bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients
Authors: Hu Yuanyu , Ouyang Hanqiang , Ye Kaifeng , Qi Junbo , Dong Yanlei , Peng Xianlong , Zhang Xin , Dong Shu , Chen Zhongqiang , Liu Zhongjun , Liu Xiaoguang , Sun Chuiguo , Li Weishi , Tian Yun 
Published: October 2022

Study Design.
A retrospective study.

Objective.
The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center.

Summary of Background Data.
Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well-established.

Materials and Methods.
We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors.

Results.
A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS.

Conclusions.
The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine surgery, thoracic kyphosis ≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS.

Level of Evidence.
4.
Feasibility and Surgical Effect of Annulus Sparing in Consecutive Patients with Tetralogy of Fallot: A Retrospective Cohort Study
Authors: Lv Lizhi , Liu Jinyang , Jiang Xianchao , Liu Yang , Tian Yanjin , Cao Hong , Liu Zhimin , Wang Qiang 
Published: October 2022

Objective:
Annulus-sparing (AS) repair for tetralogy of Fallot (TOF) with a dysplastic pulmonary valve annulus (PVA) is a challenging procedure and is controversial. This study aimed to assess the feasibility and surgical effect of AS repair versus transannular patch enlargement (TAPE) repair, especially in individuals with dysplastic pulmonary valves.

Methods:
This retrospective cohort study included 375 pediatric patients with a primary diagnosis of TOF in the Center for Pediatric Cardiac Surgery of Fuwai hospital from January 2014 to June 2017. Among them, 60 consecutive and nonselective patients underwent 1-stage repair of TOF with aggressive PVA-preserving strategies performed by a single surgeon were enrolled in AS cohort. In AS cohort, patients were divided into AS, PVA z-score ≥−2 group (33 patients) and AS, PVA z-score <−2 group (27 patients). During the same period, 315 patients underwent TAPE repair by other surgeons were enrolled as TAPE cohort, of these, 87 patients with PVA z-score ≥−2 were excluded. From the 228 patients in the TAPE group, 27 cases were selected as TAPE, PVA z-score <−2 group according to the propensity score and 1:1 ratio with AS, PVA z-score <−2 group. The primary outcome was a composite of reintervention, significant pulmonary regurgitation, and significant annular peak gradient (APG). Kaplan-Meier curve was plotted to show the survival rate of severe pulmonary regurgitation.

Results:
One death occurred after the TAPE operation in TAPE group, and 1 patient in the AS z ≥−2 group needed reintervention with a balloon. After a median follow-up of (30.3 ± 11.6) months, compared with AS z ≥−2 group, there was no difference in the technical performance score for severe pulmonary stenosis (APGs > 20 mmHg) in the AS z <−2 group. Compared with TAPE, AS repair was often accompanied by a postoperative APGs over 20 mmHg (P = 0.001). More patients underwent TAPE suffered from moderate or severe pulmonary regurgitation than those who received AS repair (20 (74.1%) vs. 7 (26.0%), P < 0.001). AS repair was associated with a shorter duration of mechanical ventilation (20 vs. 29 hours, P = 0.039), faster discharge from the intensive care unit (2.0 vs. 4.0 days, P = 0.022) and shorter postoperative hospitalization (8.0 vs. 11.0 days, P = 0.008) compared with TAPE.

Conclusions:
APG demonstrated an upward trend in the TAPE group and a downtrend in the AS group after discharge from hospital. AS repair had an acceptable surgical effect in TOF patients, even in those with a dysplastic PVA. A higher APG remained upon hospital discharge in dysplastic patients with AS, but a downward trend was observed over time.
Epigenome-wide association of neonatal methylation and trimester-specific prenatal PM2.5 exposure
Authors: Parikh Milan N. , Brokamp Cole , Rasnick Erika , Ding Lili , Mersha Tesfaye B. , Bowers Katherine , Folger Alonzo T. 
Published: October 2022

Background:
Exposure to particulate matter with an aerodynamic diameter smaller than 2.5 microns (PM2.5) can affect birth outcomes through physiological pathways such as inflammation. One potential way PM2.5 affects physiology could be through altering DNA methylation (DNAm). Considering that exposures during specific windows of gestation may have unique effects on DNAm, we hypothesized a timing-specific association between PM2.5 exposure during pregnancy and DNAm in the neonatal epithelial-cell epigenome.

