bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic vertebral artery injury: Denver grade, bilaterality, and stroke risk. A systematic review and meta-analysis
Authors: Michalopoulos Giorgos D. , Pennington Zach , Bambakidis Peter , Alexander A. Yohan , Lakomkin Nikita , Charalampous Charalampos , Sammak Sally El , Hassett Leslie C. , Graepel Stephen , Meyer Fredric B. , Bydon Mohamad 
Published: July 2023

OBJECTIVE
Vertebral artery injury (VAI), a complication of blunt trauma, may cause posterior circulation stroke. An association of disease severity, classified in Denver grades, with stroke risk has not been shown. Using a literature-based analysis, the authors estimated the incidence of VAI following blunt trauma with the aim to investigate the impact of Denver grade and bilateral VAI on stroke occurrence.

METHODS
A systematic review of the literature on VAI following blunt trauma was conducted, and data on its incidence, the severity per Denver grade, and stroke occurrence were collected. The incidence of VAI and stroke occurrence were analyzed cumulatively and between Denver grades. A meta-analysis with random-effects models was performed.

RESULTS
Fifty-six studies including 2563 patients were identified. The overall incidence of VAI was 0.49% among blunt trauma cases and 14.5% among patients screened via any type of angiography. The incidence rates of bilateral VAI and concurrent carotid injury among all VAIs were 12.3% and 19.2%, respectively. VAI severity by Denver grade was as follows: grade I, 23.4%; grade II, 28.2%; grade III, 5.8%; grade IV, 42.1%; and grade V, 0.5%. The overall stroke risk was 5.32%, differing significantly among lesions of different Denver grades (p = 0.02). Grade III and IV lesions had the highest stroke prevalence (9.8% and 10.9% respectively), while strokes occurred significantly less frequently in patients with grade I and II lesions (1.9% and 3.0%, respectively). Denver grade V cases were too rare for meaningful analysis. Bilateral VAI was associated with a 33.2% stroke prevalence. The association between Denver grade and stroke occurrence persisted in a sensitivity subanalysis including only unilateral cases (p = 0.03).

CONCLUSIONS
VAI complicates a small yet nontrivial fraction of blunt trauma cases, with Denver grade IV lesions being the most common. This is the first study to document a significantly higher stroke prevalence among grade III and IV VAIs compared with grade I and II VAIs independently from bilaterality. Bilateral VAIs carry a significantly higher stroke rate.
Genomic alterations associated with postoperative nodular leptomeningeal disease after resection of brain metastases
Authors: Morshed Ramin A. , Cummins Daniel D. , Nguyen Minh P. , Saggi Satvir , Vasudevan Harish N. , Braunstein Steve E. , Goldschmidt Ezequiel , Chang Edward F. , McDermott Michael W. , Berger Mitchel S. , Theodosopoulos Philip V. , Daras Mariza , Hervey-Jumper Shawn L. , Aghi Manish K. 
Published: July 2023

OBJECTIVE
The relationship between brain metastasis resection and risk of nodular leptomeningeal disease (nLMD) is unclear. This study examined genomic alterations found in brain metastases with the aim of identifying alterations associated with postoperative nLMD in the context of clinical and treatment factors.

METHODS
A retrospective, single-center study was conducted on patients who underwent resection of brain metastases between 2014 and 2022 and had clinical and genomic data available. Postoperative nLMD was the primary endpoint of interest. Targeted next-generation sequencing of > 500 oncogenes was performed in brain metastases. Cox proportional hazards analyses were performed to identify clinical features and genomic alterations associated with nLMD.

RESULTS
The cohort comprised 101 patients with tumors originating from multiple cancer types. There were 15 patients with nLMD (14.9% of the cohort) with a median time from surgery to nLMD diagnosis of 8.2 months. Two supervised machine learning algorithms consistently identified CDKN2A/B codeletion and ERBB2 amplification as the top predictors associated with postoperative nLMD across all cancer types. In a multivariate Cox proportional hazards analysis including clinical factors and genomic alterations observed in the cohort, tumor volume (× 10 cm3; HR 1.2, 95% CI 1.01–1.5; p = 0.04), CDKN2A/B codeletion (HR 5.3, 95% CI 1.7–16.9; p = 0.004), and ERBB2 amplification (HR 3.9, 95% CI 1.1–14.4; p = 0.04) were associated with a decreased time to postoperative nLMD.

