bluuebunny/crossref_metadata_2025_split huggingface dataset:
An enhanced mechanism for detection of Domain Name System‐based distributed reflection denial of service attacks depending on modified metaheuristic algorithms and adaptive thresholding techniques
Authors: Manickam Selvakumar , Rahef Nuiaa Riyadh , Hakem Alsaeedi Ali , Alyasseri Zaid Abdi Alkareem , Mohammed Mazin Abed , Jaber Mustafa Musa 
Published: July 2022

AbstractThe rapid growth of the number of devices connected to the Internet and the increasing demand for electronic services have led to a huge growth in the number of cyberattacks targeting cyberspace and the development of their methodology. Therefore, there must be mechanisms, laws, and rules regulating the work of these applications and protecting them from electronic attacks. The Domain Name System (DNS) has several vulnerabilities that can be exploited by cyber attackers to launch their attacks, and the most important one of these vulnerabilities is that the response size is always greater than the size of the request. According to reports published by numerous security companies, distributed reflection denial of service (DRDoS) attacks against DNS are regarded as one of the most hazardous and rapidly spreading threats in recent years. An enhanced mechanism that is able to detect DNS‐based DRDoS attacks that exploit the DNS responses to launch their attacks is proposed. The proposed mechanism was designed based on modified metaheuristic optimization algorithms and an adaptive threshold. This mechanism consists of two models and four stages. The first model is called ‘Proactive Feature Selection,’ and the second model is called ‘Evolving Dynamic Fuzzy Clustering.’ The four stages of the proposed mechanism are: the preprocessing stage, feature selection stage, detection stage, and enhancement stage. The new mechanism has been implemented on the CICDDoS2019 standard dataset and achieves a detection accuracy of 95.44% with a false‐positive rate of 0.22%. The results show that the new mechanism is better than others depending on the detection accuracy and false positives.
Effect of Microvascular Decompression of the Vagus Root Entry/Exit Zone on Blood Pressure in Patients with Hemifacial Spasm Associated with Essential Hypertension: A Retrospective Clinical Analysis
Authors: Wei Xuefeng , Wang Jiao , Kong Xuerui , Gao Caibin , Wang Feng 
Published: July 2022

Abstract
Background This study aimed to evaluate blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS) with coexisting hypertension (HTN).
Methods A total of 56 patients with HFS with concurrent HTN who underwent MVD surgery in our center between 2015 and 2019 were retrospectively analyzed. Patients were divided into control and experimental groups: patients who received MVD treatment for only the facial nerve and those who received MVD for the affected facial nerve, ipsilateral vagus nerve, and adjacent ventrolateral medulla, respectively. Preoperative (3 days) and postoperative (7 days and 6 months) blood pressure measurements were analyzed.
Results No statistically significant differences were observed in gender, age, HFS course, HTN course, HTN grade, and preoperative blood pressure between the two groups. No significant difference was observed between pre- and postoperative blood pressure in the control group. In the experimental group, systolic blood pressure significantly differed between 3 preoperative days and 7 postoperative days (p < 0.05), as did diastolic blood pressure (p < 0.05). Measurement at 6 postoperative months also showed significant differences for both systolic blood pressure and diastolic blood pressure compared with that at 3 preoperative days (p < 0.05). HTN grade according to the World Health Organization classification criteria significantly differed between preoperative and postoperative measurements (p < 0.05).
Conclusion Vascular decompression of the ipsilateral vagus nerve roots may improve blood pressure management in patients with HFS with coexisting HTN who undergo MVD. Laterality of involvement (left vs. right) did not significantly differ.
Gamma Knife Radiosurgery for Large Vestibular Schwannoma More Than 10 cm3: A Single-Center Indian Study
Authors: Yeole Ujwal , Prabhuraj A. R. , Arivazhagan Arimappamagan , Narasingarao K. V. L. , Vazhayil Vikas , Bhat Dhananjaya , Srinivas Dwarakanath , Govindswamy Bhanumathi , Sampath Somanna 
Published: July 2022

