bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual Reality Simulation for the Middle Cranial Fossa Approach: A Validation Study
Authors: Lai Carolyn , Lui Justin T. , de Lotbiniere-Bassett Madeleine , Chen Joseph M. , Lin Vincent Y. , Agrawal Sumit K. , Blevins Nikolas H. , Ladak Hanif M. , Pirouzmand Farhad 
Published: September 2023

BACKGROUND AND OBJECTIVES:
Virtual reality (VR) surgical rehearsal is an educational tool that exists in a safe environment. Validation is necessary to establish the educational value of this platform. The middle cranial fossa (MCF) is ideal for simulation because trainees have limited exposure to this approach and it has considerable complication risk. Our objectives were to assess the face, content, and construct validities of an MCF VR simulation, as well as the change in performance across serial simulations.

METHODS:
Using high-resolution volumetric data sets of human cadavers, the authors generated a high-fidelity visual and haptic rendering of the MCF approach using CardinalSim software. Trainees from Neurosurgery and Otolaryngology–Head and Neck Surgery at two Canadian academic centers performed MCF dissections on this VR platform. Randomization was used to assess the effect of enhanced VR interaction. Likert scales were used to assess the face and content validities. Performance metrics and pre- and postsimulation test scores were evaluated. Construct validity was evaluated by examining the effect of the training level on simulation performance.

RESULTS:
Twenty trainees were enrolled. Face and content validities were achieved in all domains. Construct validity, however, was not demonstrated. Postsimulation test scores were significantly higher than presimulation test scores (P < .001). Trainees demonstrated statistically significant improvement in the time to complete dissections (P < .001), internal auditory canal skeletonization (P < .001), completeness of the anterior petrosectomy (P < .001), and reduced number of injuries to critical structures (P = .001).

CONCLUSION:
This MCF VR simulation created using CardinalSim demonstrated face and content validities. Construct validity was not established because no trainee included in the study had previous MCF approach experience, which further emphasizes the importance of simulation. When used as a formative educational adjunct in both Neurosurgery and Otolaryngology–Head and Neck Surgery, this simulation has the potential to enhance understanding of the complex anatomic relationships of critical neurovascular structures.
Clival-Meckel's Cave Angle: A Predictor of Glycerol Displacement in Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia
Authors: Piper Keaton , George Zeegan , Gordon Jonah , Peto Ivo , Vakharia Kunal , Van Loveren Harry 
Published: September 2023

BACKGROUND AND OBJECTIVES:
Percutaneous glycerol rhizotomy successfully treats trigeminal neuralgia although failure rates and durability of the procedure are variable. Some of this variability in clinical outcome might be due to egress of glycerol from Meckel's cave (MC) because of surgical positioning and individual patient anatomy. In this article, we quantitatively analyzed the anatomic variances that affect glycerol fluid dynamics to better predict patients more amenable for percutaneous glycerol injections.

METHODS:
Computed tomography imaging of 11 cadaveric heads was used to calculate bilateral Clival-Meckel's cave (CMC) and sella-temporal (ST) angles. Twenty-two cadaveric percutaneous injections of dyed glycerol into the Meckel's cave were performed using Härtel's approach, and the fluid movement was documented at prespecified intervals over 1 hour. The relationship between the angles and glycerol migration was studied.

RESULTS:
Specimens with basal cistern involvement by 60 minutes had significantly greater CMC angles (median [IQR]: basal cistern involvement = 74.5° [59.5°-89.5°] vs no basal cistern involvement = 58.0° [49.0°-67.0°]), U = 6.0, P < .001. This model may predict which patients will experience glycerol migration away from the Gasserian ganglion (area under the curve: 0.950, SE: 0.046, CI: 0.859-1.041, P < .001). Increased ST angle was associated with lateral flow of glycerol (rs = 0.639, P = .001), and CMC angle was associated with total area of dispersion (rs = −0.474, P = .026).

