bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Frequency of Pleural Effusions after Bellovac Drainage following Coronary Bypass Grafting
Authors: Dunning Joel , Megahed Mahmood , Millner Russell W. J. 
Published: September 2022

Background: A common postoperative complication after CABG with internal mammary artery (IMA) harvest is the evolution of a pleural effusion. Our aim was to see if the intra-operative insertion of a Bellovac drain to the pleural cavity, with drainage continuing for 4-days post operation, eliminates the complication of pleural effusion. Methods: Using our computerised audit database, 500 consecutive patients were identified who had undergone CABG including at least one internal mammary graft by a single consultant at Blackpool Victoria Hospital. All these patients received Bellovac drainage for 4 days on the side of the harvested IMA. The chest X-ray reports were retrospectively collected from the hospital computer databases. The 4-day post-operative, and the 6-week post-operative films were found. In the cases where no consultant radiologist report was found J.D. reviewed the film, and any abnormalities were also reviewed by R.W.J.M. Results: Out of 500 radiographs, six patients (1.2%) died, 25 patients had no traceable record of a chest X-ray, 434 patients had an entirely normal chest X-ray and 461 patients had no effusion at 6 weeks. Six patients had a small effusion at 6 weeks, two had a moderate effusion successfully treated conservatively, and no patients had a pleural effusion that required drainage. Conclusion: In patients undergoing coronary arterial bypass grafting with Internal mammary artery harvest, the intra-operative insertion of a Bellovac drain on the side of the harvested IMA reduces the risk of postoperative pleural effusions
Should Ruptured Abdominal Aortic Aneurysms be Repaired in the Octogenarian?
Authors: Roddy Sean P. , Darling R. Clement , Maharaj Dale , Ozsvath Kathleen J. , Mehta Manish , Paty Philip S. K. , Kreienberg Paul B. , Choi Daniel , Chang Benjamin B. , Shah Dhiraj M. 
Published: September 2022

Purpose. Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population. Methods From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: ?⩾80 years. Outcomes were evaluated based on a Chi-square test and a P-value <0.05 indicated statistical significance. Results Over a 20-year period, 323 patients underwent rAAA repair through a left retroperitoneal (74%) or standard transperitoneal (26%) approach. In Group I (age <80 years) and II (⩾80 years), the overall 30-day mortality was 25 and 41% ( P < 0.05), respectively. Furthermore, the elderly population had a higher incidence of death due to myocardial infarction (15 vs. 7%), as well as non-fatal cardiac and cerebrovascular events (17 vs. 4%) when compared to the younger patients. Conclusion Although the elderly patients have an increased risk of having cardiac and cerebrovascular events in the postoperative period, the treatment of rAAAs in these patients should not be any different than that of a younger population. The left retroperitoneal approach is feasible and beneficial for rAAA repair and is associated with a limited morbidity and mortality.
Quality of Life and NYHA Class 30 Years after Mechanical Aortic Valve Replacement
Authors: Maliwa M. A. , van der Heijden G. J. M. G. , Bots M. L. , van Hour B. A. , Casselman F. P. , van Swieten H. , Vermeulen F. E. E. 
Published: September 2022