Abstract
Introduction Gamma Knife radiosurgery (GKRS) is an effective treatment for benign vestibular schwannomas (VSs). The established cutoffs have recently been challenged, as recent literature expanded the horizon of GKRS to larger tumors. Even though microsurgery remains the primary option for large VS, GKRS can provide reasonable tumor control and is more likely to avoid cranial neuropathies associated with open surgery.
Methods We analyzed patients with VS with volume exceeding 10 cm3 who underwent GKRS at our center from January 2006 to December 2016. Clinicoradiological and radiosurgical data were collected from medical records for statistical analysis. Follow-up was performed every 6 months with a clinical assessment along with magnetic resonance imaging (MRI) of the brain and audiometric evaluation in patients with serviceable hearing.
Results The study included 34 patients (18 males and 16 females) with an average age of 45.5 years. The mean tumor volume was 10.9 cm3 (standard deviation [SD], ± 0.83), with a median tumor dose of 12 Gy (interquartile range, 11.5–12) and a mean follow-up of 34.7 months (SD, ± 23.8). Tumor response was graded as regression in 50%, stable in 44.1%, and increase or GKRS failure in 2 cases (5.8%). Treatment failure was noted in five cases (14.7%), requiring microsurgical excision and a ventriculoperitoneal shunt post-GKRS. The tumor control rate for the cohort is 85.3%, with a facial preservation rate of 96% (24/25) and hearing loss in all (5/5), while three patients developed new-onset hypoesthesia. We noted that gait ataxia and involvement of cranial nerve V or VII at initial presentation were associated with GKRS failure in univariate analysis.
Conclusion Microsurgery should remain the first-choice treatment option for large VSs. GKRS is a viable alternative with good tumor control and improved or stabilized cranial neuropathies with a low complication rate.
The P300 Auditory Evoked Potential in Cochlear Implant Users: A Scoping Review
Authors: Amaral Maria Stella Arantes do , Zamberlan-Amorin Nelma Ellen , Mendes Karina Dal Sasso , Bernal Sarah Carolina , Massuda Eduardo Tanaka , Hyppolito Miguel Angelo , Reis Ana Cláudia Mirândola Barbosa 
Published: July 2022

Abstract
Introduction The P300 auditory evoked potential is a long-latency cortical potential evoked with auditory stimulation, which provides information on neural mechanisms underlying the central auditory processing.
Objectives To identify and gather scientific evidence regarding the P300 in adult cochlear implant (CI) users.
Data Synthesis A total of 87 articles, 20 of which were selected for this study, were identified and exported to the Rayyan search software. Those 20 articles did not propose a homogeneous methodology, which made comparison more difficult. Most articles (60%) in this review compare CI users with typical hearing people, showing prolonged P300 latency in CI users. Among the studies, 35% show that CI users present a smaller P300 amplitude. Another variable is the influence of the kind of stimulus used to elicit P300, which was prolonged in 30% of the studies that used pure tone stimuli, 10% of the studies that used pure tone and speech stimuli, and 60% of the studies that used speech stimuli.
Conclusion This review has contributed with evidence that shows the importance of applying a controlled P300 protocol to diagnose and monitor CI users. Regardless of the stimuli used to elicit P300, we noticed a pattern in the increase in latency and decrease in amplitude in CI users. The user's experience with the CI speech processor over time and the speech test results seem to be related to the P300 latency and amplitude measurements.
Migraine with Brainstem Aura Associated with SCN2A Mutation: A Case Report
Authors: Membrilla Javier A. , Sastre-Real María , Tirado Pilar , Díaz-de-Terán Javier 
Published: July 2022

