bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does preoperative serum creatinine affect the early surgical outcomes of acute Stanford type A aortic dissection?
Authors: Wu Zi-Ning , Guan Xin-Liang , Xu Shi-Jun , Wang Xiao-Long , Li Hai-Yang , Gong Ming , Zhang Hong-Jia 
Published: January 2020

Background:
Acute Stanford type A aortic dissection is a lethal disease requiring surgery. Evidence regarding the effects of preoperative creatinine in mortality is limited, and few studies have evaluated the effect of postoperative dialysis treatment on it.

Methods:
In this cohort study, we continuously recruited 632 surgical patients who were treated for acute type A aortic dissection in our hospital between January 2015 and May 2017. The preoperative level of serum creatinine was measured. All patients were followed up after surgery for 30 days to determine early mortality.

Results:
The 30-day mortality after surgery increased with elevated levels of preoperative serum creatinine. Median (interquartile range) serum creatinine levels in survivors were 9.61 μmol/dL (7.28-12.62 μmol/dL) versus 13.41 μmol/dL (10.28-20.63 μmol/dL) in death (p < 0.01). Adjusted odds ratios for increasing per μmol/dL serum creatinine were 1.09 (95% confidence interval, 1.03-1.15). We also found that the effect of preoperative creatinine on 30-day mortality was diminished by dialysis treatment after surgery.

Conclusion:
Preoperative serum creatinine predicts outcome in patients undergoing surgery for Stanford type A aortic dissection, and postoperative dialysis treatment can reduce its hazard.
Use of a Symptom Diary on Oncology Wards
Authors: IJzerman-Korevaar Margriet , de Graeff Alexander , Heijckmann Steffie , Zweers Daniëlle , Vos Bernard H. , Hirdes Marloes , Witteveen Petronella O. , Teunissen Saskia C.C.M. 
Published: January 2020

Background
Management of symptoms is essential in reducing the symptom burden of cancer patients. The effect of symptom diaries on symptom management to date has been evaluated only in ambulatory settings.

Objective
The aims of this study were to identify the key facilitators for successful implementation of symptom diaries on oncology wards from patients’ and professionals’ perspectives and to evaluate implementation outcomes.

Methods
In 2 cycles of action research, the Utrecht Symptom Diary (USD) was implemented on 3 oncology wards and a daycare unit. Key facilitators for implementation were identified by thematic coding of interviews. The effect of the implementation was evaluated in cycle II in a pretest-posttest design. We performed statistical tests (Mann-Whitney/t test/χ
2) on Symptom Management Performance items in questionnaires and medical records.

Results
We interviewed 25 patients, 8 doctors, and 25 nurses. Seven key facilitators for implementation emerged. After implementation of the USD in cycle II, Symptom Management Performance was significantly (P < .05) improved for patients (3/12 items, n = 33 pretest/26 posttest) and professionals (6/12 items, n = 21 pretest/19 posttest). Significantly more symptoms (P = .00), working hypotheses (P = .023), treatment plans (P = .00), and interventions (P = .00) were reported (n = 47 pretest/47 posttest).

Conclusions
Implementation of the USD significantly improved symptom management in oncology wards. We recommend (1) using a diagnosis-specific diary; (2) making clear, individualized working-arrangements; (3) training professionals; (4) using the plan-do-check-act cycle; (5) acting multidisciplinary; (6) providing guidelines and training; and (7) assuring adequate information communications technology (ICT).

Implications
Symptom diaries are increasingly used, but implementation is challenging. This study provides knowledge on their benefits and an evidence-based strategy for implementation with positive outcomes achieved in patient care.
Real-Time Measurement of Crowding in Pediatric Emergency Department
Authors: Noel Guilhem , Jouve Elisabeth , Fruscione Sophie , Minodier Philippe , Boiron Laurence , Viudes Gilles , Gentile Stéphanie 
Published: January 2020

