bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does surgical companionship modify the learning curve for fenestrated and branched endovascular aortic repair?
Authors: Mesnard Thomas , Jeanneau Clément , Patterson Benjamin O , Dubosq Maxime , Vidal-Diez Alberto , Haulon Stéphan , Sobocinski Jonathan 
Published: June 2023

Abstract

OBJECTIVES
The goal of this study was to describe the learning curve of an operator trained in an aortic centre during the first years of performing fenestrated/branched endovascular aortic repairs independently.

METHODS
Patients electively treated with fenestrated/branched stent grafts from January 2013 to March 2020 were included retrospectively. Groups were defined according to the treating operator: experienced operator (group 1), early-career operator (group 2) or both during a 14-month surgical companionship period (group 3). The early-career operator’s learning curve was assessed using a cumulative sum analysis. A composite criterion including technical failure, death and/or any major adverse event was evaluated in a logistic regression model.

RESULTS
Overall, 437 patients (93% male; median 69 (63, 77) years old) were included (group 1: n = 240; group 2: n = 173; group 3: n = 24). There were significantly more extended thoraco-abdominal aneurysms (extent I, II, III and V) in group 1 compared to group 2 [n = 68 (28%) vs 19 (11%), P&lt;0.001]. The technical success rate was 94% (P=0.874). The 30-day mortality and/or major adverse event rates in juxta-/pararenal aneurysms or extent IV thoraco-abdominal aneurysms were 8.1% in group 1 and 9.7% in group 2 (P = 0.612), whereas they were 10% (group 1) and 0 (group 2) for extended thoraco-abdominal aneurysms (P=0.339). The adjusted cumulative sum analysis highlighted satisfactory results from the beginning of the experience. The operator’s experience was not predictive of the composite criterion [adjusted OR 0.77; 95% (0.42, 1.40); P=0.40].

CONCLUSIONS
This study demonstrated favourable outcomes in patients treated with a fenestrated/branched aortic stent graft performed by an early-career operator trained in a high-volume centre from the beginning of independent practice.
The impact of surgical learning curve on short-term outcomes after bilateral lung transplantation: results from a multidisciplinary surgical team
Authors: Chou Pin-Li , Liu Kuo-Sheng , Chao Yin-Kai , Wen Yu-Wen , Liu Yun-Hen , Hsieh Ming-Ju , Chiu Chien-Hung , Fang Hsin-Yueh , Cheng Chia-Hui , Hu Han-Chung , Chen Wei-Hsun 
Published: June 2023

Abstract

OBJECTIVES
The aim of this study was to examine the impact of surgical learning curve on short-term clinical outcomes of patients after bilateral lung transplantation (LTx) performed by a surgical multidisciplinary team (MDT).

METHODS
Forty-two patients underwent double LTx from December 2016 to October 2021. All procedures were performed by a surgical MDT in a newly established LTx program. The time required for bronchial, left atrial cuff and pulmonary artery anastomoses was the main end point to assess surgical proficiency. The associations between the surgeon’s experience and procedural duration were examined by linear regression analysis. We employed the simple moving average technique to generate learning curves and evaluated short-term outcomes before and after achieving surgical proficiency.

RESULTS
Both total operating time and total anastomosis time were inversely associated with the surgeon’s experience. On analysing the learning curve for bronchial, left atrial cuff and pulmonary artery anastomoses using moving averages, the inflection points occurred at 20, 15 and 10 cases, respectively. To assess the learning curve effect, the study cohort was divided into early (cases 1–20) and late (cases 21–42) groups. Short-term outcomes—including intensive care unit stay, in-hospital stay and severe complications—were significantly more favourable in the late group. Furthermore, there was a notable tendency for patients in the late group to experience a decreased duration of mechanical ventilation along with reduced instances of grade 3 primary graft dysfunction.

CONCLUSIONS
A surgical MDT can perform double LTx safely after 20 procedures.
Long-term risk of atrial fibrillation or flutter after transcatheter patent foramen ovale closure: a nationwide Danish study
Authors: Skibsted Christian Valdemar , Korsholm Kasper , Pedersen Lars , Bonnesen Kasper , Nielsen-Kudsk Jens Erik , Schmidt Morten 
Published: June 2023

Abstract

Aims
Transcatheter closure of patent foramen ovale (PFO) is the recommended stroke prevention treatment in patients ≤60 years with cryptogenic ischemic stroke and PFO. Atrial fibrillation or flutter (AF) is a known potential procedure-related complication, but long-term risk of developing AF remains unknown. This paper studied the long-term risk of developing AF following PFO closure.

