bluuebunny/crossref_metadata_2025 huggingface dataset:
Reimbursement of Lumbar Decompression at an Orthopedic Specialty Hospital Versus Tertiary Referral Center
Authors: Kothari Parth , Canseco Jose A. , Karamian Brian A. , Minetos Paul D. , Jeyamohan Hareindra , Bowles Daniel R. , Mao Jennifer Z. , DiMaria Stephen L. , Conaway William , Kaye I. David , Woods Barrett I. , Kurd Mark F. , Rihn Jeffrey A. , Anderson D. Greg , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: October 2021

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to investigate the differences in Medicare reimbursement for one- to three-level lumbar decompression procedures performed at a tertiary referral center versus an orthopedic specialty hospital (OSH).

Summary of Background Data.

Lumbar decompression surgery is one of the most commonly performed spinal procedures. Lumbar decompression also comprises the largest proportion of spinal surgery that has transitioned to the outpatient setting.

Methods.

Patients who underwent a primary one- to three- level lumbar decompression were retrospectively identified. Reimbursement data for a tertiary referral center and an OSH were compiled through Centers for Medicare and Medicaid Services. Demographic data, surgical characteristics, and time cost data were collected through chart review. Multivariate regression models were used to determine independent factors associated with total episode of care cost, operating room (OR) time, procedure time, and length of stay (LOS), and to determine independent predictors of having the decompression performed at the OSH.

Results.

Total episode of care, facility, and non-facility payments were significantly greater at the tertiary referral center than the OSH, as were OR time for one- to three-level procedures, procedure time of all pooled levels, and LOS for one- and two-level procedures. Three-level procedure was independently associated with increased OR time, procedure time, and LOS. Age and two-level procedure were also associated with increased LOS. Procedure at the OSH was associated with decreased OR time and LOS. Charlson Comorbidity Index was a negative predictor of decompression being performed in the OSH setting.

Conclusion.

Significant financial savings to health systems can be expected when performing lumbar decompression surgery at a specialty hospital as opposed to a tertiary referral center. Patients who are appropriate candidates for surgery in an OSH can in turn expect faster perioperative times and shorter LOS.

Level of Evidence: 3
A Competing Risk-based Prognostic Model to Predict Cancer-specific Death of Patients with Spinal and Pelvic Chondrosarcoma
Authors: Dong Yimin , Xie Linka , Kang Honglei , Peng Renpeng , Guo Qian , Song Kehan , Wang Jai , Guan Hanfeng , Fang Zhong , Li Feng
Published: October 2021

Study Design.

Retrospective analysis.

Objective.

The aim of this study was to develop and validate a competing-risk-based prognostic model and a nomogram for predicting the three- and five-year probability of cancer-specific death (CSD) in patients with spinal and pelvic chondrosarcoma.

Summary of Background Data.

The issue of competing risk has rarely been addressed and discussed in survival analysis of bone sarcoma. In addition, the Fine and Gray model, a more accurate method for survival analysis in the context of competing risk, has also been less reported in prognostic study of chondrosarcoma.

Methods.

A total of 623 patients with spinal or pelvic chondrosarcoma were identified from the SEER database and were divided into a training and a validation cohort. These two cohorts were used to develop and validate a prognostic model to predict the 3- and 5-year probability of CSD, considering non-CSD as competing risk. The C-index, calibration plot, and decision curve analysis were used to assess the predictive performance and clinical utility of the model.

Results.

Older age (subdistribution hazards ratio [SHR]: 1.02, 95% confidence interval [CI]: 1.01∼1.03; P = 0.013), high grade (SHR: 2.68, 95% CI: 1.80∼3.99; P < 0.001), regional involvement (SHR: 1.66, 95% CI: 1.06∼2.58; P = 0.026), distant metastasis (SHR: 5.18, 95% CI: 3.11∼8.62; P < 0.001) and radical resection (SHR: 0.38, 95% CI: 0.24∼0.60; P < 0.001) were significantly associated with the incidence of CSD. These factors were used to build a competing-risk-based model and a nomogram to predict CSD. The C-index, calibration plot, and decision curve analysis indicated that the nomogram performs well in predicting CSD and is suitable for clinical use.

Conclusion.

A competing-risk based prognostic model is developed to predict the probability of CSD of patients with spinal and pelvic chondrosarcoma. This nomogram performs well and is suitable for clinical use.

Level of Evidence: 4
Diabetes mellitus promoted lymph node metastasis in gastric cancer: a 15–year single-institution experience
Authors: Chen Xinhua , Chen Yuehong , Li Tao , Liang Weiqi , Huang Huilin , Su Hongtao , Sui Chuyang , Hu Yanfeng , Chen Hao , Lin Tian , Chen Tao , Zhao Liying , Liu Hao , Li Guoxin , Yu Jiang
Published: October 2021

Background:

Previous studies have revealed that diabetes mellitus (DM) promotes disease progress of gastric cancer (GC). This study aimed to further investigating whether DM advanced lymph nodes (LNs) metastasis in GC.

Methods:

The clinicopathologic data of GC patients with >15 examined LN (ELN) between October 2004 and December 2019 from a prospectively maintained database were included. The observational outcomes included the number (N3b status) and anatomical distribution (N3 stations) of metastatic LN (MLN).

