bluuebunny/crossref_metadata_2025_split huggingface dataset:
LA REFORMA DE CAPACIDAD JURÍDICA: ALGUNOS APUNTES TEÓRICOS SOBRE SU JUSTIFICACIÓN
Authors: Smith Pamela , Burgos Mariana 
Published: May 2022

La última reforma peruana en materia de capacidad jurídica, plasmada en el Código Civil Peruano, abrió paso al reconocimiento de este derecho en condiciones de igualdad para el colectivo de personas con discapacidad. Este reconocimiento formal tiene un particular impacto en aquellas personas con discapacidad intelectual y psicosocial que habían sido tratadas históricamente como objetos y no como sujetos de este derecho. Este cambio normativo trae consigo un cambio profundo de los conceptos teórico-políticos en torno a la capacidad jurídica que deben ser abordados la dogmática civil y las disciplinas comprometidas.Encontrándonos en el proceso de aplicación de esta nueva legislación, consideramos de trascendental importancia observar con detenimiento el cambio teórico detrás de la reforma en aras de facilitar la comprensión de su real magnitud y reconocer los puntos de inflexión en nuestra teoría jurídica. Pues de lo contrario se corre el riesgo de que este cambio genere en nuestra realidad jurídica un efecto no coherente ni uniforme, en el que no sea posible alcanzar materialmente los nuevos reconocimientos y libertades.
LA FORMACIÓN JURÍDICA BASADA EN COMPETENCIAS: ROL DE LAS COMPETENCIAS EN LA EDUCACIÓN DEL FUTURO ABOGADO
Authors: Apaza Jallo Niels J. 
Published: May 2022

El trabajo desarrolla los elementos básicos que componen la formación jurídica basada en competencias (el rol de las competencias en el derecho). La educación orientada a formar por competencias, o enseñanza por competencias, implica, en lo esencial, garantizar el aprendizaje mediante la resolución de problemas, el involucramiento en proyectos, el acercamiento de la realidad y la mejora de la capacidad de adaptarse a diversos entornos. Esto tuvo gran impacto en la manera de educar a los estudiantes y se tradujo en la modificación de los planes de estudios de todos los niveles de educación, ya que las competencias son parte de la educación; además, tomó fuerza con la acreditación de los programas de estudios y el licenciamiento institucional de las universidades.En dicho escenario, la finalidad del trabajo es dar cuenta de las principales características de la educación o formación jurídica basada en competencias y, concretamente, analizar qué debe conocer, saber y hacer el abogado, en el marco de la sociedad del conocimiento y los cambios continuos que se producen.
Giant cerebral cavernous malformations: redefinition based on surgical outcomes and systematic review of the literature
Authors: Srinivasan Visish M. , Karahalios Katherine , Rumalla Kavelin , Shlobin Nathan A. , Rahmani Redi , Scherschinski Lea , Benner Dimitri , Catapano Joshua S. , Labib Mohamed A. , Graffeo Christopher S. , Lawton Michael T. 
Published: May 2022

OBJECTIVE
Giant cerebral cavernous malformations (GCCMs) are rare vascular malformations. Unlike for tumors and aneurysms, there is no clear definition of a "giant" cavernous malformation (CM). As a result of variable definitions, working descriptions and outcome data of patients with GCCM are unclear. A new definition of GCCM related to surgical outcomes is needed.

METHODS
An institutional database was searched for all patients who underwent resection of CMs > 1 cm in diameter. Patient information, surgical technique, and clinical and radiographic outcomes were assessed. A systematic review was performed to augment an earlier published review.

RESULTS
In the authors’ institutional cohort of 183 patients with a large CM, 179 with preoperative and postoperative modified Rankin Scale (mRS) scores were analyzed. A maximum CM diameter of ≥ 3 cm was associated with greater risk of severe postoperative decline (≥ 2-point increase in mRS score). After adjustment for age and deep versus superficial location, size ≥ 3 cm was strongly predictive of severe postoperative decline (OR 4.5, 95% CI 1.2–16.9). A model with CM size and deep versus superficial location was developed to predict severe postoperative decline (area under the receiver operating characteristic curve 0.79). Thirteen more patients with GCCMs have been reported in the literature since the most recent systematic review, including some patients who were treated earlier and not discussed in the previous review.