Abstract
Background Migraine with brainstem aura (MBA) is a rare subtype of migraine with aura that associates headache with paroxysmal episodes of ataxia, dysarthria, and diplopia among other symptoms attributed to brainstem involvement. The manifestation of this disease in the absence of typical aura symptoms (i.e., fully reversible visual, sensory and/or speech/language symptoms) is even more infrequent.
Case Report In this article, we reported a case of a 16-year-old male patient with MBA associated with a sodium voltage-gated channel alpha subunit 2 (SCN2A) de novo mutation. The patient did not have typical aura symptoms. Ataxia was the most prominent clinical feature, leading to initial diagnosis of episodic ataxia. Patient responded partially to treatment with onabotulinum toxin A.
Conclusion MBA needs to be taken into consideration in the differential diagnosis of recurrent ataxia, even in the absence of typical aura symptoms. Finding a de novo SCN2A mutation in our patient helps in further understanding of MBA genetics.
CALA: Cumulative Volume of Calcified Lesions of the Aorta in Cardiac Surgery
Authors: Ioannou Stelios , Braun Christian , Hartrumpf Martin , Kühnel Ralf-Uwe , Vafa Ali , Schröter Filip , Albes Johannes 
Published: July 2022

AbstractOne of the major key questions raised in this retrospective study was to identify any correlation of atherosclerotic plaque volume of the ascending aorta and aortic arch with adverse events such as postoperative stroke, critical illness polyneuropathy and myopathy, as well as delirium and all-cause in-hospital mortality. In a second phase of this study, we investigated the relationship between atherosclerotic plaque volume and adverse events regarding the construction of proximal anastomosis on coronary artery bypass grafting procedures using different clamping techniques such as construction of anastomosis on cross-clamping or cross-clamping plus consecutive partial clamping of the aorta. The key findings of our research were that the size of calcium lesions of the ascending aorta and aortic arch correlates with early mortality, critical illness polyneuropathy/myopathy, and delirium but not with stroke. On the other hand, there were no significant differences between isolated cross-clamping versus cross-clamping plus consecutive partial clamping of the aorta regarding the primary adverse events by means of mean plaque volume.
Technologies and Mental Health in University Students: An Unhealthy Combination
Authors: Silva Mariana Pires Ferreira Novaes da , Cardoso Gabriela Miloch da Silva , Priolo Filho Sidnei Rinaldo , Weber Silke Anna Theresa , Corrêa Camila de Castro 
Published: July 2022

Abstract
Introduction The exposure of medical students to a full-time schedule that includes classes, extracurricular activities, patients' lives responsibility, and great competition between classmates can interfere in emotional issues and in the sleep time.
Objective The aim of the present study was to evaluate the sleep quality, and the incidence of anxiety and depression in medical school undergraduates as well as the relationship of these parameters with the intense use of technologies.
Methods Fifty-five medical school undergraduates in their second year participated in the present study, answering questionnaires to evaluate sleep quality (Pittsburgh sleep quality index - PSQI), night-time use of technology (sleep time-related information and communication technology - STRICT), and signs of anxiety or depression (hospital anxiety and depression scale - HADS).
Results The results showed 31 students (56.4%) with poor sleep quality (PSQI > 5). Based on the STRICT questionnaire, 36 (65.4%) of the participants referred to making use of technology at night-time; and 34 (61.8%) students had compatible anxiety score, while 14 (25.4%) had a compatible score for depression on the HADS questionnaire. There has been a correlation between poor sleep quality, the abuse of technologies before sleep time, and the presence of anxiety or depression.
Conclusion The abuse of technology before sleep time reduced the sleep quality in the studied population, besides increasing the symptoms of anxiety and depression.
The Effect of Prosthesis Type on Intraoperative Soft-Tissue Balance and Clinical Outcomes in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty
Authors: Matsumoto Tomoyuki , Nakano Naoki , Ishida Kazunari , Takashima Yoshinori , Maeda Toshihisa , Kuroda Yuichi , Hayashi Shinya , Matsushita Tekehiko , Niikura Takahiro , Muratsu Hirotsugu , Kuroda Ryosuke 
Published: July 2022

