bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis
Authors: Papathanasiou Konstantinos A. , Vrachatis Dimitrios A. , Kazantzis Dimitrios , Kossyvakis Charalampos , Giotaki Sotiria G. , Deftereos Gerasimos , Raisakis Konstantinos , Kaoukis Andreas , Avramides Dimitrios , Lambadiari Vaia , Siasos Gerasimos , Deftereos Spyridon 
Published: April 2023

Abstract
Background
Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA).

Methods
The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices.

Results
A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = − 0.66; 95% CI (− 1.01, − 0.32) and SMD = − 0.56; 95% CI (− 0.73, − 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35–0.67, and SMD = 0.35; 95% CI 0.20–0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79–2.02). Moderate statistical heterogeneity and small case–control studies are the main limitations of our meta-analysis.

Conclusions
Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence.
Effect of intranasal oxytocin combination therapy with applied behavior analysis on social impairments in pediatric’s children with autism spectrum disorder
Authors: Karbasi Afsaneh , Shafiezadegan Isfahani Safie , Maracy Mohammad R. , Sabzghabaee Ali Mohammad 
Published: April 2023

Abstract
Background
The use of oxytocin as a therapy to treat social deficiencies in autism spectrum disorders (ASD) is gaining popularity. This study aimed to determine oxytocin nasal spray’s effect in combination with applied behavior analysis (ABA) method in improving social impairments in pediatrics with ASD.

Results
Our study’s main findings have revealed that intervention with INT-OXT compared to NS effectively reduced the ASD index and stereotyped behaviors on the GARS-2 scale (p < 0.05), in addition to teacher and parent’s SDQ mean score (p < 0.001). Also, during the follow-up time, the intervention with INT-OXT in ASD index, stereotyped behaviors, communication, social interaction, and parent and teacher mean SDQ scores were statically significant (p < 0.001).

Conclusions
In pediatrics with autism aged between 4 and 17 years, a 6-week course of INT-OXT combination therapy with ABA improved GARS-2 and teacher and parent SDQ scores compared to NS.
Prognostic significance of chest CT severity score in mortality prediction of COVID-19 patients, a machine learning study
Authors: Zakariaee Seyed Salman , Abdi Aza Ismail , Naderi Negar , Babashahi Mashallah 
Published: April 2023

Abstract
Background
The high mortality rate of COVID-19 makes it necessary to seek early identification of high-risk patients with poor prognoses. Although the association between CT-SS and mortality of COVID-19 patients was reported, its prognosis significance in combination with other prognostic parameters was not evaluated yet.

Methods
This retrospective single-center study reviewed a total of 6854 suspected patients referred to Imam Khomeini hospital, Ilam city, west of Iran, from February 9, 2020 to December 20, 2020. The prognostic performances of k-Nearest Neighbors (kNN), Multilayer Perceptron (MLP), Support Vector Machine (SVM), and J48 decision tree algorithms were evaluated based on the most important and relevant predictors. The metrics derived from the confusion matrix were used to determine the performance of the ML models.

Results
After applying exclusion criteria, 815 hospitalized cases were entered into the study. Of these, 447(54.85%) were male and the mean (± SD) age of participants was 57.22(± 16.76) years. The results showed that the performances of the ML algorithms were improved when they are fed by the dataset with CT-SS data. The kNN model with an accuracy of 94.1%, sensitivity of 100. 0%, precision of 89.5%, specificity of 88.3%, and AUC around 97.2% had the best performance among the other three ML techniques.

Conclusions
The integration of CT-SS data with demographics, risk factors, clinical manifestations, and laboratory parameters improved the prognostic performances of the ML algorithms. An ML model with a comprehensive collection of predictors could identify high-risk patients more efficiently and lead to the optimal use of hospital resources.
Transcatheter versus surgical closure of ventricular septal defect: a comparative study
Authors: Singab Hamdy , Elshahat Mohamed Khairat , Taha Ahmed Samy , Ali Yasmin Abdelrazek , El-Emam Ahmed Meawad , Gamal Mohamed Ahmed 
Published: April 2023

Abstract
Background

In many countries, surgical closure of ventricular septal defects remains the recommended approach of ventricular septal defect closure. The aim of this study is to compare the safety, efficacy, and clinical effects of surgical versus transcatheter closure of a ventricular septal defect.