Results:

A total of 2142 eligible patients were included in the study between October 2004 and December 2019. N3 stations metastasis (26.8% in DM vs. 19.3% in non-DM, P 
= 0.026) and N3b status (18.8% in DM vs. 12.8% in non-DM, P 
= 0.039) were more advanced in the DM group, and multivariate logistic regression analyses confirmed that DM was an independent factor of developing N3 stations metastasis (odds ratio [OR] = 1.771, P 
= 0.011) and N3b status (OR = 1.752, P 
= 0.028). Also, multivariate analyses determined DM was independently associated with more MLN (β = 1.424, P 
= 0.047). The preponderance of N3 stations metastasis (DM vs. non-DM, T1–2: 2.2% vs. 4.9%, T3: 29.0% vs. 20.3%, T4a: 38.9% vs. 25.8%, T4b: 50.0% vs. 36.6%; ELN16–29: 8.6% vs. 10.4%, ELN30–44: 27.9% vs. 20.5%, ELN ≥ 45: 37.7% vs. 25.3%), N3b status (DM vs. non-DM, T1–2: 0% vs. 1.7%, T3: 16.1% vs. 5.1%, T4a: 27.8% vs. 19.1%, T4b: 44.0% vs. 28.0%; ELN16–29: 8.6% vs. 7.9%, ELN30–44: 18.0% vs. 11.8%, ELN ≥ 45: 26.4% vs. 17.3%), and the number of MLN (DM vs. non-DM, T1–2: 0.4 vs. 1.1, T3: 8.6 vs. 5.2, T4a: 9.7 vs. 8.6, T4b: 17.0 vs. 12.8; ELN16–29: 3.6 vs. 4.6, ELN30–44: 5.8 vs. 5.5, ELN ≥ 45: 12.0 vs. 7.7) of DM group increased with the advancement of primary tumor depth stage and raising of ELN.

Conclusions:

DM was an independent risk factor for promoting LN metastasis. The preponderance of LN involvement in the DM group was aggravated with the advancement of tumor depth.
Usefulness of the CONUT index upon hospital admission as a potential prognostic indicator of COVID-19 health outcomes
Authors: Bengelloun Adrián K. , Ortega Guillermo J. , Ancochea Julio , Sanz-Garcia Ancor , Rodríguez-Serrano Diego A. , Fernández-Jiménez Guillermo , Girón Rosa , Ávalos Elena , Soriano Joan B. , de Ulíbarri J. Ignacio
Published: October 2021

Background:

In-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is high. Simple prognostic indices are needed to identify patients at high-risk of COVID-19 health outcomes. We aimed to determine the usefulness of the CONtrolling NUTritional status (CONUT) index as a potential prognostic indicator of mortality in COVID-19 patients upon hospital admission.

Methods:

Our study design is of a retrospective observational study in a large cohort of COVID-19 patients. In addition to descriptive statistics, a Kaplan–Meier mortality analysis and a Cox regression were performed, as well as receiver operating curve (ROC).

Results:

From February 5, 2020 to January 21, 2021, there was a total of 2969 admissions for COVID-19 at our hospital, corresponding to 2844 patients. Overall, baseline (within 4 days of admission) CONUT index could be scored for 1627 (57.2%) patients. Patients’ age was 67.3 ± 16.5 years and 44.9% were women. The CONUT severity distribution was: 194 (11.9%) normal (0–1); 769 (47.2%) light (2–4); 585 (35.9%) moderate (5–8); and 79 (4.9%) severe (9–12). Mortality of 30 days after admission was 3.1% in patients with normal risk CONUT, 9.0% light, 22.7% moderate, and 40.5% in those with severe CONUT (P < 0.05). An increased risk of death associated with a greater baseline CONUT stage was sustained in a multivariable Cox regression model (P < 0.05). An increasing baseline CONUT stage was associated with a longer duration of admission, a greater requirement for the use of non-invasive and invasive mechanical ventilation, and other clinical outcomes (all P < 0.05). The ROC of CONUT for mortality had an area under the curve (AUC) and 95% confidence interval of 0.711 (0.676–0746).

Conclusion:

The CONUT index upon admission is potentially a reliable and independent prognostic indicator of mortality and length of hospitalization in COVID-19 patients.
Short-term Exposure to Air Pollution and Attributable Risk of Kidney Diseases
Authors: Lee Whanhee , Prifti Kristi , Kim Ho , Kim Ejin , Yang Juyeon , Min Jieun , Park Jae Yoon , Kim Yong Chul , Lee Jung Pyo , Bell Michelle L.
Published: October 2021

Background:

Several studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency room (ER) burden. This study aimed to estimate excess ER visits attributable to short-term air pollution and to provide evidence relevant to air pollution standards to protect kidney patients.

Methods:

We conducted time-series analysis using National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter ≤10 µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney and urinary system disease, acute kidney injury (AKI), and chronic kidney disease (CKD). We performed a two-stage time-series analysis to estimate excess ER visits attributable to air pollution by first calculating estimates for each of 16 regions, and then generating an overall estimate.

Results:

For all kidney and urinary disease (902,043 cases), excess ER visits attributable to air pollution existed for all pollutants studied. For AKI (76,330 cases), we estimated the highest impact on excess ER visits from O3, while for CKD (210,929 cases), the impacts of CO and SO2 were the highest. The associations between air pollution and kidney ER visits existed for days with air pollution concentrations below current World Health Organization guidelines.

