bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Outcomes Among Pregnant Women With Congenital Heart Disease–Associated Pulmonary Hypertension
Authors: Zhang Qian , Zhu Fang , Shi Guocheng , Hu Chen , Zhang Weituo , Huang Puzhen , Zhu Chunfeng , Gu Hong , Yang Dong , Li Qiangqiang , Niu Yonghua , Chen Hao , Ma Ruixiang , Pan Ziyi , Miao Huixian , Zhang Xin , Li Genxia , Tang Yabing , Qiao Guyuan , Yan Yichen , Zhu Zhongqun , Zhang Hao , Han Fengzhen , Li Yanna , Lin Jianhua , Chen Huiwen 
Published: February 2023

Background:
Studies focused on pregnant women with congenital heart disease (CHD)–associated pulmonary hypertension (PH) are scarce and limited by small sample sizes and single-center design. This study sought to describe the pregnancy outcomes in women with CHD with and without PH.

Methods:
Outcomes for pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. PH was diagnosed on the basis of echocardiogram or catheterization. The incidence of maternal death, cardiac complications, and obstetric and offspring complications was compared for women with CHD and no PH, mild, and moderate-to-severe PH.

Results:

A total of 2220 pregnant women with CHD had completed pregnancies. PH associated with CHD was identified in 729 women, including 398 with mild PH (right ventricle to right atrium gradient 30–50 mm Hg) and 331 with moderate-to-severe PH (right ventricle to right atrium gradient >50 mm Hg). Maternal mortality occurred in 1 (0.1%), 0, and 19 (5.7%) women with CHD and no, mild, or moderate-to-severe PH, respectively. Of the 729 patients with PH, 619 (85%) had CHD-associated pulmonary arterial hypertension, and 110 (15%) had other forms of PH. Overall, patients with mild PH had better maternal outcomes than those with moderate-to-severe PH, including the incidence of maternal mortality or heart failure (7.8% versus 39.6%;
P
<0.001), other cardiac complications (9.0% versus 32.3%;
P
<0.001), and obstetric complications (5.3% versus 15.7%;
P
<0.001). Brain natriuretic peptide >100 ng/L (odds ratio, 1.9 [95% CI, 1.0–3.4],
P
=0.04) and New York Heart Association class III to IV (odds ratio, 2.9 [95% CI, 1.6–5.3],
P
<0.001) were independently associated with adverse maternal cardiac events in pregnancy with PH, whereas follow-up with a multidisciplinary team (odds ratio, 0.4 [95% CI, 0.2–0.6],
P
<0.001) and strict antenatal supervision (odds ratio, 0.5 [95% CI, 0.3–0.7],
P
=0.001) were protective.

Conclusions:
Women with CHD-associated mild PH appear to have better outcomes compared with women with CHD-associated moderate-to-severe PH, and with event rates similar for most outcomes with women with CHD and no PH. Multimodality risk assessment, including PH severity, brain natriuretic peptide level, and New York Heart Association class, may be useful in risk stratification in pregnancy with PH. Follow-up with a multidisciplinary team and strict antenatal supervision during pregnancy may also help to mitigate the risk of adverse maternal cardiac events.
Comparative Effectiveness of Left Atrial Appendage Occlusion Versus Oral Anticoagulation by Sex
Authors: Zeitler Emily P. , Kearing Stephen , Coylewright Megan , Nair Devi , Hsu Jonathan C. , Darden Douglas , O’Malley A. James , Russo Andrea M. , Al-Khatib Sana M. 
Published: February 2023

Background:
The comparative real-world outcomes of older patients with atrial fibrillation (AF) treated with anticoagulation compared with left atrial appendage occlusion (LAAO) may be different from those in clinical trials because of differences in anticoagulation strategies and patient demographics, including a greater proportion of women. We sought to compare real-world outcomes between older patients with AF treated with anticoagulation and those treated with LAAO by sex.

