bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness and safety of treat-to-target strategy in elderly-onset rheumatoid arthritis: a 3-year prospective observational study
Authors: Sugihara Takahiko , Ishizaki Tatsuro , Onoguchi Wataru , Baba Hiroyuki , Matsumoto Takumi , Iga Shoko , Kubo Kanae , Kamiya Mari , Hirano Fumio , Hosoya Tadashi , Miyasaka Nobuyuki , Harigai Masayoshi 
Published: December 2020

AbstractObjectivesTo evaluate 3-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity for patients with elderly-onset RA (EORA) and to confirm safety profile of T2T.MethodsTreatment was adjusted to target low disease activity with conventional synthetic DMARDs, followed by biologic DMARDs (bDMARDs) in 197 MTX-naïve EORA patients (mean age 74.9 years) with moderate-to-high disease activity. Non-implementation of T2T was evaluated at week 12, 24, 36, 52, 76, 104 and 128. To evaluate risks of using MTX, bDMARDs and glucocorticoids, 2122 periods of 3 months each were analysed using Bayesian hierarchical logistic regression models.ResultsOf the patients, 84.7% received methotrexate, 34.0% glucocorticoids with DMARDs and 41.6% bDMARDs during the observation period. Sixty-nine of the 197 patients failed to adhere to T2T because of comorbidities or the patient’s own decision: 33 failed once, 19 twice, 10 three times and 6 four times or more. Simplified disease activity index (SDAI) remission and HAQ Disability Index (HAQ-DI) ≤0.5 at 3 years were achieved in 57.8% and 70.3% of the 128 patients adhering to T2T, and 34.8% and 43.5% of the 69 patients who did not adhere to T2T, respectively, and these were significantly different. Eighty-nine serious adverse events (SAEs) of any type were reported in 61 patients. MTX, bDMARDs and glucocorticoid were not associated with SAEs when adjusted for mean SDAI during the observation period and comorbidities at baseline.ConclusionT2T strategy for EORA by using MTX and bDMARDs was effective with an acceptable safety profile. Adhering to T2T led to better outcomes.
Comparative Analysis of Chemotherapy-Induced Peripheral Neuropathy in Bioengineered Sensory Nerve Tissue Distinguishes Mechanistic Differences in Early-Stage Vincristine-, Cisplatin-, and Paclitaxel-Induced Nerve Damage
Authors: Pollard Kevin J , Bolon Brad , Moore Michael J 
Published: December 2020

Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a well-known, potentially permanent side effect of widely used antineoplastic agents. The mechanisms of neuropathic progression are poorly understood, and the need to test efficacy of novel interventions to treat CIPN continues to grow. Bioengineered microphysiological nerve tissue (“nerve on a chip”) has been suggested as an in vitro platform for modeling the structure and physiology of in situ peripheral nerve tissue. Here, we find that length-dependent nerve conduction and histopathologic changes induced by cisplatin, paclitaxel, or vincristine in rat dorsal root ganglion-derived microphysiological sensory nerve tissue recapitulate published descriptions of clinical electrophysiological changes and neuropathologic biopsy findings in test animals and human patients with CIPN. We additionally confirm the postulated link between vincristine-induced axoplasmic transport failure and functional impairment of nerve conduction, the postulated paclitaxel-induced somal toxicity, and identify a potential central role of gliotoxicity in cisplatin-induced sensory neuropathy. Microphysiological CIPN combines the tight experimental control afforded by in vitro experimentation with clinically relevant functional and structural outputs that conventionally require in vivo models. Microphysiological nerve tissue provides a low-cost, high-throughput alternative to conventional nonclinical models for efficiently and effectively investigating lesions, mechanisms, and treatments of CIPN. Neural microphysiological systems are capable of modeling complex neurological disease at the tissue level offering unique advantages over conventional methodology for both testing and generating hypotheses in neurological disease modeling.
Impact Statement Recapitulation of distinct hallmarks of clinical CIPN in microphysiological sensory nerve validates a novel peripheral neurotoxicity model with unique advantages over conventional model systems.
Outcomes of Neonates Requiring Neonatal Intensive Care Admission for Necrotizing Enterocolitis in a Resource-Restricted Hospital in Cape Town, South Africa
Authors: Satardien M , Van Wyk L , Sidler D , Van Zyl J I 
Published: December 2020

Lay SummaryNecrotizing enterocolitis remains one of the most common gastrointestinal emergencies in neonates. Neonates admitted to a resource-restricted neonatal intensive care unit with a presumptive diagnosis of advanced NEC were reviewed. We were able to identify risk factors associated with a higher chance of death or poor neurodevelopmental outcomes. Our outcomes are comparable with international literature.
Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery
Authors: Shaefi Shahzad , Shankar Puja , Mueller Ariel L. , O’Gara Brian P. , Spear Kyle , Khabbaz Kamal R. , Bagchi Aranya , Chu Louis M. , Banner-Goodspeed Valerie , Leaf David E. , Talmor Daniel S. , Marcantonio Edward R. , Subramaniam Balachundhar 
Published: December 2020

Background
Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery.

Methods
A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao
2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao
2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay.

Results
The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao
2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P < 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups.

Conclusions
In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery.

