bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials
Authors: Kobeissi Hassan , Adusumilli Gautam , Ghozy Sherief , Bilgin Cem , Kadirvel Ramanathan , Brinjikji Waleed , Heit Jeremy J , Rabinstein Alejandro A , Kallmes David F 
Published: February 2023

Introduction Mechanical thrombectomy (MT) is the standard of care in eligible patients presenting with acute ischemic stroke (AIS). The question of whether intravenous thrombolysis (IVT) improves outcomes in conjunction with MT remains unanswered. We performed a systematic review and meta-analysis of published randomized controlled trials (RCT) to explore outcomes of MT with and without IVT. Methods Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, Embase, Web of science, and Scopus. Outcomes of interest included 90-day modified Rankin Scale (mRS) 0–2, thrombolysis in cerebral infarction (TICI) score 2b-3, symptomatic intracranial hemorrhage (sICH), distal embolization, and mortality. We calculated pooled risk ratios (RRs) and their corresponding 95% confidence intervals (CI). Results Six RCTs with 2334 patients compared outcomes of patients treated with MT alone and MT with IVT. Both treatments resulted in comparable rates of mRS 0–2 (RR = 0.96, 95% CI = 0.88–1.04; p-value = 0.282), sICH (RR = 0.80, 95% CI = 0.55–1.17; p-value = 0.253), mortality at 90-days (RR = 1.06, 95% CI = 0.88–1.28; p-value = 0.529), and distal embolization (RR = 1.10, 95% CI = 0.79–1.52; p-value = 0.572). MT alone was associated with a lower rate of TICI 2b-3 compared to MT with IVT (RR = 0.96, 95% CI = 0.93–0.99; p-value = 0.006). Conclusions In this meta-analysis of six RCTs, MT alone was comparable to MT plus IVT for mRS 0–2, sICH, mortality, and distal embolization; however, MT alone resulted in lower rates of TICI 2b-3. Further trials are needed to determine which patient populations benefit from MT plus IVT and to increase the power of future meta-analyses.
Efficacy and safety results by menopausal status in monarchE: adjuvant abemaciclib combined with endocrine therapy in patients with HR+, HER2−, node-positive, high-risk early breast cancer
Authors: Paluch-Shimon Shani , Neven Patrick , Huober Jens , Cicin Irfan , Goetz Matthew P. , Shimizu Chikako , Huang Chiun-Sheng , Lueck Hans Joachim , Beith Jane , Tokunaga Eriko , Contreras Jessica Reyes , de Sant’Ana Rosane Oliveira , Wei Ran , Shahir Ashwin , Nabinger Sarah C. , Forrester Tammy , Johnston Stephen R. D. , Harbeck Nadia 
Published: February 2023

Background: Abemaciclib is the first and only cyclin-dependent kinases 4 and 6 inhibitor approved for adjuvant treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−), node-positive, and high-risk early breast cancer (EBC), with indications varying by geography. Premenopausal patients with HR+, HER2− tumors may have different tumor biology and treatment response compared to postmenopausal patients. Objectives: We describe the efficacy and safety of abemaciclib plus endocrine therapy (ET) for the large subgroup of premenopausal patients with HR+, HER2− EBC in monarchE. Design: Randomized patients (1:1) received adjuvant ET with or without abemaciclib for 2 years plus at least 3 additional years of ET as clinically indicated. Methods: Patients were stratified by menopausal status (premenopausal versus postmenopausal) at diagnosis. Standard ET (tamoxifen or aromatase inhibitor) with or without gonadotropin-releasing hormone agonist was determined by physician’s choice. Invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) by menopausal status were assessed at data cutoff on 1 April 2021 (median follow-up of 27 months). Results: Among randomized patients, 2451 (43.5%) were premenopausal and 3181 (56.4%) were postmenopausal. The choice of ET for premenopausal patients varied considerably between countries. Treatment benefit was consistent across menopausal status, with a numerically greater effect size in premenopausal patients. For premenopausal patients, abemaciclib with ET resulted in a 42.2% and 40.3% reduction in the risk of developing IDFS and DRFS events, respectively. Absolute improvement at 3 years was 5.7% for IDFS and 4.4% for DRFS rates. Safety profile for premenopausal patients was consistent with the overall safety population. Conclusion: Abemaciclib with ET demonstrated clinically meaningful treatment benefit for IDFS and DRFS versus ET alone regardless of menopausal status and first ET, with a numerically greater benefit in the premenopausal compared to the postmenopausal population. Safety data in premenopausal patients are consistent with the overall safety profile of abemaciclib.
A Bibliometric and Visual Analysis of the Most Cited Articles on Disc Arthroplasty
Authors: De Stefano Frank A. , Warner Tyler , Reardon Taylor , Jarrah Ryan , Mayo Timothy , Ezeudu Chibueze S. , Fiani Brian 
Published: February 2023

