bluuebunny/crossref_metadata_2025_split huggingface dataset:
The uniportal VATS in the treatment of stage II pleural empyema: a safe and effective approach for adults and elderly patients—a single-center experience and literature review
Authors: Luciani Claudio , Scacchi Andrea , Vaschetti Roberto , Di Marzo Giancarlo , Fatica Ilaria , Cappuccio Micaela , Guerra Germano , Ceccarelli Graziano , Avella Pasquale , Rocca Aldo 
Published: August 2022

Abstract
Background
Pleural empyema (PE) is a frequent disease, associated with a high morbidity and mortality. Surgical approach is the standard of care for most patients with II-III stage PE. In the last years, the minimally invasive surgical revolution involved also thoracic surgery allowing the same outcomes in terms of safety and effectiveness combined to better pain management and early discharge. The aim of this study is to demonstrate through our experience on uniportal-video-assisted thoracoscopy (u-VATS) the effectiveness and safety of its approach in treatment of stage II PE. As secondary endpoint, we will evaluate the different pattern of indication of u-VATS in adult and elderly patients with literature review.

Methods
We retrospectively reviewed our prospectively collected database of u-VATS procedures from November 2018 to February 2022, in our regional referral center for Thoracic Surgery of Regione Molise General Surgery Unit of “A. Cardarelli” Hospital, in Campobasso, Molise, Italy.

Results
A total of 29 patients underwent u-VATS for II stage PE. Fifteen (51.72%) patients were younger than 70 years old, identified as “adults,” 14 (48.28%) patients were older than 70 years old, identified as “elderly.” No mortality was found. Mean operative time was 104.68 ± 39.01 min in the total population. The elderly group showed a longer operative time (115 ± 53.15 min) (p = 0.369). Chest tube was removed earlier in adults than in elderly group (5.56 ± 2.06 vs. 10.14 ± 5.58 p = 0.038). The Length of Stay (LOS) was shorter in the adults group (6.44 ± 2.35 vs. 12.29 ± 6.96 p = 0.033). Patients evaluated through Instrumental Activities of Daily Living (IADL) scale returned to normal activities of daily living after surgery.

Conclusion
In addition, the u-VATS approach seems to be safe and effective ensuring a risk reduction of progression to stage III PE with a lower recurrence risk and septic complications also in elderly patients. Further comparative multicenter analysis are advocated to set the role of u-VATS approach in the treatment of PE in adults and elderly patients.
Strategies for lung- and diaphragm-protective ventilation in acute hypoxemic respiratory failure: a physiological trial
Authors: Dianti Jose , Fard Samira , Wong Jenna , Chan Timothy C. Y. , Del Sorbo Lorenzo , Fan Eddy , Amato Marcelo B. Passos , Granton John , Burry Lisa , Reid W. Darlene , Zhang Binghao , Ratano Damian , Keshavjee Shaf , Slutsky Arthur S. , Brochard Laurent J. , Ferguson Niall D. , Goligher Ewan C. 
Published: August 2022

Abstract
Background
Insufficient or excessive respiratory effort during acute hypoxemic respiratory failure (AHRF) increases the risk of lung and diaphragm injury. We sought to establish whether respiratory effort can be optimized to achieve lung- and diaphragm-protective (LDP) targets (esophageal pressure swing − 3 to − 8 cm H2O; dynamic transpulmonary driving pressure ≤ 15 cm H2O) during AHRF.

Methods
In patients with early AHRF, spontaneous breathing was initiated as soon as passive ventilation was not deemed mandatory. Inspiratory pressure, sedation, positive end-expiratory pressure (PEEP), and sweep gas flow (in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO)) were systematically titrated to achieve LDP targets. Additionally, partial neuromuscular blockade (pNMBA) was administered in patients with refractory excessive respiratory effort.

Results
Of 30 patients enrolled, most had severe AHRF; 16 required VV-ECMO. Respiratory effort was absent in all at enrolment. After initiating spontaneous breathing, most exhibited high respiratory effort and only 6/30 met LDP targets. After titrating ventilation, sedation, and sweep gas flow, LDP targets were achieved in 20/30. LDP targets were more likely to be achieved in patients on VV-ECMO (median OR 10, 95% CrI 2, 81) and at the PEEP level associated with improved dynamic compliance (median OR 33, 95% CrI 5, 898). Administration of pNMBA to patients with refractory excessive effort was well-tolerated and effectively achieved LDP targets.