CONCLUSION:
Anatomic variation in skull base angles affects glycerol migration. Specifically, a more obtuse CMC angle was associated with a higher risk of posterior migration away from the Gasserian ganglion. This may be a reason for differing rates of surgical success. These results suggest that anterior head flexion for 60 minutes may prevent percutaneous glycerol rhizotomy failures and some patients with large CMC angles are more likely to benefit from postinjection head positioning. However, this clinical effect needs validation in vivo.
Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study
Authors: Kurland David B. , Lendhey Matin , Delavari Nader , Winfield Jalen , Mahoney Jonathan M. , Becske Tibor , Shapiro Maksim , Raz Eytan , Pacione Donato , Bucklen Brandon S. , Frempong-Boadu Anthony K. 
Published: September 2023

BACKGROUND AND OBJECTIVES:
Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons, and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques.

METHODS:
A retrospective chart review of patients who underwent perc-cement salvage was conducted. Biomechanical characterization of revision techniques was performed in a cadaveric model of critical pedicle screw failure. Three revision cohorts involved removal and replacement of hardware: (1) screw upsizing, (2) vertebroplasty, and (3) fenestrated screw with cement augmentation. These were compared with a cohort with perc-cement salvage performed using a juxtapedicular trajectory with the failed primary screw remaining engaged in the vertebral body.

RESULTS:
Ten patients underwent perc-cement salvage from 2018 to 2022 to address screw haloing and/or endplate fracture threatening construct integrity. Pain palliation was reported by 8/10 patients. Open revision surgery was required in 4/10 patients, an average of 8.9 months after the salvage procedure (range 6.2-14.7 months). Only one revision was due to progressive hardware dislodgement. The remainder avoided open revision surgery through an average of 1.9 years of follow-up. In the cadaveric study, there were no significant differences in pedicle screw pullout strength among any of the revision cohorts.

CONCLUSION:
Perc-cement salvage of failing instrumentation is reasonably efficacious. The technique is biomechanically noninferior to other revision strategies that require open surgery for removal and replacement of hardware. Open revision surgery may be avoided by perc-cement salvage in select cases.
Targeting NHE6 gene expression identifies lysosome and neurodevelopmental mechanisms in a haploid in vitro cell model
Authors: Wu Qing , Ma Li , Joesch-Cohen Lena , Schmidt Michael , Uzun Ece D. Gamsiz , Morrow Eric M. 
Published: September 2023

ABSTRACT
Christianson syndrome (CS) is an X-linked disorder resulting from loss-of-function (LoF) mutations in SLC9A6 encoding the endosomal Na+/H+ exchanger 6 (NHE6). CS presents with developmental delay, seizures, intellectual disability, nonverbal status, postnatal microcephaly, and ataxia. To define transcriptome signatures of NHE6 LoF, we conducted in-depth RNA-sequencing (RNA-seq) analysis on a haploid NHE6 null cell model. CRIPSR/Cas9 genome editing introduced multiple LoF mutations into SLC9A6 in the near haploid human cell line Hap1. Isogenic, paired parental controls were also studied. NHE6 mutant cell lines were confirmed to have intra-endosomal over-acidification as was seen in other NHE6 null cells. RNA-seq analysis was performed by two widely used pipelines: HISAT2-StringTie-DEseq2 and STAR-HTseq-DEseq2. We identified 1056 differentially expressed genes in mutant NHE6 lines, including genes associated with neurodevelopment, synapse function, voltage-dependent calcium channels, and neuronal signaling. Weighted gene co-expression network analysis was then applied and identified a critical module enriched for genes governing lysosome function. By identifying significantly changed gene expression that is associated with lysosomal mechanisms in NHE6-null cells, our analyses suggest that loss of NHE6 function may converge on mechanisms implicated in lysosome-related neurologic disease. Further, this haploid cell model will serve as an important tool for translational science in CS.
Left triangular ligament lesions are likely hepatic in origin: a systematic review
Authors: Agarwal Siddharth , Munyal Rahul , Aravinthan Aloysious , Clarke Christopher 
Published: September 2023

Objectives:
The left lobe of the liver is connected to the left hemi-diaphragm by the left triangular ligament (LTL) which crosses the left upper quadrant (LUQ) of the abdomen. LTL lesions are rare and can cause diagnostic confusion. We encountered a hepatocellular carcinoma in the LTL of one patient and given that the LTL has been shown to contain liver tissue in cadaveric studies, we hypothesise that LTL lesions are likely hepatic in origin. The aim of this case series and systematic review was to develop a list of pathological processes encountered at the LTL, which could impact differential diagnoses of lesions within the LUQ.