Methods
We conducted a comparative randomized study on patients undergoing ventricular septal defect closure. Patients were allocated to undergo either surgical (group I) or catheter (group II) ventricular septal defect closure.

Results
Seventy-two patients were included. Operation success was achieved in 100% of the surgical group versus 33 of 36 patients of the percutaneous group (91.6%) (p value 0.076). There was no significant difference regarding the residual ventricular septal defect. The postoperative echo in group I revealed severe tricuspid regurgitation in one patient (2.7%), and one patient needed a permanent pacemaker. On the other hand, in group II, during the procedure, one patient had severe tricuspid regurge (2.7%). There was a significant difference in the postoperative data favoring group II over group I regarding ventilation duration, intensive care unit stay, total hospital stay, and blood transfusion (P value < 0.001 each).

Conclusion
Both transcatheter device closure and surgical repair are effective treatments. In contrast, the psychological profile of the transcatheter device was superior to the surgical repair, especially in terms of avoiding sternotomy scar, blood loss and transfusion, and hospital stay. On the other hand, transcatheter intervention is limited only to the anatomically suitable ventricular septal defects, in addition, surgical backup is a must in case of complicated transcatheter closure, which gives the upper hand to surgery to be the recommended approach for most of the ventricular septal defects.

Clinical registration number
NCT05306483 registered 04/05/2022 (retrospectively registered) at ClinicalTrials.gov PRS.

Graphical Abstract
Implementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study
Authors: Simpson Matthew J. , Ritger Carly , Hoppe Jason A. , Holland Wesley C. , Morris Megan A. , Nath Bidisha , Melnick Edward R. , Tietbohl Caroline 
Published: April 2023

Abstract
Background
Untreated opioid use disorder (OUD) is a significant public health problem. Buprenorphine is an evidence-based treatment for OUD that can be initiated in and prescribed from emergency departments (EDs) and office settings. Adoption of buprenorphine initiation among ED clinicians is low. The EMBED pragmatic clinical trial investigated the effectiveness of a clinical decision support (CDS) tool to promote ED clinicians’ behavior related to buprenorphine initiation in the ED. While the CDS intervention was not associated with increased rates of buprenorphine treatment for patients with OUD at intervention ED sites, attending physicians at intervention EDs were more likely to initiate buprenorphine at least once over the duration of the study compared to those in the usual care arms (44.4% vs 34.0%, P = 0.01). This suggests the CDS intervention may be associated with increased adoption of buprenorphine initiation. As a secondary aim, we sought to identify the determinants of CDS adoption, implementation, and maintenance in a variety of ED settings and geographic locations.

Methods
We purposively sampled and conducted semi-structured, in-depth interviews with clinicians across EMBED trial sites randomized to the intervention arm from five healthcare systems. Interviews elicited clinician experiences regarding buprenorphine initiation and CDS use. Interviews were analyzed using directed content analysis informed by the Practical, Robust Implementation and Sustainability Model (PRISM). We used a hybrid approach (a priori codes informed by PRISM and emergent codes) for codebook development. ATLAS.ti (version 9.0) was used for data management. Coded data were analyzed within individual interview transcripts and across all interviews to identify major themes. This process involved (1) combining, comparing, and making connections between codes; (2) writing analytic memos about observed patterns; and (3) frequent team meetings to discuss emerging patterns.

Results
Twenty-eight interviews were conducted. Major themes that influenced the successful adoption, implementation, and maintenance of the EMBED intervention and ED-initiated BUP were organizational culture and commitment, clinician training and support, the ability to connect patients to ongoing treatment, and the ability to tailor implementation to each ED. These findings informed the identification of implementation strategies (framed using PRISM domains) to enhance the ED initiation of buprenorphine.

