bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEMORRHOIDS AGAIN?
Authors: López J , Quinto S , López de Lerma C , López-Rodríguez F , Sánchez L , Oller I , Arroyo A , Lacueva J 
Published: January 2023

Abstract

Introduction
Anal cancer represents 4% of digestive tract tumors, although its incidence is increasing due to the growing number of patients with HPV infection, who are immunosuppressed or who practice anal sex. The most common histological type is carcinoma and the usual standard treatment is the combination of radiotherapy with chemotherapy. Survival at 5 years exceeds 50% even in patients with nodal disease.

Clinical case
We present the case of a 54-year-old man, with a history of anal intercourse, referred to General Surgery for hemorrhoids. During the examination in consultation, an ulcerated excrescent anal lesion was observed. A rectal swab was taken for sexually transmitted diseases and a biopsy of the lesion was HPV+, genotype 16. In the pathology study, anal squamous cell carcinoma was diagnosed. An extension study was performed, objectifying bilateral inguinal lymphadenopathies (N1a) and treatment with radiochemotherapy was started after a decision made by the multidisciplinary tumor committee.

Discussion
Anal squamous cell carcinoma is the most frequent histological variety of malignant tumors of the anus. The first-line treatment is radiotherapy (which must be to the inguinal region) associated with chemotherapy (5-FU and mitomycin C). A clinical follow-up should be carried out in all cases at 8–12 weeks and, in addition, an annual extension radiological study in locally advanced cases. Rescue surgery will be reserved for those patients with confirmed locoregional recurrence, with abdominoperineal amputation being the indicated technique in most cases.
CASES' DIAGNOSED WITH SPONDYLODISCITIS DURING THE YEARS 2010–2020. DIAGNOSIS, TREATMENT AND COMPLICATIONS
Authors: González-Herráez Fernández P , Rodríguez Dopazo M , Adeba García M , Adeba García A , Meneses Gutiérrez A , García Arias A , Cabria Fernández J , Mateo Negreira J 
Published: January 2023

Abstract

Introduction
Spondylodiscitis is a rare infectious pathology with high morbidity and mortality that affects the intervertebral disc and adjacent vertebrae. It is most commonly found in the lumbar spine. It is mainly caused by haematogenous dissemination. It is a diagnostic challenge because its main manifestation, low back pain, is a prevalent symptom in the population.

Methods
A retrospective study of patients diagnosed with spondylodiscitis between 2010–2020 (n=60) was carried out. Exclusion criteria (n=14): follow-up less than one year, previous spinal surgery, first year mortality. Measurements made in plain radiology. Statistical analysis STATA 15.2. Statistical significance p&lt;0,05.

Results
Average age: 68.17 years, 55% were males, 45% were females. Risk factors analyzed: 26.09% of the patients had diabetes, 8.70% kidney disease, 6.52% rheumatism, 6.52% were PVDA; about smoking 10.87% were smokers, 17.39% ex-smokers and the 71.74% were non-smokers; 8.70% had prescriptions of immunosuppressants and 19.57% had cancer before or during this episode. 50% had previous infection (n=23); 34.78% had urinary infection, 13.04% had knee prosthesis, 8.69% had respiratory infection, endocarditis the 30.43%, 17.36% had another sort of infection. The average delay to diagnosis was 40.36 days (SD 37.68). Total duration of antibiotic therapy, including days of hospital stay and those which were ambulatory: 134 days (SD 129.96); duration of hospitalization: 43 days. Surgical treatment was performed in 15.56% of the patients. a spacer was the technique used in the 14.29% of the patients; although the fixation was used in the 71.42% of the patients, the majority was a posterior fixation with the 57.14%, the anterior fixation was only used in the 14.29%. The acute complications found in this study were in this order, abscess with nearly half of the patients (n=22), phlegmon (n=3), vertebral destruction (n=2) and meningitis (n=1). No differences were obtained in the angle of kyphosis after pathology (p. 052), no increase in complications due to surgery (p=0.62), no difference in the cure of patients with targeted treatment (p=0.57), nor with surgical treatment (p=0.95), nor in the percentage of cure with diagnostic delay (p=0.76).

