bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the wavelength-shifting fiber upgrade for the Mu2e cosmic-ray veto detector
Authors: Coveyou D. , Dukes E.C. , Group R.C. , Oksuzian Y. , Roberts S. , Solt M. 
Published: May 2023

Abstract
The Cosmic-Ray Veto detector for the muon-to-electron conversion experiment at Fermilab consists of four plastic scintillating counter layers read out by silicon photo-multipliers through embedded wavelength-shifting fibers. In order to increase the light yield in the most critical regions of the Cosmic-Ray Veto detector for improved background rejection, a 1.8 mm diameter fiber is being used in many of the detector's critical modules instead of the previously planned 1.4 mm diameter fiber. This paper reports the testing procedure and light properties of thirty-four 1.8 mm fiber spools, with measurements performed using a custom-built scanner. We compare these new results with previously published data from the 1.4 mm diameter fiber used for regions of the cosmic-ray veto where the increased light yield is not required. In addition, measurements of fiber aging were performed.
A-296 IMPACT OF EN BLOC EXTENDED R0 RESECTION ON ONCOLOGIC OUTCOME OF STAGE III ADRENOCORTICAL CARCINOMA
Authors: Procopio P , Pennestrì F , Voloudakis N , Palmieri L , Gallucci P , Bellantone R D A , De Crea C , Raffaelli M 
Published: May 2023

Abstract

Background
In locally advanced adrenocortical carcinoma (ACC) (ENSAT stage III – S-III) R0 surgery, involving en bloc extended resection, is the only potential curative treatment. We evaluated oncologic outcome and complications rate in S-III patients who underwent extended resection in comparison with stage I/II (S-I/II).

Methods
Among 931 adrenalectomies over 25 years (1997–2022) in a tertiary referral center, medical records of ACC patients were reviewed, excluding stage IV patients.

Results
Forty-one patients were identified: 6 S-I patients (14.6%), 30 S-II (73.2%) and 5 S-III (12.2%). The latter underwent extended en bloc resection (1 partial and 2 radical nephrectomies, 1 right hepatectomy and 1 renal vein thrombectomy). Minor complications (Clavien-Dindo ≤ 2) were observed in 11.5% of S-I/II patients and 20% of S-III (p=NS). Adjuvant treatments included: mitotane (all but 1 S-I patients), chemotherapy (2 S-II and 1 S-III) and radiotherapy (3 S-II). Four S-II patients (13.3%) developed locoregional recurrence (2 lodge, 1 paracaval nodes and 1 peritoneal) (median 21 months). Metastatic disease occurred in 13 (43.3%) S-II and 1 (20%) S-III patients. At a median follow-up of 108 months, all but 8 S-II patients were alive, with recurrent disease in 9 S-II (2 regional, 7 distant) and 1 S-III (lung). No difference was observed between S-I/II and S-III in terms of DFS and OS (p=NS).

Conclusion
OS and DFS of S-III ACC patients undergoing extended en bloc R0 resection were comparable to those of SII/III, without increasing postoperative morbidity. Multi-Institutional studies are necessary to validate these results.
A-240 PHEOCHROMOCYTOMATOSIS – A RARE DISEASE WITH OMINOUS PROGNOSIS
Authors: Knyazeva P , Brinkmann S , Walz M K 
Published: May 2023

Abstract

Background
Pheochromocytomatosis is a rare but dramatic complication of pheochromocytoma surgery. In this study, we collected and analysed our experience with the surgical treatment of cases of this rare condition.

Methods
In total 9 patients were operated on between December 2001 and August 2022 at the Kliniken Essen-Mitte due to pheochromocytomatosis. There were 5 female and 4 male patients, mean age of 58 ± 18 (range: 22 to 86). The data was prospectively collected and retrospectively analysed.

Results
All patients were initially operated on due to pheochromocytoma (2 with SDHB-Syndrome and 1 with MEN-IIa-Syndrome). In 4 cases an intraoperative tumour capsule injury during the initial surgery was described. The operation due to pheochromocytomatosis was performed minimally invasive in 8 cases, 1 patient was operated on by open approach. The mean time between the primary surgery and the pheochromocytomatosis operation was 107 ± 60 months. Operation time was 246 + 119 minutes. Follow-up data were available for 8 patients (mean follow-up time 12 years). 2 patients were cured at the time of the last follow-up. 7 patients developed recurrent disease: loco-regional recurrence in 6 cases and distant metastasis in 3 cases. 4 patients with loco-regional recurrence were reoperated within 54 ± 50 months (range 10–137 months). By the follow-up, 3 patients died.