Methods and results
A Danish nationwide cohort study was conducted. During 2008–2020, this study identified a PFO closure cohort, a PFO diagnosis cohort without PFO closure, and a general population comparison cohort matched 10:1 to the PFO closure cohort on age and sex. The outcome was first-time AF diagnosis. Risk of AF and multivariable-adjusted hazard ratio (HR) of the association between PFO closure or PFO diagnosis and AF were calculated. A total of 817 patients with PFO closure, 1224 with PFO diagnosis, and 8170 matched individuals were identified. The 5 year risk of AF was 7.8% [95% confidence interval (CI): 5.5–10] in the PFO closure cohort, 3.1% (95% CI: 2.0–4.2) in the PFO diagnosis cohort, and 1.2% (95% CI: 0.8–1.6) in the matched cohort. The HR of AF comparing PFO closure with PFO diagnosis was 2.3 (95% CI: 1.3–4.0) within the first 3 months and 0.7 (95% CI: 0.3–1.7) thereafter. The HR of AF comparing PFO closure with the matched cohort was 51 (95% CI: 21–125) within the first 3 months and 2.5 (95% CI: 1.2–5.0) thereafter.

Conclusion
Patent foramen ovale closure was not associated with any substantial increased long-term risk of developing AF beyond the well-known procedure-related short-term risk.
Stepwise application of ECG and electrogram-based criteria to ensure electrical resynchronization with left bundle branch pacing
Authors: Pujol-López Margarida , Ferró Elisenda , Borràs Roger , Garre Paz , Guasch Eduard , Jiménez-Arjona Rafael , Garcia-Ribas Cora , Doltra Adelina , Niebla Mireia , Carro Esther , Roca-Luque Ivo , Guichard J Baptiste , Puente J Luis , Uribe Laura , Vázquez-Calvo Sara , Castel M Ángeles , Arbelo Elena , Porta-Sánchez Andreu , Sitges Marta , Tolosana José M , Mont Lluís 
Published: June 2023

AbstractAimsTo define a stepwise application of left bundle branch pacing (LBBP) criteria that will simplify implantation and guarantee electrical resynchronization. Left bundle branch pacing has emerged as an alternative to biventricular pacing. However, a systematic stepwise criterion to ensure electrical resynchronization is lacking.Methods and resultsA cohort of 24 patients from the LEVEL-AT trial (NCT04054895) who received LBBP and had electrocardiographic imaging (ECGI) at 45 days post-implant were included. The usefulness of ECG- and electrogram-based criteria to predict accurate electrical resynchronization with LBBP were analyzed. A two-step approach was developed. The gold standard used to confirm resynchronization was the change in ventricular activation pattern and shortening in left ventricular activation time, assessed by ECGI. Twenty-two (91.6%) patients showed electrical resynchronization on ECGI. All patients fulfilled pre-screwing requisites: lead in septal position in left-oblique projection and W paced morphology in V1. In the first step, presence of either right bundle branch conduction delay pattern (qR or rSR in V1) or left bundle branch capture Plus (QRS ≤120 ms) resulted in 95% sensitivity and 100% specificity to predict LBBP resynchronization, with an accuracy of 95.8%. In the second step, the presence of selective capture (100% specificity, only 41% sensitivity) or a spike-R &lt;80 ms in non-selective capture (100% specificity, sensitivity 46%) ensured 100% accuracy to predict resynchronization with LBBP.ConclusionStepwise application of ECG and electrogram criteria may provide an accurate assessment of electrical resynchronization with LBBP (Graphical abstract).
Unusual case of pernicious anaemia masquerading as thrombotic thrombocytopenic purpura in the setting of multiple normal vitamin B12 deficiency parameters: preventing anchoring and overdiagnosis
Authors: Mohammad Zoya , Ananthaneni Anil , Fontenot Andee , Ramadas Poornima , Nour Salloum Mohammad 
Published: June 2023

Abstract

Background
Pseudo-thrombotic microangiopathy (pseudo- thrombotic microangiopathy (TMA)) is a rare presentation of B12 deficiency. Overlapping features like elevated LDH/total bilirubin with low haemoglobin/haptoglobin/platelets could deceivingly suggest thrombotic thrombocytopenic purpura (TTP) resulting in avoidable procedures/treatments.

