bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of different therapeutic strategies for left ventricular aneurysm with mitral regurgitation
Authors: Ma Hao , Zhang Shicheng , Chen Liangcai , Nan Yifeng , Tiemuerniyazi Xieraili , Huang Siyuan , Zhao Dong , Feng Wei 
Published: April 2022

Objective
This study aims to compare the midterm outcomes of left ventricular reconstruction (LVR) added to coronary artery bypass grafting (CABG) with those of CABG alone in patients with left ventricular aneurysm (LVA) and mild or moderate mitral regurgitation (MR). We also assessed the impact of LVR on the degree of MR.

Methods
A total of 130 patients (77 who underwent CABG plus LVR and 53 who underwent CABG alone) with concomitant mild or moderate MR were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Kaplan–Meier analysis was performed to evaluate event-free survival. MR was graded 0 to 4+ by echocardiogram.

Results
The median follow-up time among all patients was 22 months. There was a significant difference between the CABG plus LVR and CABG alone groups with regard to all-cause mortality (P = 0.019). However, the statistical difference was not observed in cardiogenic mortality (P = 0.186) and MACCEs (P = 0.107). In the grade of MR, the two groups both resulted in the decreased grade of MR, but the CABG plus LVR group had a significant number of patients improving to 0 or 1+ (P = 0.030).

Conclusion
The clinical outcomes of CABG alone are comparable with those of CABG plus LVR in patients with LVA and mild or moderate MR. However, CABG+LVR demonstrated greater reduction in MR severity after surgery than CABG alone.
Clinical Characteristics and Outcomes of Children and Adolescents With Cancer Infected With SARS-CoV-2 at a Tertiary Care Medical Center in Jordan
Authors: Al-Sweedan Suleimman Ahmad , Samara Dua’ N. , Hamaidi Mo’ath A. , Al-Hamad Maram M. , Alsweedan Dalia , Jaradat Saied 
Published: April 2022

Background:
Our knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still evolving; its effects on children with cancer need to be studied more. The aim of this study is to present our experience with SARS-CoV-2 infection in this population and to highlight specific complications and outcomes.

Materials and Methods:
This is a retrospective and prospective observational study, which involved 21 cancer patients below the age of 18 years in north Jordan. Data regarding their age, sex, cancer type and progression, phase of treatment, and others were collected and reviewed. Patients were classified into confirmed, probable, and suspect according to the Centers for Disease Control and Prevention’s (CDC) 2021 classification.

Results:
A total of 21 patients with malignancy were included. Ten patients were males (48%). Mean age of 8.8 years (3 mo to 18 y). Two patients (9.5%) had died; one (4.7%) death was coronavirus disease 2019 (COVID-19)-related and the other one (4.7%) was due to cancer progression. Two patients (9.5%) had multisystem inflammatory syndrome in children. Both disease progression and new malignancies were documented in 11 (52%) of our patients.

Conclusions:
Diagnosis of COVID-19 should not distract physicians from investigating new malignancy or relapse as they may come together or may be related to COVID-19 infection. More studies are needed to identify the contribution of SARS-CoV-2 in the pathogenesis of cancer.
The Greater Occipital Nerve and Its Dynamic Compression Points: Implications in Migraine Surgery
Authors: Chung Michael , Lu Karen B. , Sanniec Kyle , Amirlak Bardia 
Published: April 2022

Background:
The greater occipital nerve is a common compression site for migraine or chronic headache, and variable relationships with the occipital artery have been shown in anatomical studies. Despite surgical decompression, there are still a subset of patients who have an incomplete response. In this article, the authors describe an observed clear and very consistent pattern between the nerve and artery, including both dynamic and static compression points, that must be evaluated for adequate treatment.

Methods:
Seventy-one patients underwent occipital nerve decompression with high-definition videos and photographs, and the dynamic relationship between the greater occipital nerve and the occipital artery was recorded in a retrospective review.