Conclusion
Respiratory effort is frequently absent under deep sedation but becomes excessive when spontaneous breathing is permitted in patients with moderate or severe AHRF. Systematically titrating ventilation and sedation can optimize respiratory effort for lung and diaphragm protection in most patients. VV-ECMO can greatly facilitate the delivery of a LDP strategy.
Trial registration: This trial was registered in Clinicaltrials.gov in August 2018 (NCT03612583).
Comparison of weight loss induced by daily caloric restriction versus intermittent fasting (DRIFT) in individuals with obesity: study protocol for a 52-week randomized clinical trial
Authors: Ostendorf Danielle M. , Caldwell Ann E. , Zaman Adnin , Pan Zhaoxing , Bing Kristen , Wayland Liza T. , Creasy Seth A. , Bessesen Daniel H. , MacLean Paul , Melanson Edward L. , Catenacci Victoria A. 
Published: August 2022

Abstract
Background
The standard of care for treating overweight and obesity is daily caloric restriction (DCR). While this approach produces modest weight loss, adherence to DCR declines over time and weight regain is common. Intermittent fasting (IMF) is an alternative dietary strategy for reducing energy intake (EI) that involves >60% energy restriction on 2–3 days per week, or on alternate days, with habitual intake on fed days. While numerous studies have evaluated IMF as a weight loss strategy, there are several limitations including lack of a standard-of-care DCR control, failure to provide guideline-based behavioral support, and failure to rigorously evaluate dietary and PA adherence using objective measures. To date, only three longer-term (52-week) trials have evaluated IMF as a weight loss strategy. None of these longer-duration studies reported significant differences between IMF and DCR in changes in weight. However, each of these studies has limitations that prohibit drawing generalizable conclusions about the relative long-term efficacy of IMF vs. DCR for obesity treatment.

Methods
The Daily Caloric Restriction vs. Intermittent Fasting Trial (DRIFT) is a two-arm, 52-week block randomized (1:1) clinical weight loss trial. The two intervention arms (DCR and IMF) are designed to prescribe an equivalent average weekly energy deficit from baseline weight maintenance energy requirements. Both DCR and IMF will be provided guideline-based behavioral support and a PA prescription. The primary outcome is change in body weight at 52 weeks. Secondary outcomes include changes in body composition (dual-energy x-ray absorptiometry (DXA)), metabolic parameters, total daily energy expenditure (TDEE, doubly labeled water (DLW)), EI (DLW intake-balance method, 7-day diet diaries), and patterns of physical activity (PA, activPAL device).

Discussion
Although DCR leads to modest weight loss success in the short-term, there is wide inter-individual variability in weight loss and poor long-term weight loss maintenance. Evidence-based dietary approaches to energy restriction that are effective long-term are needed to provide a range of evidence-based options to individuals seeking weight loss. The DRIFT study will evaluate the long-term effectiveness of IMF vs. DCR on changes in objectively measured weight, EI, and PA, when these approaches are delivered using guideline-based behavioral support and PA prescriptions.
Preoperative smoking cessation program in patients undergoing intermediate to high-risk surgery: a randomized, single-blinded, controlled, superiority trial
Authors: Fankhauser Christian D. , Affentranger Andres , Cortonesi Beatrice , Jeker Urs , Gass Markus , Minervini Fabrizio , Jung Georg , Christmann Corina , Brambs Christine , Puhan Milo A. , Held Ulrike 
Published: August 2022

Abstract
Background
At present, effectively implementing smoking cessation programs in the health care system constitutes a major challenge. A unique opportunity to initiate smoking cessation focuses on smokers scheduled for surgery. These patients are not only highly motivated to quit smoking but also likely to benefit from a reduction in postoperative complications which may translate into a decrease of costs. Nevertheless, surgical patients are not routinely informed about the benefits of preoperative smoking cessation. Potential reasons for this missed opportunity may be the lack of time and training of surgeons and anaesthesiologists. We therefore aim to analyse the impact of a preoperative high-intensity smoking cessation intervention on surgical complications up to a 90-day postoperative period in patients of various surgical disciplines. The hypothesis is that a preoperative smoking cessation program improves outcomes in smokers undergoing intermediate to high-risk surgery.

Methods
The present study is a single-centre, randomized trial with two parallel groups of smokers scheduled for surgery comparing surgery alone and surgery with preoperative smoking cessation. We plan to randomize 251 patients. The primary objective is to compare complications between patients with an institutional multifaceted smoking cessation intervention starting 4 weeks before surgery compared to patients in the advice-only group (control group) within a 90-day postoperative period. The primary endpoint is the Comprehensive Complication Index (CCI®) within 90 days of surgery. Secondary outcomes include the length of hospital stay, cost of care, quality of life, smoking abstinence, and reduction in nicotine consumption.

