bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcatheter Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: Results from a Multicenter Registry Study
Authors: Gao Xiaofei , Zhang Juan , Kong Xiangquan , Chen Jing , Chen Xiang , Zhang Longyan , Cai Xinyong , Zhu Jiancheng , Tian Nailiang , Ge Zhen , Wang Bin , Zhou Qing , Su Xi , Hong Lang , Wang Yan , Jiang Hong , Zhang Junjie , Chen Shaoliang 
Published: September 2023

Objective:
Patients with untreated severe aortic regurgitation (AR) have a high risk of mortality. Transfemoral transcatheter aortic valve replacement (TF-TAVR) is a treatment option for AR; however, the safety and efficacy of this technique have not been sufficiently established. This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR.

Methods:
Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers. The primary endpoint was device success at 1 month after TAVR. The secondary endpoint was the composite of major adverse cardiovascular events (MACE) at 6 months, including all-cause death, ischemic stroke, emergency conversion to cardiac surgery, and permanent pacemaker implantation. Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up. Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors.

Results:
Between September 2019 and February 2022, 79 patients with AR were enrolled in the study. At 1 month, device success was achieved in 60 (75.9%) patients. By 6 months, 29 (36.7%) patients had MACE. Echocardiography revealed improved left ventricular function after TAVR. Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons (STS) risk score (odds ratio (OR) 0.760, 95% confidence interval (CI): 0.584–0.989; P = 0.041) and annulus perimeter (OR 0.888, 95% CI: 0.796–0.992; P = 0.035) were 2 predictors of device success. Moreover, annulus perimeter (<80.2 mm), but not STS risk score, was associated with a significant reduction in MACE at 6 months (hazard ratio (HR) 2.223, 95% CI: 1.060–4.659; P = 0.028).

Conclusions:
TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR, particularly those with a less enlarged annulus.
Epidemiological characteristics of centenarian deaths in China during 2013–2020: A trend and subnational analysis
Authors: Mao Fan , Zhang Weiwei , Yin Peng , Wang Lijun , You Jinling , Liu Jiangmei , Liu Yunning , Zhou Maigeng 
Published: September 2023

Abstract

Background:
Studies that comprehensively address the characteristics of centenarian deaths are rare. The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.

Methods:
Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China, including date, place of death (PoD), and underlying cause of death (CoD). Descriptive analyses were performed to understand the epidemiological characteristics, and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs, CoDs among centenarians, and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older.

Results:
There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females (73.10%) and 12,627 males (26.90%). January (12.05%), February (9.99%), and December (9.74%) were the top three months with the highest number of deaths. The proportions of deaths that occurred in homes, hospitals, and nursing homes were 81.71%, 13.63%, and 2.68%, respectively. The proportion of deaths in nursing homes increased by 9.60% (95% confidence intervals [CIs], 6.4–12.9%) from 2014 to 2020. Heart disease (35.72%) was the leading cause of death, followed by respiratory diseases (17.63%), cerebrovascular disease (15.60%), and old age (11.22%). The proportion of respiratory diseases decreased by 4.8% (95% CI, –8.8 to –0.7%), and the proportion of deaths from old age decreased by 2.3% (95% CI, –4.4 to –0.1%) per year. Shanghai had the highest proportions of deaths in hospitals (39.38%) and nursing homes (14.68%). Sichuan had the highest proportion of deaths attributed to respiratory diseases (32.30%), while Jiangsu (26.58%) and Zhejiang (23.61%) had the highest proportions of deaths from old age.

Conclusion:
Unlike other countries, centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths, and this death pattern differs across provinces.
Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces
Authors: Boonipat Thanapoom , Hebel Nathan S. D. , Shapiro Daniel , Stotland Mitchell A. 
Published: September 2023

Background:
This study considers observers’ reflexive responses to the rejuvenated face, and how instinctive responses relate to subjective judgment. We investigated observers’ reflexive perception of faces both pre and post surgical intervention during the early stages of visual processing. Subjective character attribution for all test images was also assessed by the same observers.