Results:
A consistent pattern existed in 92 percent of patients, as follows: (1) hidden proximal dynamic compression of the bottom surface of the nerve as the occipital artery comes laterally to dive under the greater occipital nerve; (2) more apparent dynamic compression on the upper surface of the nerve as the occipital artery loops back on top of the greater occipital nerve; (3) intertwining compression after the bifurcation of the greater occipital nerve as the artery wraps around the medial branch; and (4) parallel travel of the terminal branch of the greater occipital nerve with the occipital artery in close proximity.

Conclusions:
There is a consistent pattern in the relationship between the greater occipital nerve and the occipital artery after its exit from the trapezius fascia. It is possible that this relationship creates dynamic compression points, including hidden areas, that can only be deactivated by radical excision of the vessel.
Utilization of Leech Therapy after Rhinoplasty
Authors: Shtraks Julie P. , Peng Grace L. , Nassif Paul S. 
Published: April 2022

Background:
The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized.

Methods:
The medical records of all patients who underwent open rhinoplasty by a single surgeon over a 4-year period were reviewed. Patient demographics, including age, sex, medical comorbidities, number of previous rhinoplasty surgeries, time to utilization of leech therapy, adjunct therapies used, resolution of skin changes, and smoking status, were recorded. Operative reports were reviewed for pertinent information, including number of tip grafts used, graft materials used, and placement of septal extension grafts or “unicorn” grafts.

Results:
Between April of 2016 and March of 2020, 545 patients underwent rhinoplasty performed by the senior author (P.S.N.). Of these patients, 39 (7.2 percent) underwent leech therapy postoperatively. The mean age of included patients was 47.4 years. Of the patients who required leech therapy, 34 (87.2 percent) had undergone revision rhinoplasty. The mean number of previous rhinoplasties was 3.4. The mean number of tip grafts used was 2.6. Thirty-three patients (84.6 percent) had either a traditional septal extension graft or unicorn graft placed. Nine patients (23.1 percent) were former smokers. Complete resolution of skin color changes was seen in 38 patients (97.4 percent). There were no major complications after leech therapy.

Conclusions:
Leech therapy is a useful tool for the rhinoplasty surgeon, particularly in the setting of complex revision rhinoplasty, in patients who have undergone multiple previous nasal surgical procedures, or in patients who require significant cartilage grafting to reconstruct the nasal tip or lengthen the nose.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
18F-FDG PET/CT in Primary Intraosseous Squamous Cell Carcinoma
Authors: Lin Shuai , Fang Na , Zhang Jing , Wang Yan-Li 
Published: April 2022

Abstract
Primary intraosseous squamous cell carcinoma is a highly malignant but rare tumor within jaws. We reported the 18F-FDG PET/CT findings of primary intraosseous squamous cell carcinoma of the mandible in a 42-year-old man. 18F-FDG PET/CT identified a cystic lesion in the mandible with irregular annular uptake of 18F-FDG, which has been confirmed as primary intraosseous squamous cell carcinoma pathologically.
Mycobacterium tuberculosis Invasion of Main Pulmonary Artery
Authors: Chen Li-Yu , Chen Yen-Kung , Fang Yu-Wei 
Published: April 2022

Abstract
Infectious causes of pulmonary artery invasion are extremely rare. A 71-year-old man had history of progressive dyspnea with abnormal salty taste. Contrast CT showed a filling defect mass in the main pulmonary artery with extraluminal extension to the heart and mediastinum. FDG PET/CT revealed a mass lesion with intense FDG uptake in the main pulmonary artery and peripheral. There were lesions with intense FDG uptake in the middle mediastinum besides the ascending aorta. Malignant tumor was suspected. Later, he received tumor debulking excision. Pathology reports showed necrotizing granulomatous inflammation, positive interferon-gamma release assays, and positive Mycobacterium tuberculosis culture.
Lymphoscintigraphic Findings of Scrotal Lymphangioma
Authors: Shen Guohua , Kuang Anren 
Published: April 2022

Abstract
As congenital lymphatic malformations, lymphangiomas commonly occur in the neck, tongue, and extremities, whereas scrotum is one of the least frequent sites. For this lymphatic flow disease, lymphoscintigraphy is regarded as a useful imaging method. Herein, in a child with scrotal cysts, scrotal region activity was detected in lymphoscintigraphy, consistent with likely lymphatic disorder. The postsurgical pathology confirmed the diagnosis of lymphangioma.
Hemodynamic Effects of High-dose Levothyroxine and Methylprednisolone in Brain-dead Potential Organ Donors
Authors: Van Bakel Adrian B. , Hino Sheryl A. , Welker Darla , Morella Kristen , Gregoski Mathew J. , Craig Michael L. , Crumbley Arthur J. , Sade Robert M. 
Published: April 2022

Background.
Hormonal replacement therapy is administered to many brain-dead organ donors to improve hemodynamic stability. Previous clinical studies present conflicting results with several randomized studies reporting no benefit.

