bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Level and Hospital-Level Risk Factors for In-Hospital Mortality in Patients Ventilated for More Than 24 Hours: Results of a Nationwide Cohort Study
Authors: Schoffer Olaf , Roessler Martin , Walther Felix , Eberlein-Gonska Maria , Scriba Peter C. , Albrecht Michael , Kuhlen Ralf , Schmitt Jochen 
Published: July 2020

Background: Prolonged ventilation is associated with a high risk of death. This study investigated both patient-level and hospital-level risk factors for in-hospital mortality in patients ventilated for more than 24 hours. Methods: The analyses were conducted in the framework of a German national multicenter retrospective cohort study. Patient and hospital characteristics were examined using descriptive statistics. Risk factors of in-hospital mortality were analyzed using multilevel robust Poisson regressions for binary outcomes. Potential effect modifications were examined by stratified analyses. Results: The sample includes 95 672 cases of patients ventilated >24 hours in 163 hospitals covering the period 2016 to 2017. According to the results of multilevel Poisson regressions, main patient-level risk factors for in-hospital mortality were age (per year relative risk [RR] = 1.021, 95% CI = 1.020-1.023), stroke (RR = 1.459; 95% CI = 1.361-1.563), emergency case admission (RR = 1.273, 95% CI = 1.156-1.403), and transfer from another hospital (RR = 1.169, 95% CI = 1.084-1.261). The individual risk of in-hospital death was positively associated with hospital size (RR of hospitals with 600-799 beds vs <100 beds = 1.412, 95% CI = 1.095-1.820) and negatively related to cumulated ventilation patient time (per 1000 days RR = 0.995, 95% CI = 0.993-0.996). University hospital status was identified as an effect modifier, particularly with regard to the patients’ admission reasons. The RR of in-hospital death in patients admitted after transfer from another hospital was higher in university hospitals (RR = 1.456, 95% CI = 1.298-1.634) compared to nonuniversity hospitals (RR = 1.077, 95% CI = 1.019-1.139). Likewise, patients admitted as emergency case had a higher relative risk in university hospitals (RR = 1.619, 95% CI = 1.359-1.929) than in nonuniversity hospitals (RR = 1.141, 95% CI = 1.080-1.205). Conclusion: By providing evidence on multiple patient-level and hospital-level risk factors for in-hospital mortality in patients ventilated for more than 24 hours, this large multicenter study has main implications for quality assessment of clinical care and the adequate specification of risk adjustment models. The revealed effect modifications indicate the relevance of stratified analyses.
The BRI and Strategic Revival of the Silk Road: Implications for Asia
Authors: Mishra Vivek 
Published: July 2020

Richard T Griffiths, The New Silk Road: Challenge and Response. Leiden: HIPE Publications, 2019, pp. 157, $19.22. ISBN 978-94-92439-04-8. Nasir Raza Khan (Ed.), India and the Silk Road: Exploring Current Opportunities. New Delhi: Primus Books, 2019, pp. 269, ₹1,250.00. ISBN 978-93-5290-722-9.
Association Between Exposure to Pesticides and ADHD or Autism Spectrum Disorder: A Systematic Review of the Literature
Authors: Tessari Luca , Angriman Marco , Díaz-Román Amparo , Zhang Junhua , Conca Andreas , Cortese Samuele 
Published: July 2020

Objective: To conduct a systematic review of studies assessing the relationship between exposure to pesticides and ADHD or Autism Spectrum Disorder (ASD). Methods: Based on a pre-registered protocol in PROPSERO (CRD42018107847), we searched PubMed, Ovid databases, and ISI Web of Knowledge with no date/language/document type restrictions, up to May 2019. The Newcastle Ottawa Scale was used to assess study quality. Results: Among the 29 retained studies, 13 focused on ADHD, 14 on ASD, and two on both disorders. Ten studies reported a significant association between exposure to pesticides and ADHD/ADHD symptoms and 12 studies found a significant association with ASD/ASD traits. The strengths of the association and the possible confounders controlled for varied substantially across studies. Conclusion: Whilst there is some evidence suggesting a possible link between pesticides and ADHD/ASD, heterogeneity across studies prevents firm conclusions. We provide methodological indications for future studies.
Risk indictors in cats with preclinical hypertrophic cardiomyopathy: a prospective cohort study
Authors: Ironside Vicky A , Tricklebank Philip R , Boswood Adrian 
Published: July 2020