Methods:
Using Medicare claims data from 2015 to 2019, we identified LAAO-eligible beneficiaries and divided them into sex subgroups. Patients receiving LAAO were matched 1:1 to those receiving anticoagulation alone through propensity score matching. The risks of mortality, stroke or systemic embolism, and bleeding were compared between matched groups with adjustment for potential confounding characteristics in Cox proportional hazards models.

Results:

Among women, 4085 LAAO recipients were matched 1:1 to those receiving anticoagulation; among men, 5378 LAAO recipients were similarly matched. LAAO was associated with a significant reduction in the risk of mortality for women and men (hazard ratio [HR], 0.509 [95% CI, 0.447–0.580]; and HR, 0.541 [95% CI, 0.487–0.601], respectively;
P
<0.0001), with a similar finding for stroke or systemic embolism (HR, 0.655 [95% CI, 0.555–0.772]; and HR, 0.649 [95% CI, 0.552–0.762], respectively;
P
<0.0001). Bleeding risk was significantly greater in LAAO recipients early after implantation but lower after the 6-week periprocedural period for women and men (HR, 0.772 [95% CI, 0.676–0.882]; and HR, 0.881 [95% CI, 0.784–0.989], respectively;
P
<0.05).

Conclusions:
In a real-world population of older Medicare beneficiaries with AF, compared with anticoagulation, LAAO was associated with a reduction in the risk of death, stroke, and long-term bleeding among women and men. These findings should be incorporated into shared decision-making with patients considering strategies for reduction in AF-related stroke.
Detection of Cardioembolic Sources With Nongated Cardiac Computed Tomography Angiography in Acute Stroke: Results From the ENCLOSE Study
Authors: Kauw Frans , Velthuis Birgitta K. , Takx Richard A.P. , Guglielmo Marco , Cramer Maarten J. , van Ommen Fasco , Bos Anneloes , Bennink Edwin , Marquering Henk A. , Kappelle L. Jaap , de Jong Hugo W.A.M. , Dankbaar Jan W. 
Published: February 2023

Background:
Identifying cardioembolic sources in patients with acute ischemic stroke is important for the choice of secondary prevention strategies. We prospectively investigated the yield of admission (spectral) nongated cardiac computed tomography angiography (CTA) to detect cardioembolic sources in stroke.

Methods:
Participants of the ENCLOSE study (Improved Prediction of Recurrent Stroke and Detection of Small Volume Stroke) with transient ischemic attack or acute ischemic stroke with assessable nongated head-to-heart CTA at the University Medical Center Utrecht were included between June 2017 and March 2022. The presence of cardiac thrombus on cardiac CTA was based on a Likert scale and dichotomized into certainly or probably absent versus possibly, probably, or certainly present. The diagnostic certainty of cardiac thrombus was evaluated again on spectral computed tomography reconstructions. The likelihood of a cardioembolic source was determined post hoc by an expert panel in patients with cardiac thrombus on CTA. Parametric and nonparametric tests were used to compare the outcome groups.

Results:

Forty four (12%) of 370 included patients had a cardiac thrombus on admission CTA: 35 (9%) in the left atrial appendage and 14 (4%) in the left ventricle. Patients with cardiac thrombus had more severe strokes (median National Institutes of Health Stroke Scale score, 10 versus 4;
P
=0.006), had higher clot burden (median clot burden score, 9 versus 10;
P
=0.004), and underwent endovascular treatment more often (43% versus 20%;
P
<0.001) than patients without cardiac thrombus. Left atrial appendage thrombus was present in 28% and 6% of the patients with and without atrial fibrillation, respectively (
P
<0.001). The diagnostic certainty for left atrial appendage thrombus was higher for spectral iodine maps compared with the conventional CTA (
P
<0.001). The presence of cardiac thrombus on CTA increased the likelihood of a cardioembolic source according to the expert panel (
P
<0.001).