Methods:
After collecting salivary samples from a cohort of 91 neonates, DNAm was assessed at over 850,000 cytosine-guanine dinucleotide (CpG) methylation sites on the epigenome using the MethylationEPIC array. Daily ambient PM2.5 concentrations were estimated based on the mother’s address of primary residence during pregnancy. PM2.5 was averaged over the first two trimesters, separately and combined, and tested for association with DNAm through an epigenome-wide association (EWA) analysis. For each EWA, false discovery rate (FDR)-corrected P < 0.05 constituted a significant finding and every CpG site with uncorrected P < 0.0001 was selected to undergo pathway and network analysis to identify molecular functions enriched by them.

Results:
Our analysis showed that cg18705808 was associated with the combined average of PM2.5. Pathway and network analysis revealed little similarity between the first two trimesters. Previous studies reported that TMEM184A, the gene regulated by cg18705808, has a putative role in inflammatory pathways.

Conclusions:
The differences in pathway and network analyses could potentially indicate trimester-specific effects of PM2.5 on DNAm. Further analysis with greater temporal resolution would be valuable to fully characterize the effect of PM2.5 on DNAm and child development.
Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals
Authors: Angelaki Eleni , Barmparis Georgios D. , Kochiadakis George , Maragkoudakis Spyros , Savva Eirini , Kampanieris Emmanuel , Kassotakis Spyros , Kalomoirakis Petros , Vardas Panos , Tsironis Giorgos P. , Marketou Maria E. 
Published: October 2022

Objectives:
Hypertension is a major risk factor for cardiovascular disease (CVD), which often escapes the diagnosis or should be confirmed by several office visits. The ECG is one of the most widely used diagnostic tools and could be of paramount importance in patients’ initial evaluation.

Methods:
We used machine learning techniques based on clinical parameters and features derived from the ECG, to detect hypertension in a population without CVD. We enrolled 1091 individuals who were classified as hypertensive or normotensive, and trained a Random Forest model, to detect the existence of hypertension. We then calculated the values for the Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the Random Forest's results.

Results:
Our Random Forest model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 78.0%, sensitivity 84.0% and area under the receiver-operating curve 0.89, using a decision threshold of 0.6. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV3), R wave amplitude in aVL and BMI-modified Sokolow-Lyon voltage (BMI divided by SV1+RV5), were the most important anthropometric and ECG-derived features in terms of the success of our model.

Conclusion:
Our machine learning algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased CVD risk.
Assessing Patient Barriers to Cochlear Implantation
Authors: Mangan Andrew R. , Davis Kyle P. , Anzalone C. Lane , Saadi Robert A. , Dornhoffer John L. , King Deanne L. 
Published: October 2022

Objective
Evaluate barriers that deter adult patients from following through with cochlear implantation.

Study Design
Retrospective chart review and phone survey.

Setting
Single tertiary referral center.

Patients
Between January 2019 and August 2021, 113 patients, without a previous cochlear implant (CI), were determined to be candidates for cochlear implantation. Thirty-eight (33.6%) patients deferred cochlear implantation. Survey response rate was 61.1% (22/36).

Intervention
None.

Main Outcome Measures
Demographic, socioeconomic, otologic history, and comorbidity factors associated with deferment of cochlear implantation. Patient survey assessment of factors that had the greatest impact, rated on a scale of 1 to 10 (10 being the most impactful), on their decision to defer a CI.