Objectives This study aimed to identify indicators of the risk of progression of preclinical hypertrophic cardiomyopathy (HCM). Methods This was a prospective cohort study following a population of cats with preclinical HCM. Cats serially underwent physical examination, blood pressure measurement, blood sampling and echocardiography. Development of congestive heart failure (CHF), arterial thromboembolism (ATE) or sudden death (SD) were considered cardiac-related events. Associations between factors recorded at baseline, and on revisit examinations, and the development of a cardiac-related event were explored using receiver operator characteristic (ROC) analysis. Results Forty-seven cats were recruited to the study and were followed for a median period of 1135 days. Fifteen cats (31.9%) experienced at least one cardiac-related event; six CHF, five ATE and five SD. One cat experienced a cardiac-related event per 10.3 years of patient follow-up. Cats with increased left atrial (LA) size and higher concentrations of N-terminal pro B-type natriuretic peptide (NTproBNP) at baseline were more likely to experience an event. Cats with a greater rate of enlargement of LA size between examinations were also more likely to experience an event. Conclusions and relevance Factors easily measured, either once or serially, in cats with preclinical HCM can help to identify those at greater risk of going on to develop clinical signs.
Stability of Skin Microbiome at Sacral Regions of Healthy Young Adults, Ambulatory Older Adults, and Bedridden Older Patients After 2 Years
Authors: Ogai Kazuhiro , Ogura Kohei , Ohgi Nozomi , Park Seohui , Aoki Miku , Urai Tamae , Nagase Satoshi , Okamoto Shigefumi , Sugama Junko 
Published: July 2020

Objective: The sacral skin of bedridden older patients often develops a dysbiotic condition. To clarify whether the condition changes or is sustained over time, we analyzed the skin microbiome and the skin physiological functions of the sacral skin in patients who completed our 2017 study. Methods: In 2019, we collected the microbiome on the sacral region and measured sacral skin hydration, pH, and transepidermal water loss from 7 healthy young adults, 10 ambulatory older adults, and 8 bedridden older patients, all of whom had been recruited for the 2017 study. For microbiome analysis, 16S ribosomal RNA-based metagenomic analysis was used. Results: No significant differences in the microbial compositions or any alpha diversity metrics were found in the bedridden older patients between the 2017 and 2019 studies; the higher gut-related bacteria were still observed on the sacral skin of the bedridden older patients even after 2 years. Only skin pH showed a significant decrease, approaching normal skin condition, in the bedridden older patients over 2 years. Conclusion: This study indicated that gut-related bacteria stably resided in the sacral skin in bedridden patients, even if the patient had tried to restore skin physiological functions using daily skin care. We propose the importance of skin care that focuses more on bacterial decontamination for the sacral region of bedridden older patients, in order to decrease the chances of skin/wound infection and inflammation.
Plasma Phospholipid Metabolites Associate With Functional Outcomes Following Mild Traumatic Brain Injury in Older Adults
Authors: Martha Sarah R. , Chen Kuan-Fu , Lin Yvonne , Thompson Hilaire J. 
Published: July 2020

Objective: To compare differences using a metabolomics approach in older adults (≥55) with mild traumatic brain injury (mTBI) to control adults and to identify a signature profile related to functional outcome 3–6 months post-injury. Methods: We performed metabolomics analysis using LC-MS of untargeted aqueous metabolites on plasma samples taken from a parent prospective cohort study. Older adults with mTBI (n = 14) were purposively sampled to include participants with worsening (decrease in GOS-E of at least 1 level) and improved (increase in GOS-E of at least 1 level) outcomes from 3 to 6 months. The data were analyzed using PLS-DA with VIP scores, Random Forest, and spline fit between the different groups as a function of time for exposure on outcome. Results: Separation of comparisons were seen at 24 hours (negative ionization) and 6 months (positive ionization), revealing two metabolites of interest, phosphatidylcholine and phosphatidylethanolamine. Phosphatidylcholine levels were higher in those with mTBI compared to controls ( p < 0.05), while lower concentration of phosphatidylethanolamine was seen in those with mTBI compared to controls ( p < 0.05). Phosphatidylinositol-3,4,5-trisphosphate was significant in those with mTBI compared to controls (n = 10) based on improved (n = 6) versus worsened (n = 8) outcomes from 3 to 6 months. Conclusion: We identified plasma metabolites related to phospholipid metabolism in older adults following mTBI and associated with long-term functional outcome. These findings may underly pathological mechanisms of outcome differences in older adults who experience mTBI.
Combined brachytherapy and vitreoretinal surgery for a large retinal capillary hemangioma with exudative retinal detachment
Authors: Barca Francesco , Vicini Giulio , Nicolosi Cristina , Pieretti Giulia , Caporossi Tomaso , Rizzo Stanislao , Giansanti Fabrizio , Mazzini Cinzia 
Published: July 2020