Conclusions:
Extending the stroke CTA to cover the heart increases the chance of detecting cardiac thrombi and helps to identify cardioembolic sources in the acute stage of ischemic stroke with more certainty. Spectral iodine maps provide additional value for detecting left atrial appendage thrombus.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04019483.
A Survey on Automatic Delineation of Radiotherapy Target Volume based on Machine Learning
Authors: Tao Zhenchao , Lyu Shengfei 
Published: February 2023

ABSTRACTRadiotherapy is one of the main treatment methods for cancer, and the delineation of the radiotherapy target area is the basis and premise of precise treatment. Artificial intelligence technology represented by machine learning has done a lot of research in this area, improving the accuracy and efficiency of target delineation. This article will review the applications and research of machine learning in medical image matching, normal organ delineation and treatment target delineation according to the procudures of doctors to delineate the target volume, and give an outlook on the development prospects.
Field-level differences in paper and author characteristics across all fields of science in Web of Science, 2000–2020
Authors: Andersen Jens Peter 
Published: February 2023

Abstract
With increasing availability of near-complete, structured bibliographical data, the past decade has seen a rise in large-scale bibliometric studies attempting to find universal truths about the scientific communication system. However, in the search for universality, fundamental differences in knowledge production modes and the consequences for bibliometric assessment are sometimes overlooked. This article provides an overview of article and author characteristics at the level of the OECD minor and major fields of science classifications. The analysis relies on data from the full Web of Science in the period 2000–2020. The characteristics include document type, median reference age, reference list length, database coverage, article length, coauthorship, author sequence ordering, author gender, seniority, and productivity. The article reports a descriptive overview of these characteristics combined with a principal component analysis of the variance across fields. The results show that some clusters of fields allow inter-field comparisons, and assumptions about the importance of author sequence ordering, while other fields do not. The analysis shows that major OECD groups do not reflect bibliometrically relevant field differences, and that a reclustering offers a better grouping.
The Role of Ocean–Atmosphere Interactions in Tropical Cyclone Intensity Predictability
Authors: Li Dian-Yi , Tan Zhe-Min 
Published: February 2023

Abstract
The negative feedback between tropical cyclone (TC) intensity and sea surface temperature (SST) plays an important role in TC development. In this study, ocean–atmosphere coupled and uncoupled ensemble forecasts are conducted to investigate the dynamics of error growth and predictability of TC intensity in an ocean–atmosphere coupled system. For the TC–ocean coupled system, the TC intensity–SST negative feedback is the essential mechanism to reduce the error growth of TC intensity by two routes, and thereby improves the TC intensity predictability. For the first route (atmosphere-limited route), the TC-induced SST cooling slows the intensification rate of the TC and weakens the final TC intensity, thereby reducing the error growth of TC intensity. In this route, the TC intensity spread is limited by the magnitude of TC intensity, while SST can be regarded as an environmental forcing. For the second route (atmosphere–ocean mutually influenced route), the interaction between the TC intensity spread and SST spread is dominant. The increasing TC intensity spread could lead to an increase in SST cooling spread, and then reduce the TC intensity spread through the negative feedback. In other words, the more (less) intense TC produces stronger (weaker) SST cooling, and thereby limits (enhances) further TC intensification in an ensemble forecast. In the second route, initial ocean temperature uncertainty could suppress the TC intensity spread reduction.

Significance Statement
Tropical cyclones force the sea surface and can lead to its cooling. This cooled sea surface can then suppress tropical cyclone intensification. The purpose of this study is to better examine the influence of such an interaction between a tropical cyclone and the ocean on tropical cyclone forecasts. We explore how accurately representing the interaction can improve the capacity to forecast tropical cyclone intensity. Given that many weather forecasting centers have considered this interaction in their models, this study should help them to understand and improve their forecasts.
Deep Learning–Based Prediction of Kuroshio Path South of Japan
Authors: Wu Xiaobo , Han Guijun , Li Wei , Shao Qi , Cao Lige 
Published: February 2023