Conclusion:

This study provides quantitative estimates of ER burdens attributable to air pollution. Results are consistent with the hypothesis that stricter air quality standards benefit kidney patients.
Can Ensemble Machine Learning Improve the Accuracy of Severe Maternal Morbidity Screening in a Perinatal Database?
Authors: Cartus Abigail R. , Naimi Ashley I. , Himes Katherine P. , Jarlenski Marian , Parisi Sara M. , Bodnar Lisa M.
Published: October 2021

Background:

Severe maternal morbidity (SMM) is an important maternal health indicator, but existing tools to identify SMM have substantial limitations. Our objective was to retrospectively identify true SMM status using ensemble machine learning in a hospital database and to compare machine learning algorithm performance with existing tools for SMM identification.

Methods:

We screened all deliveries occurring at Magee-Womens Hospital, Pittsburgh, PA (2010–2011 and 2013–2017) using the Centers for Disease Control and Prevention list of diagnoses and procedures for SMM, intensive care unit admission, and/or prolonged postpartum length of stay. We performed a detailed medical record review to confirm case status. We trained ensemble machine learning (SuperLearner) algorithms, which “stack” predictions from multiple algorithms to obtain optimal predictions, on 171 SMM cases and 506 non-cases from 2010 to 2011, then evaluated the performance of these algorithms on 160 SMM cases and 337 non-cases from 2013 to 2017.

Results:

Some SuperLearner algorithms performed better than existing screening criteria in terms of positive predictive value (0.77 vs. 0.64, respectively) and balanced accuracy (0.99 vs. 0.86, respectively). However, they did not perform as well as the screening criteria in terms of true-positive detection rate (0.008 vs. 0.32, respectively) and performed similarly in terms of negative predictive value. The most important predictor variables were intensive care unit admission and prolonged postpartum length of stay.

Conclusions:

Ensemble machine learning did not globally improve the ascertainment of true SMM cases. Our results suggest that accurate identification of SMM likely will remain a challenge in the absence of a universal definition of SMM or national obstetric surveillance systems.
LENS CAPSULAR FLAP TRANSPLANTATION AS PRIMARY TREATMENT FOR CLOSURE OF LARGE MACULAR HOLES
Authors: Peng Jie , Chen Chunli , Zhang Lihua , Huang Yue , Zhang Hongtao , Zheng Yan , Ren Jianing , Zou Yihua , Zhang Xuerui , Zhao Peiquan
Published: October 2021

Purpose:

To report the long-term outcomes of lens capsular flap transplantation (LCFT) as initial treatment for large macular holes (MHs).

Methods:

Thirteen consecutive eyes with large MHs who received LCFT as primary treatment were reviewed retrospectively. All enrolled eyes underwent standard 23-gauge vitrectomy, internal limiting membrane peeling, LCFT, and 15% perfluoropropane tamponade. Autologous whole blood was applied in selected eyes to make the LCT intact. A face-down position maintained for 2 weeks postoperatively. Data including demographic information, medical history, anatomical and functional outcomes, and complications were recorded.

Results:

The mean preoperative MHs diameter was 979.42 ± 388.28 µm. Eight eyes received autologous LCFT, and the other five eyes received allogenic LCFT. Whole blood was applied in seven eyes. The mean follow-up duration was 19.57 ± 6.24 months (range: 12.0–32.2 months). The macular hole was successfully closed in all cases (13/13). The median best-corrected visual acuity improved from 1.76 (interquartile range, 1.23–1.91) logarithm of the minimum angle of resolution (median Snellen acuity: 20/1,150) preoperatively to 1.16 ± 0.47 logarithm of the minimum angle of resolution (mean Snellen acuity: 20/290) (P < 0.01) at the last visit. No severe complications were noted.

Conclusion:

Lens capsular flap transplantation may help to improve the closure rate and visual outcomes in large MHs, which could be an alternative method as primary treatment for large MHs.
Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children
Authors: Quinn Helen E. , Comeau Jeannette L. , Marshall Helen S. , Elliott Elizabeth J. , Crawford Nigel W. , Blyth Christopher C. , Kynaston Jennifer A. , Snelling Tom L. , Richmond Peter C. , Francis Joshua R. , Macartney Kristine K. , McIntyre Peter B. , Wood Nicholas J.
Published: October 2021

Background:

Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization.

Methods:

Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group.

Results:

Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1–96.7). Across all years (2012–2019), of 55 cases 4–11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities.

Conclusions:

Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.
Surfing Performance in Para Surfers with Lower-Limb Amputations: A Cross-Sectional Study
Authors: Johnson Maureen E. , David Heather M. , Ganesan Mohan
Published: October 2021

Introduction

This study investigated surfing performance in surfers with transfemoral amputations (TFAs) and transtibial amputations (TTAs) who participated in international para surfing competitions. The purpose of this research was to compare surfers with lower-limb amputations with judged wave scores and surfing experience for para surfing classification efficacy.

Materials and Methods

Collected archived data (n = 20) from classification records included demographics, residual limb lengths, surfing experiences, and judged wave scores. Continuous variables age (years), residual leg length (cm), remaining leg length (%), prior surfing experience (years), and duration of competing experience (years) were analyzed using independent sample t-test. Ordinal variables surfing performance scores of 2019 and 2020 between the groups were compared using Mann-Whitney U test. Spearman ρ correlation coefficient was used to determine the association between the duration of prior surfing experience and duration of competition experience with the surfing score in both groups.