Objective (1) To evaluate the quality of life (QoL) scores, assessed with SF36 and EuroQol (EQ-5D), of long term survivors after mechanical aortic valve replacement (mAVR); (2) to study the association of QoL with NYHA score, number of major bleeding and thrombo-embolic events and follow-up time; (3) to compare QoL scores of long term mAVR survivors with QoL scores of other populations. Methods In total 312 patients had a mAVR between 1964 and 1974 at St. Antonius Hospital Nieuwegein (NL). Mean age at operation was 41 ( sd = 12). Mean postoperative NYHA class at 1-year follow-up was 1.7 ( sd = 0.7). In 2001 the survivors ( n = 78; 25%) were followed-up for late events, NYHA class and QoL scores. 69 patients (93%) returned completed questionnaires. Results Mean duration of follow-up was 30 years ( sd = 1.8). Mean age of responders was 65 years ( sd = 10, range 47–93). In 2001, NYHA class of responders was 2 ( sd = 0.9). The mean (sd) SF36 scores for responders were: 64 (29) for physical function. 64 (29) for role-physical, 80 (30) for bodily pain. 55 (25) for general health, 63 (23) for vitality. 73 (29) for social functioning, 70 (38) for role-emotional, 76 (18) for mental health. The mean EQ-5D score of responders was: 61 (13). These SF36 and EQ-5D scores are comparable to those of other populations (e.g. cancer, diabetes type-2, migraine, chronic liver disease and iliac artery occlusive disease and Dutch general population). For responders a moderate to high association of SF36 and EQ-5D scores and their NYHA scores(R2 = 0.36) was found. The number of major bleeding events, age, sex and survival time were not related to QoL. Conclusion At long term follow-up (mean 30 years) of patients who had mAVR, QoL was relatively high; it was moderately to highly associated with their NYHA class; bleeding and thromboembolic events seem to be of little importance for the QoL at long term follow-up. QoL at long term follow-up of patients who had mAVR is comparable to other cross sectional designed studies with short term follow-up and other population.
Minimally Invasive Coronary Artery Bypass Grafting in High-Risk Patients. Late Follow-Up with Assessment of Left Internal Mammary Artery Graft Patency and Flow by Exercise Transthoracic Doppler Echocardiography
Authors: Sunderdiek U. , Kalweit G. A. , Marx R. , Schipke J. D. , Gams E. 
Published: September 2022

Patients with significant risk factors are at increased risk of higher mortality and morbidity (9–16%) after CABG-procedures with cardiopulmonary bypass (CPB). When catheter interventions are not applicable and conventional CABG with CPB are considered to have an unacceptable perioperative risk, these patients ( n = 35) were scheduled for minimally invasive coronary artery bypass grafting (MIDCAB). Patients and methods: The risks leading to exclusion of conventional CABG procedures were: extremely impaired LV-function (EF < 20%), severe pulmonary diseases, malignant carcinoma, compromised coagulation system, age >80 years with impaired physical constitution, redoprocedures after complicated initial operation, symptomatic descending thoracic aortic aneurysm, ongoing long-term intensive care treatment with unclear prognosis. All patients received the LIMA as a single graft to the LAD. One year follow-up was performed using transthoracic Doppler echocardiography at rest and during exercise. Results: In 20 patients incomplete revascularization was accepted. There was no mortality, while signs for myocardial infarction were seen in two patients. Twenty-nine patients (82%) showed clear improvement of clinical symptoms, one patient needed further conventional CABG. Nine to thirteen months postoperatively (mean 10.8 ± 1.6 months), there were two deaths due to noncardiac reasons. Three of the survivors ( n = 33) had symptoms of angina pectoris. Exercise tests revealed an improved stress tolerance (NYHA class improved from preop. III—IV to postop. I—II). The IMA graft flow increased significantly with exercise in all patients. Flow patterns in both flow velocity and volume changed to diastolic-dominant, and the ratio of diastolic to systolic time-velocity integral of > 1.5 excluded a graft stenosis. Conclusions: In high-risk patients, with an increased likelihood of perioperative morbidity and mortality, the MIDCAB procedure can be performed accurately and safely. Even after incomplete revascularization of some high-risk patients, exercise tolerance was improved. Transthoracic Doppler echocardiography proved to be a clinically useful noninvasive method of assessing IMA graft function at rest and during exercise. Despite the small patient population, our late follow-up results suggest the potential benefit of MIDCAB for patients with otherwise inoperable heart disease.
Experiences in Robotically Enhanced IMA-Preparation as Initial Step towards Totally Endoscopic Coronary Artery Bypass Grafting
Authors: Reuthebuch O. , Comber M. , Grünenfelder J. , Zünd G. , Turina M. 
Published: September 2022