Methods.
Consecutive adult donors (N = 199) were randomized to receive high-dose levothyroxine, high-dose methylprednisolone, both (Combo), or no hormonal therapy (Control). Vasopressor requirements using the vasoactive-inotropic score (VIS) were assessed at baseline, 4 h, and at procurement. Crossover to the Combo group was sufficient to require separate intention-to-treat and per-protocol analyses.

Results.
In the intention-to-treat analysis, the mean (±SD) reduction in VIS from baseline to procurement was 1.6 ± 2.6, 14.9 ± 2.6, 10.9 ± 2.6, and 7.1 ± 2.6 for the levothyroxine, methylprednisolone, Combo, and Control groups, respectively. While controlling for the baseline score, the reduction in VIS was significantly greater in the methylprednisolone and Combo groups and significantly less in the levothyroxine group compared with controls. Results were similar in the per-protocol analysis.

Conclusions.
High-dose methylprednisolone alone or in combination with levothyroxine allowed for significant reduction in vasopressor support in organ donors. Levothyroxine alone offered no advantage in reducing vasopressor support. Organ yield, transplantation rates, and recipient outcomes were not adversely affected.
Role of Fibrinogen in Trauma-Induced Coagulopathy
Authors: Meizoso Jonathan P , Moore Ernest E , Pieracci Fredric M , Saberi Rebecca A , Ghasabyan Arsen , Chandler James , Namias Nicholas , Sauaia Angela 
Published: April 2022

BACKGROUND:
Fibrinogen is the first coagulation factor to decrease after massive hemorrhage. European massive transfusion guidelines recommend early repletion of fibrinogen; however, this practice has not been widely adopted in the US. We hypothesize that hypofibrinogenemia is common at hospital arrival and is an integral component of trauma-induced coagulopathy.

STUDY DESIGN:
This study entailed review of a prospective observational database of adults meeting the highest-level activation criteria at an urban level 1 trauma center from 2014 through 2020. Resuscitation was initiated with 2:1 red blood cell (RBC) to fresh frozen plasma (FFP) ratios and continued subsequently with goal-directed thrombelastography. Hypofibrinogenemia was defined as fibrinogen below 150 mg/dL. Massive transfusion (MT) was defined as more than 10 units RBC or death after receiving at least 1 unit RBC over the first 6 hours of admission.

RESULTS:
Of 476 trauma activation patients, 70 (15%) were hypofibrinogenemic on admission, median age was 34 years, 78% were male, median New Injury Severity Score (NISS) was 25, and 72 patients died (15%). Admission fibrinogen level was an independent risk factor for MT (odds ratio [OR] 0.991, 95% CI 0.987–0.996]. After controlling for confounders, NISS (OR 1.034, 95% CI 1.017–1.052), systolic blood pressure (OR 0.991, 95% CI 0.983–0.998), thrombelastography angle (OR 0.925, 95% CI 0.896–0.954), and hyperfibrinolysis (OR 2.530, 95% CI 1.160–5.517) were associated with hypofibrinogenemia. Early cryoprecipitate administration resulted in the fastest correction of hypofibrinogenemia.