Conclusion
Pheochromocytomatosis is a potentially lethal complication of pheochromocytoma surgery. Even if the initial pheochomocytomatosis could be managed minimally invasive, the recurrence rate is extremely high.
A-213 PROLONGED AND TAILORED FOLLOW-UP BY ENDOCRINE SURGEONS IS A PROTECTIVE FACTOR AGAINST PERSISTENT POSTOPERATIVE HYPOPARATHYROIDISM. ANALYSIS OF A SERIES OF 1965 CONSECUTIVE PATIENTS
Authors: Dughiero S , Torresan F , Armellin C , Carrillo J L , Iacobone M 
Published: May 2023

Abstract

Background
Postoperative hypoparathyroidism (HypoPTH) is the most common complication after total thyroidectomy (TT). Risk factors have been identified, but no data about the specialists performing follow-up have been previously reported.

Methods
The study focused on 1965 patients undergoing TT at a tertiary level academic centre. Anamnestic, surgical, pathological, biochemical and follow-up data were evaluated. HypoPTH was defined by serum concentration of PTH &lt;10 pg/mL in the 1st and/or the 2nd post-operative day. Persistent hypoPTH was defined by hypoPTH at the end of the trial, lasting &gt;6 months.

Results
Postoperative HypoPTH occurred in 541 patients (28%). At multivariate analysis, reduced preoperative PTH levels, association of lymph-nodal dissection, higher rate of incidentally removed parathyroids and longer duration of the surgery were independent risk factors. With a drop-out of 9% at final follow-up, hypoPTH regressed in 494 (in 6% &gt;6 months after surgery) and persisted in 53 patients (2.7%). Patients having higher product Calcium×PTH levels at 1st post-operative day (OR 0.821; p=&lt;0.001), or undergoing prolonged and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent hypoPTH (2.5% compared to 33% for other specialists) (OR 0.09; p=&lt;0.001).

Conclusion
Various patients, disease and surgeon-related risk factors may predict increased postoperative HypoPTH. Prolonged and tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.
A-252 A SINGLE CENTER SERIES OF TRACHEA RESECTIONS FOR LOCALLY ADVANCED TUMOR INFILTRATION
Authors: Staubitz J , Lozan O , Fuhrmann S , Musholt T J 
Published: May 2023

Abstract

Background
Infiltration of the cervical-visceral axis in advanced thyroid carcinoma determines the prognosis of the patients. Complete locoregional tumour resection therefore prolongs the survival even in presence of distant metastases. Results of trachea resections performed at the University Medical Center (UMC) Mainz are presented and discussed with regard to the literature.

Methods
Patients who underwent neck surgery along with trachea resection in a time period from January 2007 to December 2022 were retrospectively included in the study. Surgical resection strategy and operation-associated complications were documented. Overall survival and post resection survival were analysed.

Results
From 2007 to 2022, at the single-center UMC Mainz 36 patients (16 female, 20 male) were treated with neck surgery with trachea resections for locally advanced carcinomas. Of these, 18 underwent trachea shaving, 15 partial trachea resection and 3 circular trachea resections. Underlying histology was papillary (16/36), follicular (8/36) and poorly differentiated (4/36) thyroid carcinoma, and 8 other diagnoses. 10 patients suffered from postoperative complications (of these, 5 patients ≥ Dindo Clavien grade 4). Tumor recurrence was registered in 5 cases, whereas 19 patients remained tumour free after the operation (tumour persistence in 12 individuals). Mean overall survival from diagnosis was 75 months, mean postoperative survival was 31 months (mean postoperative follow-up period: 31 months).

Conclusion
Trachea resections for locally advanced tumour infiltration are feasible within highly individualised treatment concepts.
A-146 TRACHEAL RECONSTRUCTION IN ADVANCED THYROID CANCER USING STENTED AORTIC MATRICES
Authors: Kuczma P , Radu D , Onorati I , Martinod E , Trésallet C 
Published: May 2023

Abstract

Background
Extensive airway involvement in thyroid cancer is associated with poor prognosis and constitutes one of the main causes of mortality. Airway replacement based on the implantation of stented aortic matrices emerges as a novel tool in the treatment of primary tracheobronchial malignancies and tracheal involvement in advanced thyroid cancer.

