Muñoz-De Nova J L , Osorio-Silla I , Salvador-Egea P , Cassinello N , Beiras C , Sancho-Insenser J 
Published: May 2023

Abstract

Background
PROMs (Patient-Reported-Outcome-Measures) are an emerging method to assess healthcare quality. Similarly, we propose assessing trainee satisfaction using TROMs (Trainee-Reported-Outcome-Measure) questionnaires. With the aim to improve trainee implication and perception in Endocrine Surgery(ES) we conducted a prospective multicenter study.

Methods
The technique of thyroidectomy was split into 4 steps to be sequentially completed by the trainee. A specific TROMs survey was designed and distributed to evaluate trainee satisfaction before and after its implementation. Members of the Endocrine Section of the Spanish Association of Surgeons were invited to participate.

Results
Some 20 Spanish ES Units were involved (October/2021-March/2022), of which 17 trainees answered the poll. Most of them were in their 4th-5thyear of training, 65% were female and only 25% would choose ES as a subspecialty. Hemithyroidectomies performed as main surgeon ranged from 0 to 10 and only 60% felt they were capable of performing it unassisted. When training in a high-volume-unit, they performed a hemithyroidectomy 4 times more frequently. Initial global satisfaction was high in 70% of trainees. After implementation of the 4-step thyroidectomy, surgical items evaluated through TROMs showed improvement with increased number of surgeries performed per trainee as well as their perception of improving their surgical technique with slight increase in reported global satisfaction.

Conclusion
Teaching in ES may be improved by standardised steps and TROMS may well become a valuable tool to assess teaching satisfaction of surgical trainees.
Atrophy in behavioural variant frontotemporal dementia spans multiple large-scale prefrontal and temporal networks
Authors: Eldaief Mark C , Brickhouse Michael , Katsumi Yuta , Rosen Howard , Carvalho Nicole , Touroutoglou Alexandra , Dickerson Bradford C 
Published: May 2023

Abstract
The identification of a neurodegenerative disorder’s distributed pattern of atrophy—or atrophy ‘signature’—can lend insights into the cortical networks that degenerate in individuals with specific constellations of symptoms. In addition, this signature can be used as a biomarker to support early diagnoses and to potentially reveal pathological changes associated with said disorder. Here, we characterized the cortical atrophy signature of behavioural variant frontotemporal dementia (bvFTD).
We used a data-driven approach to estimate cortical thickness using surface-based analyses in two independent, sporadic bvFTD samples (n = 30 and n = 71, total n = 101), using age- and gender-matched cognitively and behaviourally normal individuals. We found highly similar patterns of cortical atrophy across the two independent samples, supporting the reliability of our bvFTD signature. Next, we investigated whether our bvFTD signature targets specific large-scale cortical networks, as is the case for other neurodegenerative disorders. We specifically asked whether the bvFTD signature topographically overlaps with the salience network, as previous reports have suggested. We hypothesized that because phenotypic presentations of bvFTD are diverse, this would not be the case, and that the signature would cross canonical network boundaries. Consistent with our hypothesis, the bvFTD signature spanned rostral portions of multiple networks, including the default mode, limbic, frontoparietal control and salience networks. We then tested whether the signature comprised multiple anatomical subtypes, which themselves overlapped with specific networks. To explore this, we performed a hierarchical clustering analysis. This yielded three clusters, only one of which extensively overlapped with a canonical network (the limbic network).
Taken together, these findings argue against the hypothesis that the salience network is preferentially affected in bvFTD, but rather suggest that—at least in patients who meet diagnostic criteria for the full-blown syndrome—neurodegeneration in bvFTD encompasses a distributed set of prefrontal, insular and anterior temporal nodes of multiple large-scale brain networks, in keeping with the phenotypic diversity of this disorder.
Dual-stream cortical pathways mediate sensory prediction
Authors: Chu Qian , Ma Ou , Hang Yuqi , Tian Xing 
Published: May 2023