Conclusions
Spondylodiscitis is a pathology with non-specific symptoms, which leads to diagnostic delay. The cure rate with medical treatment is high, but it is essential to identify the causal germ in order to initiate targeted antibiotherapy and avoid the appearance of complications and long-term sequelae.
LATE HAEMOPHILLUS ENDOCARDITIS AFTER SEPTAL CLOSURE BY AMPLATZER
Authors: Vázquez Alarcón de la Lastra I , Bustamante Munguira J , Fernández Gutiérrez M , Segura Méndez B , Sánchez Torralvo C , Velasco García E , Feliz Pérez D , Bernal Esteban R 
Published: January 2023

Abstract

Introduction
Atrial septal defects are the second most frequent congenital heart diseases and their treatment of choice is the percutaneous approach. Complications associated are infrequent and are mainly related with the puncture. Other complications such as embolism or endocarditis are uncommon.

Clinical case
A 17-year-old woman whose only medical history of interest was an ostium secundum-type atrial septal defect that was treated percutaneously implanting a 24-mm Amplatzer septal occlude. 15 months after the procedure she came to the emergency room presenting 40°C fever and a headache. Physical examination and tests results were normal, being discharged with antibiotic treatment. She returned 24 hours later due to persistence of the same symptoms. An echocardiogram was performed, revealing an endocarditic growth and uncomplete endothelization of the amplatzer. Following 10 days of antibiogram-guided therapy with good response, she underwent surgery. The device was extracted and the defect closed. PCR was positive for H. Parainfluenzae. The patient was discharged on the 7th day with antibiotic therapy.

Discussion
This case is relevant due to the late presentation of IE, incomplete endothelization and to being caused by infrequent IE germ source with a negative blood culture. Despite the low prevalence of these complications, it is necessary to rule them out through imaging tests as well as microbiological tests. Appropriate length of bacterial coverage usually extends from 6 months to 1 year after implantation. Documented cases of prosthetic IE related to incorrect endothelial coverage can lead to reassessing the time period during which prophylaxis should be maintained.
TUMORAL MASS AS CAUSE OF RIGHT CARDIAC INSUFFICENCY
Authors: Vázquez Alarcón de la Lastra I , Bustamante Munguira J , Fernéndez Gutiérrez M , Segura Méndez B , Sánchez Torralvo C , Velasco García E , Feliz Pérez D , Bernal Esteban R 
Published: January 2023

Abstract

Introduction
The most frequent cardiac primary tumors are Mixomas, typically being located in the left atrium. They are usually incidental findings, but probable symptoms include constitutional syndrome, syncope, congestive symptoms, or embolism. The diagnosis is based upon clinical imaging tests (with the TEE being the test of choice) which define the characteristics of the chosen treatment, surgery.

Clinical case
A 79-year-old female with a medical history of HTA and Diabetes with retinopathy nephropathy. She was hospitalized 2 months earlier with a constitutional syndrome being diagnosed of a Giant cell arteritis. Then she came to the emergency room presenting with oliguria, edema and dyspnea with a 10 kg weight loss. The tests performed showed low voltajes in the EKG, anemization and the TTE showed a mass inside the right atrium. Then she was hospitalized and a CT scan confirmed the presence of an aparent Mixoma. The patient was treated with surgery and the diagnosis was confirmed by pathology.

Discussion
We are describing the case of a pluripathological patient with congestive symptoms due to cardiac insuffciency, so the differential diagnosis must include thromboembolisms, valvulopathies and pulmonary hypertension. The constitutional syndrome can be explained due to the relation of the Mixoma with IL-6 and the anemization could be caused by the hemolyisis of the tumor. After two years of the surgery no further symptoms appeared, and no evidence of the mass where it had been seen in the imaging tests.
PREOPERATIVE ANALYTICAL PREDICTORS OF COMPLICATED ACUTE APPENDICITIS MYTH OR REALITY OF PREDICTIVE SCORES?
Authors: García González L A , Merayo M , Michi Campos J L , Carrasco Beatriz , Rodicio Miravalles J L , Granero Trancon J E 
Published: January 2023

Abstract

Introduction
Acute appendicitis (AA) is the most frequent surgical emergency. Clinical and analytical parameters are the diagnostic basis. We analyze the predictive value of inflammatory markers (IM) and their relationship with complicated appendicitis (cAA), identifying a predictive SCORE.

Methods
Retrospective observational analysis of 484 patients &gt; 14 years operated on for AA at a tertiary center between 2017–2019. 2 groups according to intraoperative findings in complicated and uncomplicated appendicitis (ncAA). Univariate logistic regression analysis was performed to evaluate the predictive ability of leukocyte count (LC), percentage of neutrophils (PN), CRP and polyglobulia) creating a multivariable predictive model.