Method:
Forty frontal facial images of 20 patients portraying the pre- and postoperative high superficial musculoaponeurotic system facelift along with variable concomitant procedures were studied. Nineteen lookzone regions were mapped post hoc onto each image. Forty observers examined the images, whereas an eye-tracking camera recorded their eye movements. Visual fixation data were recorded and analyzed. Observers also rated each image on the basis of five elemental positive character attributes.

Results:
A statistically coherent but nonsignificant (P > 0.05) trend was identified with the surgical intervention resulting in greater attention being paid to the central triangle region of the face with reduction in attention to the facial periphery. Facial rejuvenation significantly increased the subjective character ratings of all five positively valenced attributes tested. Average age estimate of the photos decreased significantly from 54 to 48.6 years (true average age of 57.4 years).

Conclusions:
We provide data illustrating both reflexive and subjective responses to facial rejuvenation. Observers reported a more favorable impression of the treated faces and evaluated them as being younger than their true age. A trend was detected for increased visual fixation of the central facial region following rejuvenation. Interpretation of these findings and indication for further research is provided.
The Ergonomic FALD Flap for One-stage Total Breast Reconstruction
Authors: Longo Benedetto , D’Orsi Gennaro , Giacalone Martina , Pistoia Angelica , Vanni Gianluca , Buonomo Claudio Oreste , Farcomeni Alessio , Cervelli Valerio 
Published: September 2023

Background:
The fat-augmented latissimus dorsi (FALD) flap combines this pedicled flap with immediate intraoperative fat transfer. Very little is described concerning its inset at the mammary site. Our efforts have concentrated on seeking the best flap orientation and skin-adipose paddle shaping, to improve the aesthetic outcome and to obtain a complete breast reconstruction (BR) in one stage.

Methods:
A prospective clinical study was performed in patients who underwent BR with FALD flaps, between December 2020 and March 2022. Patients were randomly enrolled into two groups: ergonomic inset of the FALD flap with vertical orientation of the skin-adipose paddle (group A) and FALD flap with traditional horizontal paddle orientation (group B). The study’s endpoints were the evaluation of the aesthetic outcomes (from patients’ and surgeon’s perspectives) and complications.

Results:
Thirty-two FALD flaps (23 patients) were performed for group A, and 31 FALD flaps (25 patients) for group B. The two groups were homogeneous in terms of demographic and surgical data (P > 0.05). The overall complication rate was homogeneous among the groups, without statistically significant differences (P = 1.00). The surgeon’s assessments showed a statistically significant superior aesthetic outcome in group A regarding volume, symmetry, and shape (P < 0.05). Higher satisfaction was observed in group A patients, in terms of breast size (P < 0.00001), shape (P = 0.0049), and overall satisfaction (P = 0.00061).

Conclusions:
The ergonomic vertical FALD flap technique enables surgeons to perform one-stage total BR, with excellent breast projection and upper pole fullness. These refinements in flap shaping and molding reduced the need for further autologous fat transfer, obtaining a brilliant totally autologous BR without the need for microsurgical experience.
PREDICTIVE ROLES OF QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES IN PROGNOSIS OF MYOPIC CHOROIDAL NEOVASCULARIZATION
Authors: Liu Jing , Song Shuang , Gu Xiaoya , Yu Xiaobing 
Published: September 2023

Purpose:
To explore the predictive roles of the morphologic features of neovascularization in the prognosis of myopic choroidal neovascularization.

Methods:
In this retrospective case series study, quantitative morphologic features of neovascularization were obtained from the optical coherence tomography angiography images. According to the number of anti-vascular endothelial growth factor injections administered within 1 year, the eyes were classified into a stable group (≤2 injections) or an unstable group (>2 injections). Best-corrected visual acuity was recorded before the treatment and at the 1-year follow-up.

Results:
Overall, 50 eyes with treatment-naive myopic choroidal neovascularization were included; 26 in the stable group and 24 in the unstable group. Multivariate analysis showed that the eyes in the unstable group were associated with a larger lesion area (odds ratio = 2.596, P = 0.012), higher junction density (odds ratio = 1.611, P = 0.014), and higher end point density (odds ratio = 1.435, P = 0.023).The area under the receiver operating characteristic curve of the multivariate model was 0.865, with 91.7% sensitivity and 65.4% specificity. The final best-corrected visual acuity was significantly correlated with the lesion area (β = 0.152, P = 0.032) after adjusted for age, sex, and baseline best-corrected visual acuity.