Discussion
The hypothesis is that a preoperative smoking cessation program improves outcomes in smokers undergoing surgery.

Trial registration
BASEC #2021-02004; ClinicalTrials.gov: NCT05192837. Registered on January 14, 2022.
Rhodnius (Stål, 1859) (Hemiptera, Triatominae) genus in Bolivian Amazonia: a risk for human populations?
Authors: Depickère Stéphanie , Villacís Anita G. , Santillán-Guayasamín Soledad , Callapa Rafael Jorgia Esperanza , Brenière Simone Frédérique , Revollo Zepita Susana 
Published: August 2022

Abstract
Background
Chagas disease, one of the most important neglected tropical diseases in the countries of Latin America, is considered to be a particularly important public health concern in the Amazon region due to increases in the number of outbreaks of acute Chagas disease and increased local transmission in the last 20 years. However, relative to other countries, in Bolivia there is little information available on its transmission in the Amazon region. The aim of this study was to investigate the infestation of palm trees, the main habitat of Triatominae in the region, in several localities, to evaluate the danger they represent to inhabitants.

Methods
Triatominae were collected using live bait traps left overnight in six localities in Pando and Beni Departments, Bolivia. DNA extraction and sequencing were used to establish the Triatominae species (Cytb, 16S and 28S-D2 gene fragments), and the blood meal sources (Cytb fragment). Trypanosoma sp. infection was analyzed by sequencing gene fragments (GPX, GPI, HMCOAR, LAP, PDH and COII) or by mini-exon multiplex PCR.

Results
A total of 325 Rhodnius were captured (97.3% of nymphs) from the 1200 traps placed in 238 palm trees and 32 burrows/ground holes. Sequence analyses on DNA extracted from 114 insects and phylogeny analysis identified two triatomine species: Rhodnius stali (17%) and Rhodnius montenegrensis (equated to Rhodnius robustus II, 83%). These were found in palm trees of the genera Attalea (69%), Astrocaryum (13%), Copernicia (12%), Euterpe (2%) and Acrocomia (1%). The infection rate was around 30% (165 analyzed insects), with 90% of analyzed insects infected by Trypanosoma cruzi (only the TcI discrete typing unit was detected), 3% infected by Trypanosoma rangeli (first time found in Bolivian Triatominae) and 7% infected by mixed T. cruzi (TcI)-T. rangeli. Rhodnius specimens fed on Didelphidae, rodents, gecko and humans.

Conclusions
The results of this study highlight the epidemiological importance of Rhodnius in the Bolivian Amazon region. The huge geographical distribution of Rhodnius and their proximity to the human dwellings, high infection rate and frequent meals on the human population highlight a risk of transmission of Chagas disease in the region.

Graphical Abstract
Prognostic significance of diabetes and stress hyperglycemia in acute stroke patients
Authors: Muscari Antonio , Falcone Roberta , Recinella Guerino , Faccioli Luca , Forti Paola , Pastore Trossello Marco , Puddu Giovanni M. , Spinardi Luca , Zoli Marco 
Published: August 2022

Abstract
Background
Hyperglycemic non-diabetic stroke patients have a worse prognosis than both normoglycemic and diabetic patients. Aim of this study was to assess whether hyperglycemia is an aggravating factor or just an epiphenomenon of most severe strokes.

Methods
In this retrospective study, 1219 ischemic or hemorrhagic stroke patients (73.7 ± 13.1 years) were divided into 4 groups: 0 = non-hyperglycemic non-diabetic, 1 = hyperglycemic non-diabetic, 2 = non-hyperglycemic diabetic and 3 = hyperglycemic diabetic. Hyperglycemia was defined as fasting blood glucose ≥ 126 mg/dl (≥ 7 mmol/l) measured the morning after admission, while the diagnosis of diabetes was based on a history of diabetes mellitus or on a glycated hemoglobin ≥ 6.5% (≥ 48 mmol/mol), independently of blood glucose levels. All diabetic patients, except 3, had Type 2 diabetes. The 4 groups were compared according to clinical history, stroke severity indicators, acute phase markers and main short term stroke outcomes (modified Rankin scale ≥ 3, death, cerebral edema, hemorrhagic transformation of ischemic lesions, fever, oxygen administration, pneumonia, sepsis, urinary infection and heart failure).