CONCLUSIONS
The authors propose that cerebral CMs with a diameter ≥ 3 cm be defined as GCCMs on the basis of the inflection point for functional and neurological outcomes. This definition is in line with the definitions for other giant lesions. It is less exclusive than earlier definitions but captures the rarity of these lesions (approximately 1% incidence) and variation in outcomes. GCCMs remain operable with potentially favorable outcomes. The term "giant" is not meant to deter or contraindicate surgery.
Endoscope-assisted visualization of 5-aminolevulinic acid fluorescence in surgery for brain metastases
Authors: Bettag Christoph , Hussein Abdelhalim , Schatlo Bawarjan , Barrantes-Freer Alonso , Abboud Tammam , Rohde Veit , Mielke Dorothee 
Published: May 2022

OBJECTIVE
Fluorescence-guided resection of cerebral metastases has been proposed as an approach to visualize residual tumor tissue and maximize the extent of resection. Critics have argued that tumor cells at the resection margins might be overlooked under microscopic visualization because of technical limitations. Therefore, an endoscope, which is capable of inducing fluorescence, has been applied with the aim of improving exposure of fluorescent tumor tissue. In this retrospective analysis, authors assessed the utility of endoscope assistance in 5-aminolevulinic acid (5-ALA) fluorescence–guided resection of brain metastases.

METHODS
Between June 2013 and December 2016, a standard 20-mg/kg dose of 5-ALA was administered 4 hours prior to surgery in 26 patients with suspected single brain metastases. After standard neuronavigated microsurgical tumor resection, a microscope capable of inducing fluorescence was used to examine tumor margins. The authors classified the remaining fluorescence into 3 grades (0 = none, 1 = weak, and 2 = strong). Endoscopic assistance was employed if no or only weak fluorescence was visualized at the resection margins under the microscope. Endoscopically identified fluorescent tissue at the margins was resected and evaluated separately via histological examination to prove or disprove tumor infiltration.

RESULTS
Under the microscope, weakly fluorescent tissue was seen at the margins of the resection cavity in 15/26 (57.7%) patients. In contrast, endoscopic inspection revealed strongly fluorescent tissue in 22/26 (84.6%) metastases. In 11/26 (42.3%) metastases no fluorescence at the tumor margins was detected by the microscope; however, strong fluorescence was visualized under the endoscope in 7 (63.6%) of these 11 metastases. In the 15 metastases with microscopically weak fluorescence, strong fluorescence was seen when using the endoscope. Neither microscopic nor endoscopic fluorescence was found in 4/26 (15.4%) cases. In the 26 patients, 96 histological specimens were obtained from the margins of the resection cavity. Findings from these specimens were in conjunction with the histopathological findings, allowing identification of metastatic infiltration with a sensitivity of 95.5% and a specificity of 75% using endoscope assistance.

CONCLUSIONS
Fluorescence-guided endoscope assistance may overcome the technical limitations of the conventional microscopic exposure of 5-ALA–fluorescent metastases and thereby increase visualization of fluorescent tumor tissue at the margins of the resection cavity with high sensitivity and acceptable specificity.
Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma
Authors: Kochergin Maxim , Fahmy Omar , Esken Lisa , Goetze Thorsten , Xylinas Evanguelos , Stief Christian G. , Gakis Georgios 
Published: May 2022