Conclusion:
Lesions with larger areas and higher end point and junction densities tended to have more frequent anti-vascular endothelial growth factor injections and worse visual outcomes in eyes with myopic choroidal neovascularization.
A MULTICENTER STUDY OF RETINOPATHY OF PREMATURITY FOLLOW-UP ADHERENCE
Authors: Mahmud Fahim , Karmouta Reem , Strawbridge Jason C. , Prasad Pradeep , Chu Alison , Khitri Monica , Tsui Irena 
Published: September 2023

Purpose:
Characterize clinical and socioeconomic factors that impact follow-up to complete retinal vascularization and subsequent pediatric ophthalmology follow-up in neonates with retinopathy of prematurity.

Methods:
Medical records of 402 neonates diagnosed with retinopathy of prematurity from neonatal intensive care units at the University of California, Los Angeles Mattel Children's Hospital and the University of California, Los Angeles Santa Monica Hospital, both academic medical centers, and the Harbor-University of California, Los Angeles Medical Center, a safety-net county hospital, were reviewed. Primary study outcomes were the rate of follow-up to complete retinal vascularization and adequate pediatric ophthalmology follow-up. Secondary outcome was the rate of nonretinal ocular comorbidity.

Results:
In whole-cohort analysis, 93.6% of neonates were followed to complete retinal vascularization, and 53.5% had adequate pediatric ophthalmology follow-up. Public insurance was associated with lower rates of pediatric ophthalmology follow-up (Odds ratio 0.66, 95% confidence interval 0.45–0.98, P = 0.04). Participants screened at the academic medical center had lower rates of pediatric ophthalmology follow-up compared with the safety-net county hospital (50.7% vs. 63.5%, P = 0.034). In subgroup analysis, academic medical center participants with public insurance were less likely to have pediatric ophthalmology follow-up than safety-net county hospital participants with public insurance (36.5% vs. 63.8%, P < 0.001) or those with private insurance at the academic medical center (36.5% vs. 59.2%, P< 0.001).

Conclusion:
This study identified high follow-up rates to complete retinal vascularization, lower pediatric ophthalmology follow-up rates, and nonretinal ocular comorbidity at all hospitals. Insurance status relative to hospital type was identified as a risk factor for loss to follow-up. This demonstrates a need to further study health care disparities in retinopathy of prematurity infants.
Evaluating the forces involved in bubble management in DMEK surgery: mathematical and computational model with clinical implications
Authors: Lockington David , Brown Gordon , Pearce Chris , Kaczmarczyk Lukasz 
Published: September 2023

Purpose:
To model postoperative forces involved in Descemet membrane endothelial keratoplasty (DMEK) tissue adherence and bubble management, including the impact of surface tension on graft support, with a view towards clinical applications.

Setting:
Tennent Institute of Ophthalmology, Glasgow, and James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom.

Design:
Mathematical modelling and computer simulation.

Methods:
Theoretical modelling of biphasic flow and interaction of gas, liquid and tissue within the anterior chamber for static horizontal scenario A (adherent DMEK with mobile bubble) and dynamic vertical scenario B (release of bubble due to pupil block following DMEK).

Results:
The model assumed incompressibility for both fluids within realistically achievable pressure ranges. Cahn-Hilliard Navier-Stokes equations were discretised through the application of the Finite Element Method. Mathematical modelling and computer simulation showed bubble size, corneal curvature and force intensity influences surface tension support for DMEK tissue in scenario A. Scenario B demonstrated complex, uneven distribution of surface pressure on the DMEK graft during uncontrolled bubble release. Uneven pressure concentration can cause local tissue warping, with air/fluid displacement via capillary waves generated on the fluid-air interface adversely impacting DMEK support.