Methods:
A case series of two patients are presented. MEDLINE, EMBASE, PubMed, and Google Scholar were searched for studies published until September 2022. All case reports of LTL lesions were eligible for inclusion. PROSPERO registration: CRD42022368250.

Results:
Twelve out of 166 screened studies were included, with 14 cases in total. Seven described mass lesions of hepatic origin, of which three were initially misdiagnosed as gastric tumours leading to considerable diagnostic delay and additional procedures. Seven other cases described postoperative bile leaks from aberrant biliary ducts in the LTL.

Conclusions:
All mass lesions observed in the LTL were hepatic in origin, and all iatrogenic injuries described resulted in bile leaks.

Advances in knowledge:
To reduce the burden of diagnostic delay and unnecessary procedures, we would suggest that these observations support the addition of hepatic lesions to the differential diagnosis of LUQ lesions.
A PREVIDÊNCIA SOCIAL BRASILEIRA E A SUSTENTABILIDADE FINANCEIRA DOS SEUS REGIMES: SISTEMATIZAÇÃO DA TEORIA
Authors: Reis Anna Karolina Monteiro dos , Casagranda Yasmin Gomes 
Published: September 2023

A previdência social tem como finalidade garantir subsistência a seus beneficiários, possuindo, portanto, grande importância social e econômica. Diante da relevância do tema, esta pesquisa procurou apresentar como está estruturada atualmente a previdência brasileira e compreender como tem sido retratada a sustentabilidade financeira dos regimes públicos previdenciários. Para tanto, foram realizadas uma revisão sistemática e uma análise bibliométrica por meio de artigos científicos disponíveis nas bases de dados Periódicos CAPES e SciELO. A previdência, parte integrante da seguridade social, está estruturada por meio do Regime Geral, dos Regimes Próprios e dos Regimes de Previdência Complementar. Verificou-se que muitos RPPS se encontram com a sustentabilidade comprometida em face de cenários de déficit e insolvência. Quanto ao RGPS, a sua situação pode ser não deficitária, ao se considerar todas as fontes de financiamento que a Constituição determinou para a seguridade social, as quais têm sido, em parte, utilizadas para fins além dos benefícios previdenciários.
Efficacy of vitamin D supplementation on the severity of atopic dermatitis in children: A systematic review and meta-analysis
Authors: Hidayati Afif Nurul , Sawitri Sawitri , Sari Desiana Widityaning , Prakoeswa Cita Rosita Sigit , Indramaya Diah Mira , Damayanti Damayanti , Zulkarnain Iskandar , Citrashanty Irmadita , Widia Yuri , Anggraeni Sylvia 
Published: September 2023

Background: Atopic Dermatitis (AD) is a common dermatosis in children, that includes skin architecture defects, immune dysregulation, and changes of skin flora. Several new drugs have been found to reduce the severity of AD. Vitamin D is one of the new therapies that is still controversial. The purpose of this research is to conclude the efficacy of vitamin D on atopic dermatitis severity in children aged 0-18 years old. Methods: A systematic search was conducted on the PubMed, Cochrane, ProQuest, Google Scholar, Clinical Trial website, and university repositories including studies published from January 2010 through October 2020. We compared populations, intervention, study design, and outcomes. Statistical analysis was done with Review Manager 5.4.1. Results: Eight articles met eligibility and inclusion criteria, four articles provided complete data and were analysed. Not all studies demonstrated the efficacy of vitamin D but a meta-analysis of four studies of vitamin D supplementation vs placebo found a mean difference of -0.93 (95%CI -1.76, to -0.11, p<0.001) of patient outcome, but statistically, there was no difference in cure rate (risk ratio 1.46 (95%CI 0.72, to 2.97, p=0.008) in vitamin D supplementation groups compared to placebo groups. Conclusions: Vitamin D supplementation in paediatric atopic dermatitis patients could offer improvement of disease severity but the recommended dose and duration of administration cannot be concluded yet.
Until the dawn: everyday experiences of people living with COVID-19 during the pandemic in Thailand
Authors: Imkome Ek-uma , Moonchai Kamonchanok 
Published: September 2023