Results

Surfers with TFA with longer residual limb lengths (n = 3) and surfers with TTA (n = 14) surfed with a prosthetic leg standing. Surfers with TFA with shorter residual limb lengths (n = 3) surfed without a prosthesis kneeling. We found that para surfers who stood or kneeled with TFA performed significantly better than para surfers with TTA, reflected through judged wave scores in 2019 (P = 0.028) and 2020 (P = 0.019). No statistically significant relationship existed between para surfers with TFA who kneeled or stood. No statistically significant relationship existed between years of para surfing and judged wave scores.

Conclusions

Surfers with TFA who stood or kneeled received higher judged wave scores than surfers with TTA; however, no other significant significance was found for TFA intragroup comparisons or prior surf experience. The data size was too small for confirmatory analysis. Results appeal to a new need for inquiry on para surfers with TFA and TTA, specifically biomechanical performance surfing differences.

Clinical Relevance

Individuals with transfemoral and/or transtibial amputations can participate competitively in para surfing contests. Surfers with TFAs can successfully compete either standing with a prosthesis or kneeling without a prosthesis.
Endoscopic Transcanal and Transmastoid Laser-Assisted Resection of Middle Ear Capillary Hemangioma
Authors: Patel Evan J. , Deep Nicholas L. , Liu Cheng Z. , Jethanamest Daniel
Published: October 2021

Objective:

To present a rare case of a middle ear capillary hemangioma in an adult.

Patient:

A 31-year-old woman with a 6-month history of left ear fullness, pressure, tinnitus, and progressive hearing loss.

Intervention:

Endoscopic laser-assisted resection.

Main Outcome Measures:

Clinical, radiographic, and histopathological findings of a capillary hemangioma.

Results:

Otoscopy revealed an erythematous and slightly pulsating multilobulated middle ear retrotympanic mass. Her audiogram demonstrated a left-sided mixed hearing loss with air-conduction thresholds in the severe-to-profound range. Computed tomography (CT) imaging was significant for total opacification of the left middle ear and mastoid air cells. She underwent a combined endoscopic transcanal and transmastoid excision of the mass with ossicular chain reconstruction. A KTP laser was used to ablate and shrink down the periphery of the lesion. Pathology of the specimen was consistent with a capillary hemangioma. The patient's pulsatile tinnitus and spontaneous vertigo resolved postoperatively.

Conclusions:

Capillary hemangiomas are an uncommon cause of vascular middle ear lesions in adults and typically present with symptoms of aural fullness, pulsatile tinnitus, conductive hearing loss, otalgia, and vertigo. Surgery resection provides definitive treatment and the use of laser ablation techniques can allow for hemostasis and excellent visualization.
Associations of CB1 cannabinoid receptor (CNR1) gene polymorphisms with risk for alcohol dependence
Authors: Pabalan Noel , Chaweeborisuit Phanthip , Tharabenjasin Phuntila , Tasanarong Adis , Jarjanazi Hamdi , Eiamsitrakoon Thanee , Tapanadechopone Pairath
Published: October 2021

Objectives:

Reported associations of the cannabinoid receptor 1 (CNR1) single nucleotide polymorphisms (SNPs) with alcohol dependence (AD) have been inconsistent, prompting a meta-analysis to obtain more precise estimates.

Methods:

A Boolean search of 4 databases (PubMed, Scopus, Google Scholar, and Mednar) sought articles that evaluated the association between CNR1 polymorphisms and risk of AD. We selected the articles with sufficient genotype frequency data to enable calculation of odds ratios (ORs) and 95% confidence intervals (CIs). Using the Population Intervention Comparators Outcome elements, AD patients (P) were compared by genotype data between AD-participants (I) and non-AD-participants (C) in order to determine the risk of AD (O) attributed to the CNR1 SNPs. Analyzing 4 SNPs (rs1049353, rs1535255, rs2023239, and rs806379) using standard genetic models, we examined associations where multiple comparisons were Holm–Bonferroni corrected. The pooled ORs were assessed for aggregate statistical power and robustness (sensitivity analysis). Subgroups were Caucasians and African-Americans.

Results:

From 32 comparisons, 14 were significant indicating increased risk, from which 5 outcomes (P-value for association [P
a] = .003 to <.001) survived the Holm–Bonferroni-correction, which were deemed robust. In the rs1535255 outcomes, the codominant effect (OR = 1.43, 95% CIs = 1.24–1.65, P
a < .001) had greater statistical power than the dominant effect (OR = 1.30, 95% CI = 1.08–1.57, P
a = .006). In contrast, the rs2023239 codominant outcome was underpowered. Significance of both rs806379 Caucasian outcomes (ORs = 1.20–1.43, 95% CIs = 1.07–1.57, P
a = .003) contrasted with the null effects in African-Americans (ORs = 0.98–1.08, 95% CIs = 0.70–1.53).

Conclusions:

Three CNR1 SNPs (rs1535255, rs2023239, and rs806379) were implicated in their associations with development of AD: based on aggregate statistical power, rs1535255 presented greater evidence for associations than rs2023239; rs806379 implicated the Caucasian subgroup. Multiple statistical and meta-analytical features (consistency, robustness, and high significance) underpinned the strengths of these outcomes. Our findings could render the CNR1 polymorphisms useful in the clinical genetics of AD.
Ginseng adjuvant therapy on COVID-19
Authors: Shi Hang , Xia Yawen , Gu Renjun , Yu Shuang
Published: October 2021

Background:

Corona virus disease 2019 (COVID-19) is spreading fast and it brings great pressure to the social economy. Many reports revealed that ginseng can develop immunity for respiratory disease, but there is no evidence to prove its effects on COVID-19. This protocol of systematic review and meta-analysis will clarify the safety and effectiveness of ginseng adjuvant therapy on COVID-19 patients.

