bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety Comparison of Monotherapy Aspirin to Dual Antiplatelet Therapy Following Coronary Artery Bypass Surgery
Authors: Nei Scott D. , Wamsley Kyle S. , Mara Kristin C. , Stulak John M. , Zieminski Joseph J. 
Published: September 2022

Background Dual antiplatelet therapy (DAPT) is recommended over single antiplatelet therapy (SAPT) in patients following coronary artery bypass grafting (CABG). The compilation of evidence has focused on the efficacy of DAPT to limit risk of graft occlusion, however the safety, especially in the on-pump CABG population, is less well described. The aim of this study was to assess the safety of DAPT versus SAPT after on-pump CABG. Methods This was a single-center, retrospective cohort analysis of adult patients following isolated on-pump CABG between January 2012 and December 2019 not on oral anticoagulation at discharge. The primary endpoint was occurrence of a composite bleeding event identified by pre-specified ICD codes. Secondary endpoints consisted of 30-day and 1-year mortalities along with individual bleeding components. Results Of the 2341 patients included 1250 patients were in the SAPT arm and 1091 patients in the DAPT arm. The study populations differed by age, prior MI, PAD, and CHF status/stage. Bleeding events occurred in a total of 70 patients (3.0%), with 36 patients (2.9%) in the SAPT arm and 34 patients (3.1%) in the DAPT arm ( P = .74). 30-day (SAPT 0.7% vs DAPT 0.4%) and 1-year (SAPT 3.3% vs DAPT 2.3%) mortality were not significantly different between groups. The most frequent bleed event was in the gastrointestinal tract. Conclusion In this study, DAPT was not associated with an increase in composite bleeding compared to SAPT. This study could reduce the barrier to prescribing of DAPT given previous efficacy data.
Development and validation of a new prognostic tool for impacted maxillary canines, ‘Easy box’: A cone-beam computed tomographic study
Authors: P Muhammed Shibin , Sundareswaran Shobha , Mohammed Faraj , Jisha Baby 
Published: September 2022

Objective: To develop a tool to facilitate simple, easy and rapid assessment of the level of difficulty in disimpaction of an impacted canine using cone-beam computed tomography (CBCT). Design: A cross-sectional study. Methods: A panel of four experienced orthodontists formulated a questionnaire capable of portraying the limits of a three-dimensional (3D) area around impacted maxillary canines on CBCT images, which would determine the disimpaction difficulty level. In total, 14 experienced orthodontists graded each item in the questionnaire and assigned scores in the range of 0–5. Average scores obtained outlined the limits of a 3D area, within which an impaction was deemed favourable. This area was termed ‘Easy box’. The disimpaction difficulty level of 170 impacted maxillary canines was then assessed using ‘Easy box’ and the existing tool KPG index for convergent validation. Results: Perfect inter-examiner agreement was obtained as evidenced by Fleiss kappa value of 0.984 for the tool ‘Easy box’ and 0.948 for the KPG index. There was also perfect agreement between the two methods of assessment (Cohen weighted kappa, k>0.86). The average time taken for assessment using ‘Easy box’ was 3.3 min compared to 8.8 min for the KPG index. Conclusion: ‘Easy box’ proves to be a simple, accurate and rapid assessment tool for the prognostic evaluation of impacted canines, using CBCT images. Impacted maxillary canines with cusp tips that lie beyond the limits of the 3D ‘Easy box’ area with a beta angle greater than 45°, were rated to be more difficult to align.
Operative Versus Nonoperative Treatment for Closed Displaced Midshaft Clavicle Fractures
Authors: Sax Oliver C. , Monarrez Ruben , Bains Sandeep S. , Douglas Scott J. , Ingari John V. 
Published: September 2022

Background: Nonoperative treatment for clavicle fractures has historically been standard of care, but with a concomitant rise in recent operative fixation for displaced midshaft clavicle fractures (MCF), a re-evaluation of treatment modalities is necessary. The purpose of this study was to compare nonunion rates among operative and nonoperative treatment of closed displaced MCF. Specifically, we assessed the following between operative and nonoperative management: (1) 90-day to 1-year nonunion and malunion incidence; (2) 90-day medical complications; and (3) 90-day to 1-year total costs of care. Methods: An all-payer national database was retrospectively reviewed for closed displaced MCF from 2010 to 2020 (n = 173 188). Of these, patients undergoing operative fixation within 30 days of a displaced MCF were identified (n = 17 452). Nonoperative displaced MCF patients were matched with operative patients at a 3:1 ratio. Outcomes at 90 days and 1 year included: nonunion, total cost, and complications. Results: Closed displaced MCF with operative fixation resulted in significantly increased nonunion rates at 1 year compared with nonoperative treatment (3.97% vs 1.63%, odds ratio = 2.50 [2.26-2.77], P < .001). Kaplan-Meier survivorship and log-rank score demonstrated the same for a 1-year nonunion endpoint ( P < .001). As expected, the operative cohort incurred higher median total costs of care at 90 days ($3255.00 vs $1024.00, P < .001) and 1 year ($1978.00 vs $4799.50, P < .001) compared with nonoperative treatment. Conclusion: Our study found higher nonunion incidence after operative fixation of displaced MCF. These results may serve as a catalyst for future high-quality prospective studies comparing treatment options for closed displaced MCF.
SERI Technique for Isolated Juvenile Hallux Valgus Patients: A Retrospective Evaluation With Mid-term to Long-term Follow-up
Authors: Caravelli Silvio , Vocale Emanuele , Di Ponte Marco , Fuiano Mario , Massimi Simone , Zannoni Francesca , Zaffagnini Stefano , Mosca Massimiliano 
Published: September 2022