Case presentation
A 36-year-old female with hypothyroidism initially presented to clinic with fatigue, palpitations, lightheadedness, and dyspnoea over a 3-month duration and was found to have a haemoglobin of 5.7 g/dL. She received two packed red blood cell units in the emergency room and subsequently discharged with outpatient follow-up and empiric oral iron. During her follow-up visit, she was found to have easy bruisability, gum bleeding, and generalized weakness from hemolytic anaemia (mean corpuscular volume (MCV) 90 fL, haptoglobin &lt;8 mg/dL, LDH &gt;4,000 U/L and schistocytosis on CBC) and thrombocytopenia of 52 K/uL. Due to PLASMIC score of 6 and suspicion for TTP, she was transferred to our facility and tr eated with three cycles of plasma exchange and prednisone but were discontinued when ADAMTS13 levels returned normal. While the patient had normal B12 levels, further testing revealed positive intrinsic factor antibodies (IF-Ab) and an elevated MMA level of 1.56 umol/L. Replacement with cobalamin led to normalization of labs and symptoms.

Conclusions
Timely diagnosis of pseudo-TMA was exceptionally challenging due to several overlapping features with TTP including normal B12 and normal MCV. B12 levels may falsely appear normal in pernicious anemia due to IF-Ab interference with chemiluminescent immunoassay. Schistocytes lower the MCV in automated cell counters. Lower reticulocyte index (&lt;2%), presence of immature/large platelets and teardrop cells, elevated MMA and a higher LDH (&gt;2500) are indicative of B12 deficiency.
Spatial patterns in host-associated and free-living bacterial communities across six temperate estuaries
Authors: Suzzi Alessandra L , Stat Michael , Gaston Troy F , Huggett Megan J 
Published: June 2023

Abstract
A major goal of microbial ecology is to establish the importance of spatial and environmental factors in driving community variation. Their relative importance likely varies across spatial scales, but focus has primarily been on free-living communities within well-connected aquatic environments rather than less connected island-like habitats such as estuaries, and key host-associated communities within these systems. Here we sampled both free-living (seawater and sediment) and host-associated (estuarine fish hindgut microbiome, Pelates sexlineatus) communities across six temperate Australian estuaries spanning ∼500 km. We find that spatial and environmental factors have different influences on these communities, with seawater demonstrating strong distance-decay relationships (R = -0.69) and significant associations with a range of environmental variables. Distance-decay relationships were weak for sediment communities but became stronger over smaller spatial scales (within estuaries, R = -0.5) potentially reflecting environmental filtering across biogeochemical gradients or stochastic processes within estuary sediments. Finally, P. sexlineatus hindgut microbiome communities displayed weak distance-decay relationships (R = -0.36) and limited variation explained by environmental variables, indicating the significance of host-related factors in driving community variation. Our findings provide important ecological insights into the spatial distributions and driving forces of both free-living and host-associated bacterial patterns across temperate estuarine systems.
The Evolutionary Constraints on Angiosperm Chloroplast Adaptation
Authors: Robbins Elizabeth H J , Kelly Steven 
Published: June 2023

Abstract
The chloroplast (plastid) arose via the endosymbiosis of a photosynthetic cyanobacterium by a nonphotosynthetic eukaryotic cell ∼1.5 billion years ago. Although the plastid underwent rapid evolution by genome reduction, its rate of molecular evolution is low and its genome organization is highly conserved. Here, we investigate the factors that have constrained the rate of molecular evolution of protein-coding genes in the plastid genome. Through phylogenomic analysis of 773 angiosperm plastid genomes, we show that there is substantial variation in the rate of molecular evolution between genes. We demonstrate that the distance of a plastid gene from the likely origin of replication influences the rate at which it has evolved, consistent with time and distance-dependent nucleotide mutation gradients. In addition, we show that the amino acid composition of a gene product constraints its substitution tolerance, limiting its mutation landscape and its corresponding rate of molecular evolution. Finally, we demonstrate that the mRNA abundance of a gene is a key factor in determining its rate of molecular evolution, suggesting an interaction between transcription and DNA repair in the plastid. Collectively, we show that the location, the composition, and the expression of a plastid gene can account for &gt;50% of the variation in its rate of molecular evolution. Thus, these three factors have exerted a substantial limitation on the capacity for adaptive evolution in plastid-encoded genes and ultimately constrained the evolvability of the chloroplast.
Reduced histone gene copy number disrupts Drosophila Polycomb function
Authors: McPherson Jeanne-Marie E , Grossmann Lucy C , Salzler Harmony R , Armstrong Robin L , Kwon Esther , Matera A Gregory , McKay Daniel J , Duronio Robert J 
Published: June 2023