Methods:

Different databases (Web of Science, Cochrane Library, PubMed, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database, Wan fang Database, ClinicalTrials, World Health Organization Trials, and Chinese Clinical Trial Registry) will be retrieved to search related articles according to pre-defined inclusion and exclusion criteria. Clinical recovery time and effective rates will be assessed as the primary outcomes and any changes of patient's condition will be considered as the secondary outcomes. Subgroup analysis and sensitivity analysis will be conducted to explore sources of heterogeneity. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.3 and Stata/SE 15.1 software.

Results:

This study will assess the effects and safety for ginseng adjuvant therapy on COVID-19 patients.

Conclusion:

The discussion will be considered to determine whether sufficient evidence exists to prove the effects of ginseng adjuvant therapy for COVID-19 patients.

Systematic review registration:

PROSPERO (ID: CRD42021277843)
Spinal cord ischemia following open surgery of a ruptured isolated internal iliac artery aneurysm
Authors: Akabane Kentaro , Uchida Tetsuro , Umetsu Rieko , Hirooka Shuto , Kim Cholus , Uchino Hideaki , Shimanuki Takao
Published: October 2021

Introduction:

Isolated internal iliac artery (IIA) aneurysms (IIIAAs) rarely occur. However, they may enlarge asymptomatically and rupture, causing fatality. Even after successful surgery of ruptured IIIAAs, there might be a potential risk of postoperative spinal cord ischemia (SCI)-related paraplegia, which is extremely rare. However, this paraplegia significantly impacts patients’ activities of daily living.

Patient concerns:

A 71-year-old man who had no remarkable medical history was referred to our hospital with sudden lower abdominal pain.

Diagnosis:

Computed tomography (CT) revealed right IIIAA with small volumes of contrast medium extravasation and hematoma. He presented with cyanosis in the bilateral lower limbs. Moreover, blood gas analysis showed lactic acidosis. Therefore, he was diagnosed with ruptured IIIAA complicated by peripheral circulatory failure.

Interventions:

Considering his pre-shock status, an emergency operation comprising ligation of the proximal neck and suture closure of the distal IIA orifice was successfully performed.

Outcomes:

Immediately after surgery, motor and sensory dysfunction in the bilateral lower limbs occurred. Magnetic resonance imaging confirmed the presence of SCI. The patient could not stand independently and had neurogenic bladder and rectal disorder.

Conclusion:

Postoperative SCI is a serious complication with no definitive predictors, preventive methods, or highly efficacious treatments. Therefore, vascular surgeons should preempt its occurrence and focus on preventing hemodynamic instability and maintain collateral extra-segmental arterial blood flow, especially in ruptured cases.
Effect of weather variables on the incidence of trauma
Authors: Kim Se Heon , Sul Young Hoon , Kim Joong Suck
Published: October 2021

The occurrence of trauma is associated with various factors, including weather. We aimed to elucidate the relationship between local weather factors and the incidence of trauma to effectively manage and treat patients in a community setting. A retrospective study was conducted at a single center from January 2016 to December 2019. The study participants were trauma patients in the Cheongju area where the regional trauma center is located. Weather data including average daily temperature (°C), rainfall duration (hours), amount of rainfall (mm), average relative humidity (%), wind speed (m/s), and total sunlight hours per day were collected. One-way analysis of variance, correlation analysis, and linear regression analysis were performed. The average age of the participants (n = 3352) was 52.69 years. As regards seasonal difference in the incidence of trauma, there were more patients in spring than in winter (2.42/day vs 2.06/day, P = .05). The highest number of average daily trauma incidents occurred from April to June, and the difference between this value and that from January to February was significant (F = 2.20, P = .01). According to the distributed lag nonlinear model (DLnM), the relative risk is greater than 1 when the mean temperature is high (>15°C) compared to when the temperature is low (<15°C). The trauma patient prevalence was the highest at high wind speed (4.5 m/s). When the total amount of sunlight was long (>Ref. 8 hours), the trauma patient prevalence was relatively higher than the median value (lag = 0). DLnM analysis results showed that the relative risk of trauma patients increased as the amount of precipitation increased, and the incidence of trauma increased when the relative humidity was 40% to 50%. Multiple linear regression analysis revealed that high average daily temperatures and long average daily total sunlight hours resulted in an increased incidence of trauma (F = 6.605, P < .001). An increase in temperature, an increase in the daily sunlight hours, an increase in rainfall, high wind speed, and relative humidity of 40% to 50% are associated with a relatively high risk of trauma.
Acupuncture combined with traditional Chinese medicine preparation for the treatment of marrow suppression after chemotherapy
Authors: Zhu Qiongjie , Xu Wenjin , Li Xuesong
Published: October 2021

Background:

From the perspective of evidence-based medicine, the efficacy and safety of combined therapy for marrow suppression after chemotherapy is still unclear. Given that there is no high-quality meta-analysis to incorporate existing evidence, the purpose of this protocol is to design a systematically review and meta-analysis of the level I evidence to ascertain the efficacy and safety of acupuncture combined with traditional Chinese medicine preparation for marrow suppression after chemotherapy.