Conclusion
The findings from this qualitative analysis can provide guidance to build better systems to promote the adoption of ED-initiated buprenorphine.
Transthoracic Echocardiographic Assessment of the Heart in Pregnancy—a position statement on behalf of the British Society of Echocardiography and the United Kingdom Maternal Cardiology Society
Authors: Curtis Stephanie L. , Belham Mark , Bennett Sadie , James Rachael , Harkness Allan , Gamlin Wendy , Thilaganathan Baskaran , Giorgione Veronica , Douglas Hannah , Carroll Aisling , Kitt Jamie , Colebourn Claire , Ribeiro Isabel , Fairbairn Sarah , Augustine Daniel X. , Robinson Shaun , Thorne Sara A. 
Published: April 2023

AbstractPregnancy is a dynamic process associated with profound hormonally mediated haemodynamic changes which result in structural and functional adaptations in the cardiovascular system. An understanding of the myocardial adaptations is important for echocardiographers and clinicians undertaking or interpreting echocardiograms on pregnant and post-partum women. This guideline, on behalf of the British Society of Echocardiography and United Kingdom Maternal Cardiology Society, reviews the expected echocardiographic findings in normal pregnancy and in different cardiac disease states, as well as echocardiographic signs of decompensation. It aims to lay out a structure for echocardiographic scanning and surveillance during and after pregnancy as well as suggesting practical advice on scanning pregnant women.
A case of adult granulosa cell tumor presenting as thoracic lesions
Authors: Suzuki Kosuke , Kitami Akihiko , Okada Momoka , Takamiya Shinnosuke , Ohashi Shinichi , Tanaka Yoko , Uematsu Shugo , Nemoto Tetsuo , Kadokura Mitsutaka 
Published: April 2023

Abstract
Background
Granulosa cell tumors (GCTs) are uncommon sex cord-stromal ovarian neoplasms. We report a case of GCT presenting in the chest, 18 years after oophorectomy for ovarian cystadenocarcinoma.

Case presentation
A 63-year-old female was admitted to our hospital for evaluation of a right hilar lesion. Subsequent abdominal and pelvic computed tomography and brain magnetic resonance imaging were unremarkable. Eighteen years earlier, the patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy at another institution for a uterine myoma, with the pathological findings indicating a uterine myoma, dermoid cyst of the right ovary, and serous cystadenocarcinoma and endometrioid adenoacanthofibroma around hemorrhagic cyst of the left ovary. No indication of a granulosa cell tumor (GCT) was present in either ovary. As such, diagnostic video-assisted thoracoscopic surgery was performed, revealing a well encapsulated tumor located next to the inferior pulmonary vein and small, disseminated lesions on the chest wall and diaphragm. Thereafter, we performed resection of the main tumor in its entirety and the disseminated lesions to the extent possible. Pathological examination of the resected specimens revealed a neoplasm characterized by sheets and islands of closely packed tumor cells exhibiting small follicles (Call-Exner bodies) surrounded by cells with pale, uniform nuclei, typically observed in the microfollicular pattern of adult GCT. Although the etiology of occurrence of intrathoracic granulosa cell tumor is unknown, we assumed that the neoplasm oriented from radiologically undetectable peritoneal seeding at the time of her previous surgery, with subsequent migration through the diaphragm. Over the next 10 years, she received chemotherapy with cyclophosphamide, adriamycin, and cisplatin; other combination chemotherapy; single-agent chemotherapy; and palliative radiotherapy. She died from malignant pleuritis and peritonitis 10 years after thoracoscopic surgery.