Study Design Bibliometric literature review. Objective Total disc arthroplasty (TDA) is an evolving technique used by surgeons to preserve neural elements and range of motion in patients with degenerative disc disease, spondylosis and more. In comparison to discectomy, disc arthroplasty has been shown to decrease morbidity, reduce adjacent-level disease, and preserve pre-operative range of motion. The objective of this manuscript is to provide a bibliometric analysis of the use of disc arthroplasty in scientific literature and highlight the main contributing authors and their publication characteristics. Methods The Scopus database was used to perform a title-specific, keyword-based search for all publications until June 2022. The keyword “total disc arthroplasty” was used. The most-cited 100 articles were selected for analysis. Parameters included the following: title, citation count, citations per year, authors, specialty first author, institution, country of origin, publishing journal, Source Normalized, Impact Per Paper (SNIP), and Hirsch index. Results Our search on disc arthroplasty yielded 580 articles that were published, with the first publication on the topic found in 1966. The most cited 100 articles received a total of 8694 citations, with an average of 86.94 citations per article. After assessing countries with the greatest contributions, United States, China, and Germany were top 3 with 54, 14, and 7 articles, respectively. Conclusion The bibliometric analysis provides an overview of how medical research is analyzed in academic medicine. In the present study, we evaluated the global trends in disc arthroplasty for the treatment of degenerative disc disease.
Initial Heart Rate Predicts Functional Independence in Patients With Spinal Cord Injury Requiring Surgery: A Registry-Based Study in a Mature Trauma System Over the Past 10 Years
Authors: Mouchtouris Nikolaos , Luck Trevor , Yudkoff Clifford , Hines Kevin , Franco Daniel , Al Saiegh Fadi , Thalheimer Sara , Khanna Omaditya , Prasad Srinivas , Heller Joshua , Harrop James , Jallo Jack 
Published: February 2023

Study Design Retrospective Cohort Study. Objectives To determine the ability of early vital sign abnormalities to predict functional independence in patients with SCI that required surgery. Methods A retrospective analysis of data extracted from the Pennsylvania Trauma Outcome Study database. Inclusion criteria were patients >18 years with a diagnosis of SCI who required urgent spine surgery in Pennsylvania from 1/1/2010-12/31/2020 and had complete records available. Results A total of 644 patients met the inclusion criteria. The mean age was 47.1 ± 14.9 years old and the mean injury severity score (ISS) was 22.3 ± 12.7 with the SCI occurring in the cervical, thoracic, and lumbar spine in 61.8%, 19.6% and 18.0%, respectively. Multivariable logistic regression analyses for predictors of functional independence at discharge showed that higher HR at the scene (OR 1.016, 95% CI 1.006-1.027, P = .002) and lower ISS score (OR .894, 95% CI .870-.920, P < .001) were significant predictors of functional independence. Similarly, higher admission HR (OR 1.015, 95% CI 1.004-1.027, P = .008) and lower ISS score (OR .880, 95% CI 0.864-.914, P < .001) were significant predictors of functional independence. Peak Youden indices showed that patients with HR at scene >70 and admission HR ≥83 were more likely to achieve functional independence. Conclusions Early heart rate is a strong predictor of functional independence in patients with SCI. HR at scene >70 and admission HR ≥83 is associated with improved outcomes, suggesting lack of neurogenic shock.
Simultaneous Arthroscopic Glenohumeral Stabilization and Glenoid Microfracture in Young, Active-Duty Military Patients: Outcomes at 5-Year Follow-up
Authors: Green Clare K. , Scanaliato John P. , Sandler Alexis B. , Dunn John C. , Covillon Emma , Parnes Nata 
Published: February 2023