Results
83.7% &lt;65 years, with ultrasonography being the most frequent diagnostic study and laparoscopy the preferred route of approach. 43.30% (207) complicated vs 54.81% (262) uncomplicated. Both LC and PN and CRP present statistically significant associations with complicated appendicitis, with a cut-off point of LC &gt;18,990, PN &gt;61.8% and CRP &gt;5.05 respectively, while polyglobulia is related to less complication OR 0.63% (p 0.01402). According to the multivariable model 1/ [1 + e - (- 4.45–0.000003 * leukocytes + 0.043 * neutrophil percentage + 0.138 * CRP - 0.028 (if red series anemia) - 1.031 (if red series polyglobulia))] good predictive capacity is evidenced. Harrel's C corrected index of 0.743 CI95% (0.69%-0.78%).

Conclusions
Elevation of IM is associated with cAA. The predictive ability of the described SCORE is acceptable, and useful in surgical planning. Prospective validation is needed.
What Can a Few Make of Mankind?
Authors: Derrig Ríán 
Published: January 2023

Abstract
Harlan Grant Cohen and Timothy Meyer present International Law as Behavior as a collection that aspires to exemplify and set an agenda for an interdisciplinary movement of scholars studying the ‘behavioral roots of international law’. This review essay places the book within a larger context of interactions between behavioural psychology and social sciences. Identifying the origins of contemporary behavioural international law scholarship in behavioural economics, and especially the 1970s work of the psychologists Amos Tversky and Daniel Kahneman, this essay questions the plausibility of the model of human motivation theorized in International Law as Behavior. Moreover, detailed analysis of the consequences of explaining international law phenomena using behavioural concepts demonstrates that responsibility is systematically under-attributed to the powerful and over-attributed to the vulnerable. Ultimately, this essay contends that viewing legal and social phenomena through behavioural psychology offers little explanatory power, while inuring us to a condition of passivity and control, seeking to replace politics with technique.
The Pitfalls of Ineffective Conceptualization: The Case of the Distinction between Procedure and Substance
Authors: Mayer Benoit 
Published: January 2023

Abstract
This review essay explores the distinction that judges and scholars have occasionally made between legal norms that they consider to be procedural and those considered to be substantive in nature. Approaching the issue from different angles, the three books under review all struggle to define procedure and substance as concepts informing a decontextualized distinction among international norms. Overall, they fail to show how this distinction is useful, either to understand what the law is or to account for its evolution. The essay argues that the concepts of ‘procedure’ and ‘substance’ hinder the clarity and, often, the soundness of the analysis presented in these books. At times, this ineffective conceptualization is an intellectual detour that hinders the development of more useful distinctions – for instance, between ‘principal’ and ‘accessory’ obligations, to determine when the breach of an obligation implies the breach of another obligation. Through this case study focused on recent publications on the distinction between procedure and substance, this essay reflects on the capacity of ineffective concepts to hinder the analysis of international law when their relevance and usefulness is too readily taken for granted.
Musical instruments in the Venetian home: contextualizing Marietta Robusti’s self-portrait
Authors: Hurley Bláithín 
Published: January 2023

Abstract
In her self-portrait of c.1578, Marietta Robusti, daughter of Tintoretto, and a successful artist in her own right, represented herself not with the tools of her chosen profession but with a keyboard instrument and holding a music book. Much has been written about how this painting, and others like it, reflect the necessity for well-bred 16th-century young women to promote their musical skills. However, little effort has so far been made to connect the world this image represents with the documentary evidence available in Venetian domestic household inventories. The current article analyses post-mortem and other inventories in order to establish the musical instruments found in 16th-century Venetian homes, and the rooms in which they were found and potentially used. Such inventories, through their employment of simple language and stock descriptive adjectives, offer strong insights into ordinary lives in Renaissance Venice, including the domestic lives of the otherwise invisible musical women of the Venetian household.
Orientation of conduction velocity vectors on cardiac mapping surfaces
Authors: Padilla Jairo Rodriguez , Anderson Robert D , Joens Christian , Masse Stephane , Bhaskaran Abhishek , Niri Ahmed , Lai Patrick , Azam Mohammed Ali , Lee Geoffrey , Vigmond Edward , Nanthakumar Kumaraswamy 
Published: January 2023