Results
Group 1 patients had more severe strokes, with larger cerebral lesions and higher inflammatory markers, compared to the other groups. They also had a high prevalence of atrial fibrillation, prediabetes, previous stroke and previous arterial revascularizations. In this group, the highest frequencies of cerebral edema, hemorrhagic transformation, pneumonia and oxygen administration were obtained. The prevalence of dependency at discharge and in-hospital mortality were equally high in Group 1 and Group 3. However, in multivariate analyses including stroke severity, cerebral lesion diameter, leukocytes and C-reactive protein, Group 1 was only independently associated with hemorrhagic transformation (OR 2.01, 95% CI 0.99–4.07), while Group 3 was independently associated with mortality (OR 2.19, 95% CI 1.32–3.64) and disability (OR 1.70, 95% CI 1.01–2.88).

Conclusions
Hyperglycemic non-diabetic stroke patients had a worse prognosis than non-hyperglycemic or diabetic patients, but this group was not independently associated with mortality or disability when size, severity and inflammatory component of the stroke were accounted for.
Exome sequencing can misread high variant allele fraction of somatic variants in UBA1 as hemizygous in VEXAS syndrome: a case report
Authors: Wilke Matheus V. M. B. , Morava-Kozicz Eva , Koster Matthew J. , Schmitz Christopher T. , Foster Shannon Kaye , Patnaik Mrinal , Warrington Kenneth J. , Klee Eric W. , Pinto e Vairo Filippo 
Published: August 2022

Abstract
Background
VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic syndrome) is a recently described syndrome caused by a somatic missense variant at the methionine-41 (p.(Met41)) position in the ubiquitin-like modifier activating enzyme 1 (UBA1) in Xp11.3. Germline pathogenic variants in UBA1 are associated with a distinct phenotype: a syndrome with severe neurologic features associated with loss of anterior horn cells and infantile death denominated X-Linked Spinal Muscular Atrophy 2 (SMAX2) (OMIM 301,830).

Case presentation
We report a male individual with the phenotype of VEXAS syndrome that was initially identified through exome sequencing (ES) as having a hemizygous germline variant in UBA1 due to high variant allele frequency (VAF). Research Sanger sequencing was able to confirm the absence of the p.(Met41Val) variant in a skin biopsy and in gastric mucosa tissue sample confirming the variant happened as a postzygotic event.

Conclusions
The present case exemplifies the diagnostic challenge that was imposed by the high VAF detected by ES that failed to correctly demonstrate that the variant was in a mosaic state. Sequencing of different tissues should be considered when there is conflict between the UBA1 variant status and the clinical findings.
Management of medication overuse (MO) and medication overuse headache (MOH) S1 guideline
Authors: Diener Hans-Christoph , Kropp Peter , Dresler Thomas , Evers Stefan , Förderreuther Stefanie , Gaul Charly , Holle-Lee Dagny , May Arne , Niederberger Uwe , Moll Sabrina , Schankin Christoph , Lampl Christian 
Published: August 2022

Abstract
Introduction
Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5–2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH).

Recommendations
Treatment of headache due to overuse of analgesics or specific migraine medications involves several stages. Patients with medication overuse (MO) or medication overuse headache (MOH) should be educated about the relationship between frequent use of symptomatic headache medication and the transition from episodic to chronic migraine (chronification), with the aim of reducing and limiting the use of acute medication. In a second step, migraine prophylaxis should be initiated in patients with migraine and overuse of analgesics or specific migraine drugs. Topiramate, onabotulinumtoxinA and the monoclonal antibodies against CGRP or the CGRP-receptor are effective in patients with chronic migraine and medication overuse. In patients with tension-type headache, prophylaxis is performed with amitriptyline. Drug prophylaxis should be supplemented by non-drug interventions. For patients in whom education and prophylactic medication are not effective, pausing acute medication is recommended. This treatment can be performed in an outpatient, day hospital or inpatient setting. Patients with headache due to overuse of opioids should undergo inpatient withdrawal. The success rate of the stepped treatment approach is 50–70% after 6 to 12 months. A high relapse rate is observed in patients with opioid overuse. Tricyclic antidepressants, neuroleptics (antiemetics) and the administration of steroids are recommended for the treatment of withdrawal symptoms or headaches during the medication pause. Consistent patient education and further close monitoring reduce the risk of relapse.
Rare condition of unilateral submandibular gland aplasia and its diagnostic significance in oral cavity carcinoma
Authors: Targe Mangala , Yasam Venkata Ramesh , Gandhe Sucheta , Manek Dhruti , Nagarkar Raj 
Published: August 2022

Abstract
Background
The unilateral submandibular gland aplasia (agenesis) is a rare, asymptomatic condition usually discovered incidentally on imaging. This is associated commonly with either compensatory hypertrophy of contralateral submandibular gland or sublingual glands.