Abstract
Variation of the Kuroshio path south of Japan has an important impact on weather, climate, and ecosystems due to its distinct features. Motivated by the ever-popular deep learning methods using neural network architectures in areas where more accurate reference data for oceanographic observations and reanalysis are available, we build four deep learning models based on the long short-term memory (LSTM) neural network, combined with the empirical orthogonal function (EOF) and complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN), namely, the LSTM, EOF–LSTM, CEEMDAN–LSTM, and EOF–CEEMDAN–LSTM. Using these models, we conduct long-range predictions (120 days) of the Kuroshio path south of Japan based on 50-yr ocean reanalysis and nearly 15 years of satellite altimeter data. We show that the EOF–CEEMDAN–LSTM performs the best among the four models, by attaining approximately 0.739 anomaly correlation coefficient and 0.399° root-mean-square error for the 120-day prediction of the Kuroshio path south of Japan. The hindcasts of the EOF–CEEMDAN–LSTM are successful in reproducing the observed formation and decay of the Kuroshio large meander during 2004/05, and the formation of the latest large meander in 2017. Finally, we present predictions of the Kuroshio path south of Japan at 120-day lead time, which suggest that the Kuroshio will remain in the state of the large meander until November 2022.
Sinonasal Schwannomas: Imaging Findings and Review of Literature
Authors: Brahmbhatt Pavan , Kumar Tushar , Bhatt Alok A. , Vibhute Prasanna , Patel Vishal , Desai Amit , Gupta Vivek , Agarwal Amit 
Published: February 2023

ObjectiveSchwannomas are common nerve sheath tumors and may occur anywhere in the body. 4% of head and neck schwannomas occur in the sinonasal cavity, and fewer yet have an intracranial component, making these presentations extremely rare. Furthermore, schwannomas present with nonspecific imaging signs and can only be definitively differentiated via histopathologic review, leading to misdiagnosis as various nasal tumors. We aim to conduct a review of published literature on sinonasal schwannomas with and without intracranial extension and provide additional case representations.MethodsA literature review was conducted using the PubMed Database with the terms “sinonasal schwannoma,” “intracranial,” “anterior skull base,” and “schwannoma.” Results were reviewed, and additional cases identified were referenced and included in the study. Inclusion criteria were any case with intracranial extension of the schwannoma. There were no exclusion criteria. Review data was compiled into Excel and used for data analysis and comparison. Additionally, a search was done within our institution to identify additional cases of sinonasal schwannoma.ResultsWe identified 17 cases of sinonasal schwannoma with intracranial extension, five from our institution and twelve from literature. Analysis revealed: 8 females (47%), 9 males (53%), 9 patients presented with headaches (53%), 6 patients presented with anosmia (35%), 4 patients presented with nasal obstruction (24%), and 2 patients with no symptoms (12%). Mean age and median were 39.4 ± 10.1 and 40, respectively. For treatment, 4 patients underwent endoscopic resection (24%), 11 underwent craniotomy (65%), and data was unavailable for 2 patients. Post-treatment complications occurred in 6 patients, 5 had CSF leaks (29%) and 1 had a hematoma (6%).ConclusionWe identified and discussed 17 cases of sinonasal schwannoma with intracranial extension. We hope our review provides insight for clinicians to maintain schwannoma as a potential differential when evaluating nasal and anterior skull base masses.
Image quality using synthetic brain MRI: an age-stratified study
Authors: Zou Mengsha , Zhou Qin , Li Ruocheng , Hu Manshi , Qian Long , Yang Zhiyun , Zhao Jing 
Published: February 2023