Abstract
Predictions are constantly generated from diverse sources to optimize cognitive functions in the ever-changing environment. However, the neural origin and generation process of top-down induced prediction remain elusive. We hypothesized that motor-based and memory-based predictions are mediated by distinct descending networks from motor and memory systems to the sensory cortices. Using functional magnetic resonance imaging (fMRI) and a dual imagery paradigm, we found that motor and memory upstream systems activated the auditory cortex in a content-specific manner. Moreover, the inferior and posterior parts of the parietal lobe differentially relayed predictive signals in motor-to-sensory and memory-to-sensory networks. Dynamic causal modeling of directed connectivity revealed selective enabling and modulation of connections that mediate top-down sensory prediction and ground the distinctive neurocognitive basis of predictive processing.
A comprehensive evaluation of multicentric reliability of single-subject cortical morphological networks on traveling subjects
Authors: Yin Guole , Li Ting , Jin Suhui , Wang Ningkai , Li Junle , Wu Changwen , He Hongjian , Wang Jinhui 
Published: May 2023

Abstract
Despite the prevalence of research on single-subject cerebral morphological networks in recent years, whether they can offer a reliable way for multicentric studies remains largely unknown. Using two multicentric datasets of traveling subjects, this work systematically examined the inter-site test-retest (TRT) reliabilities of single-subject cerebral morphological networks, and further evaluated the effects of several key factors. We found that most graph-based network measures exhibited fair to excellent reliabilities regardless of different analytical pipelines. Nevertheless, the reliabilities were affected by choices of morphological index (fractal dimension &gt; sulcal depth &gt; gyrification index &gt; cortical thickness), brain parcellation (high-resolution &gt; low-resolution), thresholding method (proportional &gt; absolute), and network type (binarized &gt; weighted). For the factor of similarity measure, its effects depended on the thresholding method used (absolute: Kullback–Leibler divergence &gt; Jensen–Shannon divergence; proportional: Jensen–Shannon divergence &gt; Kullback–Leibler divergence). Furthermore, longer data acquisition intervals and different scanner software versions significantly reduced the reliabilities. Finally, we showed that inter-site reliabilities were significantly lower than intra-site reliabilities for single-subject cerebral morphological networks. Altogether, our findings propose single-subject cerebral morphological networks as a promising approach for multicentric human connectome studies, and offer recommendations on how to determine analytical pipelines and scanning protocols for obtaining reliable results.
Differential biventricular adaption to pulmonary vascular disease in patients with idiopathic/heritable and congenital heart disease: a prospective cardiac magnetic resonance and invasive study
Authors: Xu Zhuoyuan , Dou Ruiyu , Zhou Zhen , Zhang Hongsheng , Zhang Chen , Li Qiangqiang , Xu Lei , Gu Hong 
Published: May 2023

Abstract

Aims
Despite shared pathophysiological mechanisms, patients with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH) have a poorer prognosis than those with PAH after congenital heart defect repair. Ventricular adaption remains unclear and could provide a basis for explaining differences in clinical outcomes. The aim of this prospective study was to assess clinical status, haemodynamic profile, and biventricular adaptation to PAH in children with various forms of PAH.

Methods and results
Consecutive patients with IPAH/HPAH or post-operative PAH were prospectively recruited (n = 64). All patients underwent a comprehensive, protocolized assessment including functional assessment, measurement of brain natriuretic peptide (BNP) levels, invasive measurements, and a cardiac magnetic resonance (CMR) assessment. A cohort of age- and sex-matched healthy subjects served as controls. Patients with post-operative PAH had a better functional class (61.5 vs. 26.3% in Class I/II, P = 0.02) and a longer 6-min walk distance (320 ± 193 vs. 239 ± 156 m, P = 0.008) than IPAH/HPAH. While haemodynamic parameters were not significantly different between IPAH/HPAH and post-operative patients, post-operative patients with PAH presented with higher left ventricular volumes and better right ventricular function compared with patients with IPAH/HPAH (P &lt; 0.05). On correlation analyses, left ventricular volumetric parameters were highly correlated with BNP and 6-min walk test distance in this population.