Results
Out of the 113 patients who met inclusion criteria, 75 (66.3%) underwent cochlear implantation and 38 (33.6%) patients deferred. Comparing implanted versus deferred groups, there was no statistical difference in age (67.1 y versus 68.5 y; p = 0.690) or male sex (53.3% versus 57.9%; p = 0.692). The deferred group had higher mean neighborhood disadvantage state decile (5.3 versus 4.3; p = 0.064) and national percentile (73.0 versus 66.2; p = 0.106) scores, although neither were statistically significant. A greater proportion of the deferred group were not living independently at time of CI evaluation (13.2 versus 2.7%; p = 0.017). Fear of losing residual hearing was rated the highest among the survey respondents (mean rating of 5.1), followed by general medical health (4.9) and cost and financial concerns (3.6).

Conclusion
The greatest concern among the patients was the fear of losing residual hearing. Spending greater time educating patients about the success and failure rates of cochlear implantation may reduce patient hesitancy with implantation.
The Frailty Phenotype in Older Adults Undergoing Cochlear Implantation
Authors: Kay-Rivest Emily , Friedmann David R. , McMenomey Sean O. , Jethanamest Daniel , Thomas Roland J. , Waltzman Susan B. 
Published: October 2022

Objective
To prospectively evaluate the frailty phenotype in a population of older adults and determine its association with 1) perioperative complications, 2) need for vestibular rehabilitation after surgery, and 3) early speech perception outcomes.

Study Design
Prospective cohort study.

Setting
Tertiary care hospital.

Patients
Adults older than 65 years undergoing cochlear implantation.

Interventions
The Fried Frailty Index was used to classify patients as frail, prefrail, or not frail based on five criteria: 1) gait speed, 2) grip strength, 3) unintentional weight loss, 4) weekly physical activity, and 5) self-reported exhaustion.

Main Outcomes Measures
Rates of intraoperative and postoperative complications, postoperative falls, need for vestibular rehabilitation, and early speech perception outcomes.

Results
Forty-six patients were enrolled in this study. Five patients (10.8%) were categorized as frail and 10 (21.7%) as prefrail. The mean ages of frail, prefrail, and not frail patients were 80.9, 78.8, and 77.5, respectively. There were no intraoperative complications among all groups. Three patients required postoperative vestibular rehabilitation; all were not frail. One postoperative fall occurred in a nonfrail individual. Mean (standard deviation) device use times at 3 months in frail, prefrail, and not frail patients were 7.6 (3.5), 11.1 (3.6), and 11.6 (2.9) hours per day, respectively. Consonant–nucleus–consonant word scores 3 months after surgery in frail, prefrail, and not frail patients were 13% (12.2), 44% (19.7), and 51% (22.4), respectively. The median (range) number of missed follow-up visits (surgeon, audiologist, speech language pathologist combined) was 7 (1–10) in frail patients, compared with a median of 3 (0–4) and 2 (0–5) in prefrail and not frail patients.

Conclusions
Frail patients did not have increased rates of surgical complications, need for vestibular rehabilitation, or postoperative falls. However, frail patients experienced challenges in accessing postoperative care, which may be addressed by using remote programming and rehabilitation.
Clinical Impact of Genetic Diagnosis of Sensorineural Hearing Loss in Adults
Authors: Corriols-Noval Patricia , López Simón Eugenia Carmela , Cadiñanos Juan , Diñeiro Marta , Capín Raquel , González Aguado Rocío , Costales Marcos María , Morales Angulo Carmelo , Cabanillas Farpón Rubén 
Published: October 2022

Hypothesis
Adult genetic sensorineural hearing loss (SNHL) may be underestimated.

Background
The diagnosis of genetic hearing loss is challenging, given its extreme genetic and phenotypic heterogeneity, particularly in adulthood. This study evaluated the utility of next-generation sequencing (NGS) in the etiological diagnosis of adult-onset SNHL.

Materials and Methods
Adults (>16 yr old) with SNHL were recruited at the Otolaryngology Department at Marqués de Valdecilla University Hospital (Spain). Environmental factors, acoustic trauma, endolymphatic hydrops, and age-related hearing loss were excluding criteria. An NGS gene panel was used, including 196 genes (OTOgenics v3) or 229 genes (OTOgenics v4) related to syndromic and nonsyndromic hearing loss.