Background Synthetic magnetic resonance imaging (MRI) might replace the conventional MR sequences in brain evaluation to shorten scan time and obtain multiple quantitative parameters. Purpose To evaluate the image quality of multiple-delay-multiple-echo (MDME) sequence-derived synthetic brain MR images compared to conventional images by considering a multi-age sample. Material and Methods Image sets of conventional and synthetic MRI of 200 participants were included. On the basis of the presence of intracranial lesions, the participants were divided into a normal group and a pathological group. Two neuroradiologists compared the anonymous and unordered images. Image quality, artifacts, and diagnostic performance were analyzed. Results In the quantitative analysis, comparing with conventional images, MDME sequence-derived synthetic MRI demonstrated an equal/greater signal-to-noise ratio and contrast-to-noise ratio (CNR) in all age groups. Specifically, for participants aged ≤2 years, synthetic T2-fluid-attenuated inversion recovery imaging showed a significantly higher cerebellum gray/white matter CNR ( P < 0.05). In the qualitative and artifact analyses, except for the superior sagittal sinus and cranial nerves, synthetic MRI showed good imaging quality (≥3 points) in all brain structures. On synthetic T1-weighted imaging, high signal intensity within the superior sagittal sinus was found in most of our participants (107/118, 90.7%). No difference was observed between synthetic and conventional MRI in diagnosing the lesions. Conclusion MDME sequence-derived synthetic MRI showed similar image quality and diagnostic performance with a shorter acquisition time than conventional MRI. However, the high signal intensity within the superior sagittal sinus on synthetic T1-weighted images requires consideration.
Incidence of Complications and Revision Surgery After High Tibial Osteotomy: A Systematic Review
Authors: Miltenberg Benjamin , Puzzitiello Richard N. , Ruelos Verdinand C.B. , Masood Raisa , Pagani Nicholas R. , Moverman Michael A. , Menendez Mariano E. , Ryan Scott P. , Salzler Matthew J. , Drager Justin 
Published: February 2023

Background: High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure. Purpose: To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs. Study Design: Systematic review; Level of evidence, 4. Methods: The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded. Results: A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%). Conclusion: Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
Effect of Posterior Malleolar Fixation on Syndesmotic Stability
Authors: Stake Ingrid Kvello , Bryniarski Anna R. , Brady Alex W. , Miles Jon W. , Dornan Grant J. , Madsen Jan Erik , Haytmanek C. Thomas , Husebye Elisabeth Ellingsen , Clanton Thomas O. 
Published: February 2023

Background: Transsyndesmotic fixation with suture buttons (SBs), posterior malleolar fixation with screws, and anterior inferior tibiofibular ligament (AITFL) augmentation using suture tape (ST) have all been suggested as potential treatments in the setting of a posterior malleolar fracture (PMF). However, there is no consensus on the optimal treatment for PMFs. Purpose: To determine which combination of (1) transsyndesmotic SBs, (2) posterior malleolar screws, and (3) AITFL augmentation using ST best restored native tibiofibular and ankle joint kinematics after 25% and 50% PMF. Study Design: Controlled laboratory study. Methods: Twenty cadaveric lower-leg specimens were divided into 2 groups (25% or 50% PMF) and underwent biomechanical testing using a 6 degrees of freedom robotic arm in 7 states: intact, syndesmosis injury with PMF, transsyndesmotic SBs, transsyndesmotic SBs + AITFL augmentation, transsyndesmotic SBs + AITFL augmentation + posterior malleolar screws, posterior malleolar screws + AITFL augmentation, and posterior malleolar screws. Four biomechanical tests were performed at neutral and 30° of plantarflexion: external rotation, internal rotation, posterior drawer, and lateral drawer. The position of the tibia, fibula, and talus were recorded using a 5-camera motion capture system. Results: With external rotation, posterior malleolar screws with AITFL augmentation resulted in best stability of the fibula and ankle joint. With internal rotation, all repairs that included posterior malleolar screws stabilized the fibula and ankle joint. Posterior and lateral drawer resulted in only small differences between the intact and injured states. No differences were found in the efficacy of treatments between 25% and 50% PMFs. Conclusion: Posterior malleolar screws resulted in higher syndesmotic stability when compared with transsyndesmotic SBs. AITFL augmentation provided additional external rotational stability when combined with posterior malleolar screws. Transsyndesmotic SBs did not provide any additional stability and tended to translate the fibula medially. Clinical Relevance: Posterior malleolar fixation with AITFL augmentation using ST may be the preferred surgical method when treating patients with acute ankle injury involving an unstable syndesmosis and a PMF ≥25%.