Conclusion
Despite comparable haemodynamic profiles, patients with post-operative PAH had less functional limitation than their IPAH/HPAH counterparts. This is potentially related to the differential biventricular adaptation pattern evident on CMR with better myocardial contractility and higher left ventricular volumes in post-operative patients with PAH, highlighting the importance of ventriculo-ventricular interaction in the setting of PAH.
Long-term follow-up of cardiac magnetic resonance imaging in myocarditis following messenger ribonucleic acid COVID-19 vaccination: a case report
Authors: Kittichokechai Pakaparn , Seripanu Panupong , Laksomya Thanakorn 
Published: May 2023

Abstract

Background
Presently, the association between myocarditis and messenger ribonucleic acid (mRNA) COVID-19 vaccination is well established. From the most current data, cases of myocarditis following COVID-19 vaccination seem to be mild with fast clinical recovery. Nevertheless, the complete resolution of the inflammatory process is still unclear.

Case summary
We report the case of a 13-year-old boy who developed chest pain following the second dose of the Pfizer-BioNTech COVID-19 vaccine with long-term follow-up of cardiac magnetic resonance (CMR) imaging. An electrocardiogram (ECG) revealed progressively ST-segment elevation on the 2nd day of admission with a rapid improvement within 3 hours where only mild ST-segment elevation remained. The peak level of high-sensitivity cardiac troponin T was 1546 ng/L with rapid reduction. Echocardiogram revealed depressed left ventricular septal wall motion. CMR mapping techniques showed myocardial oedema with an increase in native T1 and extracellular volume (ECV). On the other hand, T1-weighted and T2-weighted images and late gadolinium enhancement (LGE) did not detect inflammation. The patient’s symptoms were relieved by oral ibuprofen. After 2 weeks, ECG and echocardiogram were unremarkable. However, the inflammation process was still present based on the CMR by mapping technique. During the 6-month follow-up, CMR returned to normal.

Discussion
In our case, the subtle myocardial inflammation was diagnosed by mapping technique with only a T1-based marker according to the updated Lake Louise Criteria and the inflammation of the myocardium returned to normal within 6 months after the onset of the disease. Further follow-up and larger studies are needed to determine the complete resolution of the disease.
C21 A FLOATING THROMBUS IN THE ASCENDING AORTA, AS A COMPLICATION OF A PERCUTANEOUS CORONARY ANGIOGRAPHY
Authors: Cortese F , Di Marino S , Calculli G , Costantino M 
Published: May 2023

Abstract
Free–floating thrombus of the ascending aorta is a rare disease entity which carries a potential risk of distal embolization with catastrophic consequences. We present the case of a 46–year–old patient with floating thrombus in the ascending aorta, likely caused by catheter injury, after a percutaneous coronary angiography with stent implantation at the circumflex artery and no antiplatelet agents. A 46–year–old female patient was admitted to the emergency room with acute chest pain radiating to the left arm for the past 3 days. She reported a history of cigarette smoking and a ST–elevation myocardial infarction with stent implantation at the level of the circumflex artery about 1 month before. The patient was not taking any antiplatelet therapy for explicit refusal. Transthoracic echocardiography showed an isoechoic lesion in the ascending aorta and no other abnormalities of the cardiac structure and function and of the valve systems. Transoesophageal echocardiography confirmed the presence of a coarse (17 mm 14 mm) isoechoic formation, with a large base of implantation at the level of the non–coronary aortic cusp, extending approximately 45 mm into the aortic vessel with a floating attitude (Panels A–C). Computed tomography angiography showed a pedunculated mass measuring 22 mm 22 mm 45 mm in ascending aortic lumen (Panels D and E). Intact intima and normal size of ascending aorta with no signs of aortic dissection or intramural haematoma were also reported. The patient underwent a thrombectomy (Panel F) and aortic replacement. A histopathologic examination revealed the mass to be a fibrin thrombus. The post–operative course was uneventful. No recrudescence or concomitant visceral or vascular embolism was observed. The patient was discharged with dual antiplatelet agents.
C77 GENDER GAP IN TIME TO ST–ELEVATION MYOCARDIAL INFARCTION DIAGNOSIS: A RETROSPECTIVE COHORT STUDY
Authors: Tavecchia G , Milani M , Tognola C , Garatti L , Villanova L , Colombo C , Scavelli F , Viola G , Oliva F , Sacco A 
Published: May 2023

