bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Mechanical Performance Assessment at Different Levels of Exercise in Childhood Acute Lymphoblastic Leukemia Survivors
Authors: Uwase Egidie , Caru Maxime , Curnier Daniel , Abasq, Meng Maxence , Andelfinger Gregor , Krajinovic Maja , Laverdière Caroline , Sinnett Daniel , Périé Delphine 
Published: June 2023

Background:
There is a shortage of relevant studies interested in cardiac mechanical performance. Thus, it is clinically relevant to study the impact of cancer treatments on survivors’ cardiac mechanical performance to improve our knowledge. The first objective of this study is to assess survivors’ cardiac mechanical performance during a cardiopulmonary exercise test (CPET) using both ventricular-arterial coupling (VAC) and cardiac work efficiency (CWE) from cardiac magnetic resonance (CMR) acquisitions. The second objective is to assess the impact of doxorubicin and dexrazoxane (DEX) treatments.

Methods:
A total of 63 childhood acute lymphoblastic leukemia survivors underwent a CMR at rest on a 3T magnetic resonance imaging system, followed by a CPET on ergocycle. The CircAdapt model was used to study cardiac mechanical performance. At different levels of exercise, arterial elastance, end-systolic elastance, VAC, and CWE were estimated.

Results:
We observed significant differences between the different levels of exercise for both VAC (P<0.0001) and CWE parameters (P=0.001). No significant differences were reported between prognostic risk groups at rest and during the CPET. Nevertheless, we observed that survivors in the SR group had a VAC value slightly lower than heart rate (HR)+DEX and HR groups throughout the CPET. Moreover, survivors in the SR group had a CWE parameter slightly higher than HR+DEX and HR groups throughout the CPET.

Conclusions:
This study reveals that the combination of CPET, CMR acquisitions and CircAdapt model was sensitive enough to observe slight changes in the assessment of VAC and CWE parameters. Our study contributes to improving survivors’ follow-up and detection of cardiac problems induced by doxorubicin-related cardiotoxicity.
Return to school among service members and veterans after traumatic brain injury: a scoping review
Authors: Nguyen Michael V. , Hackman Dawn E. , Truitt Anjali R. 
Published: June 2023

Objective:
The purpose of this scoping review was to evaluate the current literature related to return to school among US service members and veterans with traumatic brain injury.

Methods:
Seven research databases (Ovid Medline, PsycINFO, Embase, CINAHL Plus, Cochrane Library, Scopus, SPORTDiscus) were queried for human studies. We included studies that focused on US service members and veterans who sustained traumatic brain injuries and their vocational outcomes. Conference abstracts, systematic reviews, literature reviews, editorials, consensus reports, commentaries, dissertations, and qualitative studies were excluded. Two rounds of independent reviews were performed. Details of study design, intervention, and vocational outcomes were recorded.

Results:
The search yielded 5667 articles; 18 articles met the inclusion criteria. Seventeen studies were observational (94%), and 1 was randomized control trial. Most studies relied on self-reported student or school enrollment status. The only intervention identified for return to school utilized physical therapy and occupational therapy to address cognitive skills and functional deficits.

Conclusion:
Research related to educational outcomes after traumatic brain injury among service members and veterans is largely unstudied. Most studies were observational and related heavily to self-reported educational status. Longitudinal research is needed to understand the facilitators and barriers to return to school after traumatic brain injury among this patient population.
Intracranial Pressure Patterns in Children with Sagittal Craniosynostosis
Authors: Kalmar Christopher L. , Malphrus Elizabeth L. , Blum Jessica D. , Kosyk Mychajlo S. , Zapatero Zachary D. , Heuer Gregory G. , Bartlett Scott P. , Taylor Jesse A. , Lang Shih-Shan , Swanson Jordan W. 
Published: June 2023

Background:
Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions.

Methods:
Infants and children with sagittal craniosynostosis and unaffected control subjects were prospectively evaluated with spectral-domain optical coherence tomography from 2014 to 2021. Elevated ICP was determined based on previously validated algorithms using retinal optical coherence tomography parameters.