AbstractAimsElectroanatomical maps using automated conduction velocity (CV) algorithms are now being calculated using two-dimensional (2D) mapping tools. We studied the accuracy of mapping surface 2D CV, compared to the three-dimensional (3D) vectors, and the influence of mapping resolution in non-scarred animal and human heart models.Methods and resultsTwo models were used: a healthy porcine Langendorff model with transmural needle electrodes and a computer stimulation model of the ventricles built from an MRI-segmented, excised human heart. Local activation times (LATs) within the 3D volume of the mesh were used to calculate true 3D CVs (direction and velocity) for different pixel resolutions ranging between 500 μm and 4 mm (3D CVs). CV was also calculated for endocardial surface-only LATs (2D CV). In the experimental model, surface (2D) CV was faster on the epicardium (0.509 m/s) compared to the endocardium (0.262 m/s). In stimulation models, 2D CV significantly exceeded 3D CVs across all mapping resolutions and increased as resolution decreased. Three-dimensional and 2D left ventricle CV at 500 μm resolution increased from 429.2 ± 189.3 to 527.7 ± 253.8 mm/s (P &lt; 0.01), respectively, with modest correlation (R = 0.64). Decreasing the resolution to 4 mm significantly increased 2D CV and weakened the correlation (R = 0.46). The majority of CV vectors were not parallel (&lt;30°) to the mapping surface providing a potential mechanistic explanation for erroneous LAT-based CV over-estimation.ConclusionVentricular CV is overestimated when using 2D LAT-based CV calculation of the mapping surface and significantly compounded by mapping resolution. Three-dimensional electric field-based approaches are needed in mapping true CV on mapping surfaces.
Improved prediction of sudden cardiac death in patients with heart failure through digital processing of electrocardiography
Authors: Shiraishi Yasuyuki , Goto Shinichi , Niimi Nozomi , Katsumata Yoshinori , Goda Ayumi , Takei Makoto , Saji Mike , Sano Motoaki , Fukuda Keiichi , Kohno Takashi , Yoshikawa Tsutomu , Kohsaka Shun 
Published: January 2023

AbstractAimsAvailable predictive models for sudden cardiac death (SCD) in heart failure (HF) patients remain suboptimal. We assessed whether the electrocardiography (ECG)-based artificial intelligence (AI) could better predict SCD, and also whether the combination of the ECG-AI index and conventional predictors of SCD would improve the SCD stratification among HF patients.Methods and resultsIn a prospective observational study, 4 tertiary care hospitals in Tokyo enrolled 2559 patients hospitalized for HF who were successfully discharged after acute decompensation. The ECG data during the index hospitalization were extracted from the hospitals’ electronic medical record systems. The association of the ECG-AI index and SCD was evaluated with adjustment for left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and competing risk of non-SCD. The ECG-AI index plus classical predictive guidelines (i.e. LVEF ≤35%, NYHA Class II and III) significantly improved the discriminative value of SCD [receiver operating characteristic area under the curve (ROC-AUC), 0.66 vs. 0.59; P = 0.017; Delong’s test] with good calibration (P = 0.11; Hosmer–Lemeshow test) and improved net reclassification [36%; 95% confidence interval (CI), 9–64%; P = 0.009]. The Fine–Gray model considering the competing risk of non-SCD demonstrated that the ECG-AI index was independently associated with SCD (adjusted sub-distributional hazard ratio, 1.25; 95% CI, 1.04–1.49; P = 0.015). An increased proportional risk of SCD vs. non-SCD with an increasing ECG-AI index was also observed (low, 16.7%; intermediate, 18.5%; high, 28.7%; P for trend = 0.023). Similar findings were observed in patients aged ≤75 years with a non-ischaemic aetiology and an LVEF of &gt;35%.ConclusionTo improve risk stratification of SCD, ECG-based AI may provide additional values in the management of patients with HF.
Feasibility and safety of a three-dimensional anatomic map–guided transseptal puncture for left-sided catheter ablation procedures
Authors: Bohnen Marius , Minners Jan , Eichenlaub Martin , Weber Reinhold , Allgeier Hans-Jürgen , Jadidi Amir , Neumann Franz-Josef , Westermann Dirk , Arentz Thomas , Lehrmann Heiko 
Published: January 2023