Conclusions
We have reported a case of a 63-year-old female with a history of ovarian cystadenocarcinoma who underwent resection of a pleural neoplasm, which turned out to be a granulosa cell tumor. This possibility resulted from dissemination of a previous abdominal lesion.
Managing Estrogen Therapy in the Pituitary Patient
Authors: Shoung Nicholas , Ho Ken K Y 
Published: April 2023

Abstract
Growth hormone (GH) regulates metabolic and physical health in the adult human. Because the GH system is regulated by estrogens, therapeutic estrogen compounds are likely to affect metabolic health. Estrogens are available for oral and parenteral use in natural, prodrug, and synthetic formulations including selective estrogen receptor modulators (SERMs). This review covers the pharmacology of estrogen and the effects on GH action to inform judicious use in the pituitary patient. The effects on the GH system are route dependent due to first-pass hepatic metabolism. Oral but not parenteral estrogen compounds inhibit GH action, reducing hepatic insulin-like growth factor-1 (IGF-1) production, protein anabolism, and fat utilization. In patients with GH deficiency, oral estrogen therapy exacerbates the degree of hyposomatotrophism and attenuates the beneficial effects of GH replacement therapy, effects that are greater with contraceptive than replacement doses. Surveys report that less than one-fifth of hypopituitary women are appropriately replaced by a transdermal route and up to half on oral therapy are inappropriately treated with contraceptive steroids. In acromegaly, however, estrogens, especially synthetic formulations of greater potency, reduce IGF-1, improving disease control, an effect also observed in men treated with SERMs. The route-dependent effects and potency of estrogen formulations are important considerations for optimizing the management of hypogonadal patients with pituitary disease, in particular GH deficiency and acromegaly. For hypopituitary women, estrogens should be replaced by a nonoral route. For acromegaly, oral estrogen formulations can be considered as simple adjuvant therapy for disease control.
A gut microbiome metabolite paradoxically depresses contractile function while activating mitochondrial respiration
Authors: Naghipour Saba , Fisher Joshua J. , Perkins Anthony V. , Peart Jason N. , Headrick John P. , Toit Eugene F. Du 
Published: April 2023

ABSTRACT
Trimethylamine-N-oxide (TMAO) is an end-product of gut microbiome metabolism linked to cardiovascular disease (CVD). However, precise cardiovascular influences of the TMAO concentrations reported in early or severe disease remain to be detailed. We investigated acute effects of TMAO on cardiac contractile, coronary and mitochondrial function. Male C57Bl/6 mouse hearts were Langendorff perfused to assess concentration-dependent effects of TMAO (1-300 µM) on left ventricular (LV) function, coronary flow and select protein expression. Effects of 10 µM and 100 µM TMAO on LV mitochondrial function were examined via respirometry. TMAO at 10-300 μM concentration-dependently depressed LV contractile function, with coronary flow paralleling changes in isovolumic pressure development. Direct coronary effects were evident at &gt;30 µM TMAO in hearts performing minimal isovolumic work, although this response was reduced by &gt;65%. In contrast, exposure to 10 µM or 100 μM TMAO increased mitochondrial complex I, II and maximal respiratory fluxes while appearing to reduce outer membrane integrity. Expression of phosphorylated AMPKα and total GSK-3β declined. Thus, acute exposure of mouse hearts to TMAO levels reported in advanced CVD significantly inhibits cardiac contractility and induces modest coronary constriction while paradoxically overactivating mitochondrial respiration.
Jumping over fences: why field- and laboratory-based biomechanical studies can and should learn from each other
Authors: Moore Talia Y. , Clifton Glenna T. 
Published: April 2023

ABSTRACT
Locomotor biomechanics faces a core trade-off between laboratory-based and field-based studies. Laboratory conditions offer control over confounding factors, repeatability, and reduced technological challenges, but limit the diversity of animals and environmental conditions that may influence behavior and locomotion. This article considers how study setting influences the selection of animals, behaviors and methodologies for studying animal motion. We highlight the benefits of both field- and laboratory-based studies and discuss how recent work leverages technological advances to blend these approaches. These studies have prompted other subfields of biology, namely evolutionary biology and ecology, to incorporate biomechanical metrics more relevant to survival in natural habitats. The concepts discussed in this Review provide guidance for blending methodological approaches and inform study design for both laboratory and field biomechanics. In this way, we hope to facilitate integrative studies that relate biomechanical performance to animal fitness, determine the effect of environmental factors on motion, and increase the relevance of biomechanics to other subfields of biology and robotics.
The 3Es
Authors: Ford Claire , Kercher Vanessa M. (Martinez) , Kercher Kyle A. 
Published: April 2023