Results:
Seventy-two patients with isolated sagittal craniosynostosis and 25 control subjects were evaluated. Overall, 31.9% (n = 23) of patients with sagittal craniosynostosis had evidence of ICP greater than or equal to 15 mmHg, and 27.8% (n = 20) of patients had ICP greater than or equal to 20 mmHg. Children with sagittal craniosynostosis younger than 6 months were more likely to have normal ICP (88.6% <15 mmHg; 91.4% <20 mmHg) than those aged between 6 and 12 months (54.5%, P = 0.013; 54.5%, P = 0.005) than those older than 12 months (46.2%, P < 0.001; 53.8%, P = 0.001). ICP was directly correlated with severity of scaphocephaly (P = 0.009). No unaffected control subjects at any age exhibited retinal thickening suggestive of elevated ICP.

Conclusion:
Elevated ICP is rare in isolated sagittal craniosynostosis younger than 6 months, but it becomes significantly more common after 6 months of age, and may correlate with severity of scaphocephaly.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Magnetic Resonance Imaging of the Velopharynx: Clinical Findings in Patients with Velopharyngeal Insufficiency
Authors: Sitzman Thomas J. , Williams Jessica L. , Singh Davinder J. , Temkit M’hamed , Snodgrass Taylor D. , Perry Jamie L. 
Published: June 2023

Background:
Magnetic resonance imaging (MRI) is the only imaging modality capable of directly visualizing the levator veli palatini (LVP) muscles: the primary muscles responsible for velopharyngeal closure during speech. MRI has been used to describe normal anatomy and physiology of the velopharynx in research studies, but there is limited experience with use of MRI in the clinical evaluation of patients with velopharyngeal insufficiency (VPI).

Methods:
MRI was used to evaluate the velopharyngeal mechanism in patients presenting for VPI management. The MRI followed a fully awake, nonsedated protocol with phonation sequences. Quantitative and qualitative measures of the velopharynx were obtained and compared with age- and sex-matched individuals with normal speech resonance.

Results:
MRI was completed successfully in 113 of 118 patients (96%). Compared with controls, patients with VPI after cleft palate repair had a shorter velum (P < 0.001), higher incidence of LVP discontinuity (P < 0.001), and shorter effective velar length (P < 0.001). Among patients with persistent VPI after pharyngeal flap placement, findings included a pharyngeal flap base located inferior to the palatal plane [11 of 15 (73%)], shorter velum (P < 0.001), and higher incidence of LVP discontinuity (P = 0.014). Patients presenting with noncleft VPI had a shorter (P = 0.004) and thinner velum (P < 0.001) and higher incidence of LVP discontinuity (P = 0.014).

Conclusions:
MRI provides direct evidence of LVP muscle anomalies and quantitative evaluation of both velar length and velopharyngeal gap. This information is unavailable with traditional VPI imaging tools, suggesting that MRI may be a useful tool for selecting surgical procedures to address patient-specific anatomic differences.
Color Match Following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis
Authors: Dermody Sarah M. , Kahng Peter W. , Rao Vishwanatha M. , Casper Keith A. , Malloy Kelly M. , Rosko Andrew J. , Stucken Chaz L. , Chinn Steven B. , Spector Matthew E. , Feng Allen L. 
Published: June 2023

Background:
Many options for free tissue transfer have been described for head and neck reconstruction. While functional outcomes remain paramount, aesthetic considerations like color match can be equally consequential for patient quality of life. It is important to understand differences in color match based on flap donor site for head and neck reconstruction.

Methods:
A retrospective review was performed of patients who underwent head and neck reconstruction with free tissue transfer at a tertiary care academic medical center between November 2012 and November 2020. Patients with documented pictures of their reconstruction and external skin paddles were considered. Patient demographics and surgery specific factors were recorded. Objective differences in color match were obtained by calculating the International Commission on Illumination Delta E 2000 (dE2000) score. Standard univariate descriptive statistics and multivariable statistical analyses were performed.

Results:
Lateral arm, parascapular, and medial sural artery perforator (MSAP) free tissue transfer performed favorably compared to other donor sites, whereas anterolateral thigh flaps had the highest average dE2000 scores. Differences in dE2000 scores were mitigated by post-operative radiation to the flap site and with increasing time beyond 6 months post-operatively.