Methods:

The following databases will be searched electronically by keyword combination mode: 4 British literature databases including PubMed, EMBASE, Scopus, and Cochrane Library, and 4 Chinese literature databases, including Chinese national knowledge infrastructure, VIP, and Wan fang database. The randomized controlled trials on acupuncture plus traditional Chinese medicine preparation for marrow suppression after chemotherapy will be included. The primary outcome is the elevation of hemoglobin, platelets, leukocytes, and neutrophils. The other outcomes include clinical symptoms, quality of life, and absolute value of reticulocyte. Risk bias analysis of the studies will be performed independently by 2 reviewers using the Cochrane Risk of Bias Assessment Tool.

Results:

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

Conclusion:

This protocol will provide a reliable theoretical basis for the following research.
Device-related infections in a pediatric intensive care unit
Authors: Elnasser Ziad , Obeidat Haneen , Amarin Zouhair
Published: October 2021

To estimate the prevalence of the most frequent infections related to device utilization and their antimicrobial sensitivity panel, and to investigate the overall incidence of device associated infection rates per 1000 device days, at the pediatric intensive care unit of the Jordan University of Science and Technology.

This is a retrospective study from a single pediatric intensive care unit. Data were collected in relation to bloodstream infections associated with central venous catheters, pneumonia associated with ventilator endotracheal tubes, and urinary tract infections associated with Foley catheters, between January 2013 and December 2018, according to the center of disease control and prevention protocols.

During the 5-year study, 3195 patients were admitted to the pediatric intensive care unit for a total of 16,487 days. Forty-six patients (1.4%) developed 55 infections, with a median incidence rate of 7.4, 3.7, and 0.7 per 1000 days for central line associated infections, ventilator associated pneumonia, and catheter associated infections, respectively. The commonest isolated microorganisms were gram-negative bacteria in 89.1% of cases, and fungi in 10.9% of cases. Among the resistant bacterial isolates, 59.2% were multidrug resistant, and 32.6% were extended spectrum beta lactamase producers Klebsiella pneumoniae and Eschericia coli. High infection rates were related to Acinetobacter baumannii and K pneumoniae, associated with high resistance to cephalosporins. Susceptibility was highest to tigecycline and imipenem at 42.9% and 32.7% respectively.

Microbial isolates are commonly associated with healthcare device insertions in pediatric intensive care unit, invasive bacterial infections associated with critical morbidity and mortality. Further studies on device associated infections are recommended for regional profiling purposes.
Efficacy and safety of acupuncture and moxibustion combined with the external application of traditional Chinese medicine in the treatment of primary liver cancer
Authors: Wang Song , Xiong Zhuang , Liu Yangyang , Leng Yan , Deng Houbo , Shen Dong , Meng Xiangtong , Liu Tiejun
Published: October 2021

Background:

Primary liver cancer (PLC) is one of the most common malignant tumors in the world, and its incidence and fatality rate are increasing year by year. Due to the large population base in China, the aging population is severely affected by environmental pollution, eating habits, and unhealthy lifestyles. And many other influences have caused the number of new PLC cases and deaths in China to rank first in the world. Acupuncture combined with external application of Chinese medicine to treat PLC is currently one of the commonly used treatments in China. However, this combined treatment still lacks evidence-based medicine support. Therefore, this systematic review and meta-analysis aims to evaluate the efficacy and safety of acupuncture combined with external application of traditional Chinese medicine in the treatment of PLC.

Method:

We will search PubMed, Web of Science, GCBI, Embase, OVID, AMED, Cochrane Library, CNKI, VIP, CBM, and Wanfang databases. As of September 15, 2021, there are no restrictions on search language, publication time, and publication status. We will use the following medical keywords to search, including: “acupuncture”, “external application of traditional Chinese medicine”, and “primary liver cancer”. At the same time, we will manually search all reference lists from relevant systematic reviews to find other eligible studies. We will use the random effects model in REVMAN v5.3 for meta-analysis. The study for acupuncture combined with Chinese herbal medicine in the treatment of PLC was a randomized controlled study. Two researchers will independently review the research selection, data extraction, and research quality assessments. Finally, we will observe the outcome measures.

Results:

This study will provide evidence-based guidance for the treatment of PLC with acupuncture and the external application of traditional Chinese medicine and offers new ideas and methods for the treatment of PLC.
Impact of serum albumin level and variability on short-term cardiovascular-related and all-cause mortality in patients on maintenance hemodialysis
Authors: Chen Chun , Zhang Jing , Zhou Zemei , Liu Jiguo , Li Chunyin , Liu Chun
Published: October 2021

Studies have shown that low serum albumin (Salb) levels are associated with a high risk of mortality among patients on maintenance hemodialysis (MHD); however, the impact of Salb variability on short-term cardiovascular mortality remains unclear. Herein, we investigated the association between Salb levels and Salb variability on short-term all-cause and cardiovascular-related mortality in patients on MHD.

Eligible patients on MHD at Chongqing General Hospital between June 2017 and June 2020 were recruited in this study. Patients were grouped by Salb levels (normal Salb, ≥3.8 g/dL; low Salb, 3.4–3.8 g/dL; and lower Salb, 2–3.4 g/dL) and Salb variability (decreased, >5% loss; increased, >5% gain; and steady, 5% loss to 5% gain). Associations between Salb levels, Salb variability, and all-cause and cardiovascular-related mortality were analyzed using Cox regression models. A survival analysis was performed using the Kaplan–Meier analysis.