Abstract
Introduction Kinematically aligned total knee arthroplasty (KA-TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. One of the advantages of KA-TKA is reported to be an easy acquisition of intraoperative soft-tissue balance without excessive medial release for varus osteoarthritis. However, we hypothesized that the prosthesis type affects intraoperative soft-tissue balance even in the KA-TKA. The present study aimed to compare intraoperative soft-tissue balance and clinical outcomes of KA-TKAs using single-radius (SR) or multiradius (MR) prostheses.
Materials and Methods Consecutive 70 cruciate-retaining modified KA-TKAs (31 SR and 39 MR) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative soft-tissue balance including joint component gap and varus/valgus balance was measured with femoral component placement and patellofemoral joint reduction throughout the range of motion using offset-type tensor and compared between the two groups. Two years postoperatively, the range of motion and 2011 Knee Society Scores were compared between the two groups.
Results and Conclusion Joint component gaps showed no significant differences between the two groups from 0 to 30 degrees of flexion. However, during 60 to 120 degrees of flexion, joint component gaps of SR group showed significantly larger values than those of MR group (p < 0.05). There were no significant differences in varus/valgus balance throughout the range of motion between the two groups. The postoperative clinical outcomes showed no significant differences between the two groups.
Interpretation Despite no difference in clinical outcomes, joint component gap showed different patterns due to the prosthesis type in modified KA-TKAs.
The Effect of Vitamin D Levels in Multisystem Inflammatory Syndrome in Children
Authors: Kan Ahmet , Türe Mehmet , Akın Alper , Yılmaz Kamil , Sürücü Mehmet , Ünal Edip , Şen Velat , Üzel Veysiye Hülya 
Published: July 2022

Abstract
Objective Multiple factors being overweight, asthmatic, or being of Asian or black ethnic origins have been reported vis-à-vis the “multisystem inflammatory syndrome in children” (MIS-C). There is an association between these conditions and vitamin D deficiency, which explains why MIS-C is more common in these patients. In the present study, we attempted to retrospective evaluate the 25-hydroxy vitamin D levels of patients with MIS-C, its association with acute phase reactants, its treatment, and clinical status.
Methods Patients aged between 1.5 months to 18 years with MIS-C were included in the study. All of the laboratory parameters, treatment, and response to the treatment were evaluated retrospectively. Two groups were formed. Patients had 25‐hydroxycholecalciferol D vitamin < 20 ng/mL in group 1 and ≥ 20 ng/mL in group 2.
Results A total of 52 patients were included in the study. There was no statistical difference between groups in terms of acceptance of the intensive care unit treatment (p = 0.29) and response to the first-line treatment (p = 0.56). A lower median lymphocyte count (p = 0.01) and a higher median C-reactive protein (p = 0.04) and procalcitonin (p = 0.01) with N-terminal pro-B-type natriuretic peptide (p = 0.025) values were found in group 1.
Conclusion Vitamin D deficiency was associated with an increased inflammatory response in children with MIS-C. More studies are required to determine the potential impact of vitamin D deficiency on the clinical outcome of MIS-C.
Distal Femoral Tracker Pin Placement Prevents Delayed Pin Tract-Induced Fracture in Robotic-Assisted Total Knee Arthroplasty: Results of Minimum 1-Year Follow-Up
Authors: Baek Ji-Hoon , Lee Su Chan , Kim Jin-Hong , Ahn Hye Sun , Nam Chang Hyun 
Published: July 2022

AbstractThe purpose of this study was to determine the outcomes of the placement of a pin tracker in the distal femur in robotic-assisted total knee arthroplasty (TKA) over a minimum follow-up period of 1 year. A consecutive series of 81 TKAs were performed in 59 patients using a robotic-assisted system (Mako) at our hospital. The mean follow-up period was 1.1 years (range, 1–1.2 years). No periprosthetic fracture at a pin tracker site was reported at a minimum of 1 year of follow-up. No patients reported minor or major complications associated with the distal femoral pins. In addition, unicortical pin-site drilling marks in all patients disappeared on one-postoperative-year follow-up radiographs. Our technique, which used unicortical pin placement in the distal femur in robotic-assisted TKA, demonstrated that it was a safe and reliable method at a minimum follow-up period of 1 year. The level of evidence is IV.
Analysis of Health-Related Quality of Life and Clinical Evaluations in Patients with the Triad of Combined Knee Injuries
Authors: Ochiai Satoshi , Hagino Tetsuo , Senga Shinya , Yamashita Takashi , Ando Takashi , Taniguchi Naofumi , Haro Hirotaka 
Published: July 2022