Introduction Many different operative procedures have been described to treat hallux valgus, but many of them are inappropriate for active, skeletally immature patients. This retrospective evaluation aimed to show the efficacy of SERI (Simple, Effective, Rapid, Inexpensive) technique in young patients affected by mild to moderate hallux valgus deformity at a mid-term to long-term follow-up. Methods All patients were clinically and radiographically evaluated, independently by 2 researchers, by American Orthopaedic Foot and Ankle Society (AOFAS) Hallux-Metatarsophalangeal-Interphalangeal score and radiographic examination. Results Twenty-nine feet, undergone SERI procedure, have been reviewed at a mean follow-up of 5 years. The mean AOFAS score was significantly improved from 59.7 preoperatively to a mean value of 90.7 at last follow-up. Mean correction degrees have been recorded for both angles (hallux valgus angle [HVA] −13.7° and intermetatarsal angle [IMA] −6.7°). Conclusions The SERI technique represents a powerful surgical procedure for the treatment of painful, mild to moderate, juvenile hallux valgus. Recurrence and complication rate make this surgical approach effective, repeatable, and safe. Level of Evidence: Level IV, Retrospective case series
Clinical utility of new bone imaging using zero-echo-time sequence in neurosurgical procedures: Can zero-echo-time be used in clinical practice in neurosurgery?
Authors: Inoue Akihiro , Watanabe Hideaki , Suehiro Satoshi , Nishida Naoya , Shiraishi Yasuhiro , Furumochi Taichi , Takimoto Yoshihiro , Ohnishi Takanori , Shigekawa Seiji , Kunieda Takeharu 
Published: September 2022

Purpose The purpose of this study was to evaluate the clinical usefulness of zero-echo-time (ZTE)–based magnetic resonance imaging (MRI) in planning the optimum surgical approach and applying ZTE for anatomical guidance during transcranial surgery. Methods Eleven of 26 patients who underwent transcranial surgery and carotid endarterectomy and in whom ZTE-based MRI and magnetic resonance angiography (MRA) data were obtained were analyzed by creating ZTE/MRA fusion images and 3D ZTE-based MRI models. We examined whether these images and models can be substituted for computed tomography imaging for neurosurgical procedures. Furthermore, the clinical usability of the 3D ZTE-based MRI models was evaluated by comparing them with actual surgical views. Results Zero-echo-time/MRA fusion images and 3D ZTE-based MRI models clearly illustrated the cranial and intracranial morphology without radiation exposure or the use of iodinated contrast medium. The models allowed determination of the optimum surgical approach to cerebral aneurysms, brain tumors near the brain surface, and cervical internal carotid artery stenosis by visualizing the relationship of lesions with adjacent bone structures. However, ZTE-based MRI did not provide useful information for surgery for skull base lesions such as vestibular schwannoma because bone structures of the skull base often include air components, which cause signal disturbance in MRI. Conclusions Zero-echo-time sequences on MRI allowed distinct visualization of not only bone but also vital structures around the lesion. This technology has low invasiveness for patients and was useful for preoperative planning and guidance of the optimum approach during surgery in a subset of neurosurgical diseases.
Perception of Physicians Working in Chile Toward Assisted Suicide and Euthanasia: A Nationwide Cross-Sectional Study
Authors: Picón-Jaimes Yelson Alejandro , Orozco-Chinome Javier Esteban , Lozada-Martínez Iván David , Mass-Ramirez Sandra , Higuera-Cetina Carlos Iván , Montaña-Gómez Lina María , Moscote-Salazar Luis Rafael , Narvaez-Rojas Alexis Rafael 
Published: September 2022