BACKGROUND: Radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. The impact of perioperative red blood cell (RBC) transfusion on oncological outcomes after RC is not clearly established as the existing publications show conflicting results. OBJECTIVES: The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC. METHODS: Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software. RESULTS: From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS ( Z = 1.34; p = 0,18) and significant negative impact on CSS ( Z = 2.67; p = 0.008) and OS ( Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS ( Z = 0.58; p = 0.56) and CSS ( Z = 1.06; p = 0.29) and OS ( Z = 1.47; p = 0.14). Postoperative RBC transfusion showed non-significant trend towards improved RFS ( Z = 1.89; p = 0.06) and no impact on CSS ( Z = 1.56; p = 0.12) and OS ( Z = 0.53 p = 0.60). CONCLUSION: In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.
Las tecnologías de la información: su repercusión en el cuidado del medio ambiente
Authors: Núñez Moreno María Soledad , Martínez Chérrez Whymper Eduardo 
Published: May 2022

Introducción. Las TIC traen significativos beneficios al medio ambiente, no obstante, tienen una huella ambiental, causando un impacto sobre el entorno, que debe tenerse en cuenta. Objetivo. Establecer los criterios referentes a las TIC y su repercusión en el cuidado del medio ambiente, así como los beneficios y afectaciones que generan su uso. Metodología. En el estudio se utilizó una metodología descriptiva, no experimental. Basada en la revisión de la literatura y en métodos teóricos, los cuales permitieron establecer los criterios de búsquedas relacionados con el tema Resultados. 1. Estudios precedentes evidencian que se sobreestima la percepción que se tiene de las TIC como herramientas limpias, cuando realmente también causan un impacto sobre el entorno. 2. El uso de las TIC aporta beneficios al medio ambiente y a la sociedad, constituyendo herramientas fundamentales para la observación meteorológica y la predicción del cambio climático global. 3. Actualmente es perentorio ser consciente respecto al verdadero impacto que producen las TIC al medio ambiente, derivado de la extracción de minerales para sus componentes, así como un desproporcionado aumento de residuos tecnológicos que generan. 4. Se hace necesario la implementación y cumplimiento de políticas y medidas orientadas a la reducción del impacto ambiental que genera la utilización de las TIC, de conjunto con su concientización partiendo de la educación básica escolar hasta todos los niveles educativos. Conclusiones. Mediante la revisión sistemática realizada a la literatura, se evidenciaron las repercusiones que sobre el medio ambiente generan las TIC, relacionados con el desarrollo socioeconómico y los efectos del cambio climático, así como la huella ambiental que tiene, que causa un impacto sobre el entorno y la concientización y promulgación de políticas y medidas encaminadas a la reducción de este impacto ambiental.
Short QRS Duration After His-Purkinje Conduction System Pacing Predicts Left Ventricular Complete Reverse Remodeling in Patients With True Left Bundle Branch Block and Heart Failure
Authors: Guan Xu-Min , Li Dan-Na , Zhao Fu-Lu , Zhao Yan-Ni , Yang Yi-Heng , Dai Bai-Ling , Dai Shi-Yu , Gao Lian-Jun , Xia Yun-Long , Dong Ying-Xue 
Published: May 2022