Aim To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA). Method Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO2 insufflation and single lung ventilation using electrocautery. Results In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7 ± 1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7 ± 21.1 and 99.2 ± 8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9 ± 13.1 s, clip applier 72.8 ± 28.4 s). Conclusion Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.
Conservative vs. Invasive Treatment of Aortocoronary Saphenous Vein Graft Aneurysms: Treatment Algorithm Based upon a Large Series
Authors: Dieter Robert S. , Patel Ashvin K. , Yandow Donald , Pacanowski John P. , Bhattacharya Abhik , Gimelli Giorgio , Kosolcharoen P. , Russell Douglas 
Published: September 2022

Background The development of a saphenous vein graft aneurysm (SVGA) after coronary artery bypass graft surgery is a rare occurrence. There are approximately 60 cases reported in the literature, the majority being single case reports. There is no consensus on the treatment of SVGA. Methods Retrospective analysis of the patients treated with SVGA was performed at our institution. Demographic and co-morbidity data were acquired on the patients. Patients who underwent surgical treatment were compared to those treated conservatively with the primary outcome being survival time from diagnosis of the SVGA. Results Thirteen patients with 15 SVGA were identified. The average age at the time of the most recent coronary artery bypass grafting (CABG) was similar in the conservative and the surgically treated groups (55 vs. 56.5 years, respectively). The average number of grafts per patient at the most recent CABG was similar (3.83 vs. 4.0, respectively). The average time from CABG to diagnosis was similar in both the groups (12.6 vs. 15 years, respectively). The average survival from diagnosis was similar in both the groups (2.3 vs. 1.5 years, respectively, p > 0.05). Conclusions Early surgical treatment of SVGA does not provide longer short-term survival compared with conservative management. A treatment algorithm for SVGA based upon patient co-morbidities and aneurysm characteristics is proposed.
Coil Embolization of an Inferior Pancreaticoduodenal Artery Aneurysm Associated with Celiac Artery Occlusion
Authors: Peterson Brian G. , Resnick Scott A. , Eskandari Mark K. 
Published: September 2022

Pancreaticoduodenal arcade aneurysms are rare. Untreated, these lesions enlarge progressively and have the potential for spontaneous rupture. Aneurysmal degeneration of pancreaticoduodenal arcade vessels is known to be associated with celiac artery occlusion, vasculitis, and certain connective tissue disorders. Given their precarious location, surgical expiration is a challenging endeavor. Innovations in endovascular techniques offer a possible alternative. We report a case of a 55-year-old gentleman with a 2.2 × 2.1 - cm aneurysm of one of the inferior pancreaticoduodenal arteries and a concomitant finding of occlusion of the celiac artery trunk. Percutaneous coil embolization of the aneurysm was employed as the treatment in this case with the successful exclusion of the aneurysm sac, while maintaining continuity of the native circulation. This case report demonstrates that, due to the success rate of aneurysm exclusion and the relatively low morbidity and mortality rates seen with endovascular repair as compared to surgical intervention, endovascular treatment has become the treatment of choice for pancreaticoduodenal artery aneurysms.
Intracavitary Cardiac Hydatid Cyst
Authors: Abid A. , Ben Omrane S. , Kaouel K. , Marghli A. , Dhiab M. , Abid N. , Ben Zarkouna S. , Khayati A. 
Published: September 2022

The purpose of this study is to determine the diagnosis means, the surgical management and the prognosis of patients with intracavitary cardiac hydatid cyst. We report a series of seven patients. The diagnosis was orientated by coexisting pulmonary locations in all patients. The cyst was located in the right cardiac chambers. Cardiopulmonary bypass with aortic cross clamping and cardioplegia was necessary in all cases. The postoperative course was satisfactory for all patients. There was a recurrence of pulmonary cysts in all patients after a mean duration of 42 months. Medical treatment (Albendazole) was instituted. One late death occurred at 3 years of follow-up due to chronic right heart failure. In conclusion, cardiac hydatid cysts with intracavitary location must be suspected in patients with pulmonary or systemic embolization. Early surgical treatment is necessary and medical treatment must be instituted after surgery.
Aducanumab for Alzheimer’s disease: Observations and opportunities
Authors: Pridmore William 
Published: September 2022