CONCLUSIONS
In addition to increased resected tumor volume, ERBB2 amplification and CDKN2A/B deletion were independently associated with an increased risk of postoperative nLMD across multiple cancer types. Additional work is needed to determine if targeted therapy decreases this risk in the postoperative setting.
Neurosurgery residency match for international medical graduates in the United States
Authors: Yekula Anudeep , Sreeram Sattwik , Dhawan Sanjay , Sharma Mayur , Sandoval-Garcia Carolina , Huling Jared D. , Suri Ashish , Belani Kumar , Park Michael C. , Carter Bob S. , Chen Clark C. 
Published: July 2023

OBJECTIVE
Training of international medical graduates (IMGs) offers opportunities for the US neurosurgery community to engage the global talent pool and impact national and international healthcare. Here, the authors analyzed the time trend of IMGs matching into US neurosurgery programs and identified potential opportunities for enhancing IMG engagement.

METHODS
The authors analyzed the National Resident Matching Program (NRMP) match results, NRMP program director (PD) surveys, and applicant surveys from 2013 to 2022. Regression methods were used to analyze time trends.

RESULTS
Between 2013 and 2022, the number of US neurosurgery residency positions increased by 17.6% (from 204 to 240). During this period, the percentage of IMGs matching into neurosurgery increased from 3.5% to 7%, translating into a 6.8% increase in the likelihood of a successful IMG match per year (95% CI 0.3%–13.8%, p = 0.042). The likelihoods of a successful match for US MDs and IMGs scoring > 260 on the USMLE Step 1 were > 90% and approximately 55%, respectively. In PD surveys, approximately 90% of PDs indicated that they seldom/never interview or rank IMGs. In terms of factors that influenced the PD decision for interviewing/ranking, IMGs are disadvantaged in several categories, including the ability to secure an audition elective/rotation, and proper letters of recommendation, as well as the influence of the culture on the preconceived perception of poor interpersonal skills.

CONCLUSIONS
The number of IMGs matching successfully in neurosurgery has increased marginally during the past decade. The authors outline the challenges that IMGs encounter in this process and suggest strategies for considerations of IMG training in NRMP-associated institutions.
Are we improving in the optimization of surgery for high-risk adult cervical spine deformity patients over time?
Authors: Passias Peter G. , Tretiakov Peter S. , Smith Justin S. , Lafage Renaud , Diebo Bassel , Scheer Justin K. , Eastlack Robert K. , Daniels Alan H. , Klineberg Eric O. , Khabeish Khaled M. , Mundis Gregory M. , Turner Jay D. , Gupta Munish C. , Kim Han Jo , Schwab Frank , Bess Shay , Lafage Virginie , Ames Christopher P. , Shaffrey Christopher I. 
Published: July 2023

OBJECTIVE
The aim of this study was to investigate whether surgery for high-risk patients is being optimized over time and if poor outcomes are being minimized.

METHODS
Patients who underwent surgery for cervical deformity (CD) and were ≥ 18 years with baseline and 2-year data were stratified by year of surgery from 2013 to 2018. The cohort was divided into two groups based on when the surgery was performed. Patients in the early cohort underwent surgery between 2013 and 2015 and those in the recent cohort underwent surgery between 2016 and 2018. High-risk patients met at least 2 of the following criteria: 1) baseline C2–7 Cobb angle > 15°, mismatch between T1 slope and cervical lordosis ≥ 35°, C2–7 sagittal vertical axis > 4 cm, or chin-brow vertical angle > 25°; 2) age ≥ 70 years; 3) severe baseline frailty (Miller index); 4) Charlson Comorbidity Index (CCI) ≥ 1 SD above the mean; 5) three-column osteotomy as treatment; and 6) fusion > 10 levels or > 7 levels for elderly patients. The mean comparison analysis assessed differences between groups. Stepwise multivariable linear regression described associations between increasing year of surgery and complications.

RESULTS
Eighty-two CD patients met high-risk criteria (mean age 62.11 ± 10.87 years, 63.7% female, mean BMI 29.70 ± 8.16 kg/m2, and mean CCI 1.07 ± 1.45). The proportion of high-risk patients increased with time, with 41.8% of patients in the early cohort classified as high risk compared with 47.6% of patients in the recent cohort (p > 0.05). Recent high-risk patients were more likely to be female (p = 0.008), have a lower BMI (p = 0.038), and have a higher baseline CCI (p = 0.013). Surgically, high-risk patients in the recent cohort were more likely to undergo low-grade osteotomy (p = 0.003). By postoperative complications, recent high-risk patients were less likely to experience any postoperative adverse events overall (p = 0.020) or complications such as dysphagia (p = 0.045) at 2 years. Regression analysis revealed increasing year of surgery to be correlated with decreasing minor complication rates (p = 0.030), as well as lowered rates of distal junctional kyphosis by 2 years (p = 0.048).