Background: Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid osteochondral defects. Purpose: To report clinical outcomes and survivorship after combined microfracture of isolated chondral lesions of the glenoid and labral repair among young, active-duty military patients and to compare outcomes with those of patients who underwent isolated shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 31 active-duty military patients aged <40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 (microfracture group) and 209 patients without chondral defects who underwent shoulder stabilization during the same time period (instability group). Preoperative and 5-year postoperative outcomes (range of motion [ROM], visual analog scale [VAS] for pain, Single Assessment Numeric Evaluation [SANE] score, American Shoulder and Elbow Surgeons [ASES] shoulder score, and Rowe instability score) were compared within and between groups, and separate subgroup analyses were performed to determine whether variant of instability and dominant-shoulder involvement were associated with worse outcomes. Results: The mean follow-up was significantly longer for the microfracture group versus the instability group (95.58 ± 23.12 vs 83.38 ± 25.93 months; P = .014). Age and sex distributions were similar between groups. In both groups, there was significant pre- to postoperative improvement on all outcomes scores ( P = .0001 for all). When compared with the instability cohort, microfracture patients had significantly worse postoperative VAS pain (2.65 ± 1.78 vs 1.55 ± 1.92; P = .003), SANE (79.13 ± 14.43 vs 91.23 ± 13.20; P < .0001), and ASES (79.90 ± 13.87 vs 89.03 ± 14.28; P = .001) scores, as well as decreased ROM in forward flexion (151.29° ± 11.76° vs 155.48° ± 10.3°; P = .039) and external rotation (63.65° ± 8.34° vs 65.17° ± 0.64°; P = .010). At latest follow-up, 58% of microfracture patients had returned to active-duty military service compared with 93.78% of isolated instability patients ( P < .0001). Conclusion: Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient-reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty. However, microfracture patients had significantly worse outcomes than patients who underwent stabilization without concomitant chondral defects.
Evidence for Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: A Systematic Review of Data From 2010 to 2022
Authors: Bono Olivia J. , Jenkin Bryan , Forlizzi Julianne , Mousad Albert , Le Breton Stephen , MacAskill Meghan , Mandalia Krishna , Mithoefer Kai , Ramappa Arun , Ross Glen , Shah Sarav S. 
Published: February 2023

Background: Biologic healing after rotator cuff repair remains a significant challenge. Injectable biologic augmentation may improve tissue quality at the suture-tendon interface. Purpose: To investigate the effect of injectable biologic supplementation in rotator cuff repair and to assess the quality and adherence to evolving reporting standards. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were 40 studies: 29 preclinical (in vivo animal models) and 11 clinical. Each clinical study was assessed for quality, risk of bias, and adherence to relevant MIBO (Minimum Information for Studies Evaluating Biologics in Orthopaedics) guidelines. The outcomes of interest were reported load to failure, load to gap, gap size, and stiffness in the preclinical studies, and healing rate and any patient-reported outcome measures in the clinical studies. Results: Injectables reported included growth factors (eg, transforming growth factor–beta 3, erythropoietin), bone marrow–derived mesenchymal stem cells and adipose-derived mesenchymal stem cells (ADSCs), and other agents such as platelet-rich plasma (PRP) and hyaluronic acid. The most common findings for preclinical injectables were increased load to failure (16/29 studies; 55.2%) and improved collagen histological quality (11/29 studies; 37.9%). All 11 clinical studies (10 PRP, 1 ADSC) indicated no adverse events, with similar or improved patient-reported outcomes compared with repairs in the control groups. In 1 study utilizing an innovative delivery technique, a concentrated PRP globule with fibrin matrix was shuttled over a suture to maintain concentrated PRP at the repair site and demonstrated a significant decrease in retears ( P = .03) at a 31-month follow-up. A matched-cohort study investigating augmentation with ADSCs demonstrated a significantly lower retear rate in the ADSC-augmented group than the control group at a 28-month follow-up ( P < .001). On average, the clinical studies adhered to 66% of relevant MIBO reporting guidelines and had a low risk of bias. Conclusion: Approximately 83% of preclinical studies found a positive biomechanical or histological effect, with no studies showing an overall negative effect. Clinically, utilization of innovative delivery techniques may reduce the risk of arthroscopic washout of PRP and improve retear rates. ADSCs were shown to reduce retear rates at a 28-month follow-up.
The Carbon Footprint of the Craniomaxillofacial Surgeon: A Single Center Analysis of 3D-Printed Constructs
Authors: Heron Matthew J. , Bhagwat Atharva M. , Zhu Katherine J. , Yusuf Cynthia T. , Febre-Alemañy David A. , Lopez Christopher D. , Yang Robin 
Published: February 2023