Conclusions:
We provide an objective assessment of external skin color match in patients undergoing free tissue transfer for head and neck cancer by donor site. MSAP, lateral arm, and parascapular free flaps performed well compared to traditional donor sites. These differences are more significant at the face and mandible when compared to the neck, but diminish 6 months after surgery and with post-operative radiation to the free flap skin paddle.
Total Face Reconstruction with Flap Prefabrication and Soft Tissue Expansion Techniques
Authors: Qiao Zhihua , Wang Xiancheng , Li Qingfeng , Zan Tao , Gu Bing , Sun Yang , Xiong Xiang , Meng Xianxi , Zeng Weiliang , Yang Kai 
Published: June 2023

SUMMARY
Total facial deformities always lead to psychological and functional consequences, making plastic and reconstructive surgery a great challenge. And the skin of the anterior chest area is matched in thickness, texture, and color to the head and face. The purpose of this article was to discuss and evaluate reconstructive surgeons' experiences with obtaining a monoblock flap from the anterior thoracic area for entire face reconstruction using flap prefabrication, soft tissue expansion, and facial plastic surgery following skin flap transplantation. Two patients underwent prefabricated expanded anterior thoracic flap reconstructions for total facial deformities; data collection included face defect size, flap type, the shape of the expander, expansion time, and complications. All the face flaps that were transplanted survived without major complications. It is concluded that using a prefabricated expanded flap to reconstruct an entire facial soft tissue defect can provide a high degree of matching, a wide enough covering area, and a thin enough skin thickness to cover the face. Autologous flap grafting is easy to implement and has a high application value.
Anterior Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh Reinforcement: A Comparative Study
Authors: Giordano Salvatore , Garvey Patrick B. , Mericli Alexander , Baumann Donald P. , Liu Jun , Butler Charles E. 
Published: June 2023

Background:
It is not clear whether mesh-reinforced anterior component separation (CS) for abdominal wall reconstruction (AWR) results in better outcomes than mesh-reinforced primary fascial closure (PFC) without CS, particularly when acellular dermal matrix (ADM) is used. We compared outcomes of CS versus PFC repair in AWR procedures aiming to determine whether CS results in better outcomes.

Methods:
This retrospective study of prospectively collected data included 461 patients who underwent AWR with ADM during a 10-year period at an Academic Cancer Center. The primary endpoint was hernia recurrence; the secondary outcome was surgical site occurrence (SSO).

Results:
Three hundred and twenty-two (69.9%) patients who underwent mesh-reinforced AWR with CS (AWR-CS) and 139 (30.1%) who underwent AWR with PFC (AWR-PFC) without CS were compared. AWR-PFC repairs had a higher hernia recurrence rate than AWR-CS repairs (10.8% vs. 5.3%, p=0.002) but similar overall complication (28.8% vs. 31.4%, p=0.580) and SSO (18.7% vs. 25.2%, p=0.132) rates. CS repairs experienced significantly higher wound separation (17.7% vs. 7.9%, p=0.007), fat necrosis (8.7% vs. 2.9%, p=0.027) and seroma (5.6% vs. 1.4%, p=0.047) rates than PFC repairs. The best cutoff with respect to hernia recurrence was 7.1 cm of abdominal defect width.

Conclusions:
AWR-CS repair results in a lower hernia recurrence rate than AWR-PFC, but despite the additional surgery had similar SSO rates on long-term follow-up.

Level of Evidence:
III
Machine learning and artificial intelligence for the diagnosis of infectious diseases in immunocompromised patients
Authors: Tran Nam K. , Kretsch Cileah , LaValley Clayton , Rashidi Hooman H. 
Published: June 2023

Purpose of review
Immunocompromised patients are at high risk for infection. During the coronavirus disease (COVID-19) pandemic, immunocompromised patients exhibited increased odds of intensive care unit admission and death. Early pathogen identification is essential to mitigating infection related risk in immunocompromised patients. Artificial intelligence (AI) and machine learning (ML) have tremendous appeal to address unmet diagnostic needs. These AI/ML tools often rely on the wealth of data found in healthcare to enhance our ability to identify clinically significant patterns of disease. To this end, our review provides an overview of the current AI/ML landscape as it applies to infectious disease testing with emphasis on immunocompromised patients.

Recent findings
Examples include AI/ML for predicting sepsis in high risk burn patients. Likewise, ML is utilized to analyze complex host-response proteomic data to predict respiratory infections including COVID-19. These same approaches have also been applied for pathogen identification of bacteria, viruses, and hard to detect fungal microbes. Future uses of AI/ML may include integration of predictive analytics in point-of-care (POC) testing and data fusion applications.