AbstractOur study aimed to develop and validate a real-time crowding composite scale for pediatric emergency department (PED). The study took place in one teaching PED for 2 months. The outcome was the perception of crowding evaluated by triage nurses and pediatricians on a 10-level Likert scale. Triage nurses evaluated crowding at each moment of a child's admission and pediatrician at each moment of a child's discharge. The outcome was the hourly mean of all evaluations of crowding (hourly crowding perception). For analysis, originally, we only selected hours during which more than 2 nurses and more than 2 pediatricians evaluated crowding and, moreover, during which evaluations were the most consensual. As predictors, we used hourly means of 10 objective crowding indicators previously selected as consensual in a published French national Delphi study and collected automatically in our software system. The model (SOTU-PED) was developed over a 1-month data set using a backward multivariable linear regression model. Then, we applied the SOTU-PED model on a 1-month validation data set. During the study period, 7341 children were admitted in the PED. The outcome was available for 1352/1392 hours, among which 639 were included in the analysis as “consensual hours.” Five indicators were included in the final model, the SOTU-PED (R2= 0.718). On the validation data set, the correlation between the outcome (perception of crowding) and the SOTU-PED was 0.824. To predict crowded hours (hourly crowding perception >5), the area under the curve was 0.957 (0.933–0.980). The positive and negative likelihood ratios were 8.16 (3.82–17.43) and 0.153 (0.111–0.223), respectively. Using a simple model, it is possible to estimate in real time how crowded a PED is.
Male Rhinoplasty: Update
Authors: Rohrich Rod J. , Mohan Raja 
Published: January 2020

Summary:
Male rhinoplasty is unique in that it requires precise preoperative planning to achieve a successful result. Better communication and clarity are paramount with male rhinoplasty patients because the patients may be less attentive. It is important for the surgeon to screen the patients for any psychosocial disorders. Through a series of cases, male rhinoplasty techniques are highlighted. Masculine features should be preserved, and the nose should not be feminized or oversculpted. Another key component in any rhinoplasty case is proper skin care, especially during the postoperative period.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Intravesical Antibiotic Administration in the Treatment of Recurrent Urinary Tract Infections: Promising Results From a Case Series
Authors: Chernyak Sofiya , Salamon Charbel 
Published: January 2020

Objective
Intravesical antibiotic administration for the treatment of recurrent urinary tract infections (UTIs) provides targeted therapy that may be a useful alternative to oral antibiotics. The objective of the study was to assess the rate of UTIs before and after intravesical antibiotic instillations in community-dwelling postmenopausal women with recurrent UTIs.

Methods
Patients with recurrent UTI who underwent antibiotic bladder instillations were included. Instillation was performed in the office by trained nursing staff using either gentamycin or tobramycin. Every instillation was preceded by bladder irrigation with sterile water. Retrospective chart review was performed to compare rates of UTIs for 6 months before and after intervention. Descriptive and nonparametric statistics were used for data analysis.

Results
Twelve patients were evaluated. The average rate of UTIs decreased from a median of 2.5 to 1.5 infections (P = 0.025) after intravesical instillations. The number of pathogen types decreased from a median of 2.5 to 1.5 after therapy (P = 0.025). There was a reduction in bacterial antibiotic resistance after completion of instillations, with an estimated median difference of −5.250 (P = 0.065). There were no adverse effects reported during instillations.

Conclusions
Intravesical instillations offer a promising therapy for the treatment of recurrent UTIs in postmenopausal women who failed oral antibiotic therapy. Future prospective studies are needed to further elucidate the clinical utility and long-term benefits of antibiotic instillations.
The Stress Urinary Incontinence in CrossFit (SUCCeSS) Study
Authors: Elks Whitney , Jaramillo-Huff Ashley , Barnes K. Lauren , Petersen Timothy R. , Komesu Yuko M. 
Published: January 2020

Objective
To evaluate the prevalence and severity of urinary incontinence (UI) in women who participate in CrossFit classes compared with women who participate in non-CrossFit group fitness classes.

Methods
The authors conducted a cross-sectional study of women who participate in either CrossFit or non-CrossFit group fitness classes using an online survey. Participants provided demographic information and completed the Incontinence Severity Index and Urinary Distress Inventory. Participants were recruited from local CrossFit and non-CrossFit gyms, online via social media, and an electronic CrossFit Newsletter. Associated comorbidities, exercises associated with UI, and coping mechanisms for urinary leakage were also assessed.