AbstractCombined knee injuries of the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus were called “the unhappy triad” in the past. With recent advances in diagnostic technology, combined ACL, MCL, and lateral meniscus injuries are now known to be the predominant triad. We examined and verified the treatment outcomes of the triad of combined knee injuries from both patient-based subjective evaluation and objective assessments. We studied 49 knees (49 patients) with combined injuries of the ACL, MCL, and lateral meniscus. These cases were divided into those who underwent simultaneous ACL and MCL reconstruction (group A, 18 cases) and those who underwent ACL reconstruction only because MCL injury could be treated conservatively (group B, 31 cases). Clinical evaluation was conducted preoperative and 24 months or longer after surgery. The methods included patient-reported outcomes using Short Form-36, and conventional assessments using Lysholm's score, visual analogue scale (VAS), and quantitative measurement of knee instability using Telos SE. Compared with presurgical scores, the postsurgical Short Form-36 scores showed improvements in all eight subscales, all reaching the national standard values. Significant improvements were observed in the five subscales in group A and seven subscales in group B. Furthermore, significant improvements in Lysholm's score, VAS pain score, and quantitative knee instability were achieved in both groups. This study demonstrated successful clinical outcomes in patients with a triad of knee injuries who were treated with lateral meniscus repair or partial meniscectomy and either combined MCL/ACL reconstruction or ACL reconstruction alone.
Clinical Response to Adjunctive Pegylated Interferon Alpha-2a Treatment in Disseminated Mycobacterial Infection in Children with Complete IFNGR1 Deficiency: A Case Report
Authors: Atakul Gizem , Atay Özge , Asrak Hatice Karaoğlu , Erbaş İrem Ceren , Asilsoy Suna , Belet Nurşen , Boyacıoğlu Özge Kangallı , Köse Seda Şirin , Al Serdar , Uzuner Nevin , Karaman Özkan 
Published: July 2022

Objective Interferon gamma receptor 1 (IFNGR1) deficiency is a primary immunodeficiency that causes systemic infections with weakly virulent nontuberculous mycobacteria, which are very difficult to control with combined antimycobacterial agents.
Methods Disseminated mycobacterial infection that could not be controlled with combined antimycobacterial treatments in a 13-year-old patient with a novel mutation in the IFNGR1 gene. Despite receiving intravenous antibiotic therapy, fever continued, bone involvement gradually increased, and proteinuria and microscopic hematuria occurred. Peg-IFNα-2a was administered as an adjuvant therapy that resulted in good clinical response with no side effects. Fever improved and no new bone lesions occurred with edema of existing lesions regressing after 2 weeks of peg-IFNα-2a therapy.
Conclusion Aggressive treatment with antimycobacterial antibiotics and hematopoietic stem cell transplantation remains the single accepted method for the management of patients with complete IFNGR1 deficiency. Peg-IFNα-2a treatment may be an adjunct treatment in this disorder.
Acute Colonic Variceal Bleeding in a Cirrhotic Patient Treated by Modified Balloon-occluded Retrograde Transvenous Obliteration: A Case Report
Authors: Yasin Ahmad L. F. , Kassamali Rahil Hussein , Khader Mohammad , Almokdad Omran , Barah Ali Raza , Omar Ahmad 
Published: July 2022

AbstractColonic varices are an uncommon type of ectopic varices that can occur due to underlying liver cirrhosis and portal hypertension. They form a very rare cause of lower gastrointestinal bleeding that can result in massive hemorrhage. We present a 38-year-old woman with a background of ulcerative colitis complicated by primary sclerosing cholangitis-induced liver cirrhosis presenting with fresh rectal bleeding. The colonoscopy failed to identify the source of bleeding. Then, computed tomography scan showed multiple dilated tortuous venous collaterals around the descending colon that extended into the colonic submucosa and drained via the left ovarian vein representing colonic varices. She underwent balloon-occluded retrograde transvenous obliteration (BRTO), which successfully embolized these varices with no significant complications. Despite there being no established management guidelines for colonic variceal bleeding, BRTO is a minimally invasive procedure that can be considered as good option for the treatment of these varices, especially when other alternatives are not applicable.