CONCLUSION:
Hypofibrinogenemia is common after severe injury and predicts MT. Cryoprecipitate transfusion results in the most expeditious correction. Earlier administration of cryoprecipitate should be considered in MT protocols.
Machine Learning Approach to Stratifying Prognosis Relative to Tumor Burden after Resection of Colorectal Liver Metastases: An International Cohort Analysis
Authors: Paro Alessandro , Hyer Madison J , Tsilimigras Diamantis I , Guglielmi Alfredo , Ruzzenente Andrea , Alexandrescu Sorin , Poultsides George , Aucejo Federico , Cloyd Jordan M , Pawlik Timothy M 
Published: April 2022

BACKGROUND:
Assessing overall tumor burden on the basis of tumor number and size may assist in prognostic stratification of patients after resection of colorectal liver metastases (CRLM). We sought to define the prognostic accuracy of tumor burden by using machine learning (ML) algorithms compared with other commonly used prognostic scoring systems.

STUDY DESIGN:
Patients who underwent hepatectomy for CRLM between 2001 and 2018 were identified from a multi-institutional database and split into training and validation cohorts. ML was used to define tumor burden (ML-TB) based on CRLM tumor number and size thresholds associated with 5-year overall survival. Prognostic ability of ML-TB was compared with the Fong and Genetic and Morphological Evaluation scores using Cohen’s d.

RESULTS:
Among 1,344 patients who underwent resection of CRLM, median tumor number (2, interquartile range 1 to 3) and size (3 cm, interquartile range 2.0 to 5.0) were comparable in the training (n = 672) vs validation (n = 672) cohorts; patient age (training 60.8 vs validation 61.0) and preoperative CEA (training 10.2 ng/mL vs validation 8.3 ng/mL) was also similar (p > 0.05). ML empirically derived optimal cutoff thresholds for number of lesions (3) and size of the largest lesion (1.3 cm) in the training cohort, which were then used to categorize patients in the validation cohort into 3 prognostic groups. Patients with low, average, or high ML-TB had markedly different 5-year overall survival (51.6%, 40.9%, and 23.1%, respectively; p < 0.001). ML-TB was more effective at stratifying patients relative to 5-year overall survival (low vs high ML-TB, d = 2.73) vs the Fong clinical (d = 1.61) or Genetic and Morphological Evaluation (d = 0.84) scores.

CONCLUSIONS:
Using a large international cohort, ML was able to stratify patients into 3 distinct prognostic categories based on overall tumor burden. ML-TB was noted to be superior to other CRLM prognostic scoring systems.
Preoperative Opioid Dose and Surgical Outcomes in Colorectal Surgery
Authors: Lo Brian D , Zhang George Q , Canner Joseph K , Stem Miloslawa , Taylor James P , Atallah Chady , Efron Jonathan E , Safar Bashar 
Published: April 2022

BACKGROUND:
The worsening opioid epidemic has led to an increased number of surgical patients with chronic preoperative opioid use. However, the impact of opioids on perioperative outcomes has yet to be fully elucidated. The purpose of this study was to assess the association between preoperative opioid dose and surgical outcomes among colectomy patients.

METHODS:
Adult colectomy patients in the IBM MarketScan database (2010–2017) were stratified based on preoperative opioid dose, calculated as the average opioid dose in morphine milligram equivalents (MME) in the 90 days prior to surgery: 0 MME, 1 to 49 MME, and 50 or more MME. The association between preoperative opioid dose and anastomotic leak, the primary outcome of interest, as well as other postoperative complications, was assessed using multivariable regression.

RESULTS:
Among 45,515 adult colectomy patients, 71.4% did not use opioids (0 MME), 27.4% had an opioid dose between 1 and 49 MME, and 1.2% had an opioid dose at or above 50 MME. Patients with preoperative opioid use exhibited a higher incidence of anastomotic leak (0 MME: 4.8%, 1–49 MME: 5.5%, ≥50 MME: 8.3%; p trend = 0.001). Multivariable analysis demonstrated a dose–response relationship between preoperative opioids and surgical outcomes, as the odds of anastomotic leak worsened with increasing opioid dose (1–49 MME: OR 1.19, 95% CI 1.08–1.31, p < 0.001; ≥50 MME: OR 1.64, 95% CI 1.20–2.24, p = 0.002). Similar dose–response relationships were seen after risk-adjustment for lung complications, pneumonia, delirium, and 30-day readmission (p < 0.05 for all).