Background: This study aims to understand and analyze the complex experiences of people living with COVID-19 to support future cases. Methods: Purposive and snowball sampling techniques were employed to collect data through in-depth interviews; the data were combined with non-aggregated behavioral observations. Lived experiences of 15 individuals were collected through semi-structured interviews and analyzed using a phenomenological-hermeneutic approach. We used the thematic analysis technique to analyze the data. Results: Through analysis, themes of stress, economic impact, social stigma, social support, and unexpected benefits were identified. Participants further expressed economic and social concerns during the interviews. Conclusion: The identified themes can help develop multidisciplinary treatment strategies that would be useful during a healthcare crisis, establish comprehensive support systems that could address economic and social problems, and provide training for employees for post-COVID-19 assistance.
Numerical Scheme for Compartmental Models: New Matlab Software Codes for Numerical Simulation
Authors: Okyere Samuel , Ackora-Prah Joseph , Bonyah Ebenezer , Akwasi Adarkwa Samuel 
Published: September 2023

Background: This paper presents a newly developed Matlab code for the numeri- cal simulation of compartmental/deterministic models. It addresses modeling and simulation issues concerning compartmental models. The code is easy to under- stand and edit for the simulation of compartmental models. An alternative codes for statistical software package R has been proposed for the same model. R software is freely available for use. Methods: We proposed a basic SEIR model for illustration purposes. Matlab and R software codes are developed for the SEIR model which users can follow and easily understand the computations. Results: The two codes work on all Matlab and R versions. For models with more compartments, we suggest using higher version of Matlab and R. Matlab works on windows, Mac and Linux Conclusions: New Matlab software codes purposely for numerical simulations of classical deterministic models which can run on any version of Matlab has been introduced in this paper. This code can be edited/modify to suit any deterministic models and any desired output required. An alternative open source free version has been written in R has been provided as well
Peruvian contributions to scientific publications on experimental research against COVID-19: a systematic review
Authors: Coronel-Monje Katiusca , Candia-Puma Mayron Antonio , Vilca-Alosilla Juan Jeferson , Goyzueta-Mamani Luis Daniel , Aguilar-Bravo Herbert Mishaelf , Sánchez-Zegarra Jorge Augusto , Barazorda-Ccahuana Haruna Luz , Ferraz Coelho Eduardo Antonio , Chávez-Fumagalli Miguel Angel 
Published: September 2023

Background: One of the countries most adversely affected by the COVID-19 outbreak was Peru. Worldwide scientific knowledge creation has significantly grown because of this pandemic. This systematic study aims to examine several facets of Peru's experimental scientific production concerning COVID-19. Methods: Between December 2019 and June 2022, searches were made in the PubMed database for experimental scientific articles created in Peruvian institutions. Data were extracted and analyzed on the type of biomedical research, the study's applicability, the thematic area and specific thematic, journal impact factor and quartile, funding, grants, and institution of affiliation for the first and correspondence authors. Results: The systematic review resulted in nine studies that met the requirements. The results revealed that Peru needs to promote policies to boost research funding and the number of researchers to produce information that will be useful for managing diseases in the future. Yet, despite the funding provided by national organizations like National Council for Science, Technology, and Technological Innovation (CONCYTEC), there were few publications and little international collaboration. The studies that have been published focus mostly on applied research in the areas of diagnostics, sanitary products, and treatment and transmission, and they have great visibility because they are indexed in Q1 journals. Conclusions: This thorough study revealed Peru's inadequate reaction to COVID-19 regarding experimental scientific research. Peruvian authorities should think about supporting the required policies to boost the number of researchers and financial aid to produce information that may be utilized to manage potential new diseases in the future. Inplasy registration: INPLASY202340080 (23/04/2023).
Prevalence of pre-operative anxiety and associated risk factors among patients awaiting elective surgery in a tertiary care hospital
Authors: Adhikari Suman Prasad , Pathak Bishnu Deep , Ghimire Bhuwan , Baniya Sunil , Joshi Prabhas , Kafle Pooja , Adhikari Prawesh , Rana Aakanksha , Regmi Laxmi , Dhakal Bishal , Simkhada Nabin , Tandon Om Prakash , Pathak Indra Dev , Rawal Namrata Mahara 
Published: September 2023