CONCLUSIONS
Over time, high-risk CD patients have an increase in frequency and comorbidity rates but have demonstrated improved postoperative outcomes. These findings suggest that spine surgeons have improved over time in optimizing selection and reducing potential adverse events in high-risk patients.
Limited number of spine surgeons among recipients of National Institutes of Health grants awarded for degenerative spine disease research
Authors: Silvestre Jason , Clemmons James A. , Wu Hao-Hua , Caldwell Kyra , Kang James D. 
Published: July 2023

OBJECTIVE
Surgeon scientists remain underrepresented among recipients of National Institutes of Health (NIH) grants despite their unique ability to perform translational research. This study elucidates the portfolio of NIH grants awarded for degenerative spine diseases and the role of spine surgeons in this portfolio.

METHODS
The most common diagnoses and surgical procedures for degenerative spine diseases were queried on the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database (2011–2021). Total NIH funding was extracted for 20 additional clinical areas and compound annual growth rates (CAGRs) were calculated. A retrospective cohort study of principal investigators (PIs) was conducted. NIH grants and funding totals were extracted and compared to those from other clinical areas.

RESULTS
The total NIH research budget increased from $31 to $43 billion over the 10-year period (CAGR 3.4%). A total of 273 unique grants equaling $91 million (CAGR 0%) were awarded for degenerative spine diseases. Diabetes ($11.8 billion, CAGR 0%), obesity ($10.6 billion, CAGR 3%), and chronic pain ($5.6 billion, CAGR 7%) received the most funding. Most NIH funding for degenerative spine disease research was awarded through the R01 (66%) and R44 (8%) grant mechanisms. The National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded the most NIH funding (64%). Departments of orthopedic surgery were awarded the most funding (32%). NIH funding supported clinical (28%), translational (37%), and basic science (35%) research. Disease mechanisms (58%), imaging modalities (20%), and emerging technologies (16%) received the most funding. Nineteen spine surgeons were identified as PIs (16%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p > 0.05)—except for full professors, who had the most NIH funding (p = 0.007) and highest h-index values (p < 0.001).

CONCLUSIONS
Few spine surgeons receive NIH grants for degenerative spine disease research. Future opportunities may exist for spine surgeons to collaborate in identified areas of clinical interest. Additional strategies are needed to increase NIH funding in spine surgery.
Enhancing Breast Reconstruction: An Analysis of 117 Patients Undergoing Delayed Autologous Fat Grafting
Authors: Fitoussi Alfred , Razzouk Kais , Raei Nahid 
Published: August 2023

Background: The number of total mastectomy patients requesting breast reconstruction is increasing. However, many patients refuse this surgery because the procedures are too complex, too prone to complications, or even just because of the fear of breast implants and their long-term consequences. In this study, a comprehensive assessment of the results and complications of only fat grafting breast reconstruction is presented.
Methods: Between 2012 and 2021, 127 fat grafting breast reconstruction was performed in 117 patients who previously received total mastectomy. These included 70 cases of delayed breast reconstruction (DBR) and 57 "conversions," i.e., removal of a reconstructive implant replaced by iterative fat injections. The patients were fully informed about the procedure's risks and benefits before intervention. All the patients signed an informed consent. The procedure, complications, and results were analyzed on a regular basis every 3-6 months (average follow-up of 3 years).
Results: Data from 117 patients with a mean age of 59 years (25-83) were included in this study. The mean body mass index was 23 (19-30). Seventy patients had received radiotherapy before mastectomy (55%). An average of 3.17 injections (2 to 7) with an average volume of 300 cc were required to finalize the breast reconstruction, with a total average injected volume of 933 cc. Simple fat transfers were performed on an outpatient basis except for bilateral or associated procedures. In 48 cases (40%), the patients received appropriate procedures on the contralateral breast to make it symmetrical. Complications happened in 10 percent of cases, mostly minor complications like fatty cysts or much-localized Cytosteatonecrosis though in a limited number of patients, more serious problems with hematomas, abscesses, diffuse Cytosteatonecrosis or very extensive lymphoceles appeared.
Conclusion: The findings of this study support fat transfer breast reconstruction as a safe procedure with acceptably low complications, even in patients who have received radiotherapy in their history. Furthermore, this procedure can be applied in an outpatient setting. It seems that the application and the indications of this easy and feasible procedure will be increased in the coming years.
Strategi Komunikasi Dakwah Gus Badar Pada Komunitas Jaljalut
Authors: Falahuddin Ma'ruf An'im , Ulfa Ni’amah Luthfi 
Published: July 2023