Results
Sixty-five patients were included in the study (average age at the onset of SNHL, 41 yr). Fifteen pathogenic/likely pathogenic variants considered to be causative were found in 15 patients (23% diagnostic yield) in TECTA (4), KCNQ4 (3), GJB2 (2), ACTG1 (1), COL2A1 (1), COCH (1), COCH/COL2A1 (1), STRC (1), and ABHD12 (1). Three patients had syndromic associations (20% of patients with genetic diagnosis) that had not been previously diagnosed (two Stickler type I and one polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, cataract syndrome). Seven variants of unknown significance were found in COL11A1 (1), GSMDE (2), DNTM1 (1), SOX10 (1), EYA4 (1), and TECTA (1).

Conclusion
NGS gene panels can provide diagnostic yields greater than 20% for adult SNHL, with a significant proportion of variant of unknown significance that could potentially contribute to increasing diagnostic output. Identifying a genetic cause enables genetic counseling, provides prognostic information and can reveal unrecognized syndromes contributing to an accurate management of their associated manifestations.
The Relationship Between Defenses and Learning
Authors: Patra Vlachopanou , Evangelia Karagiannopoulou , Georgios Ntritsos 
Published: October 2022

Abstract
This study investigates the relationship among defense styles and learning through academic procrastination and psychological well-being. The sample comprises 628 social science students from a Greek university. Path analysis is used to explore associations and interactions among the variables. The results show that academic procrastination and psychological well-being mediate the relationship between defense styles and approaches to learning, indicating the expected direct and indirect effects. Defense styles are directly related to approaches to learning. Mature defense styles are associated with learning through psychological well-being in a positive way, and immature defense styles are associated with learning through academic procrastination in a negative way. This study supports the current line of research in associations between defense styles and learning and the importance of linking mental health variables with learning.
The Relationship Among Autistic Traits, Impulsivity, and Functionality in Patients With Obsessive-Compulsive Disorder
Authors: Namli Zeynep , Tamam Lut , Demirkol Mehmet Emin , Karaytuğ Mahmut Onur , Sun Tunahan 
Published: October 2022

Abstract
Obsessive-compulsive disorder (OCD) is a chronic mental disorder that causes disabilities. This study investigated the relationship among impulsivity, autistic traits, and disabilities in patients with OCD. We included 88 patients with OCD and 90 healthy volunteers without any mental disorders. The participants were evaluated using the Yale-Brown Obsessive-Compulsive Scale, Autism Spectrum Quotient (AQ), Barratt Impulsiveness Scale-11 (BIS-11), and World Health Organization Disability Assessment Schedule (WHODAS 2.0). Regression analyses revealed that AQ-attention switching and BIS-attentional subscale scores were associated with WHODAS-overall score in the OCD group (p = 0.017 and p = 0.034, respectively). In the OCD group, AQ total, social skills, and communication subdomain scores partially mediated the relationship between impulsivity and disability. BIS total, attentional, and nonplanning subscale scores partially mediated the relationship between autistic traits and disability. Developing new treatment strategies for cognitive recovery, in addition to traditional treatment approaches in patients with OCD, may help increase functionality in patients with OCD.
3-Dimensional Morphometric Outcomes After Endoscopic Strip Craniectomy for Unicoronal Synostosis
Authors: Elawadly Ahmed , Smith Luke , Borghi Alessandro , Nouby Radwan , Silva Adikarige H.D. , Dunaway David J. , Jeelani Noor ul O. , Ong Juling , James Greg 
Published: October 2022

Background:
Endoscopic strip craniectomy with postoperative helmeting (ESCH) for unicoronal synostosis has shown to be a less morbid procedure when compared with fronto-orbital remodeling (FOR). We aim in this pilot study to report objective methods and quantitative morphologic outcomes of endoscopically treated unicoronal synostosis using 3-dimensional surface scans.