Conclusions:
We have quantitatively and qualitatively modelled the forces involved in DMEK adherence in normal circumstances. We have shown releasing air/gas can abruptly reduce DMEK tissue support via generation of large pressure gradients at the liquid/bubble/graft interfaces, creating negative local forces. Surgeons should consider these principles to reduce DMEK graft dislocation rates via optimised bubble size to graft size, longer acting bubble support and avoiding rapid decompression where possible.
Deep learning using computed tomography to identify high-risk patients for acute small bowel obstruction: development and validation of a prediction model : A retrospective cohort study
Authors: Oh Seungmin , Ryu Jongbin , Shin Ho-Jung , Song Jeong Ho , Son Sang-Yong , Hur Hoon , Han Sang-Uk 
Published: September 2023

Objective:
To build a novel classifier using an optimized 3D-convolutional neural network for predicting high-grade small bowel obstruction (SBO).

Summary Background Data:
Acute SBO (ASBO) is one of the most common acute abdominal diseases requiring urgent surgery. While AI and abdominal CT have been used to determine surgical treatment, differentiating normal cases, high-grade small bowel obstruction (HGSBO) requiring emergency surgery, and low-grade SBO or paralytic ileus (LGSBO) is difficult.

Methods:
A deep learning classifier was used to predict high-risk ASBO patients using CT images at a tertiary hospital. Images from three groups of subjects (normal, nonsurgical, and surgical) were extracted; the dataset used in the study included 578 cases from 250 normal subjects, with 209 HGSBO and 119 LGSBO patients; over 38,000 CT images were used. Data were analyzed from June 1, 2022, to February 5, 2023. The classification performance was assessed based on accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve.

Results:
After 5-fold cross-validation, the WideResNet classifier using dual-branch architecture (DBA) with depth retention pooling (DRP) achieved an accuracy of 72.6%, an area under receiver operating characteristic of 0.90, a sensitivity of 72.6%, a specificity of 86.3%, a positive predictive value of 74.1%, and a negative predictive value of 86.6% on all the test sets.

Conclusions:
These results show the satisfactory performance of the deep learning classifier in predicting HGSBO compared to the previous machine learning model. The novel 3D classifier with DBA and DRP based on AI algorithms could be a reliable screening and decision-support tool for high-risk patients with SBO.
Laparoscopic natural orifice specimen extraction (NOSE) colectomy versus conventional laparoscopic colorectal resection in patients with rectal endometriosis: a randomized, controlled trial
Authors: Dobó Noémi , Márki Gabriella , Hudelist Gernot , Csibi Noémi , Brubel Réka , Ács Nándor , Bokor Attila 
Published: September 2023

Background:
The conventional laparoscopic approach for the surgical management of deep endometriosis (DE) infiltrating the rectum appears to ensure improved digestive functional outcomes. The natural orifice specimen extraction (NOSE) technique for the treatment of colorectal DE can significantly accelerate postoperative recovery; however, data on gastrointestinal function following conventional laparoscopic segmental bowel resection (CLR) compared with NOSE-colectomy (NC) for DE are sparse.

Materials and methods:
Between September 30, 2019, and December 31, 2020, a randomized, open-label, two-arm, parallel-group controlled trial with women aged 18–45 years was conducted at University Hospital.
91 patients were randomized to CLR or NC, with DE infiltrating at least the muscular layer, at least 50% of the circumference of the bowel, up to 15 cm from the anal verge, exhibiting pain and bowel symptoms and/or infertility. The primary endpoint was bowel function, represented by Low Anterior Resection Syndrome (LARS). Secondary parameters included the Endometriosis Health Profile 30 (EHP30), Gastrointestinal Quality of Life Index (GIQLI), Visual Analog Scale (VAS) scores preoperatively and at set times (one and six months, one year) following surgery.

Results:
No significant differences were observed in the postoperative LARS scores, VAS, EHP30, and GIQLI between the NC and CLR groups. LARS scores did not reveal significant differences 12 months postoperatively compared to the preoperative values in both groups (CLR-group P=0.93 versus NC-group, P=0.87). GIQLI scores were significantly improved 12 months after the operation compared with baseline values in the CLR-group (P=0.002) and NC-group (P=0.001). Pain symptoms and quality of life scores significantly improved 12 months postoperatively in both groups.