We enrolled a total of 181 patients on MHD with an average age of 65 years (interquartile range [IQR], 53–75 years). The mean Salb level was 3.8 ± 0.6 g/dL (IQR 2.9–4.4 g/dL), and the median Salb variability was 2.6% per year (IQR, −4.1 to 6.5). Fifty-two (29%) patients died, including 31 (17%) patients who died due to cardiovascular-related causes. Compared with the other groups, the lower Salb group had higher all-cause mortality (P < .01). Cox regression analyses revealed that lower Salb levels and decreased Salb variability were independently associated with all-cause mortality (hazard ratio [HR] = 1.95, 95% confidence interval [CI] 1.103–3.452; HR = 2.245, 95% CI 1.084–4.650), whereas increased Salb variability was independently associated with cardiovascular-related mortality (HR = 2.919, 95% CI 1.178–7.234; P < .05).

Lower Salb levels were an independent predictor of all-cause mortality in patients on MHD. Increased Salb variability was strongly associated with cardiovascular-related mortality in the same population, especially in the short-term and in patients with normal Salb levels. Significantly elevated Salb variability should be evaluated to reduce cardiovascular-related mortality.
Predictors of the Failure of Noninvasive Ventilation in Patients With Acute Respiratory Failure Caused by Severe Acute Pancreatitis
Authors: Shu Weiwei , Huang Tao , Jiang Ting , Bai Linfu , Han Xiaoli , Huang Shicong , Duan Jun
Published: October 2021

Objective

The aim of the study was to identify risk factors associated with the failure of noninvasive ventilation (NIV) in patients with severe acute pancreatitis (SAP).

Methods

Patients who received NIV as a first-line therapy because of acute respiratory failure caused by SAP were enrolled.

Results

A total of 133 patients were enrolled. Of the patients, 32 (24%) experienced NIV failure. Male sex (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.48–12.22), older age (OR, 1.04; 95% CI, 1.01–1.08), a higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.18; 95% CI, 1.03–1.36), and a procalcitonin level greater than 3.8 ng/mL (OR, 6.28; 95% CI, 2.04–19.31) were independently associated with NIV failure. The receiver operating characteristic curves for predicting NIV failure were 0.67, 0.72, and 0.76 tested by age, procalcitonin, and Acute Physiology and Chronic Health Evaluation II score, respectively. From initiation to 24 hours, the patients in the NIV failure group had a higher proportion of Glasgow Coma Scale scores of 14 or less, a higher proportion of pH ≤7.35, and higher respiratory rates than ones in the successful NIV group.

Conclusions

One of 4 SAP patients experience NIV failure. Age, sex, disease severity, level of inflammation, and vital signs can be used to predict NIV failure.
Quality of Life Instruments and Trajectories After Pancreatic Cancer Resection
Authors: Toms Clare , Steffens Daniel , Yeo David , Pulitano Carlo , Sandroussi Charbel
Published: October 2021

This systematic review aimed to investigate the instruments available to measure quality of life (QOL) after pancreatic cancer surgery and to describe short- and long-term QOL outcomes. A comprehensive literature search was completed using PubMed, Embase, and Medline from inception to March 2019. Studies investigating QOL outcomes in patients undergoing pancreatic cancer surgery who were 18 years or older were included. The main outcomes of interest were QOL instruments and short (≤6 months) and long term (>6 months) QOL outcomes. The overarching domains of physical, psychosocial, overall QOL, symptoms, and other were used to summarize QOL outcomes. Thirty-five studies reporting on 3573 patients were included. Fifteen unique QOL instruments were identified, of which 4 were disease-specific instruments. Most of the included studies reported no changes in QOL at short- and long-term follow-ups for the overarching domains. No difference in QOL outcomes was reported between different surgical approaches, except laparoscopic versus open distal pancreatectomy, and pancreaticoduodenectomy versus distal pancreatectomy. There are a wide range of instruments available to measure QOL outcomes in pancreatic cancer surgical patients, although only few are disease-specific. Most of the included studies reported no significant changes in QOL outcomes at short- or long-term follow-ups.
Epigenetic Dysregulation of 5-hydroxymethylcytosine in Well-Differentiated Pancreatic Neuroendocrine Tumors
Authors: Sharma Aarti E. , Olivas Andrea , Parilla Megan , Yassan Lindsay , Wang Hanlin , Zhang Sharon S. , Weber Christopher , Keutgen Xavier M. , Hart John , Krausz Thomas , Setia Namrata
Published: October 2021

Dysregulation of epigenetic mechanisms, reflected by loss of expression of 5-hydroxymethylcytosine (5-hmC) is being increasingly recognized as a marker of aggressive behavior in several neoplasms; however, the role of such epigenetic modifiers in pancreatic neuroendocrine tumors (PanNETs) has not been studied. Annotated cohort of 60 PanNETs was evaluated for 5-hmC expression using immunohistochemistry. Univariable and multivariable analyses were performed. To determine intratumor heterogeneity of 5-hmC expression, 26 additional synchronous metastatic deposits of PanNETs from 8 patients were evaluated for 5-hmC expression. 5-hmC level showed significant association with the presence of distant metastases (P=0.02), female sex (P=0.04), and Ki-67 proliferation index (P=0.002). A multivariate model created using the stepwise logistic regression analysis showed the presence of nodal metastases (odds ratio=6.15), lymphovascular invasion (odds ratio=4.07) and lack of 5-hmC expression (odds ratio=5.34) were predictive of the risk of distant metastasis in PanNETs with a c-statistic of 0.845. Epigenetic intratumoral heterogeneity of 5-hmC expression was seen in 37.5% cases (3/8). Our work provides evidence that epigenetic regulators are involved in the pathobiology of PanNETs and immunohistochemical analysis of 5-hmC may be able to refine prognostic evaluation of these tumors.
Reading Man Flap
Authors: Mutaf Mehmet , Temel Metin
Published: October 2021