Methods
We conducted a retrospective cohort study including patients who had tracheal replacement with a stented aortic matrix for advanced thyroid cancer with (crico)-tracheal invasion at our centre. Cryopreserved aortic allografts were used for tracheal reconstruction. To prevent airway collapse, silicone stents were placed inside the grafts. The bioprostheses were covered with local muscle flaps. No immunosuppressive therapy was required.

Results
Over 5 years, 10 patients underwent tracheal replacement with stented aortic matrices. 2 patients underwent a concomitant thyroidectomy with neck dissection and 8 had thyroidectomy prior to airway replacement and presented with recurrence. A R0 resection was achieved in all patients. There were no cases of perioperative mortality. At a median follow-up of 19 months, 8 patients were alive and breathing and speaking normally. 2 patients died of causes unrelated to the graft. De novo generation of pseudocartilage was observed within the grafts.

Conclusion
Tracheal resection using stented aortic allografts is a simple and efficient technique of tracheal replacement that is becoming part of standard care at our institution. This approach allows for a R0 resection in advanced thyroid malignancies considered thus far as non-resectable.
A-207 IMPACT OF THE USE OF AUTOFLUORESCENCE FOR DETECTION OF PARATHYROID GLANDS DURING THYROIDECTOMY: A RANDOMISED CONTROLLED TRIAL
Authors: Bergenfelz A , Hermann M , Passler C , Schneider M , Muth A , Dahlberg J , Elf A-K , Heie A , Brauckhoff K , Wierzbicka P , Konturek A , Barczynski M 
Published: May 2023

Abstract

Background
Hypoparathyroidism is the most frequent complication to thyroid surgery. Recently techniques for auto fluorescence have been introduced in order to visualise and protect the parathyroid glands during surgery. Only a few randomised controlled trials have been reported.

Methods
A multi-center randomised controlled trial to investigate the use of FluobeamÒLX to visualise the parathyroid glands during first time surgery with total thyroidectomy compared to no use. There was no restriction in the indication for thyroid surgery. The primary endpoint was the rate parathyroid hormone (PTH) levels below the lower reference limit the day after surgery.

Results
Some 486 patients were randomised to the use of FluobeamÒLX (n=246) or controls (n=240). Mean age was 51 (s.d. 15) years and 389 (80.0 per cent) were women.
The rate of low levels of PTH on the first postoperative day was 64 (26.0 per cent) in the FluobeamÒgroup and 77 (32.1 per cent) in the control group (p=0.141). Sub-analysis of 174 patients undergoing central lymph node clearance showed that 15 of 82 (18.3 per cent) patients in the FluobeamÒgroup and 31 of 92 (33.7 per cent) in the control group (p=0.021) had low levels of PTH the day after surgery.

Conclusion
The use of auto-fluorescence to detect parathyroid glands during thyroidectomy did not reduce the rate of low PTH levels at postoperative day one significantly. However, it was beneficial in sub-groups of patients.
Convergent and distinct neural structural and functional patterns of mild cognitive impairment: a multimodal meta-analysis
Authors: Yang Chengmin , Gao Xin , Liu Naici , Sun Hui , Gong Qiyong , Yao Li , Lui Su 
Published: May 2023

AbstractMild cognitive impairment (MCI) is regarded as a transitional stage between normal aging and Alzheimer’s disease. Numerous voxel-based morphometry (VBM) and resting-state fMRI (rs-fMRI) studies have provided strong evidence of abnormalities in the structure and intrinsic function of brain regions in MCI. Studies have recently begun to explore their association but have not employed systematic information in this pursuit. Herein, a multimodal meta-analysis was performed, which included 43 VBM datasets (1,247 patients and 1,352 controls) of gray matter volume (GMV) and 42 rs-fMRI datasets (1,468 patients and 1,605 controls) that combined 3 metrics: amplitude of low-frequency fluctuation, the fractional amplitude of low-frequency fluctuation, and regional homogeneity. Compared to controls, patients with MCI displayed convergent reduced regional GMV and altered intrinsic activity, mainly in the default mode network and salience network. Decreased GMV alone in ventral medial prefrontal cortex and altered intrinsic function alone in bilateral dorsal anterior cingulate/paracingulate gyri, right lingual gyrus, and cerebellum were identified, respectively. This meta-analysis investigated complex patterns of convergent and distinct brain alterations impacting different neural networks in MCI patients, which contributes to a further understanding of the pathophysiology of MCI.
Italian Association of Hospital Cardiologists practical guidance for sodium–glucose cotransporter 2 inhibitors use in patients with heart failure
Authors: Di Fusco Stefania Angela , Spinelli Antonella , Aquilani Stefano , Borrelli Nunzia , Iannopollo Gianmarco , Gulizia Michele Massimo , Gabrielli Domenico , Oliva Fabrizio , Colivicchi Furio 
Published: May 2023