ObjectiveThis study aimed to explore the outcomes of His-Purkinje conduction system pacing (HPCSP) and to screen the predictors of left ventricular (LV) complete reverse remodeling in patients with true left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF).MethodsPatients who underwent HPCSP for true LBBB and HFrEF from April 2018 to August 2020 were consecutively enrolled. All participants were followed up for at least 1 year. Thrombosis, infection, lead dislodgement, perforation, and other complications were observed after HPCSP. Clinical data, including echocardiographic parameters, electrocardiogram measurements, and cardiac function, were assessed before and after the procedure.ResultsA total of 46 patients were enrolled. HPCSP was successfully deployed in 42 cases (91.30%), which included 37 cases with His bundle pacing (HBP) and 5 cases with left bundle branch pacing (LBBP). The QRS duration decreased significantly (169.88 ± 19.17 ms vs. 113.67 ± 20.68 ms, P &lt; 0.001). Left ventricular end-systolic volume (LVESV) (167.67 ± 73.20 ml vs. 85.97 ± 62.24 ml, P &lt; 0.001), left ventricular end-diastolic diameter (LVEDD) (63.57 ± 8.19 mm vs. 55.46 ± 9.63 mm, P = 0.003) and left ventricular ejection fraction (LVEF) (26.52 ± 5.60% vs. 41.86 ± 11.56%, P &lt; 0.001) improved dramatically. Complete reverse remodeling of the LV with normalized LVEF and LVEDD was found in nearly half of the patients (45.24%). A short QRS duration after HPCSP was a strong predictor of normalized LVEF and LVEDD (P &lt; 0.001). The thresholds increased markedly in two patients approximately 6 months after HBP. No patients died during the total follow-up period of 20.07 ± 6.45 months.ConclusionComplete reverse remodeling of the LV could be found in nearly half of the patients with HFrEF and true LBBB after HPCSP, and the short QRS duration after HPCSP was a strong predictor.
Systemically Silencing Long Non-coding RNAs Maclpil With Short Interfering RNA Nanoparticles Alleviates Experimental Ischemic Stroke by Promoting Macrophage Apoptosis and Anti-inflammatory Activation
Authors: Wang Yan , Liu Cuiying , Chen Yong , Chen Tiffany , Han Tao , Xue Lixiang , Xu Baohui 
Published: May 2022

BackgroundMaclpil is a proinflammatory long non-coding RNA highly expressed on monocyte-derived macrophages in the ischemic brain. This study investigated the impact and the mechanisms of systemically delivering nanoparticle Maclpil short interfering RNA (siRNA) on experimental ischemic stroke in a mouse model.MethodsIschemic stroke (focal cerebral ischemia) was induced in male C57BL/6 mice through the middle cerebral artery occlusion. Three hours thereafter, mice were intravenously injected with Maclpil siRNA or scramble siRNA nanoparticles. Bone marrow cell-derived macrophages were transfected with Maclpil or scramble siRNA and subjected to oxygen glucose deprivation culture. The influence of silencing Maclpil on stroke outcomes, neuroinflammation, and macrophage fates was assessed via histology, flow cytometry, Western blotting, and quantitative PCR analysis.ResultsThree days following stroke induction, siRNA silencing Maclpil substantially reduced ischemic infarction size and improved neurological behaviors. Silencing Maclpil also markedly attenuated the accumulation of monocyte-derived macrophages, CD4+ T cells, and CD8+ T cells in the ischemic hemisphere without affecting microglia cellularity. Reciprocally, myeloid cells and both subsets of T cells were elevated in mouse peripheral blood following Maclpil siRNA treatment. Under oxygen glucose deprivation conditions that mimicked hypoxia and hypoglycemia in vitro, Maclpil siRNA silencing augmented macrophage apoptosis in conjunction with upregulation of proapoptotic Bax and caspase 3 expressions. siRNA knocking down Maclpil skewed macrophages from proinflammatory classical toward anti-inflammatory alternative activation as evidenced by increased arginase 1, Ym1, and Fizz1 and reduced inducible nitric oxide synthase, IL-1β, and TNF-α mRNA levels. Consistent with macrophage phenotype switching, silencing Maclpil by siRNA enhanced fatty acid oxidation as indicated by increased mRNA levels of 3 key metabolic enzymes (ACADM, ACADVL, and HADHA).ConclusionSystemically silencing Maclpil by siRNA nanoparticles attenuated experimental ischemic stroke by promoting macrophage apoptosis and anti-inflammatory alternative activation. Identifying and targeting Maclpil human homolog(s) may help develop a novel therapy for stroke clinical management.
Association Between the Frailty and New-Onset Atrial Fibrillation/Flutter Among Elderly Hypertensive Patients
Authors: Hang Fei , Chen Jieruo , Wang Zefeng , Yan Jiafu , Wu Yongquan 
Published: May 2022