Background: Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60–92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country. Methods: This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability consecutive sampling was adopted. The researchers themselves collected the data using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately. Results: The prevalence of pre-operative anxiety was 53 (25.85%). The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272–4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107–5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265–0.985, p = 0.045). Conclusions: One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.
Prospective effect of linkers type on the anticancer activity of pemetrexed-monoclonal antibody (atezolizumab) conjugates
Authors: Ibraheem Faten Q. , Maraie Nidhal K. , Al-Sudani Basma Talib , Raauf Ayad M.R. 
Published: September 2023

Background: Conventional chemotherapy results in severe toxic side effects due to affecting normal and cancer cells. The conjugation of chemotherapy with mAb will improve the chemotherapy selectivity towards cancer cells and at the same time will potentiate immune system to detect and kill cancer cells. The aim of the study was to prepare atezolizumab-pemetrexed conjugate using two types of linkers (linker conjugated with -NH2 of lysine amino acid in the mAb). Methods: This study utilizes (for the first time) the mAb atezolizumab (AtZ) to prepare a new, selective conjugate carrier for pemetrexed (PMX) by using gamma amino butyric acid (GABA) as linker for the first time in comparison to the commonly used linker polyethylene glycol (PEG) using carbodiimide (EDC) / N-hydroxysulfosuccinimide (Sulfo-NHS) zero length cross linker. Stepwise evaluation for PMX-linkers linkage as well as mAb conjugates was evaluated by FTIR, 1HNMR, DSC, LC-MS, gel-electrophoresis as well as the anticancer activity against lung cells A549. Results: The work revealed that two molecules of GABA combined with PMX, which in turn conjugated with an average ratio of 4:1 with mAb, while one molecule of PEG combined with PMX, which in turn conjugated with mAb in the same average ratio. The IC50 for the prepared PMX-GABA-AtZ conjugate was 0.048 µM, which was much lower than PMX alone, antibody AtZ alone as well as PMX-PEG-AtZ conjugate in a dose and time dependent manner. Conclusions: The potential use of such conjugate that selectively directed to the overexpressed lung cells antigen in a low dose leading to reduction of serious side effects of PMX and the cost of therapeutically AtZ mAb used.
Case Report: Hives and faints, an unusual affair
Authors: Toshniwal Saket , Kinkar Jiwan , Kumar Sunil , Acharya Sourya , Tikas Madhukar , Sahai Isha , Ghosh Benumadhab , Naseri Suhit 
Published: September 2023

Cholinergic urticaria (CholU) is a rare condition characterized by itchy hives in the form of 1-4 mm small, raised wheals on skin, which are short-lived for duration of 15 to 20 minutes; they are caused by stimuli associated with sweating such as from physical exercise. CholU is also known as cholinergic angioedema urticaria. Hereby, we present a case report of a 42-year-old male with ChoIU who presented with systemic manifestation in the form of recurrent attacks of syncope. Diagnosis was made after a detailed history taking and all cardiac and neurological evaluations done that were normal, and widespread literature research was done to rule out other causes of syncope as systemic symptoms are rarely seen in ChoIU. His IgE antibodies levels were highly increased. He was managed with nonsedating antihistamines and health education regarding the rare condition.