Abstract
Sodium–glucose cotransporter 2 inhibitors (SGLT2-is) have recently been included among the first-line drugs for the treatment of heart failure with reduced ejection fraction. International guidelines recommend SGLT2-i use in association with neuro-hormonal modulators (renin–angiotensin blockers, beta blockers, and aldosterone antagonists). Although SGLT2-is are well tolerated, it is important to know potential side effects and conditions that may lead to an increased risk of adverse events in order to maximize clinical benefits. The aim of this Italian Association of Hospital Cardiologists document is to briefly report clinical evidence that supports SGLT2-i use in patients with heart failure and provide practical indications for clinical implementation.
C3 OUTCOME OF CARDIAC SYMPATHETIC DENERVATION IN CARDIOMYOPATHIES AND PREDICTORS OF RECURRENCES
Authors: Dusi V , Ruffinazzi M , Pugliese L , Guerrera F , Baldi E , Sanzo A , Vicentini A , Savastano S , Greco A , Camporotondo R , Vairo A , Frea S , Proclemer A , Driussi M , Massimo I , Tritto M , Trompeo A , Belliato M , Ghio S , Raineri C , Rordorf R , De Ferrari G 
Published: May 2023

Abstract

Background
Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). Long–term outcome and predictors of recurrences after the procedure are still poorly defined. Aim: To describe our multicenter Italian experience with CSD in CMP patients with refractory VAs.

Methods
32 patients with CMP and refractory VAs underwent either left CSD (n=4) or BCSD (n=28). All patients had a Video Assisted Thoracoscopic Surgery, in 8 cases with the robotic technique. The main reason (3/4 cases, 75%) to perform LCSD instead of BCSD was sinus bradycardia in single ICD lead recipients.

Results
84% of patients were male, mean age was 55 ± 16 yrs and mean LVEF was 32± 12%; most (n=26, 81%) had non–ischemic CMP (including 3 with hypertrophic CMP and 2 with cardiolaminopathy) and 34% were in NYHA class ≥3. Main indications for CSD were refractory polymorphic/fast VAs (&gt;200 bpm) in 56% of pts and refractory monomorphic VAs in the rest. Except for 5 patients (15%) with previous thyrotoxicosis, the majority were either on amiodarone (n=20, 63%) or on sotalol (n=3, 9%) and 53% had previously undergone ≥1 catheter ablation for VAs. The median follow–up (FU) after CSD was 16 months (IQR 5–45 months). No major complications occurred. Eleven patients (34%) either died during FU (n=8, 25%), mostly due to end–stage heart failure, or underwent heart transplant (n=3, 9%). After CSD, the percentage of patients with ES decreased from 78% to 40% (p&lt;0.01), while patients with appropriate ICD shocks decreased from 100% to 62%. The mean number of ICD shocks was reduced from 6 (IQR 3–16) in the 6 months before CSD to 0 (IQR 0–2) in the 6 months after (p=0.001). Overall, 69% of patients experienced a 6–months reduction in ICD shocks ≥ 75%, 81% a reduction ≥ 50%. At the univariate Kaplan Meier survival analysis, NYHA class ≥ 3 (p&lt;0.001), VT heart rate &lt; 180 bpm (p=0.02) and left ventricular ejection fraction (LVEF) ≤ 25% (p=0.02) were associated with ICD shock recurrences.

Conclusions
Our case series of CSD in CMP represents the largest reported in Europe and the one with the longest follow–up. The occurrence of electrical storms was almost halved by CSD, and most patients had a reduction in ICD shocks at 6 months larger than 75%. Patients with better functional class, better LVEF and faster VAs benefited more from CSD, suggesting the opportunity of an earlier referral of these patients.
C5 FUNCTIONAL MAPPING: A NEW APPROACH FOR SUBSTRATE CHARACTERIZATION IN PATIENTS AFFECTED BY ATRIAL FIBRILLATION
Authors: Gabriele P , Grossi B , Ceriotti C , Poggio L , Galimberti P , Taormina A , Battaglia V , Pagani S , Del Monaco G , Valcher S , Latini A , Gregusova N , Condorelli G , Frontera A 
Published: May 2023

Abstract

Background
The ongoing challenge is to generate meaningful data during electrophysiological (EP) studies, integrating the knowledge on atrial fibrillation (AF) progression gained by the EP community in the latest years. At the present time there is a lack of EP protocols and none of the most used approaches take in consideration neither the wavefront propagation nor the analysis of functional phenomena. Purpose. To investigate whether zones of delayed conduction (slow conduction, SC) or functional propagation (pivot sites, PS) may play a role in terms of maintenance of paroxysmal (PAF) and persistent (PsAF) AF.