Introduction: Three-dimensional (3D) printing plays an expansive role in craniofacial surgical planning and implementation. To better understand when the benefits of this technology outweigh its environmental costs, a focused exploration of the environmental impact of 3D printing is warranted to quantify carbon emissions attributable to craniofacial surgical constructs. Methods: All invoice data from commercial vendors used at Johns Hopkins Hospital for the 2-year period from January 2020 to December 2021 were reviewed. Information on the material composition of each construct was recorded. Additionally, a total of 19 commercial printers were included. Conversion factors from the U.S. EIA were used to calculate the carbon emissions generated by the fuel consumption of each printer per hour. Results: Invoice data revealed 406 patient-specific constructs (158 contour models, 104 guides, 84 implants, and 60 splints). A total of 2644.4 printer hours and 36.1 MW of power were needed to manufacture all constructs. This is equivalent to releasing 15.71 metric tons of carbon emissions, corresponding to the emissions produced by burning 7882.1 kg of coal or 36.4 barrels of oil. Conclusion: 3D printing is a resource-intensive practice in CMF surgery. Therefore, when weighing patient benefits against environmental detriment, CMF surgeons must determine indications where 3D printing is unessential. Restricting prints to the anatomy of interest, minimizing support structures, and reusing printed constructs may all help to lessen the environmental impact of this growing practice.
Selective modulation of activated protein C activities by a nonactive site–targeting nanobody library
Authors: Sim Derek S. , Shukla Meenal , Mallari Cornell R. , Fernández José A. , Xu Xiao , Schneider Doug , Bauzon Maxine , Hermiston Terry W. , Mosnier Laurent O. 
Published: February 2023

AbstractActivated protein C (APC) is a pleiotropic coagulation protease with anticoagulant, anti-inflammatory, and cytoprotective activities. Selective modulation of these APC activities contributes to our understanding of the regulation of these physiological mechanisms and permits the development of therapeutics for the pathologies associated with these pathways. An antibody library targeting the nonactive site of APC was generated using llama antibodies (nanobodies). Twenty-one nanobodies were identified that selectively recognize APC compared with the protein C zymogen. Overall, 3 clusters of nanobodies were identified based on the competition for APC in biolayer interferometry studies. APC functional assays for anticoagulant activity, histone H3 cleavage, and protease-activated receptor 1 (PAR1) cleavage were used to understand their diversity. These functional assays revealed 13 novel nanobody-induced APC activity profiles via the selective modulation of APC pleiotropic activities, with the potential to regulate specific mechanisms for therapeutic purposes. Within these, 3 nanobodies (LP2, LP8, and LP17) inhibited all 3 APC functions. Four nanobodies (LP1, LP5, LP16, and LP20) inhibited only 2 of the 3 functions. Monofunction inhibition specific to APC anticoagulation activity was observed only by 2 nanobodies (LP9 and LP11). LP11 was also found to shift the ratio of APC cleavage of PAR1 at R46 relative to R41, which results in APC-mediated biased PAR1 signaling and APC cytoprotective effects. Thus, LP11 has an activity profile that could potentially promote hemostasis and cytoprotection in bleedings associated with hemophilia or coagulopathy by selectively modulating APC anticoagulation and PAR1 cleavage profile.
Conifers and non-native tree species shift trophic niches of generalist arthropod predators in Central European beech forests
Authors: Wildermuth Benjamin , Fardiansah Riko , Matevski Dragan , Lu Jing-Zhong , Kriegel Peter , Scheu Stefan , Schuldt Andreas 
Published: February 2023