Abstract

Introduction
Timely reperfusion with primary percutaneous coronary intervention (pPCI) in patients with ST–elevation myocardial infarction (STEMI) must be the standard of care, irrespective of gender. Current guidelines mandate a door–to–balloon time of less than 90 minutes from STEMI diagnosis to wire crossing. However, coronary artery disease is characterized by relevant gender differences in terms of anatomy, pathophysiology, and clinical presentation. Female’s symptoms could be deceitful, and diagnosis could be delayed. Aim of our study was to evaluate the presence of gender differences at our Centre in diagnosing and treating STEMI.

Methods
We retrospectively analyzed a cohort of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit of ASST Great Metropolitan Hospital Niguarda (Milan) between January 2014 and July 2022. Clinical parameters were collected and waiting times from symptoms onset and ECG recording to pPCI were compared between sexes.

Results
489 STEMI patients were included in our study, 384 men and 105 women. Median age was higher in women (75 years vs 61 years, p &lt; 0.05) as was the incidence of arterial hypertension (70% vs 52.9%, p &lt; 0.05). Women smoked less frequently than men (20.9% vs 39.1%, p &lt; 0.05). Median waiting times from symptoms onset to balloon and from ECG recording to balloon were higher in females (320 vs 240 min, p &lt; 0.05 and 111 vs 80 min, p &lt; 0.05). After stratifying patients by age, chest pain to balloon times were higher in women aged &gt; 65 compared to men in the same age category (320 min vs 292 min, p &lt; 0.05). Regarding younger patients, ECG to balloon and chest pain to balloon times were always longer in females but without reaching statistical significance. A trend towards increased in–hospital mortality was noticed in females (7.6% vs 3.3%, p = 0.05).

Conclusion
Our study suggests that a gender gap may exist in diagnosing STEMI, with longer times from symptoms onset to balloon and from ECG recording to balloon in female patients. This may lead to increased in–hospital mortality in women.
P12 COMPLEX LEAD EXTRACTION: A PERCUTANEOUS MULTIDISCIPLINARY APPROACH
Authors: Taravelli E , Peirone A , Menardi E , Fratini E , Balderi A , Rossini R 
Published: May 2023

Abstract

Introduction
The infection represents one of the most serious complications of implantable cardiac systems (ICDs and PMs) and is associated with increased mortality and significant expenditure of financial resources. The incidence, which ranges from 0.6 to 3.4%, depends by the patient characteristics, the type of implanted system, and from other factors related to the procedure itself. When diagnosed, it is recommended extraction of the system. A 77–year–old patient, hypertensive, obese, former tobacco user, suffering from chronic ischemic heart disease and carrier of bicameral PM since 2019 for BAV grade III. In June 2022 decubitus of the PM pocket. Considering the negativity of coltural tests and the absence of fever, it was decided to use a conservative approach by doing a curettage of the pocket and by repositioning the device at the submuscular level. After about a month, a reappearance of decubitus with exposure of the PM case occurred, therefore, a complete extraction of the leads and removal of the device was performed. The surgery, performed under general anaesthesia, was complicated by the fracture of both leads at the level of the anonymous vein. With the introduction of dedicated ligature through the right femoral vein, it was possible to successfully extract the ventricular lead stump. During the recapture of the atrial stump, a migration of the stump into the right ventricle and then into the pulmonary circulation to a terminal branch of the right pulmonary artery occurred. The recovery of such stump was possible with the help of interventional radiologists and through the use of a dedicated material (“Gooseneck ligature catheter”). Subsequent implantation of temporary PM by the right jugular given the absence of underlying spontaneous rhythm.