Apply It!After reading this article, the reader should be able to:• Recognize how fitness environments and experiences with fitness professionals may contribute to women's perceived barriers to weightlifting.• Understand commonly reported barriers to weightlifting among women.• Apply the 3E framework in practice to decrease women's reported barriers to weightlifting.
Effects of Sprint Interval and Endurance Respiratory Muscle Training on Postcycling Inspiratory and Quadriceps Fatigue
Authors: SCHAER CORINA E. , ERNE DESIRÉE , TAGELDIN DINA , WÜTHRICH THOMAS U. , BELTRAMI FERNANDO G. , SPENGLER CHRISTINA M. 
Published: April 2023

ABSTRACT

Purpose
We investigated whether a 4-wk period of respiratory muscle endurance training (RMET) or respiratory muscle sprint interval training (RMSIT) would lead to an attenuation of inspiratory muscle and quadriceps fatigue after a bout of high-intensity cycling compared with a placebo intervention (PLAT), as predicted by the respiratory metaboreflex model.

Methods
Thirty-three active, young healthy adults performed RMET, RMSIT, or PLAT. Changes in inspiratory muscle and quadriceps twitches in response to a cycling test at 90% of peak work capacity were assessed before and after training. EMG activity and deoxyhemoglobin (HHb, via near-infrared spectroscopy) of the quadriceps and inspiratory muscles were also monitored during the cycling test, along with cardiorespiratory and perceptual variables.

Results
At pretraining, cycling reduced the twitch force of the inspiratory muscles (86% ± 11% baseline) and quadriceps (66% ± 16% baseline). Training did not attenuate the drop in twitch force of the inspiratory muscles (PLAT, −3.5 ± 4.9 percent-points [p.p.]; RMET, 2.7 ± 11.3 p.p.; RMSIT, 4.1 ± 8.5 p.p.; group–training interaction, P = 0.394) or quadriceps (PLAT, 3.8 ± 18.6 p.p.; RMET, −2.6 ± 14.0 p.p.; RMSIT, 5.2 ± 9.8 p.p.; group–training interaction P = 0.432). EMG activity and HHb levels during cycling did not change after training for either group. Only RMSIT showed a within-group decrease in the perception of respiratory exertion with training.

Conclusions
Four weeks of RMET or RMSIT did not attenuate the development of exercise-induced inspiratory or quadriceps fatigue. The ergogenic effects of respiratory muscle training during whole-body exercise might be related to an attenuation of perceptual responses.
Single-cell transcriptional uncertainty landscape of cell differentiation
Authors: Gao Nan Papili , Gandrillon Olivier , Páldi András , Herbach Ulysse , Gunawan Rudiyanto 
Published: April 2023

Background: Single-cell studies have demonstrated the presence of significant cell-to-cell heterogeneity in gene expression. Whether such heterogeneity is only a bystander or has a functional role in the cell differentiation process is still hotly debated. Methods: In this study, we quantified and followed single-cell transcriptional uncertainty – a measure of gene transcriptional stochasticity in single cells – in 10 cell differentiation systems of varying cell lineage progressions, from single to multi-branching trajectories, using the stochastic two-state gene transcription model. Results: By visualizing the transcriptional uncertainty as a landscape over a two-dimensional representation of the single-cell gene expression data, we observed universal features in the cell differentiation trajectories that include: (i) a peak in single-cell uncertainty during transition states, and in systems with bifurcating differentiation trajectories, each branching point represents a state of high transcriptional uncertainty; (ii) a positive correlation of transcriptional uncertainty with transcriptional burst size and frequency; (iii) an increase in RNA velocity preceding the increase in the cell transcriptional uncertainty. Conclusions: Our findings suggest a possible universal mechanism during the cell differentiation process, in which stem cells engage stochastic exploratory dynamics of gene expression at the start of the cell differentiation by increasing gene transcriptional bursts, and disengage such dynamics once cells have decided on a particular terminal cell identity. Notably, the peak of single-cell transcriptional uncertainty signifies the decision-making point in the cell differentiation process.