AbstractAimsTransseptal puncture (TP) for left-sided catheter ablation procedures is routinely performed under fluoroscopic or echocardiographic guidance [transoesophageal echocardiography (TEE) or intracardiac echocardiography (ICE)], although three-dimensional (3D) mapping systems are readily available in most electrophysiology laboratories. Here, we sought to assess the feasibility and safety of a right atrial (RA) 3D map–guided TP.Methods and resultsIn 104 patients, 3D RA mapping was performed to identify the fossa ovalis (FO) using the protrusion technique. The radiofrequency transseptal needle was visualized and navigated to the desired potential FO-TP site. Thereafter, the interventionalist was unblinded to TEE and the potential FO-TP site was reassessed regarding its convenience and safety. After TP, the exact TP site was documented using a 17-segment-FO model. Reliable identification of the FO was feasible in 102 patients (98%). In these, 114 3D map–guided TP attempts were performed, of which 96 (84%) patients demonstrated a good position and 18 (16%) an adequate position after TEE unblinding. An out-of-FO or dangerous position did not occur. A successful 3D map–guided TP was performed in 110 attempts (97%). Four attempts (3%) with adequate positions were aborted in order to seek a more convenient TP site. The median time from RA mapping until the end of the TP process was 13 (12–17) min. No TP-related complications occurred. Ninety-eight TP sites (85.1%) were in the central portion or in the inner loop of the FO.ConclusionA 3D map–guided TP is feasible and safe. It may assist to decrease radiation exposure and the need for TEE/ICE during left-sided catheter ablation procedures.
Two clinical case reports of embryonic mosaicism identified with PGT-A persisting during pregnancy as true fetal mosaicism
Authors: Greco Ermanno , Yakovlev Pavel , Kornilov Nikolay , Vyatkina Svetlana , Bogdanova Daria , Ermakova Marina , Tarasova Yulia , Tikhonov Andrei , Pendina Anna , Biricik Anil , Sessa Maria Teresa , Listorti Ilaria , Ronsini Carlo , Greco Pier Francesco , Victor Andrea , Barnes Frank , Zouves Christo , Spinella Francesca , Viotti Manuel 
Published: January 2023

Abstract
The health risks associated with transferring embryos classified as mosaic by preimplantation genetic testing for aneuploidies (PGT-A) are currently unknown. Such embryos produce PGT-A results indicating the presence of both euploid and aneuploid cells and have historically been deselected from transfer and grouped with uniformly aneuploid embryos as ‘abnormal’. In recent years, numerous groups have reported the intentional transfer of mosaic embryos in the absence of uniformly euploid embryos, largely observing births of seemingly healthy babies. However, it remains to be understood whether the embryonic mosaicism invariably becomes resolved during the ensuing pregnancy, or whether the placenta and/or fetal tissues retain aneuploid cells, and if so to what potential clinical effect. Here, we report two cases of mosaicism persisting from the embryonic stage to the established pregnancy. Case 1 involved an embryonic low-level segmental mosaic loss in Chromosome (Chr) 1, which was confirmed in amniocentesis as well as in brain tissue of the products of conception. This pregnancy was terminated due to the chromosomal pathologies associated with 1p36 deletion syndrome, such as severe intellectual disability. Case 2 involved a low-level mosaic Chr 21 trisomy, which was confirmed with chorionic villus sampling and amniocentesis. The ensuing pregnancy was terminated after ultrasound identification of severe abnormalities in the placenta and fetus. Together, these two cases should be taken into account for risk-benefit assessments of prospective mosaic embryo transfers.
Older Adults’ Concurrent and Retrospective Think-Aloud Verbalizations for Identifying User Experience Problems of VR Games
Authors: Fan Mingming , Tibdewal Vinita , Zhao Qiwen , Cao Lizhou , Peng Chao , Shu Runxuan , Shan Yujia 
Published: January 2023

AbstractWhile virtual reality (VR) games are beneficial for older adults to improve their physical functions and cognitive abilities, VR research often does not include older adults. Our review of the proceedings of major HCI conferences (i.e. ASSETS, CHI, CHI PLAY, CSCW and DIS) between 2016 and 2020 shows that only three out of 352 VR-related papers involved older adults. Consequently, older adults tend to encounter user experience (UX) problems with VR. One common way to identify UX problems is to conduct usability testing with think-aloud (TA) protocols. As VR games tend to be perceptually and physically demanding, older adults might need to allocate more resources to VR content and interaction and thus have fewer resources for thinking aloud. This raises the question of whether TA protocols are still a viable approach to detecting UX problems of VR games for older adult participants. To answer this question, we conducted usability testing with older adults who played two common types of VR games (i.e. the exergame and experience game) using concurrent and retrospective TA protocols (i.e. CTA and RTA), which are widely used in the industry. We analyzed participants’ TA verbalizations and uncovered how different categories of verbalizations indicate UX problems. We further show how older adults perceived the effects of thinking aloud on their game experiences in two TA protocols and offer design implications.