Conclusions
CIED extraction surgery is burdened with a high risk of complications even serious ones, including lead rupture and distal fragment embolization. A multidisciplinary approach with shared choices and techniques allowed the resolution percutaneous resolution of a complex picture.
P48 PATIENT SELECTION FOR TRANSCATHETER TRICUSPID ANNULOPLASTY: CASE PRESENTATION
Authors: Cammardella A , Russo M , Ranocchi F , Pergolini A , Bruno N , Nazzaro M , Musumeci F 
Published: May 2023

Abstract

Clinical case
We describe the case of an 87–year–old woman, BSA 1.7 m2, affected by arterial hypertension, atrial fibrillation, COPD, stage III chronic renal failure. The patient underwent aortic valve replacement with a biological prosthesis. The patient had good quality of life. n the last year, the patient had had two hospitalizations for right heart failure, with a home dose of Furosemide of 250 mg/day. A transthoracic echocardiogram, performed in outpatient setting, showed massive tricuspid regurgitation (ERO 0.8 cm2), TAPSE 21 mm, S TDI 0.12 cmc/sec, LVEF 55%, sPAP 40 mmHg (RHC). The TRISCORE (specific risk score for tricuspid pathology) was equal to 8%, therefore at a high preoperative risk. The case was collectively discussed in the Heart Team and we decided for transcatheter treatment of the isolated tricuspid pathology. A transesophageal echocardiogram confirmed the severity of the tricuspid regurgitation, characterized by multiple jets of which the prevalent central and posteroseptal. The coaptation gap was 10 mm, with partial retraction of the septal flap. Therefore, the possibility of an edge–to–edge treatment was excluded and the screening for annuloplasty device evaluation (Cardioband) continued. Cardio–CT showed feasibility for Cardioband with adequate implant safety and distance from the right coronary artery. Therefore, a Cardioband (Edwards Lifesciences) was implanted in the tricuspid position. The procedural time was 220 minutes. The final result was tricuspid regurgitation less than grade 2 (R vol 30 mL/beat, EROA 0.2). The patient was discharged on the 4th postoperative day. At the 30–day follow–up, he was in NYHA class I–II, with a furosemide dose of 75 mg/day, in the absence of peripheral edema.

Conclusions
Patients with isolated tricuspid regurgitation are, in most cases, not treated due to the high postoperative surgical risk. In recent years, transcatheter technologies have been a valid solution in the event of inoperability. Where a treatment on the valve leaflets is not feasible, tricuspid annuloplasty represents a valid alternative.
P51 PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE IN CHILDREN :SINGLE CENTER EXPERIENCE
Authors: Marzullo R , Gaio G , Giordano M , Palladino M , Ancona R , Cappelli Bigazzi M , Della Cioppa N , Russo M 
Published: May 2023

Abstract

Background
Transcatheter patent foramen ovale (PFO) closure is a validated strategy to prevent recurrent cerebral events in adult patients; limited data are available for children.

Methods
This is a retrospective analysis including pediatric population underwent to percutaneous treatment of PFO in our center.

Results
From 2006 to 2021, 21 transcatheter PFO closures have been performed in children (mean age: 14 +3 years; female: 58%, weight: 59 + 20 kg). Indications for the closure of PFO consisted in the occurrence of cryptogenic ischemic events for 18 patients (86%), in disabling migraine symptoms for 2 patients (9,5%) and in prophylactic measure to prevent paradoxical embolism in high risk abdominal surgery for 1 patient (4,5%). Transcatheter PFO closure was performed under general anesthesia with transesophageal ultrasound guidance. Complex anatomies of PFO included atrial septal aneurysm in 4 cases (with accessory fenestration of atrial membrane in 2 of these cases) and long and stiff PFO tunnel in one case. Single device was used in 20 procedures. ASD closure device was required for 5 cases because of anatomic characteristics of PFO. In one case of large multifenestrated atrial septal aneurysm, percutaneous treatment was performed using both PFO closure device and ASD closure device. No peri and/or post procedural complications have been reported . All patients were treated with Acetylsalicylic acid and Clopidogrel for the first six months after the procedure.

Conclusions
Transcatheter PFO closure is a safe procedure in pediatric patients in high volume center that should be used for preventing recurrent cerebral events also in children.