Introduction: We report about a large retinal capillary hemangioma (RCH) with exudative retinal detachment and a macular fold, treated with Ruthenium-106 brachytherapy (Ru-106 BT) and scleral buckling surgery, followed by pars plana vitrectomy (PPV), for the removal of macular tractions. Case description: A 17-year-old boy was referred to our Ocular Oncology Unit for a large RCH in the left eye. BCVA was hand motion. The RCH measured 4.9 × 6.85 mm in basal diameters and 4.0 mm in thickness and was located in the mid-peripheral temporal retina. It was surrounded by extensive subretinal exudation, forming an exudative retinal detachment, with a retinal fold that extended from the lesion to the optic disc. We performed Ru-106 BT and at the moment of the plaque removal we placed a radial buckle with the aim to unbend the retinal fold. At 3-months follow-up the exudation decreased, we achieved the opening of the peripheral side of the retinal fold, but the macula was still detached. We decided to perform a lens sparing PPV, macular peeling and air tamponade, to remove the vitreoretinal tractions ab interno and to try to complete the opening of the macular fold. After 1-month BCVA was counting fingers, the retina appeared attached, also in the macular area, but the retinal fold remained partially close in the macular side. After 6 months the tumor was inactivated, the macula remained attached, unfortunately, the macular fold remained partially close. Conclusion: Ru-106 BT and scleral buckling concurrent approach can be an effective treatment modality in selected cases of large RCHs, followed by PPV to remove eventual vitreo-retinal tractions.
Can palatal depth influence the buccolingual inclination of molars? A cone beam computed tomography-based retrospective evaluation
Authors: Arvind TR Prasanna , Dinesh SP Saravana 
Published: July 2020

Objective: To interpret a correlation between buccolingual inclination of molars and palatal depth in hyperdivergent patients and to identify importance of determining inclination of molars in assessing transverse discrepancies (as skeletal or dental) Design: This was a retrospective cone beam computed tomography (CBCT) study. Setting: The study was conducted in the Department of Orthodontics, Saveetha Dental College and Hospital, Tamil Nadu, India. Methods: This was a retrospective CBCT study of 79 patients who underwent diagnostic CBCT for treatment purposes. The CBCT scans were evaluated systematically and the required parameters were accessed with suitable reference planes. Student’s t-test (95% confidence interval) was performed to determine buccolingual inclination of first molars between the right and left sides. Only patients with a vertical growth pattern and skeletal class I relation were included and they were classified into three groups based on their palate depth. Results: In patients with palatal depth > 22 mm, the mean inclination of molars was 7.4°; with palatal depth in the range of 19–22 mm, the mean inclination of molars was 5.23°; and with palatal depth < 19 mm, the mean inclination of molars was 2.9°. Results showed that there was a significant correlation between the buccolingual inclination of molars and the palate depth in vertical growers ( P < 0.05). Conclusion: The buccolingual inclination of first molars is increased in patients with greater palatal depth. This parameter is helpful in classifying crossbites as skeletal or dental. The amount of compensation required to correct the cross bite can be adjusted using Korkhaus Index.
Knowledge of, and attitudes to, shared decision-making in orthodontics in the UK
Authors: Barber Sophy K , Ryan Fiona , Cunningham Susan J 
Published: July 2020