Summary
Immunocompromised patients are at high risk for infections. AI/ML is transforming infectious disease testing and has great potential to address challenges encountered in the immune compromised population.
Evaluation of Swallowing Function in Relation to Oropharyngeal Dysphagia in Patients with Operated Unilateral Cleft Lip and Palate
Authors: Aras Isil , Yalcin Aycan , Gode Sercan , Aras Aynur , Sezgin Baha , Durusoy Duygu , Eyigor Sibel 
Published: June 2023

Objective:
To determine the occurrence of oropharyngeal dysphagia (OD) signs and symptoms in patients with operated unilateral cleft lip and palate (CLP).

Materials and Methods:
This prospective study was conducted on 15 adolescents with operated unilateral CLP (CLP group) and 15 non-cleft volunteers (control group). Initially, the Eating Assessment Tool-10 (EAT-10) questionnaire was administered to subjects. OD signs and symptoms such as coughing, the sensation of choking, globus sensation, the need to clear the throat, nasal regurgitation, difficulties of bolus control multiple swallowing were evaluated by patient complaints and physical examination of swallowing function. Also, the Functional Outcome Swallowing Scale was used to determine the severity of the OD. Fiberoptic endoscopic evaluation of swallowing (FEES) with water, yogurt, and crackers was performed.

Results:
The prevalence of OD signs and symptoms based on patient complaints and physical examination of swallowing was low (range, 6.7 to 26.7%), and nonsignificant differences were observed between the groups for these parameters as well as for EAT-10 scores. According to the Functional Outcome Swallowing Scale findings, 11 of 15 patients with CLP were asymptomatic. Fiberoptic endoscopic evaluation of swallowing indicated that post-swallow pharyngeal wall residues with yogurt were significant in the CLP group with a prevalence of 53% (P < 0.05), whereas differences between the groups in terms of cracker and water residues were nonsignificant (P > 0.05).

Conclusion:
OD in patients with repaired CLP was manifested mainly in the form of pharyngeal residue. However, it did not appear to cause significant increases in patient complaints compared with healthy individuals.
Outcomes of Targeted Muscle Reinnervation and Regenerative Peripheral Nerve Interfaces for Chronic Pain Control in the Oncologic Amputee Population
Authors: Roubaud Margaret S , Hassan Abbas M , Shin Ashley , Mericli Alexander F , Adelman David M , Hagan Katherine , Popat Keyuri , Lin Patrick , Moon Bryan , Lewis Valerae O 
Published: June 2023

Background:
Outcomes of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) in the oncologic population are limited. We sought to examine the safety and effectiveness of TMR and RPNI in controlling postamputation pain in the oncologic population.

Methods:
A retrospective cohort study of consecutive patients who underwent oncologic amputation followed by immediate TMR and/or RPNI was conducted from November 2018 to May 2022. Primary study outcome was postamputation pain, assessed using the Numeric Pain Scale (NPS), and Patient-Reported Outcomes Measurement Information System (PROMIS ®) for residual limb pain (RLP) and phantom limb pain (PLP). Secondary outcomes included postoperative complications, tumor recurrence, and opioid use.

Results:
Sixty-three patients were evaluated with mean follow-up period of 11.3 months. The majority of patients (65.1%) had a history of previous limb salvage. At final follow-up, patients had an average NPS RLP of 1.3 ± 2.2 and PLP 1.9 ± 2.6. The final average raw PROMIS® measures were Pain Intensity 6.2 ± 2.9 (T-score 43.5), Pain Interference 14.6 ± 8.3 (T-score 55.0), and Pain Behavior 39.0 ± 22.1 (T-score 53.4). Patient opioid use decreased from 85.7% preoperatively to 37.7% postoperatively and morphine milligram equivalents (MME) decreased from a mean of 52.4 ± 53.0 preoperatively to 20.2 ± 38.4.

Conclusions:
TMR and RPNI in the oncologic population are safe surgical techniques associated with significant reductions in PLP, RLP and improvements in patient-reported outcomes. This study provides evidence for the routine incorporation of TMR and RPNI in the multidisciplinary care of oncologic amputees.
Spatial Transcriptomics of Meningeal Inflammation Reveals Inflammatory Gene Signatures in Adjacent Brain Parenchyma
Authors: Gadani Sachin P. , Singh Saumitra , Kim Sophia , Hu Jingwen , Smith Matthew D. , Calabresi Peter A. , Bhargava Pavan 
Published: June 2023