AbstractBackgroundFunctional diversity is vital for forest ecosystem resilience in times of climate-induced forest diebacks. Admixing drought resistant non-native Douglas fir, as a partial replacement of climate-sensitive Norway spruce, to native beech forests in Europe appears promising for forest management, but possible consequences for associated biota and ecosystem functioning are poorly understood. To better link forest management and functional diversity of associated biota, we investigated the trophic niches (∆13C, ∆15N) of epigeic generalist predators (spiders and ground beetles) in mixed and pure stands of European beech, Norway spruce and non-native Douglas fir in north-west Germany. We assessed the multidimensional niche structure of arthropod predator communities using community-based isotopic metrics.ResultsWhilst arthropod ∆13C differed most between beech (high ∆13C) and coniferous stands (low ∆13C), ∆15N was lowest in non-native Douglas fir. Tree mixtures mitigated these effects. Further, conifers increased isotopic ranges and isotopic richness, which is linked to higher canopy openness and herb complexity. Isotopic divergence of ground beetles decreased with Douglas fir presence, and isotopic evenness of spiders in Douglas fir stands was lower in loamy sites with higher precipitation than in sandy, drier sites.ConclusionsWe conclude that tree species and particularly non-native trees alter the trophic niche structure of generalist arthropod predators. Resource use and feeding niche breadth in non-native Douglas fir and native spruce differed significantly from native beech, with more decomposer-fueled and narrower feeding niches in beech stands (∆13C, isotopic ranges and richness). Arthropod predators in non-native Douglas fir, however, had shorter (∆15N) and simplified (isotopic divergence) food chains compared to native forest stands; especially under beneficial abiotic conditions (isotopic evenness). These findings indicate potential adverse effects of Douglas fir on functional diversity of generalist arthropod predators. As tree mixtures mitigated differences between beech and conifers, mixed stands including (non-native) conifers constitute a promising compromise between economic and conservational interests.
Gut microbiome variations in Rhinopithecus roxellanae caused by changes in the environment
Authors: Zhao Gang , Qi Mingpu , Wang Qiankun , Hu Changmin , Li Xiang , Chen Yingyu , Yang Jingyuan , Yu Huiliang , Chen Huanchun , Guo Aizhen 
Published: February 2023

AbstractBackgroundThe snub-nosed monkey (Rhinopithecus roxellanae) is an endangered animal species mainly distributed in China and needs to be protected. Gut microbiome is an important determinant of animal health and population survival as it affects the adaptation of the animals to different foods and environments under kinetic changes of intrinsic and extrinsic factors. Therefore, this study aimed to elucidate gut fecal microbiome profiles of snub-nosed monkeys affected by several extrinsic and intrinsic factors, including raising patterns (captive vs. wild), age, sex, and diarrheal status to provide a reference for making protection strategies.ResultsThe 16S rRNA gene sequencing was firstly used to pre-check clustering of 38 fecal samples from the monkeys including 30 wild and 8 captive (5 healthy and 3 diarrheal) from three Regions of Shennongjia Nature Reserve, Hubei Province, China. Then the 24 samples with high-quality DNA from 18 wild and 6 captive (4 healthy and 2 diarrheal) monkeys were subjected to shotgun metagenomic sequencing to characterize bacterial gut microbial communities. We discovered that the raising pattern (captive and wild) rather than age and sex was the predominant factor attributed to gut microbiome structure and proportionality. Wild monkeys had significantly higher bacterial diversity and lowerBacteroidetes/Firmicutesratios than captive animals. Moreover, the gut microbiomes in wild healthy monkeys were enriched for the genes involved in fatty acid production, while in captive animals, genes were enriched for vitamin biosynthesis and metabolism and amino acid biosynthesis from carbohydrate intermediates. Additionally, a total of 37 antibiotic resistant genes (ARG) types were detected. Unlike the microbiome diversity, the captive monkeys have a higher diversity of ARG than the wild animals.ConclusionTaken together, we highlight the importance of self-reprogramed metabolism in the snub-nosed monkey gut microbiome to help captive and wild monkeys adapt to different intrinsic and extrinsic environmental change.