Objective: To establish UK orthodontic treatment providers’ knowledge of, and attitudes to, shared decision-making (SDM). SDM involves patients as equal partners in decisions about treatment. Design: Cross-sectional survey. Setting: Online survey across the UK. Population: Dentists and orthodontists providing orthodontic treatment in the UK. Methods: Potential participants were contacted through the British Orthodontic Society mailing lists. An online survey was developed to examine knowledge of, and attitudes to, SDM using a combination of evidence-based statements and free text boxes. Questions regarding previous training in SDM and preferences for further training were also included. Results: The survey was completed by 210 respondents, yielding an approximate response rate of 15%. Respondents were mainly consultants (34%) and specialist orthodontists (42%). SDM was well described in terms of the people involved in this process, how it is approached, the components and topics of discussion, and the overall purpose of SDM. Generally, there was consistency in attitudinal responses, with the largest variance in responses to questions about the professional–patient partnership, the interface between SDM and clinical guidelines, and accepting a decision that is discordant with the professional’s opinion. Fifty-one respondents reported having some previous teaching/training in SDM, with the majority (87%) indicating that they would like more training. Conclusion: Clinicians providing orthodontic treatment in the UK have a good understanding of the meaning of shared decision-making. Concerns raised about using SDM and knowledge gaps suggest there is value in providing SDM training for the orthodontic team and that orthodontic providers would welcome it.
Topical anaesthesia as an adjuvant to local anaesthetic injection in open trigger digit release: a randomized controlled trial
Authors: Laohaprasitiporn Panai , Monteerarat Yuwarat , Limthongthang Roongsak , Vathana Torpon , Wilairatana Vajara 
Published: July 2020

We conducted a randomized controlled trial to compare pain scores and patient satisfaction between topical anaesthetic cream (5% lidocaine-prilocaine cream) versus placebo cream, applied approximately 90 minutes before local anaesthetic injection for open trigger digit release. One hundred participants were enrolled and randomly allocated into the two groups between May 2019 and February 2020. The visual analogue pain scores and satisfaction scores were measured. Most participants were female with Quinnell Grade 2–3 trigger digits. The pain scores during needle injection, local anaesthetic infiltration, the overall pain and satisfaction scores had no statistically significant differences between groups. There was no correlation between duration of topical anaesthetic drug application and pain scores. Subgroup analysis did not show significant differences in pain scores between genders. No complications were found during the study period. The topical anaesthetic drug was ineffective to use on the palmar skin during open trigger digit release surgery. Level of evidence: II
Assessment of Simple Bedside Wound Characteristics for a Prediction Model for Diabetic Foot Ulcer Outcomes
Authors: Bender Clara , Cichosz Simon Lebech , Pape-Haugaard Louise , Hartun Jensen Merete , Bermark Susan , Laursen Anders Christian , Hejlesen Ole 
Published: July 2020

Background: Evidence-based learning systems built on prediction models can support wound care community nurses (WCCNs) during diabetic foot ulcer care sessions. Several prediction models in the area of diabetic foot ulcer healing have been developed, most built on cardiovascular measurement data. Two other data types are patient information (i.e. sex and hemoglobin A1c) and wound characteristics (i.e. wound area and wound duration); these data relate to the status of the diabetic foot ulcer and are easily accessible for WCCNs. The aim of the study was to assess simple bedside wound characteristics for a prediction model for diabetic foot ulcer outcomes. Method: Twenty predictor variables were tested. A pattern prediction model was used to forecast whether a given diabetic foot ulcer would (i) increase in size (or not) or (ii) decrease in size. Sensitivity, specificity, and area under the curve (AUC) in a receiver-operating characteristics curve were calculated. Results: A total of 162 diabetic foot ulcers were included. In combination, the predictor variables necrosis, wound size, granulation, fibrin, dry skin, and age were most informative, in total an AUC of 0.77. Conclusions: Wound characteristics have potential to predict wound outcome. Future research should investigate implementation of the prediction model in an evidence-based learning system.
Anatomic Structures at Risk During Posterior to Anterior Percutaneous Screw Fixation of Posterior Malleolar Fractures: A Cadaveric Study
Authors: Czerwonka Natalia , Momenzadeh Kaveh , Stenquist Derek S. , O’Donnell Seth , Kwon John Y. , Nazarian Ara , Miller Christopher P. 
Published: July 2020