Case presentation
We report the case of a 34-year-old male with incidentally detected unilateral submandibular gland aplasia associated with hypertrophy of ipsilateral sublingual gland, demonstrated by imaging modalities, where we have highlighted the diagnostic significance of such rare findings in oncology, particularly in oral cavity carcinoma cases with metastatic submandibular lymph nodes (level IB) mimicking as submandibular gland. Hence, lymphadenopathy can be missed preoperatively which is an important part of staging and treatment planning.

Conclusions
Aim of the present report is to create awareness about such rare entity in both clinicians/radiologists and highlight the imaging features for correct identification and to avoid any diagnostic dilemmas.
Realizing an excellent solution for detecting and solving conflicts between viewpoints of designers in self-adaptive systems
Authors: Do The-Can 
Published: August 2022

AbstractRecently, given the rise of emerging demands on intelligent technological systems, increasing attention has been given to proliferating and enhancing the adaptation capacities of self-adaptive systems (SAS), which are capable of adapting their behavior to changes in the context or system resources contributing to overcome the complexity of today’s software-intensive systems. However, there are a significant number of challenges for developing adaptations on the SAS, such as simplifying the designer’s task, improving responsiveness, and reducing the conflicts between its adaptations. This study focuses on simplifying the designers’ tasks by utilizing independent designers’ viewpoints on context modeling. We proposed several solutions for solving the conflicts among different viewpoints of designers in the layer of context-aware management (CAM). The validation results are promising and show that our method effectively provides a solution that supports the problem of using independent viewpoints in the context modeling process and improves the SAS adaptation capacity.
Approach to the Patient: Diagnosis of Cushing Syndrome
Authors: Savas Mesut , Mehta Sonal , Agrawal Nidhi , van Rossum Elisabeth F C , Feelders Richard A 
Published: August 2022

Abstract
Cushing syndrome results from supraphysiological exposure to glucocorticoids and is associated with significant morbidity and mortality. The pathogenesis includes administration of corticosteroids (exogenous Cushing syndrome) or autonomous cortisol overproduction, whether or not ACTH-dependent (endogenous Cushing syndrome). An early diagnosis of Cushing syndrome is warranted; however, in clinical practice, it is very challenging partly because of resemblance with other common conditions (ie, pseudo-Cushing syndrome). Initial workup should start with excluding local and systemic corticosteroid use. First-line screening tests including the 1-mg dexamethasone suppression test, 24-hour urinary free cortisol excretion, and late-night salivary cortisol measurement should be performed to screen for endogenous Cushing syndrome. Scalp-hair cortisol/cortisone analysis helps in the assessment of long-term glucocorticoid exposure as well as in detection of transient periods of hypercortisolism as observed in cyclical Cushing syndrome. Interpretation of results can be difficult because of individual patient characteristics and hence requires awareness of test limitations. Once endogenous Cushing syndrome is established, measurement of plasma ACTH concentrations differentiates between ACTH-dependent (80%-85%) or ACTH-independent (15%-20%) causes. Further assessment with different imaging modalities and dynamic biochemical testing including bilateral inferior petrosal sinus sampling helps further pinpoint the cause of Cushing’s syndrome. In this issue of “Approach to the patient,” the diagnostic workup of Cushing syndrome is discussed with answering the questions when to screen, how to screen, and how to differentiate the different causes. In this respect, the latest developments in biochemical and imaging techniques are discussed as well.
Rational Synthesis of Benzoheterole-fused Porphyrins and π-System Switching by Central Metal Ion
Authors: Higashino Tomohiro , Iizumi Rikiya , Imahori Hiroshi 
Published: August 2022

Abstract
We developed a rational synthetic approach for benzoheterole-fused porphyrins and demonstrated the synthesis of benzothiophene- and indole-fused porphyrins using the approach. The fused porphyrins exhibited red-shifted absorption and fluorescence due to the effective π-expansion through heterole-fused structures. In addition, the π-circuit of indole-fused porphyrin can be switched by a central metal ion.