Objective To analyse the overseas approval of aducanumab for Alzheimer’s disease, in order to derive lessons of potential interest to individuals and groups involved in dementia drug development and regulation in Australia. Conclusions Opportunities were identified regarding optimising clinical trial design and solidifying regulatory responsibilities. Increased awareness of the attitudes and needs of patients and patient advocacy organisations would likely improve the patient-clinician alliance. Incorporation of these factors into research design has the potential to improve patient satisfaction with outcomes.
Measuring Some Oxidative Stress Biomarkers in Autistic Syrian Children and Their Siblings: A Case-Control Study
Authors: Nasrallah Oula , Alzeer Samar 
Published: September 2022

Objective: Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder whose cause remains unknown. Oxidative stress is one of the possible causes of many disorders, including neurological ones. This study aims to measure some oxidative stress biomarkers (Malondialdehyde “MDA,” Advanced Oxidation Protein Product “AOPP,” Glutathione “GSH”) within Syrian children with ASD. Methods: MDA, AOPP & GSH were measured in the plasma of a total of 60 children. The ages of the children ranged from 1 to 13 years old. Thirty children had ASD and were compared with 30 controls that don’t have ASD. Fifteen of the controls were siblings of an ASD child, while the remaining 15 had no relations with ASD. Results: MDA and AOPP plasma levels were higher in ASD children compared with non-related controls ( P = .0001). However, there were no significant differences between MDA and AOPP plasma levels in ASD children in comparison with related controls ( P > .05). Alternatively, GSH plasma levels were lower in ASD children compared with both related and non-related controls ( P = .0001). Conclusion: Further studies are needed to investigate more regarding the diagnostic use of oxidative stress biomarkers, and the therapeutic use of antioxidants in children affected with the autism spectrum disorder.
Combined use of F22 aligners and intermaxillary elastics in mild skeletal Class II: Two case reports
Authors: Palone Mario , Cremonini Francesca , Guiducci Daniela , Lombardo Luca 
Published: September 2022

Introduction: The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively. Case presentation: Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic. Discussion: Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning. Conclusion: In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.
Rehabilitation to Improve Gaze and Postural Stability in People With Multiple Sclerosis: A Randomized Clinical Trial
Authors: Loyd Brian J. , Fangman Annie , Peterson Daniel S. , Gappmaier Eduard , Thackeray Anne , Schubert Michael C. , Dibble Leland E. 
Published: September 2022

Background People with multiple sclerosis (PwMS) frequently experience dizziness and imbalance that may be caused by central vestibular system dysfunction. Vestibular rehabilitation may offer an approach for improving dysfunction in these people. Objective To test the efficacy of a gaze and postural stability (GPS) retraining intervention compared to a strength and endurance (SAE) intervention in PwMS. Methods About 41 PwMS, with complaints of dizziness or history of falls, were randomized to either the GPS or SAE groups. Following randomization participants completed 6-weeks of 3×/week progressive training, delivered one-on-one by a provider. Following intervention, testing was performed at the primary (6-weeks) and secondary time point (10-weeks). A restricted maximum likelihood estimation mixed effects model was used to examine changes in the primary outcome of the Dizziness Handicap Inventory (DHI) between the 2 groups at the primary and secondary time point. Similar models were used to explore secondary outcomes between groups at both timepoints. Results Thirty-five people completed the study (17 GPS; 18 SAE). The change in the DHI at the primary time point was not statistically different between the GPS and SAE groups (mean difference = 2.33 [95% CI −9.18, 12.85]). However, both groups demonstrated significant improvement from baseline to 6-weeks (GPS −8.73; SAE −7.31). Similar results were observed for secondary outcomes and at the secondary timepoint. Conclusions In this sample of PwMS with complaints of dizziness or imbalance, 6-weeks of GPS training did not result in significantly greater improvements in dizziness handicap or balance compared to 6-weeks of SAE training.
Real-world global data on targeting epidermal growth factor receptor mutations in stage III non-small-cell lung cancer: the results of the KINDLE study
Authors: Jazieh Abdul Rahman , Onal Huseyin Cem , Tan Daniel Shao-Weng , Soo Ross A. , Prabhash Kumar , Kumar Amit , Huggenberger Reto , Cho Byoung Chul 
Published: September 2022