Background

Closure of the nasal skin defects that resulted from excision of the skin neoplasms represents a challenging problem in reconstructive surgery. Here, the use of the reading man procedure as a new alternative in reconstruction of the skin defects of the nose is presented.

Materials and Methods

In this procedure, 2 local flaps designed in an unequal Z-plasty manner are used. Defect coverage is achieved by transposing the first flap to the defect area, whereas the second flap is used for closure of the first flap's donor site. In last 10 years, this technique has been used for closure of the nasal skin defects that resulted from removal of skin cancers in 28 patients (15 men and 13 women) aged from 45 to 98 years. The defects were ranging between 1.5 and 3.1 cm in diameter.

Results

In all patients, a tension-free 1-stage closure was obtained. There was no patient with dog ear formation and/or distortion of the mobile anatomical structures, such as nasal tip, alar lobules, and nostrils. All patients healed without complications. A mean follow-up of 52 months (8 months to 6.5 years) revealed satisfactory cosmetic results in all patients. No tumor recurrence was observed.

Conclusions

Using the advantage of extra tissue relaxation provided by an unequal Z-plasty, the reading man procedure seems to be a useful alternative for the closure of nasal defects with alike local skin. As a critical achievement, this procedure does not require excision of additional healthy tissue. Borrowing tissue from multiple directions, it avoids dog ear formation and distortion of the mobile anatomic structures.
The Melbourne Classification of the Complete Unilateral Cleft Lip Based on Hypoplasia
Authors: Van Slyke Aaron C. , Chong David K.
Published: October 2021

Background:

The hypoplastic lateral lip element within the cleft lip presentation is a recognized entity that has been recently shown to be more common on the right side. The spectrum of such change is yet to be defined. The authors propose the Melbourne classification system of cleft lip hypoplasia and see it as an important step towards discerning the relevance of these anatomical observations to the management of cleft lip/palate patients.

Methods:

This is a retrospective observational study of patients with complete unilateral cleft lips treated by the senior author (DKC) at the Royal Children's Hospital, Melbourne. Patient charts were retrospectively reviewed and patients were classified into different degrees of hypoplasia based on preoperative, intraoperative, and postoperative photography. Data was reported using descriptive statistics.

Results:

Fifty-nine patients with complete unilateral cleft lip deformity were grouped according to lateral lip element hypoplasticity. Twenty patients had right-sided clefts and 39 patients had cleft lips on the left side. Of those with right-sided clefts, 18 patients had evidence of hypoplasia (90%). Three patients had Type 1 deformities, 3 patients were Type 2, and 12 patients were Type 3. Patients with left-sided clefts were found to have hypoplasia less frequently with 15 patients showing evidence (38.5%).

Conclusions:

The authors report a classification system of hypoplasia involving the lateral lip element in complete unilateral cleft lip. The authors propose this classification system as a new measure of cleft severity that will have implications for patient expectations, surgical planning, and future outcome studies.
Echocardiographic Correlates of Mortality Among Cardiac Intensive Care Unit Patients With Cardiogenic Shock
Authors: Jentzer Jacob C. , Tabi Meir , Wiley Brandon M. , Singam Narayana S. V. , Anavekar Nandan S.
Published: October 2021

Background:

Prior studies have shown worse outcomes in patients with cardiogenic shock (CS) who have reduced left ventricular ejection fraction (LVEF), but the association between other transthoracic echocardiogram (TTE) findings and mortality in CS patients remains uncertain. We hypothesized that Doppler TTE measurements would outperform LVEF for risk stratification.

Methods:

Retrospective analysis of cardiac intensive care unit patients with an admission diagnosis of CS and a TTE within 1 day of admission. Hospital survivors and inpatient deaths were compared, and multivariable logistic regression was used to analyze the associations between TTE variables and hospital mortality.

Results:

We included 1,085 patients, with a median age of 69.5 (59.6, 77.5) years; 37% were females and 62% had an acute coronary syndrome. Most patients (66%) had moderate or severe left ventricular (LV) systolic dysfunction, and 48% had moderate or severe right ventricular (RV) systolic dysfunction. Hospital mortality occurred in 31%, and inpatient deaths had a lower median LVEF (29% vs. 35%, P < 0.001). Patients with mild or no LV or RV dysfunction were at lower risk of adjusted hospital mortality (P < 0.01). The LV outflow tract (LVOT) velocity-time integral (VTI) was the single best predictor of hospital mortality. After multivariable adjustment, both the LVEF and LVOT VTI remained strongly associated with hospital mortality (P < 0.001).

Conclusions:

Early comprehensive Doppler TTE can provide important prognostic insights in CS patients, highlighting its potential utility in clinical practice. The LVOT VTI, reflecting forward flow, is an important measurement to obtain on bedside TTE.