This research was described the da’wah communication strategy implemented by Gus Mochammad Badaruddin Abdulloh in da’wah activities of Jaljalut community. This research was used a qualitative approach by observations, interviews, and collecting the evidence by field documentation. The data obtained was analyzed by data reduction, visualization, and conclusion/verification. Based on the results of the research, it was found that the main target in preaching from the Jaljalut community is young people, especially children who live on the streets. The success of Gus Badar’s preaching to the Indonesian Jaljalut community was greatly influenced by the use of the right approach strategy, as well as the selection of media according to their preferences and tendencies towards mad’u. The result of this research was found in three formulations of da’wah strategies, namely sentimental da’wah strategies, rational strategies, sensory strategies that preachers can use in conveying their da’wah. It is hoped that the three da’wah communication strategy formulations found in this study can help preachers convey their da’wah materials to mad’u.
ON THE GROUP OF POINTWISE INNER AUTOMORPHISMS
Authors: AYDIN Ela 
Published: July 2023

Let $L_{m,c}$ stand for the free metabelian nilpotent Lie algebra of class $c$ of rank $m$ over a field $K$ of characteristic zero.
Automorphisms of the form $\varphi(x_i)=e^{adu_i}(x_i)$ are called pointwise inner, where $e^{adu_i}$, is the inner automorphism
induced by the element $u_i\in L_{m,c}$ for each $i=1,\ldots,m$. In the present study, we investigate the group structure of
the group $\text{\rm PInn}(L_{m,c})$ of pointwise inner automorphisms of $L_{m,c}$ for low nilpotency classes.
T cell immune response predicts survival in severely ill COVID-19 patients requiring venovenous extracorporeal membrane oxygenation support
Authors: Ulakcsai Zsuzsanna , Szabo Liliana , Szabo Zsofia , Karaszi Eva , Szabo Tamas , Fazekas Levente , Vereb Alexandra , Kovacs Nora Fanna , Nemeth Dora , Kovacs Eniko , Nemeth Endre , Nagy Gyorgy , Vago Hajnalka , Merkely Bela 
Published: August 2023

IntroductionThere is a critical gap in understanding which SARS-CoV-2 patients would benefit most from venovenous extracorporeal membrane oxygenation (VV-ECMO) support. The potential role of a dysregulated immune response is still unclear in this patient population.ObjectivesTo assess the potential predictive value of SARS-CoV-2 specific cellular and humoral immune responses for survival in critically ill COVID-19 patients requiring VV-ECMO.MethodsWe conducted a prospective single-center observational study of unvaccinated patients requiring VV-ECMO support treated at the intensive care unit of Semmelweis University Heart and Vascular Center between March and December 2021. Peripheral blood samples were collected to measure the humoral and cellular immune statuses of the patients at the VV-ECMO cannulation. Patients were followed until hospital discharge.ResultsOverall, 35 COVID-19 patients (63% men, median age 37 years) on VV-ECMO support were included in our study. The time from COVID-19 verification to ECMO support was a median (IQR) of 10 (7-14) days. Of the patients, 9 (26%) were discharged alive and 26 (74%) died during their hospital stay. Immune tests confirmed ongoing SARS-CoV-2 infection in all the patients, showing an increased humoral immune response. SARS-CoV-2-specific cellular immune response was significantly higher among survivors compared to the deceased patients. A higher probability of survival was observed in patients with markers indicating a higher T cell response detected by both QuantiFeron (QF) and flow cytometry (Flow) assays. (Flow S1 CD8+ ≥ 0.15%, Flow S1 CD4+ ≥ 0.02%, QF CD4 ≥ 0.07, QF whole genome ≥ 0.59). In univariate Cox proportional hazard regression analysis BMI, right ventricular (RV) failure, QF whole genome T cell level, and Flow S1 CD8+ T cell level were associated with mortality, and we found that an increased T cell response showed a significant negative association with mortality, independent of BMI and RV failure.ConclusionEvaluation of SARS-CoV-2 specific T cell response before the cannulation can aid the risk stratification and evaluation of seriously ill COVID-19 patients undergoing VV-ECMO support by predicting survival, potentially changing our clinical practice in the future.
Metabolomic and transcriptomic profiling reveals the effect of dietary protein and lipid levels on growth performance in loach (Paramisgurnus dabryanus)
Authors: Wang Zi-Rui , Li Shu-Yao , Zhang Ya-Zhou , Li Yong-An , Huo Huan-Huan , Yu Chuan-Qi , Zhou Qiu-Bai 
Published: August 2023