BackgroundFrailty was found to be common in patients with atrial fibrillation/flutter (AF), but there was still a lack of evidence regarding the relationship between frailty and new-onset AF.MethodsWe performed a post hoc analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT). In addition, we evaluated the relationship between baseline frailty status and new-onset AF in older adult patients with hypertension.ResultsIn total, 7,316 participants were included in our analysis, and a total of 115 new-onset AF occurred during an average of 3.54 years of follow-up. Using SPRINT frailty index criteria, 1,535 fit, 4,041 less fit, and 1,740 frailty were enrolled. Compared with other groups, the incidence of new-onset AF in the frailty group was significantly higher. We constructed three Cox models to assess the relationship between the frailty status (fit group as reference) and new-onset AF. Participants with frailty had a significantly higher risk of new-onset AF compared with the fit group in all the models we used. We combined the fit group and the less fit group into a no frailty group to assess the impact of frailty on new-onset AF in various subgroups. After full adjustment (Model 3), frailty remained associated with the increased risk of new-onset AF compared with the no frailty group [hazard ratio [HR] = 2.09, 95% CI:(1.41, 3.09), p &lt; 0.001]. Additionally, we examined the frailty index as continuous variable to assess the relationship between the frailty index and new-onset AF. The smooth curve showed that log HR appeared to increase linearly. And there was a significant interaction between baseline systolic blood pressure (SBP) categories and frailty on the risk of new-onset AF (p for interaction = 0.030).ConclusionThis study found baseline frailty status was a strong independent risk factor for new-onset AF among older adult patients with hypertension. Screening for frailty should be considered in older adult patients with hypertension to prevent new-onset AF.
Performance of a HeartLogicTM Based Care Path in the Management of a Real-World Chronic Heart Failure Population
Authors: Feijen Michelle , Egorova Anastasia D. , Treskes Roderick W. , Mertens Bart J. A. , Jukema J. Wouter , Schalij Martin J. , Beeres Saskia L. M. A. 
Published: May 2022

AimEarly detection of impending fluid retention and timely adjustment of (medical) therapy can prevent heart failure related hospitalizations. The multisensory cardiac implantable electronic device (CIED) based algorithm HeartLogicTM aims to alert in case of impending fluid retention. The aim of the current analysis is to evaluate the performance of the HeartLogicTM guided heart failure care path in a real-world heart failure population and to investigate whether the height of the index and the duration of the alert state are indicative of the degree of fluid retention.MethodsConsecutive adult heart failure patients with a CIED and an activated HeartLogicTM algorithm were eligible for inclusion. Patients were followed up according to the hospital's heart failure care path. The device technician reviewed alerts for a technical CIED checkup. Afterwards, the heart failure nurse contacted the patient to identify impending fluid retention. An alert was either true positive or false positive. Without an alert a patient was true negative or false negative.ResultsAmong 107 patients, [82 male, 70 (IQR 60–77) years, left ventricular ejection fraction 37 ± 11%] 130 HeartLogicTM alerts were available for analysis. Median follow up was 14 months [IQR 8–23]. The sensitivity to detect impending fluid retention was 79%, the specificity 88%. The positive predictive was value 71% and the negative predictive value 91%. The unexplained alert rate was 0.23 alerts/patient year and the false negative rate 0.17 alerts/patient year. True positive alerts [42 days (IQR 28–63)] lasted longer than false positive alerts [28 days (IQR 21–44)], p = 0.02. The maximal HeartLogicTM index was higher in true positive alerts [26 (IQR 21–34)] compared to false positive alerts [19 (IQR 17–24)], p &lt; 0.01. Patients with higher HeartLogicTM indexes required more intense treatment (index height in outpatient setting 25 [IQR 20–32], day clinic treatment 28 [IQR 24–36] and hospitalized patients 45 [IQR 35–58], respectively), p &lt; 0.01.ConclusionThe CIED-based HeartLogicTM algorithm facilitates early detection of impending fluid retention and thereby enables clinical action to prevent this at early stage. The current analysis illustrates that higher and persistent alerts are indicative for true positive alerts and higher index values are indicative for more severe fluid retention.