Background. There are no established guidelines for fixation of posterior malleolus fractures (PMFs). However, fixation of PMFs appears to be increasing with growing evidence demonstrating benefits for stability, alignment, and early functional outcomes. The purpose of this study was to determine the risk to anatomic structures utilizing a percutaneous technique for posterior to anterior (PA) screw fixation of PMFs. Methods. Percutaneous PA screw placement was carried out on 10 fresh frozen cadaveric ankles followed by dissection to identify soft tissue and neurovascular structures at risk. The distance from the guidewire to each anatomic structure of interest was measured. The correlation between the mean distances from the guidewire to each structure was calculated. Results. The sural nerve was directly transected in 1/10 specimens (10%) and in contact with the wire in a second specimen (10%). There was a significant correlation between the proximity of the guidewire to the apex of Volkmann’s tubercle and its proximity to the sural nerve. The flexor hallucis longus (FHL) muscle belly was perforated by the guidewire 40% of the time but was not tethered or entrapped by the screw. Conclusions. Percutaneous PA screw placement is a safe technique which can be improved with several modifications. A mini-open technique is recommended to protect the sural nerve. There may be potential for tethering of the FHL with use of a washer or large screw head. Risk to the anterior and posterior neurovascular bundles is minimal. Levels of Evidence: Level V
Fixation of Unstable Osteochondritis Dissecans Lesions and Displaced Osteochondral Fragments Using New Biodegradable Magnesium Pins in Adolescents
Authors: Jungesblut Oliver D. , Moritz Menard , Spiro Alexander S. , Stuecker Ralf , Rupprecht Martin 
Published: July 2020

Objective Fixation of unstable osteochondritis dissecans (OCD) lesions and displaced osteochondral fragments are frequently performed procedures in pediatric orthopedic surgery. Since 2018, CE-certified MAGNEZIX pins are used in our institution in these cases. The aim of this study was (1) to analyze safety, efficiency, and limitations of magnesium-pin-based fixation of unstable OCD lesions and displaced osteochondral fragments and (2) to report clinical and radiological outcomes at short-term follow-up (FU). Design In this prospective cohort study, 19 patients (10 girls and 9 boys) were included. Inclusion criteria were (1) magnetic resonance imaging–confirmed unstable OCD lesion or displaced osteochondral fragment, (2) fixation with magnesium-based pins, and (3) minimum FU of 6 months. X-rays were taken 6 weeks and 6 months after operation and magnetic resonance imaging scans every 4 to 6 months to assess the healing progress. Results In total 67 pins were used, with a mean of 3.6 ± 1.4 per patient. Average age at surgery was 13.7 years (11-17 years). Mean time of operation was 56 ± 31 minutes, including arthroscopy, fixation, and patellar realignment ( n = 6). No intraoperative complications occurred. Average FU was 11.3 ± 4.2 months (6-20 months). No redislocation or new dislocation occurred. Until now a complete radiographic healing occurred in 12 cases. Due to an implant failure in one case 11 weeks after the index surgery a revision became necessary. Conclusions In short-term FU of 11 ± 4 months MAGNEZIX pins provide high stability after fixation of unstable OCDs and displaced osteochondral fragments leading to uncomplicated and timely healing.
Intra-articular Administration of Tranexamic Acid Has No Effect in Reducing Intra-articular Hemarthrosis and Postoperative Pain After Primary ACL Reconstruction Using a Quadruple Hamstring Graft: A Randomized Controlled Trial
Authors: Lee Ja-Woon , Kim Sang-Gyun , Kim Su-Hyun , Cho Hyun-Woo , Bae Ji-Hoon 
Published: July 2020

Background: Insufficient data are available to support the routine use of tranexamic acid (TXA) in anterior cruciate ligament (ACL) surgeries with respect to administration method and frequency, exposure duration, dose, and adverse effects. Purpose: To investigate whether intra-articular (IA) administration of TXA could reduce hemarthrosis and postoperative pain in patients after ACL reconstruction. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 47 patients were included in this study, which was performed between July 2017 and May 2019. Single-bundle reconstructions using autologous hamstring tendon grafts were performed in all patients. The patients were randomized into 2 groups: the TXA group (received the index procedure with 100-mL IA injection of TXA [30 mg/mL]) and a control group (did not receive IA injection of TXA). No patients received a drain. Blood loss was calculated on the basis of hemoglobin balance at postoperative day (PD) 2. The visual analog scale (VAS) for pain score was assessed at PD 3. The midpatellar circumference was measured at PD 2 and PD 5. Knee range of motion (ROM) was evaluated 6 weeks after surgery. Results: The mean ± SD blood loss was 467 ± 242 mL in the TXA group and 558 ± 236 mL in the control group. No significant differences were found for blood loss ( P = .20), VAS pain scores ( P = .28), ROM at postoperative week 6 ( P = .61), or patellar circumference at PD 2 ( P = .75) and PD 5 ( P = .84). Conclusion: This study showed that IA administration of 3.0 g of TXA had no effect in reducing blood loss and postoperative pain after primary anatomic single-bundle ACL reconstruction using quadruple hamstring autografts. Registration: NCT04042688 ( ClinicalTrials.gov identifier).