Introduction: Assisted suicide and euthanasia are controversial issues today and have been throughout the history of humanity, mainly because there are individuals for and against them. Currently, the legalization of these practices is being discussed in Chile, and the perception of physicians regarding this issue is unknown. Therefore, this study aimed to assess physicians’ perception of Chile’s euthanasia and assisted suicide. Methods: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians’ attitudes and opinions on assisted suicide and euthanasia was used. The population was the doctors who work in Chile, and the sample was convenient with a sample calculation of 384 physicians. About 20 variables were considered and included in a form created through the Google forms option, which was distributed through social networks: LinkedIn, Facebook, Twitter, and WhatsApp. To guarantee the anonymity of the participants, the option to request and remember the participant’s email was deactivated. A generated database allowed the quantitative analysis of the variables and their expression through frequencies, percentages, and graphs. The European University of the Atlantic’s research ethics committee approved this study as stated in the document CE-55 of March 2021. Results: A total of 410 physicians were surveyed. 50.7% (n = 208) of the participants identified themselves as men, and 69.8% (n = 286) were Chilean. The city of Santiago was the area of residence of 72.9% (n = 299) of the participants. About 34.6% (n = 142) of participants were general practitioners, and 39.3% (n = 161) of the physicians had more than 20 years of experience. About 68.7% had favorable attitudes toward euthanasia and 54.4% toward assisted suicide; However, although the majority favored legalizing euthanasia and assisted suicide, approximately 48.8% stated that they would not participate in an assisted suicide procedure. Conclusions: There was evidence of support for the implementation and legalization of euthanasia and assisted suicide by physicians in Chile. However, there are still professionals who have not yet decided on a definitive position on these practices.
The Utility of 24-h Ambulatory Blood Pressure Monitoring for the Diagnosis and Management of White Coat Hypertension in a Primary Care Setting
Authors: Zhu Xiaolei , Hwu Irene , Jacabacci Stephanie , Wu Shenhong 
Published: September 2022

Objectives: Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recommended in patients with white coat hypertension (HTN) by national guideline, but was poorly utilized, and is available only in very limited subspecialty clinics. We aim to examine the feasibility and utility of ABPM in a primary care setting in the diagnosis and management of white coat HTN including the implementation and modification of antihypertensive therapy. Methods: Patients who have elevated blood pressure in clinic office but normal blood pressure readings at home are eligible for 24-h ambulatory BP monitoring. We analyzed data from patients who were suspected to have white coat HTN in the last 2 years underwent ABPM in our practice. Results: Among 68 patients, 54 patients met the selection criteria. ABPM showed that 13 patients had normal BP (24%), while 41 patients (76%) had persistent HTN. Among these patients with persistent HTN, 28 patients had intervention including 24 patients prescribed with new anti-hypertensive medication or medication increase, 3 patients prescribed with additional lifestyle modification and one started CPAP.13 patients with slightly elevated BP (133/77 for average daytime BP) didn’t have medication adjustment. Conclusion: ABPM has substantial utility in the diagnosis and management of white coat HTN in a primary care setting.
The 8-item Modified Frailty Index Is an Effective Risk Assessment Tool in Anterior Cervical Decompression and Fusion
Authors: Momtaz David , Prabhakar Gautham , Gonuguntla Rishi , Ahmad Farhan , Ghali Abdullah , Kotzur Travis , Nagel Sarah , Chaput Christopher 
Published: September 2022

Study Design Case-control study; Level of evidence, 3. Objective Anterior cervical discectomy and fusion (ACDF) is one of the most common procedures for cervical diseases often with reliable outcomes. However, morbidity rates can be as high as 19.3% so appropriate patient selection and risk stratification is imperative. Our modified frailty index (MFI) predicts postoperative complications after other orthopaedic procedures. We hypothesized that this index would predict complications in a large cohort of ACDF patients. Methods We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, including patients who underwent ACDF from 2015-2020. An 8-item MFI score was calculated for each patient. We recorded 30-days postoperative complications, readmission, and reoperation rates, adjusting for baseline features using standard multivariate regression. This project was approved of by the University of Texas Health Science Center Institutional Review Board and an IRB exception was granted. Results We identified 17 662 ACDF cases. Patients with MFI of 5 or greater had a 37.53 times increased odds of incurring postoperative complications compared to patients with MFI of 0 ( P < .001) even when age, sex, race, and ethnicity were controlled for. Specifically, life-threatening Clavien-Dindo IV complications, as well as wound, cardiac, renal, and pulmonary complications were significantly increased in patients with an MFI of 5 or greater. Also, as MFI increased from 1-2 to 3-4 to 5 or greater, the odds of readmission increased from 1.36 to 2.31 to 5.42 times ( P < .001) and odds of reoperation from 1.19 ( P = .185) to 2.3 to 6.54 times ( P < .001). Frailty was still associated with increased complications, readmission, and reoperation after controlling for demographic data, including age, as well as operative time and length of stay. Conclusion Frailty is highly predictive of postoperative complications, readmission, and reoperation following ACDF. Employing a simple frailty evaluation can guide surgical decision-making and patient counseling for cervical disease.
Effect of Accelerated Rehabilitation on Early Return to Sport After Arthroscopic Ankle Lateral Ligament Repair
Authors: Teramoto Atsushi , Murahashi Yasutaka , Takahashi Katsunori , Watanabe Kota , Yamashita Toshihiko 
Published: September 2022