Results
Four hundred twenty-three women meeting inclusion criteria completed the survey, including 322 CrossFit participants and 101 non-CrossFit participants. We found that CrossFit participants were older than non-CrossFit participants and more likely to self-identify as non-Hispanic white. CrossFit participants more commonly reported UI (84% vs 48%, P = <0.001), higher severity of UI (Urinary Distress Inventory score: 20.8 vs 12.5, P < 0.001), and specifically more stress UI (73% vs 47%, P < 0.001). Weightlifting and jumping movements were the most common exercises associated with UI in CrossFit participants. Age and participation in CrossFit are significant and independent predictors of UI.

Conclusions
More than 80% of CrossFit participants reported UI and half of these reported moderate-severe UI, as compared with women who participate in non-CrossFit classes, less than half of whom reported UI with a small minority reporting moderate-severe UI. Exercises most associated with UI were jumping and weightlifting.
Implantation Time Has No Effect on the Morphology and Extent of Previously Reported “Degradation” of Prolene Pelvic Mesh
Authors: Thames Shelby F. , Blanton Michael D. , Williams Eric B. , White Joshua B. , Stoner Kirsten E. , Ong Kevin L. 
Published: January 2020

Objectives
Prolene polypropylene (“Prolene”) meshes demonstrate no in vivo degradation, yet some claim degradation continues until no more Prolene polypropylene can be oxidized. We studied whether implantation time affects the morphology/extent of previously reported as cracking/degradation of completely cleaned Prolene explants.

Methods
Urogynecological explants (248 patients) were collected. After excluding non-Prolene/unknown meshes and those without known implantation times, completely cleaned explants (n = 205; 0.2–14.4 years implantation) were analyzed with light microscopy, scanning electron microscopy, and Fourier transform infrared spectroscopy. Based on implant times and storage (fixative or dry), representative specimens were randomly selected for comparison. Controls were unused (“exemplar”) TVT specimens with and without intentional oxidation via ultraviolet light exposure.

Results
Prolene explants included 31 dry (18 TVT; 7 Prolift; 4 Gynemesh; 2 others) and 174 wet (87 TVT; 47 Prolift; 10 Gynemesh; 30 others) specimens. Specimens had similar morphologies before cleaning. Progressive cleaning removed tissue and cracked tissue-related material exposing smooth, unoxidized, and nondegraded fibers, with no visible gradient-type/ductile damage. Fourier transform infrared spectroscopy of the explants confirmed progressive loss of proteins. Cleaning intentionally oxidized exemplars did not remove oxidized carbonyl frequencies and showed deep cracks and gross fiber rupture/embrittlement, unlike the explants and nonoxidized exemplars.

Conclusions
If in vivo Prolene degradation exists, there should be wide-ranging crack morphology and nonuniform crack penetration, as well as more cracking, degradation, and physical breakage for implants of longer implantation times, but this was not the case. There is no morphologic or spectral/chemical evidence of Prolene mesh degradation after up to 14.4 years in vivo.
Optical Vaginal Biopsy Using Optical Coherence Tomography
Authors: Sudol Neha Talreja , Miao Yusi , Li Yan , Chen Jason J. , Jing Joseph C. , Zhu Jiang , Tadir Yona , Chen Zhongping , Lane Felicia 
Published: January 2020

Objective
Optical coherence tomography is a noninvasive technology that visualizes tissue microstructure with high spatial resolution. We designed a novel vaginal system that demonstrates a clear distinction between vaginal tissues planes. In this study, we sought to compare vaginal tomographic images of premenopausal, perimenopausal, and postmenopausal women, demonstrate feasibility of tracking vaginal tissue changes after treatment with fractional-pixel CO2 laser therapy, and obtain a histologic correlation of these findings.

Methods
Enrolled subjects underwent imaging and were divided into 3 groups based on menopausal status. Women with genitourinary syndrome of menopause who received fractional-pixel CO2 laser therapy were assessed before and after treatment. A cadaveric vagina was used to obtain tomographic and histologic images to assess for accuracy. Our primary outcome was mean vaginal epithelial thickness. Statistical analysis was performed using analysis of variance and t tests, respectively.