Methods
Twenty–seven consecutive patients with PAF (14 patients) and PsAF (13 patients) have been enrolled in this study. For each patient, a sinus rhythm activation map and a paced map have been created. Abnormal conduction was defined as a delimited zone in which the propagation became suddenly slower (slow conduction zones) or changed its direction (pivot sites). At each of these sites, EGMs were collected and characterized in terms of amplitude (mV), location and fractionation.

Results
In sinus rhythm maps, a total number of 65 pivot sites and slow conduction corridors was identified. In the PAF group 22 PS and SC were found (1,6/pt), whereas those included in the PsAF one showed a significantly higher number: 43 (3,3/pt). The bipolar voltage value reported at abnormal conduction areas amounted to 1,95 ± 0,93 mV and 1,78 ± 0,54 mV for PAF and PsAF patients, respectively, showing a lower value with respect to healthy tissue areas (2,94 ± 4,81 mV). More than four deflections per signal were identified in 57/65 zones. In PsAF cases, these areas were mainly found on the posterior wall. A concordance with esophagus location occurred in the 89%. In paced maps, instead, we documented an average value of 38 PS and SC zones (1,5/pt), of which 27 in persistent patients. As for bipolar values, a lower voltage value was reported in PS and SC zones. Fractionation of EGMs was confirmed in almost all cases.

Conclusion
The main findings of this analysis are: (i) in PsAF patients the number of pivot sites is higher with respect to PAF cases; (ii) In PsAF patients, abnormal conduction phenomena are predominantly localized on the posterior wall, with a strong correlation with esophagus location; (iii) slow conduction zones and pivot sites are characterized by lower voltage amplitude and higher fractionation with respect to normal conduction areas.
C8 INSTITUTIONAL VALIDATION OF THE JOINT ANMCO AND AIOM TUSCANY CLINICAL CARDIO–ONCOLOGY PATHWAY FOR THE CARDIOLOGY MANAGEMENT OF CANCER OUTPATIENTS
Authors: Canale M , Camerini A , Bisceglia I , Orso F , Misuraca L , Carluccio M , Talini E , Sorini Dini C , Magnaghi G , Grippo G , Simonetti F , Amoroso D , Allegrini G , Bengala C , Casolo G 
Published: May 2023

Abstract

Background
Given the relevance and the growing complexity of the management of cardio–oncology (CO) outpatients, a common care pathway has been recently proposed by ANMCO and AIOM Tuscany. Materials and methods: The proposal: 1) defined 3 categories of patients to be entered into the pathway (A: known cardiac disease needing active oncology treatment; B: undergoing cancer treatments with potential cardiac toxicity; C: experiencing cardiac toxicity and/or worsening of cardiovascular risk profile); 2) proposed two standard request forms for oncology (ONCO) and hematology (HEM); 3) set the minimum requirements for a cardio–oncology path; 4) indicated follow–up strategies during and after oncological treatments. Given the short observation interval we focused on points 1 and 2. Medical records of all cancer patients for whom a CO examination was required were analized to check if proposed forms have been used and if cases fulfilled into appropriate categories. Observation period was retrospectively set to 1 year starting from October 2022. Minimum appropriateness threshold for each process index was set to 80%.

Results
A total of 480 requests for a CO visit were retrospectively identified, 322 out of 480 (67%) from medical oncology and 158 out of 480 (33%) from hematology units. Appropriate request form was used in 95% of cases (456 out of 480) with no difference between ONCO and HEM units. All patients but 20 (460 out of 480, 95.8%) fulfilled (at least) one of the 3 pre–defined categories with no difference between ONCO and HEM units. Categories distribution was: A group 25%, B group 60%, and C group 15%. Patients from medical oncology were more likely to belong to A and B groups while cases from hematology to B and C groups.

Conclusions
Our data indicate that minimum thresholds were met for both index 1 and 2 (with values that are approaching to 100%) so supporting the use of the proposed clinical CO pathway.