Background: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport. Purpose: To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing. Study Design: Case series; Level of evidence, 4. Methods: This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire). Results: Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P < .01), anterior drawer distance (8.2-4.4 mm, P < .01), and anterior translation (10.5-4.6 mm, P < .01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P < .01) and all subscales of the SAFE-Q ( P ≤ .01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively. Conclusion: When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.
Ginsenoside compound K-loaded gold nanoparticles synthesized from Curtobacterium proimmune K3 exerts anti-gastric cancer effect via promoting PI3K/Akt-mediated apoptosis
Authors: Puja Aditi Mitra , Xu Xingyue , Wang Rongbo , Kim Hoon , Kim Yeon-Ju 
Published: September 2022

Abstract
Background
Compound K (CK) is the minor ginsenoside present in fermented Panax ginseng extract. Despite the pharmacological efficacy of CK, its industrial use has been restricted due to its low water solubility and poor permeability. To overcome this defect, our study was to synthesize gold nanoparticles from CK (CK-AuNPs) to investigate their potential as anticancer candidates.

Methods
To biologically synthesize CK-AuNPs, a novel strain, Curtobacterium proimmune K3, was isolated from fermented ginseng beverage, then combined with CK and gold salts to biosynthesize gold nanoparticles (CurtoCK-AuNPs). Their physicochemical characteristics were evaluated using UV–Vis spectrometry, FE-TEM, EDX, elemental mapping, XRD, SAED, DLS and TGA.

Results
CurtoCK-AuNPs exerted significant selective cytotoxic effects on AGS human gastric cancer cells. Fluorescence staining with Hoechst, propidium iodide, and MitoTracker demonstrated that CurtoCK-AuNPs induce apoptosis and mitochondrial damage, respectively. Quantitative real-time PCR and western blotting analyses showed that cytotoxic effect of CurtoCK-AuNPs were involved in apoptosis, based on their activation of Bax/Bcl-2, cytochrome c, caspase 9, and caspase 3, as well as their suppression of PI3K–Akt signaling.

Conclusion
Our findings provide data for understanding the molecular mechanisms of nanoparticles; thus, providing insight into the development of alternative medications based on gold nanoparticles of ginseng-derived CK.
Construction and validation of a predictive model for hepatocellular carcinoma based on serum markers
Authors: Zheng Liming , Huang Zeyu , Li Xiaoping , He Meifang , Liu Xiaoqin , Zheng Guojun , Zhou Xike , Liu Longgen 
Published: September 2022

Abstract
Background
Early hepatocellular carcinoma (HCC) detection with non-invasive biomarkers remains an unmet clinical need. We aimed to construct a predictive model based on the pre-diagnostic levels of serum markers to predict the early-stage onset of HCC.

Methods
A total of 339 HCC patients (including 157 patients from Changzhou cohort and 182 patients from Wuxi cohort) were enrolled in our retrospective study. Levels of 25 baseline serum markers were collected. Propensity score matching (PSM) analysis was conducted to balance the distributions of patients’ gender, age, and the surveillance time between HCC group and control group. Then, Receiver operating characteristic (ROC) and Logistic regression analysis were performed to screen the independent predictive variables and construct a non-invasive predictive model. Subsequently, ROC curve and Kaplan–Meier (K–M) curve were used to evaluate the predictive values of the model. Clinical net benefit of the model was demonstrated by decision curve analysis (DCA) and clinical impact curve.

Results
Five independent predictive variables for HCC onset and two general characteristics of patients (age and gender) were incorporated into the score model. ROC and DCA curves showed that the score model had better predictive performance in discrimination and clinical net benefit compared with single variable or other score systems, with the area under the curve (AUC) of 0.890 (95% CI 0.856–0.925) in Changzhou cohort and 0.799 (95% CI 0.751–0.849) in Wuxi cohort. Meanwhile, stratification analysis indicated that the score model had good predictive values for patients with early tumor stage (AJCC stage I) or small tumors (< 2 cm). Moreover, the score of HCC patient began to increase at 30 months before clinical diagnosis and reach a peak at 6 months.

Conclusion
Based on this model, we could optimize the current risk stratification at an early stage and consider further intensive surveillance programs for high-risk patients. It could also help clinicians to evaluate the progression and predict the prognosis of HCC patients.