Abstract
The chromatin of animal cells contains two types of histones: canonical histones that are expressed during S phase of the cell cycle to package the newly replicated genome, and variant histones with specialized functions that are expressed throughout the cell cycle and in non-proliferating cells. Determining whether and how canonical and variant histones cooperate to regulate genome function is integral to understanding how chromatin-based processes affect normal and pathological development. Here, we demonstrate that variant histone H3.3 is essential for Drosophila development only when canonical histone gene copy number is reduced, suggesting that coordination between canonical H3.2 and variant H3.3 expression is necessary to provide sufficient H3 protein for normal genome function. To identify genes that depend upon, or are involved in, this coordinate regulation we screened for heterozygous chromosome 3 deficiencies that impair development of flies bearing reduced H3.2 and H3.3 gene copy number. We identified two regions of chromosome 3 that conferred this phenotype, one of which contains the Polycomb gene, which is necessary for establishing domains of facultative chromatin that repress master regulator genes during development. We further found that reduction in Polycomb dosage decreases viability of animals with no H3.3 gene copies. Moreover, heterozygous Polycomb mutations result in de-repression of the Polycomb target gene Ubx and cause ectopic sex combs when either canonical or variant H3 gene copy number is reduced. We conclude that Polycomb-mediated facultative heterochromatin function is compromised when canonical and variant H3 gene copy number falls below a critical threshold.
Phenotype switching of the mutation rate facilitates adaptive evolution
Authors: Lobinska Gabriela , Pilpel Yitzhak , Ram Yoav 
Published: June 2023

Abstract
The mutation rate plays an important role in adaptive evolution. It can be modified by mutator and anti-mutator alleles. Recent empirical evidence hints that the mutation rate may vary among genetically identical individuals: evidence from bacteria suggests that the mutation rate can be affected by expression noise of a DNA repair protein and potentially also by translation errors in various proteins. Importantly, this non-genetic variation may be heritable via a transgenerational epigenetic mode of inheritance, giving rise to a mutator phenotype that is independent from mutator alleles. Here, we investigate mathematically how the rate of adaptive evolution is affected by the rate of mutation rate phenotype switching. We model an asexual population with two mutation rate phenotypes, non-mutator and mutator. An offspring may switch from its parental phenotype to the other phenotype. We find that switching rates that correspond to so-far empirically described non-genetic systems of inheritance of the mutation rate lead to higher rates of adaptation on both artificial and natural fitness landscapes. These switching rates can maintain within the same individuals both a mutator phenotype and intermediary mutations, a combination that facilitates adaptation. Moreover, non-genetic inheritance increases the proportion of mutators in the population, which in turn increases the probability of hitchhiking of the mutator phenotype with adaptive mutations. This in turns facilitates the acquisition of additional adaptive mutations. Our results rationalize recently observed noise in the expression of proteins that affect the mutation rate and suggest that non-genetic inheritance of this phenotype may facilitate evolutionary adaptive processes.
The Movement Deviation Profile Can Differentiate Faller and Non-Faller Older Adults
Authors: Júlio Cíntia Elord , Antonialli Fernanda Colella , Nascimento Tamara Medeiros do , Sá Karina Araújo , Barton Gábor József , Lucareli Paulo Roberto Garcia 
Published: June 2023

Abstract

Background
The World Health Organization considers falls the second leading cause of death by accidental injury worldwide and one of the most frequent complications in older adults during activities of daily living. Several tasks related to fall risk have been individually assessed describing kinematic changes in older adults. The study proposal was to identify which functional task differentiates faller and non-faller older adults using the movement deviation profile (MDP).