Methods:
Our electronic records were reviewed for ophthalmological, neurodevelopmental outcomes, and helmet-related complications. For morphologic outcomes, the following parameters were used: Cranial Index, Cranial Vault Asymmetry Index, Anterior Symmetry Ratio (ASR), and Root Mean Square between the normal and synostotic sides of the head. Three-dimensional stereophotogrammetry scans were evaluated at 3 time points preoperative, 6 months post-op, and at the end of the treatment, which was compared with age-matched scans of normal controls and FOR patients. Nonparametric tests were used for statistical analysis.

Results:
None of the ESCH cases developed strabismus, major neurodevelopmental delay, or helmet complications. All morphologic parameters improved significantly at 6 months post-op except for the Cranial Vault Asymmetry Index. The ASR was the only parameter to change significantly between 6 months post-op and final scans. At end of helmet treatment, ASR and Root Mean Square differed significantly between the ESCH and both FOR and control groups.

Conclusions:
Endoscopic strip craniectomy with postoperative helmeting for single unicoronal synostosis had excellent clinical outcomes. Most of the improvement in head morphology occurred in the first 6 months of treatment. Despite the normalization of the overall head shape, there was residual asymmetry in the frontal and temporal regions of the head.
Met and Unmet Needs of Older Adults With Cognitive Impairment, and Burden and Benefits of Their Family Caregivers
Authors: Sung Pildoo , Hashim Nawal , Malhotra Rahul , Chan Angelique 
Published: October 2022

Objectives:
This study examined the association between met and unmet needs of older adults with cognitive impairment living in the community and unique types of caregiving experience, each comprising different levels of caregiving burden and benefits.

Methods:
Latent class analysis and multivariable regression were applied to data on 266 caregivers of community-dwelling Singaporean older adults, aged 60 years and above, with cognitive impairment who participated in a community-based dementia care study in 2018.

Results:
Three unique types of caregiving experience were identified: satisfied (low burden and high benefits; 54% of caregivers), dissatisfied (low burden and low benefits; 35%), and intensive (high burden and high benefits; 11%). Met needs were positively associated with satisfied caregiving experience (vs. dissatisfied caregiving experience), and both met and unmet needs were positively associated with intensive caregiving experience (vs. dissatisfied caregiving experience). Specifically, caregivers tended to have satisfied caregiving experience if older adults’ care needs in daytime activities or mobility were met.

Discussion:
Fulfillment of unmet needs of older adults with cognitive impairment is associated with a satisfied caregiver experience characterized by lower caregiver burden and greater caregiver benefits. Identification of and tailored interventions for unmet care needs of older adults will likely promote satisfied caregiving experience.
Evolution of the cardiac dyad
Authors: Mackrill John James 
Published: October 2022

Cardiac dyads are the site of communication between the sarcoplasmic reticulum (SR) and infoldings of the sarcolemma called transverse-tubules (TT). During heart excitation–contraction coupling, Ca2+-influx through L-type Ca2+channels in the TT is amplified by release of Ca2+-from the SR via type 2 ryanodine receptors, activating the contractile apparatus. Key proteins involved in cardiac dyad function are bridging integrator 1 (BIN1), junctophilin 2 and caveolin 3. The work presented here aims to reconstruct the evolutionary history of the cardiac dyad, by surveying the scientific literature for ultrastructural evidence of these junctions across all animal taxa; phylogenetically reconstructing the evolutionary history of BIN1; and by comparing peptide motifs involved in TT formation by this protein across metazoans. Key findings are that cardiac dyads have been identified in mammals, arthropods and molluscs, but not in other animals. Vertebrate BIN1 does not group with members of this protein family from other taxa, suggesting that invertebrate BINs are paralogues rather orthologues of this gene. Comparisons of BIN1 peptide sequences of mammals with those of other vertebrates reveals novel features that might contribute to TT and dyad formation. The analyses presented here suggest that the cardiac dyad evolved independently several times during metazoan evolution: an unexpected observation given the diversity of heart structure and function between different animal taxa.This article is part of the theme issue ‘The cardiomyocyte: new revelations on the interplay between architecture and function in growth, health, and disease’.