AbstractWhile modern high efficacy disease modifying therapies have revolutionized the treatment of relapsing-remitting multiple sclerosis, they are less effective at controlling progressive forms of the disease. Meningeal inflammation is a recognized risk factor for cortical grey matter pathology which can result in disabling symptoms such as cognitive impairment and depression, but the mechanisms linking meningeal inflammation and grey matter pathology remain unclear. Here, we performed MRI-guided spatial transcriptomics in a mouse model of autoimmune meningeal inflammation to characterize the transcriptional signature in areas of meningeal inflammation and the underlying brain parenchyma. We found broadly increased activity of inflammatory signaling pathways at sites of meningeal inflammation, but only a subset of these pathways active in the adjacent brain parenchyma. Sub-clustering of regions adjacent to meningeal inflammation revealed the subset of immune programs induced in brain parenchyma, notably complement signaling and antigen processing/presentation. Trajectory gene and gene set modeling analysis confirmed variable penetration of immune signatures originating from meningeal inflammation into the adjacent brain tissue. This work contributes a valuable data resource to the field, provides the first detailed spatial transcriptomic characterization in a model of meningeal inflammation, and highlights several candidate pathways in the pathogenesis of grey matter pathology.
HistoMIL: a Python package for training Multiple Instance Learning models on histopathology slides
Authors: Pan Shi , Secrier Maria 
Published: June 2023

SUMMARYHaematoxilin and eosin (H&E) stained slides are commonly used as the gold standard for disease diagnosis. Remarkable progress in the deep learning field in recent years has enabled the detection of complex molecular patterns within such histopathology slides, suggesting automated approaches could help inform pathologists’ decisions. In this context, Multiple Instance Learning (MIL) algorithms have been shown to outperform Transfer Learning (TL) based methods for a variety of tasks. However, there is still a considerable complexity to implementing and using such methods for computational biology research and clinical practice. We introduce HistoMIL, a Python package designed to simplify the implementation, training, and inference process of MIL-based algorithms for computational pathologists and biomedical researchers. In HistoMIL, we have integrated a self-supervised learning-based module to train the feature encoder, a full pipeline encompassing TL as well as three MIL algorithms, namely ABMIL (1), DSMIL (2), and TransMIL (3). By utilising the PyTorch Lightning framework (4), HistoMIL enables effortless customization of training intricacies and implementation of novel algorithms. We illustrate the capabilities of HistoMIL by building predictive models for 2,487 cancer hallmark genes on breast cancer histology slides from The Cancer Genome Atlas, on which we demonstrate AUROC performances of up to 85%. Cell proliferation processes were most easily detected, shedding light on the opportunities but also limitations of applying deep learning for gene expression detection. The HistoMIL package is proposed as a tool to simplify the implementation and usage of deep learning tasks for researchers.
Mendelian randomization analysis with pleiotropy-robust log-linear model for binary outcomes
Authors: Li Mintao , Huang Tao , Jia Jinzhu 
Published: June 2023

AbstractMendelian randomization (MR) is a statistical technique that uses genetic variants as instrumental variables to infer causality between traits. In dealing with a binary outcome, there are two challenging barriers on the way toward a valid MR analysis, that is, the inconsistency of the traditional ratio estimator and the existence of horizontal pleiotropy. Recent MR methods mainly focus on handling pleiotropy with summary statistics. Many of them cannot be easily applied to one-sample MR. We propose two novel individual data-based methods, respectively named random-effects and fixed-effects MR-PROLLIM, to surmount both barriers. These two methods adopt risk ratio (RR) to define the causal effect for a continuous or binary exposure. The random-effects MR-PROLLIM models correlated pleiotropy, accounts for variant selection, and allows weaker instruments. The fixed-effects MR-PROLLIM can function with only a few selected variants. We demonstrate in this study that the random-effects MR-PROLLIM exhibits high statistical power while yielding fewer false-positive detections than its competitors. The fixed-effects MR-PROLLIM generally performs at an intermediate level between the classical median and mode estimators. In our UK Biobank data analyses, we also found (i) the MR ratio method tended to underestimate binary exposure effects to a large extent; (ii) about 26.5% of the trait pairs were detected to have significant correlated pleiotropy; (iii) the pleiotropy-sensitive method showed estimated relative biases ranging from -103.7% to 178.0% for inferred non-zero effects. MR-PROLLIM exhibits the potential to facilitate a more rigorous and robust MR analysis for binary outcomes.