CONCLUSIONS:
Providers should exercise caution when prescribing opioids preoperatively, as increasing doses of preoperative opioids were associated with worse surgical outcomes and higher 30-day readmission among adult colectomy patients.
Deep learning applied to 4-electrode EEG resting-state data detects depression in an untrained external population
Authors: Jan Damian , de Vega Manuel , López-Pigüi Joana , Padrón Iván 
Published: April 2022

AbstractIn this study we trained and tested several deep learning algorithms to classify depressive individuals and controls based on their electroencephalography data. Traditionally, classification methods based on electroencephalography resting-state are based primarily on linear features or a combination of linear and non-linear features. Based on different theoretical grounds, some authors claim that the more electrodes, the more accurate the classifiers, while others consider that working on a selection of electrodes is a better approach□. In this study, a data-driven approach was initially applied on a selection of electrodes to classify 25 depressive and 24 control participants. Using a classifier with just four electrodes, based on non-linear features with high temporo-spatial complexity, proved accurate enough to classify depressive and control participants. After the classifier was internally trained and tested, it was applied to electroencephalography resting-state data of control and depressive individuals available from a public database, obtaining a classifier accuracy of 93% in the depressive and 100% in the control group. This validates the generalizability of the classifier to untrained data from different teams, populations and settings. We conclude that time-window span analysis is a promising approach to understand the neural dynamics of depression and to develop an independent biomarker.
Cerebrovascular risk factors impact brain phenotypes and cognitive function in healthy population
Authors: Li Bingli , Wei Yiran , Zhang Kaijia , Schönlieb Carola-Bibiane , Rudd James , Li Chao 
Published: April 2022

AbstractCognitive decline is a major characteristic of ageing. Studies show that cardiovascular risk factors (CVR) are associated with cognitive declines and brain phenotypes, but the causality between CVR and cognitive function needs further understanding. In this study, we seek to investigate the causalities between CVR, brain phenotypes and cognitive function. We first generate a general factor (gCVR) representing common CVR and a score representing the polygenic risk (PRS). We then identify phenotypes of brain and cognitive functions associated with gCVR and PRS. Moreover, we conduct causal mediation analysis to evaluate the indirect effect of PRS through CVR, which infers the causality of gCVR on brain phenotypes and cognition. Further, we test the mediation effect of gCVR on the total effect of brain phenotypes on cognitive function. Finally, the causality between CVR and brain phenotypes is cross validated using Mendelian randomization (MR) with genetic instruments. The results show that CVR mediates the effect of PRS on brain phenotypes and cognitive function, and CVR also mediates the effect of brain phenotypes on cognitive changes. Additionally, we validate that the variation in a few brain phenotypes., e.g., volume of grey matter, are caused by CVR.
Stochastic analysis of frequency bandwidth and noise attenuation in neurotransmission
Authors: Vahdat Zahra , Singh Abhyudai 
Published: April 2022

AbstractAction potential (AP)-triggered neurotransmitter release forms the key basis of inter-neuronal communication. We present a stochastic hybrid system model that captures the release of neurotransmitter-filled vesicles from a presynaptic neuron. More specifically, vesicles arrive as a Poisson process to attach at a given number of docking sites, and each docked vesicle has a certain probability of release when an AP is generated in the presynaptic neuron. The released neurotransmitters enhance the membrane potential of the postsynaptic neuron, and this increase is coupled to the continuous exponential decay of the membrane potential. The buildup of potential to a critical threshold level results in an AP firing in the postsynaptic neuron, with the potential subsequently resetting back to its resting level. Our model analysis develops formulas that quantify the fluctuations in the number of released vesicles and mechanistically connects them to fluctuations in both the postsynaptic membrane potential and the AP firing times. Increasing the frequency of APs in the presynaptic neuron leads to saturation effects on the postsynaptic side, resulting in a limiting frequency range of neurotransmission. Interestingly, AP firing in the postsynaptic neuron becomes more precise with increasing AP frequency in the presynaptic neuron. We also investigate how noise in AP timing varies with different parameters, such as the probability of releases, the number of docking sites, the voltage threshold for AP firing, and the timescale of voltage decay. In summary, our results provide a systematic understanding of how stochastic mechanisms in neurotransmission enhance or impinge the precision of AP fringing times.