Results
Among 6 women, the mean vaginal epithelial thickness decreased with menopause (P < 0.01). Although change in epithelial thickness after fractional-pixel CO2 laser treatment varied between the 2 subjects evaluated, it increased significantly for the subject who reported improvement of vaginal symptoms (P < 0.01). Using a cadaveric specimen, optical biopsy was correlated to an hematoxylin and eosin–stained biopsy of the same vaginal site.

Conclusions
This study establishes feasibility of optical coherence tomography in providing an optical biopsy of the vaginal epithelium and lamina propria. In addition, it demonstrates vaginal changes as women enter menopause. This report is the initial phase of a longitudinal cohort study to evaluate changes in vaginal microstructure after energy-based treatment.
A reappraisal of polymyxin B dosing based on population pharmacokinetic model in patient with renal insufficiency
Authors: Yu Xuben , Zhang Chunhong , Pan Jingye , Dai Ying , Zhou Ziye , Yang Fan , Sun Ruolan , Wang Yexuan , Cao Yancheng , Sheng Changcheng , Jiao Zheng , Lin Guanyang 
Published: January 2020

AbstractBackgroundCurrent FDA-approved label recommends polymyxin B dosing should be adjusted according to renal function, despite several studies proved poor correlation between polymyxin B PK and creatinine clearance. The study aims to assess the impact of renal function on polymyxin B metabolism and identify an alternate dosing strategy by population analysis.MethodsBlood samples from adult patients were collected at steady state during routine therapeutic drug monitoring. Nonlinear mixed effects modeling was employed to build a population PK model of polymyxin B. Monte Carlo simulations were performed to design polymyxin B dosing regimens across various renal function.ResultsPharmacokinetic analyses included 112 polymyxin B concentrations at steady state from 32 adult patients aged 37-93 received intravenous polymyxin B (100-200 mg/d). The creatinine clearance in patients was 5.91-244 mL/min. In the final population PK model, CrCL was the significant covariate on CL (typical value, 1.59 L/hr; between-subject variability, 13%). Mean (SD) individual empirical Bayesian estimates of CL was 1.75 (0.43) L/hr. A new dosing strategy combining the PK/PD targets and Monte Carlo simulation indicated that polymyxin B dose reductions improved the probability of achieving optimal exposures in simulated patients with renal insufficiency. For severe infections caused by organisms with MIC of ≥ 2 mg/L, though a high daily dose (e.g. 200mg/day) would possible for bacterial eradication, the risk of nephrotoxicity is significantly increased.ConclusionA population PK model was established to develop individualized polymyxin B dosage regimens that the dose of polymyxin B should be adjusted according to CrCL.
Lab-wide association scan of polygenic scores identifies biomarkers of complex disease
Authors: Dennis Jessica K , Sealock Julia M , Straub Peter , Hucks Donald , Actkins Ky’Era , Faucon Annika , Goleva Slavina B , Nirachou Maria , Singh Kritika , Morley Theodore , Ruderfer Douglas M. , Mosley Jonathan D , Chen Guanhua , Davis Lea K 
Published: January 2020

AbstractClinical laboratory (lab) tests are used in clinical practice to diagnose, treat, and monitor disease conditions. Test results are typically stored in electronic health records (EHRs), and a growing number of EHRs are linked to patient DNA, offering unprecedented opportunities to query relationships between clinical lab tests and genetics. Clinical lab data, however, are of uneven quality, and previous studies have focused on a small number of lab traits. We present two methods, QualityLab and LabWAS, to clean and analyze EHR labs at scale in a Lab-Wide Association Scan. In a proof of concept analysis focused on blood lipids and coronary artery disease, we found that heritability estimates of QualityLab lipid values were comparable to previous reports; polygenic scores for lipids were strongly associated with the referent lipid in a LabWAS; and a LabWAS of a polygenic score for coronary artery disease recapitulated known heart disease biomarker profiles and identified novel associations. Our methods extend previous EHR-based analysis tools and increase the amount of EHR data usable for discovery.
Connectome-wide search for functional connectivity locus associated with pathological rumination as a target for real-time fMRI neurofeedback intervention
Authors: Misaki Masaya , Tsuchiyagaito Aki , Zoubi Obada A , Paulus Martin , Bodurka Jerzy ,   Tulsa 1000 Investigators
Published: January 2020