Conclusions:
NC is a feasible surgical approach for treating patients with rectal DE. Our study did not show a statistically significant difference between CLR and NC techniques in mid-term digestive and pain outcomes.
Pregnancy outcomes following self-reported and objective-measured exposure to oral preexposure prophylaxis in South Africa
Authors: Joseph Davey Dvora Leah , Nyemba Dorothy C. , Mvududu Rufaro , Mashele Nyiko , Johnson Leigh , Bekker Linda-Gail , Dean Sarah Schoetz , Bheemraj Kalisha , Coates Thomas J. , Myer Landon 
Published: September 2023

Objective:
To compare pregnancy outcomes using self-reported and objective levels of intracellular tenofovir diphosphate (TFV-DP) in pregnant women using preexposure prophylaxis (PrEP).

Design:
We enrolled pregnant women >15 years without HIV at first antenatal care visit in an observational cohort study to compare pregnancy outcomes by PrEP use.

Methods:
Exposure defined as: any PrEP use [tenofovir disoproxil and emtricitabine (TDF/FTC]) prescription + reported taking PrEP], or objectively-measured TFV-DP in dried blood spots in PrEP-using pregnant women. The primary outcome was a composite of pregnancy loss, preterm birth (<37weeks), low birthweight (<2500 g), small for gestational age ([SGA] ≤ tenth percentile), or neonatal death. Multivariable logistic regression models evaluated individual and composite adverse outcomes by self-reported or objectively measured PrEP use adjusting for age, gestational age, gravidity and socio-economic status.

Results:
Between August 19 and February 23, we followed 1195 pregnant women and ascertained 1145 pregnancy outcomes (96%); 72% (n = 826) reported taking PrEP while pregnant, 16% did not take PrEP (n = 178), 12% were unconfirmed (n = 141). Overall, 94.5% (n = 1082) had singleton live births with a median birthweight of 3.2 kg [interquartile range (IQR) = 2.9–3.5], with no difference in pregnancy loss between self-reported PrEP exposed vs. unexposed [4.0 vs. 5.6%; adjusted odds ratio (aOR) = 0.65, 95% confidence interval (CI) = 0.32–1.47]. Composite adverse outcomes did not differ by reported PrEP use (20% for both groups; aOR = 1.07, 95% CI = 0.71–1.63). Comparing objective PrEP use (any TFV-DP vs. no TFV-DP or not on PrEP), adverse outcomes did not differ (aOR = 0.64, 95% CI = 0.39–1.04), nor did other outcomes including preterm birth nor SGA.

Conclusions:
Pregnancy outcomes did not differ by PrEP exposure (self-reported or objective), suggesting real-world efficacy that TDF/FTC as PrEP is safe in pregnancy.
Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection: Reviewing the ChEETAh Trial
Authors: Ferreira Julia , Joos Emilie , Bhandari Mohit , Dixon Elijah , Brown Carl J ,   on behalf of the Evidence-Based Reviews in Surgery (EBRS) group
Published: September 2023

Summary:
“Evidence-Based Reviews in Surgery” (EBRS) was developed to foster critical appraisal skills in practicing surgeons and trainees in order that they may evaluate surgical literature and practice Evidence-based Based Surgery. EBRS virtually connects experts in clinical surgery and evidence-based methodology to collaboratively assess the strengths and weaknesses of current practice compared to the risks and benefits of new approaches to care. Since the inception of EBRS, summaries of each review have been published. The present article is a comprehensive review of the ChEETAh trial, investigating the effectiveness of routine glove and instrument change before abdominal wound closure to prevent surgical site infection (SSI). The trial was conducted in low- and middle-income countries (LMICs) and employed a cluster-randomized design. The results indicate a statistically significant reduction in SSI rates. Although the ChEETAh trial has strengths, caution is advised before implementing the intervention globally. The study's clinical relevance and cost-effectiveness need to be considered, and targeted implementation in specific patient clusters and hospitals with the necessary resources is recommended. Institutions should not only assess their unique circumstances (resources, baseline SSI rates, and use of other effective preventive measures) before implementing glove and instrument changes in their setting but also monitor their outcomes and costs should they choose in favor of implementation. Further research, including long-term effects, is suggested to refine the understanding of the intervention's implications in diverse settings.