The subject of this study was to explore the optimum requirements of loach (Paramisgurnus dabryanus) regarding dietary proteins and lipids and discuss the underlying mechanism. We designed nine diets to determine the effects of different levels of dietary crude protein (CP: 30%, 35%, and 40%) and ether extract (EE: 6%, 10%, and 14%) on the growth performance and metabolism of P. dabryanus. In total, 2160 healthy P. dabryanus (5.19 ± 0.01 g) were divided into nine groups with four replications at 60 fish per barrel stocking density. The trial lasted for eight weeks. Serum and liver samples were gathered for metabolomic and transcriptomic analyses. The results showed that the specific growth rate of P. dabryanus in the CP40EE10 group was the fastest and notably higher than that in other groups (P&lt; 0.05). Analysis of the metabolome results found that the mTOR signaling pathway, glycerophospholipid metabolism, D-arginine and D-ornithine metabolism were significantly enriched pathways in the CP40EE10 group compared with the other groups (P&lt; 0.05). Moreover, the transcriptomic analysis of differentially expressed genes (DEGs) showed that the expression of ARG (arginase) involved in protein synthesis was significantly upregulated in the CP40EE10 group compared to the slowest growing group (P&lt; 0.05). Additionally, the expression of SPLA2 (secretory phospholipase A2) involved in lipid metabolism and FBP (fructose-1,6-bisphosphatase) involved in glucose metabolism were all significantly downregulated in the CP30EE6 group compared with the CP40EE10 group (P&lt; 0.05). Furthermore, the analysis of differentially expressed metabolites (DEMs) and DEGs co-enriched in the KEGG pathway revealed that the significantly enriched pathways were arginine and proline metabolism, glycerophospholipid metabolism, and glycolysis/gluconeogenesis in CP40EE10 compared with other groups (P&lt; 0.05). We conclude that including 40% CP and 10% EE in the P. dabryanus diet could result in a better growth rate. We hypothesized from metabolomic and transcriptomic analyses that the CP40EE10 diet might promote the growth of P. dabryanus by promoting protein synthesis, lipid metabolism, and energy production.
Racial disparities in access to DBS: results of a real-world U.S. claims data analysis
Authors: Frassica Michael , Kern Drew S. , Afshari Mitra , Connolly Allison T. , Wu Chengyuan , Rowland Nathan , Ramirez-Castaneda Juan , Ushe Mwiza , Salazar Claudia , Mason Xenos 
Published: August 2023

IntroductionDeep brain stimulation (DBS) is an effective and standard-of-care therapy for Parkinson’s Disease and other movement disorders when symptoms are inadequately controlled with conventional medications. It requires expert care for patient selection, surgical targeting, and therapy titration. Despite the known benefits, racial/ethnic disparities in access have been reported. Technological advancements with smartphone-enabled devices may influence racial disparities. Real-world evidence investigations can shed further light on barriers to access and demographic disparities for DBS patients.MethodsA retrospective cross-sectional study was performed using Medicare claims linked with manufacturer patient data tracking to analyze 3,869 patients who received DBS. Patients were divided into two categories: traditional omnidirectional DBS systems with dedicated proprietary controllers (“traditional”; n = 3,256) and directional DBS systems with smart controllers (“smartphone-enabled”; n = 613). Demographics including age, sex, and self-identified race/ethnicity were compared. Categorical demographics, including race/ethnicity and distance from implanting facility, were analyzed for the entire population.ResultsA significant disparity in DBS utilization was evident. White individuals comprised 91.4 and 89.9% of traditional and smartphone-enabled DBS groups, respectively. Non-White patients were significantly more likely to live closer to implanting facilities compared with White patients.ConclusionThere is great racial disparity in utilization of DBS therapy. Smartphone-enabled systems did not significantly impact racial disparities in receiving DBS. Minoritized patients were more likely to live closer to their implanting facility than White patients. Further research is warranted to identify barriers to access for minoritized patients to receive DBS. Technological advancements should consider the racial discrepancy of DBS utilization in future developments.