AbstractReal-time fMRI neurofeedback (rtfMRI-nf) enables noninvasive targeted intervention in brain activation with high spatial specificity. To achieve this promise of rtfMRI-nf, we introduced and demonstrated a data-driven framework to design a rtfMRI-nf intervention through the discovery of precise target location associated with clinical symptoms and neurofeedback signal optimization. Specifically, we identified the functional connectivity locus associated with rumination symptoms, utilizing a connectome-wide search in resting-state fMRI data from a large cohort of mood and anxiety disorder individuals (N=223) and healthy controls (N=45). Then, we performed a rtfMRI simulation analysis to optimize the online functional connectivity neurofeedback signal for the identified functional connectivity. The connectome-wide search was performed in the medial prefrontal cortex and the posterior cingulate cortex/precuneus brain regions to identify the precise location of the functional connectivity associated with rumination severity as measured by the ruminative response style (RRS) scale. The analysis found that the functional connectivity between the loci in the precuneus (−6, −54, 48 mm in MNI) and the right temporo-parietal junction (RTPJ; 49, −49, 23 mm) was positively correlated with RRS scores (depressive,p< 0.001; brooding,p< 0.001; reflective,p= 0.002) in the mood and anxiety disorder group. We then performed a rtfMRI processing simulation to optimize the online computation of the precuneus-RTPJ connectivity. We determined that the two-point method without a control region was appropriate as a functional connectivity neurofeedback signal with less dependence on signal history and its accommodation of head motion. The present study offers a discovery framework for the precise location of functional connectivity targets for rtfMRI-nf intervention, which could help directly translate neuroimaging findings into clinical rtfMRI-nf interventions.
Two-stage biologically interpretable neural-network models for liver cancer prognosis prediction using histopathology and transcriptomic data
Authors: Zhan Zhucheng , Jing Zheng , He Bing , Hosseini Noshad , Westerhoff Maria , Choi Eun-Young , Garmire Lana X. 
Published: January 2020

ABSTRACTPurposePathological images are easily accessible data with the potential as prognostic biomarkers. Moreover, integration of heterogeneous data types from multi-modality, such as pathological image and gene expression data, is invaluable to help predicting cancer patient survival. However, the analytical challenges are significant.Experimental DesignHere we take the hepatocellular carcinoma (HCC) pathological image features extracted by CellProfiler, and apply them as the input for Cox-nnet, a neural network-based prognosis. We compare this model with conventional Cox-PH model, CoxBoost, Random Survival Forests and DeepSurv, using C-index and log ranked p-values on HCC testing samples. Further, to integrate pathological image and gene expression data of the same patients, we innovatively construct a two-stage Cox-nnet model, and compare it with another complex neural network model PAGE-Net.Resultspathological image based prognosis prediction using Cox-nnet is significantly more accurate than Cox-PH and random survival forests models, and comparable with CoxBoost and DeepSurv methods. Additionally, the two-stage Cox-nnet complex model combining histopathology image and transcriptomics RNA-Seq data achieves better prognosis prediction, with a median C-index of 0.75 and log-rank p-value of 6e-7 in the testing datasets. The results are much more accurate than PAGE-Net, a CNN based complex model (median C-index of 0.68 and log-rank p-value of 0.03). Imaging features present additional predictive information to gene expression features, as the combined model is much more accurate than the model with gene expression alone (median C-index 0.70). Pathological image features are modestly correlated with gene expression. Genes having correlations to top imaging features have known associations with HCC patient survival and morphogenesis of liver tissue.ConclusionThis work provides two-stage Cox-nnet, a new class of biologically relevant and relatively interpretable models, to integrate multi-modal and multiple types of data for survival prediction.