Background: Tyrosine kinase inhibitors (TKIs) are the standard of care for resectable and metastatic non-small-cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations (EGFRm). We describe the real-world practice of EGFRm testing, prevalence, treatment and outcomes in EGFRm stage III NSCLC from a multi-country, observational study. Methods: The KINDLE study retrospectively captured diagnostic information, treatments and survival outcomes in patients with stage III NSCLC from January 2013 to December 2017. Baseline characteristics and treatments were described and real-world outcomes from initial therapy were analysed using Kaplan–Meier methods. Results: A total of 3151 patients were enrolled across three regions: Asia ( n = 1874), Middle East and North Africa (MENA) ( n = 1046) and Latin America (LA) ( n = 231). Of these, 1114 patients (35%) were tested for EGFRm (46% in Asia, 17% in MENA and 32% in LA) and EGFRm was detected in 32% of tested patients (34.3% in Asia, 20.0% in MENA and 28.4% in LA). In a multi-variate analysis, overall EGFRm patients treated with EGFR-TKI monotherapy as initial treatment, without any irradiation, had twice the risk of dying (hazard ratio: 1.983, 95% confidence interval: 1.079–3.643; p = 0.027) versus any other treatment. Finally, unresectable patients with EGFRm NSCLC who received concurrent chemoradiotherapy (cCRT) as initial therapy had longer overall survival (OS) compared with their counterparts who only received TKI monotherapy without any irradiation (48 months versus 24 months; p < 0.001). Conclusion: The KINDLE study showed that a minority of stage III NSCLC patients were tested for EGFRm. Patients with EGFRm with unresectable NSCLC had similar outcomes from cCRT as initial therapy compared with EGFR wild type with a trend in OS favouring the EGFRm group. Outcomes with EGFR-TKI monotherapy as initial therapy, without any irradiation, were worse. The ongoing LAURA study (NCT03521154) will help define the role of EGFR-TKIs in EGFRm stage III NSCLC treated with cCRT. Trial Registration: NCT03725475.
The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill
Authors: Roberts Greg , Krinsley James S. , Preiser Jean-Charles , Quinn Stephen , Rule Peter R. , Brownlee Michael , Schwartz Michael , Umpierrez Guillermo E. , Hirsch Irl B. 
Published: September 2022

Background: Interventional studies investigating blood glucose (BG) management in intensive care units (ICU) have been inconclusive. New insights are needed. We assessed the ability of a new metric, the Glycemic Ratio (GR), to determine the relationship of ICU glucose control relative to preadmission glycemia and mortality. Methods: Retrospective cohort investigation (n = 4790) in an adult medical-surgical ICU included patients with minimum four BGs, hemoglobin (Hgb), and hemoglobin A1c (HbA1c). The GR is the quotient of mean ICU BGs (mBG) and estimated preadmission BG, derived from HbA1c. Results: Mortality displayed a J-shaped curve with GR (nadir GR 0.9), independent of background glycemia, consistent for HbA1c <6.5% vs >6.5%, and Hgb >10 g/dL vs <10 g/dL and medical versus surgical. An optimal range of GR 0.80 to 0.99 was associated with decreased mortality compared with GR above and below this range. The mBG displayed a linear relationship with mortality at lower HbA1c but diminished for HbA1c >6.5%, and dependent on preadmission glycemia. In adjusted analysis, GR remained associated with mortality (odds ratio = 2.61, 95% confidence interval = 1.48-4.62, P = .0012), but mBG did not (1.004, 1.000-1.009, .059). A single value on admission was not independently associated with mortality. Conclusions: The GR provided new insight into malglycemia that was not apparent using mBG, or an admission value. Mortality was associated with acute change from preadmission glycemia (GR). Further assessment of the impact of GR deviations from the nadir in mortality at GR 0.80 to 0.99, as both relative hypo- and hyperglycemia, and as duration of exposure and intensity, may further define the multifaceted nature of malglycemia.