Methods
This cross-sectional study recruited 68 older adults aged ≥60 years by convenience sampling. Older adults were divided into 2 groups: with and without a history of falls (34 older adults in each group). The MDP analyzed the 3-dimensional angular kinematics data of tasks (ie, gait, walking turn, stair ascent and descent, sit-to-stand, and stand-to-sit), and the Z score of the mean MDP identified which task presented the greatest difference between fallers and non-fallers. A multivariate analysis with Bonferroni post hoc verified the interaction between groups considering angular kinematic data and the cycle time of the task. Statistical significance was set at 5% (p &lt; .05).

Results
Z score of the MDPmean showed an interaction between groups (λ = 0.67, F = 5.085, p &lt; .0001). Fallers differed significantly from non-fallers in all tasks and the greatest difference was in stair descent (Z score = 0.89). The time to complete each task was not different between groups.

Conclusions
The MDP distinguished older adult fallers from non-fallers. The stair descent task should be highlighted because it presented the greatest difference between groups.
Have Middle-Aged and Older Americans Become Lonelier? 20-Year Trends From the Health and Retirement Study
Authors: Surkalim Daniel L , Clare Philip J , Eres Robert , Gebel Klaus , Bauman Adrian , Ding Ding 
Published: June 2023

Abstract

Objectives
Despite media and public dialog portraying loneliness as a worsening problem, little is known about how the prevalence of loneliness has changed over time. Our study aims to identify (a) temporal trends in episodic and sustained loneliness (lonely in 1 wave vs consistently lonely in 3 consecutive waves); (b) trends across sociodemographic subgroups by sex, race/ethnicity, birth cohort, education, employment status, marital status, and living alone; and (c) longitudinal predictors of loneliness in middle-aged and older Americans (≥50 years).

Methods
Based on Waves 3 (1996) to 14 (2018) of the Health and Retirement Study (n = 18,841–23,227), we conducted a series of lagged mixed-effects Poisson regression models to assess trends of episodic and sustained loneliness in the overall and sociodemographic subgroup samples (by sex, race/ethnicity, birth cohort, education, employment, relationship, and living alone status). To examine the predictors of episodic and sustained loneliness, we used a multivariate mixed-effects Poisson regression model with all sociodemographic variables entered into the same model.

Results
Episodic loneliness prevalence decreased from 20.1% to 15.5% and sustained loneliness from 4.6% to 3.6%. Trends were similar across most subgroups. Males, Caucasians, those born in 1928–1945, with university education, working, married/partnered, and those not living alone reported lower episodic and sustained loneliness, although associations with sustained loneliness were stronger.

Discussion
Contrary to common perceptions, loneliness has decreased over 20 years of follow-up in middle-aged and older Americans. Several sociodemographic subgroups have been identified as having a higher risk of loneliness, prompting targeted public health attention.
Method for estimating azimuthal intensity distribution of microtremors using simple arrays
Authors: Kimura Harusato , Tomobe Haruka , Morikawa Hitoshi 
Published: June 2023

SUMMARY
In this paper, a method is proposed for estimating the intensity distribution of microtremors for the arrival direction, from simultaneous observations of vertical motion, using an array of simple geometry consisting of only three receivers. This method is based on the fact that the complex coherence function, which is defined as the normalized cross-spectrum of microtremor recordings observed at two sites, contains information about the azimuthal intensity distribution of the microtremor field. To obtain the azimuthal intensity distribution from a limited number of conditions, the functional form of the azimuthal intensity distribution of the microtremor field was assumed and its parameters were estimated. Information on the arrival direction of the microtremor field was specifically obtained using particle swarm optimization (PSO), one of the metaheuristic methods, and then employed to identify the parameters. The proposed method was applied to ideal synthetic data to clarify the potential problems that may arise from using PSO as the core algorithm. Despite PSO-induced errors, the proposed method was able to accurately infer directional information over a wide frequency range. The proposed method was also applied to actual field data to verify its effectiveness and applicability. The results indicate that the proposed method can provide similar results to the frequency–wavenumber (FK) method in a wide frequency range. The quasi-FK spectrum, an effective mode representation of the FK spectrum, was displayed to visualize the directionality.