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An old disease on the rise: new approaches to syphilis in pregnancy
Authors: Liew Zi-Qi , Ly Victoria , Olson-Chen Courtney 
Published: December 2020

Purpose of reviewMaternal and congenital syphilis infection is on the rise in the United States and worldwide. Without adequate testing or provider recognition of infection, treatment can be neglected resulting in significant perinatal morbidity and mortality. This review article discusses the epidemiology ofT. pallidum, describes novel diagnostic tests, and considers the need to expand therapeutic options.Recent findingsA new chemiluminescence immunoassay for use in the reverse-sequence algorithm is more sensitive and specific in pregnant women than previously noted and is helpful for identifying pregnant women at highest risk for neonatal congenital syphilis. Point-of-care testing may be used to detect early syphilitic disease and provide same-day testing and treatment. Randomized control trials of oral cefixime for treatment of syphilis are paving the way for potential use in pregnant women. Penicillin skin testing, challenge, and desensitization in pregnancy can be done safely.SummaryCongenital syphilis is a preventable disease and treatable infection in the modern world, but we are still met with challenges in its eradication. We should proceed with advancing efficient laboratory testing, expanding medical therapy, and implementing public health measures to curb the rise of the disease.
Four-Year Survival Comparison of Endothelial Keratoplasty Techniques in Patients With Previous Glaucoma Surgery
Authors: Alshaker Sara , Mimouni Michael , Batawi Hatim , Cohen Eyal , Trinh Tanya , Santaella Gisella , Chan Clara C. , Slomovic Allan R. , Rootman David S. , Sorkin Nir 
Published: December 2020

Purpose:
To compare 4-year survival outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma surgery.

Methods:
This is a retrospective, comparative case series, including patients with previous trabeculectomy or glaucoma drainage device implantation, who later underwent either DMEK (n = 48) or DSAEK (n = 41). Follow-up was limited to 12 to 60 months to prevent bias. Primary outcomes were graft survival and rejection. Secondary outcomes were best spectacle-corrected visual acuity (BSCVA), detachment/rebubble, endothelial cell loss, and intraocular pressure elevations.

Results:
Baseline characteristics, follow-up duration, and preexisting glaucoma parameters did not differ significantly between the groups. Graft survival probability after DMEK and DSAEK was 75% and 75% at 1 year, 63% and 50% at 2 years, 49% and 44% at 3 years, 28% and 33% at 4 years, and 28% and 29% at 5 years, respectively (P = 0.899 between the groups). Graft rejection rates were 20.8% and 19.5%, respectively (P = 1.000). Primary failure, rebubbling, endothelial cell loss, and intraocular pressure elevation did not differ significantly between the groups. Preoperative BSCVA did not differ between the groups (P = 0.821). Postoperative BSCVA was significantly better in the DMEK group at 6, 12, and 24 months (P < 0.001, P = 0.022, and P = 0.047, respectively). In a multivariable model (R
2 = 0.576), the type of surgery was the only significant factor affecting postoperative BSCVA, in favor of DMEK (coefficient value −0.518, P = 0.002).

Conclusions:
In eyes with previous glaucoma surgery, DMEK and DSAEK had comparably low survival and comparably high rejection rates. Postoperative visual acuity might be better after DMEK in this setting.
Endothelial Biopsy for the Diagnosis and Management of Culture-Negative Retrocorneal Fungal Keratitis With the Assistance of Optical Coherence Tomography Imaging
Authors: Palioura Sotiria , Tsiampali Chara , Dubovy Sander R. , Yoo Sonia H. 
Published: December 2020

Purpose:
To report a case of a culture-negative deep fungal corneal infection that was diagnosed after histopathology of an anterior segment optical coherence tomography–guided endothelial biopsy.

Methods:
A 22-year-old woman with history of contact lens wear and concomitant topical steroid use presented with a mid-stromal corneal infiltrate that failed to respond to oral acyclovir and topical fortified antibiotics. Although cornea stains, cultures, and confocal microscopy showed negative results, there was high clinical suspicion for fungal keratitis. After 2 months on topical natamycin, oral voriconazole, and serial intrastromal and intracameral voriconazole injections, the infiltrate enlarged and deepened. Imaging with anterior segment optical coherence tomography revealed that the infection had progressed to an endothelial plaque.

Results:
Diagnostic endothelial biopsy was performed in the operating room. Cultures showed again negative results, whereas histopathology of the removed specimen revealed fungal elements. The postoperative edema at the site of the biopsy resolved over the course of 4 weeks, and a posterior stromal scar formed. Serial intrastromal and intracameral voriconazole injections were continued for the first postoperative month. At the 1-year and the 3-year follow-up examinations, the patient's vision was 20/20 without recurrence.

Conclusions:
Intraoperative scraping of the endothelial plaque and histopathologic evaluation of the specimen proved to be of utmost importance for definitive diagnosis and resolution of the culture-negative deep fungal infection in this case. This young patient's cornea was retained and vision remains excellent.
Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis
Authors: Kwekkeboom Kristine , Serlin Ronald C. , Ward Sandra E. , LeBlanc Thomas W. , Ogunseitan Adeboye , Cleary James 
Published: December 2020

Abstract
Patient fear of addiction is a well-documented barrier to the use of analgesic medications for cancer pain control. Over the past 2 decades in the United States, an “opioid crisis” has arisen, accompanied by risk messages delivered through news outlets, public health education, and patient–provider communication. The purpose of this study was to determine if patient-related barriers to cancer pain management–specifically, fears of addiction–and related pain outcomes (pain severity, pain interference with daily life, and adequacy of pain management) have worsened over the last 20 years. A sample of 157 outpatients with active recurrent or active metastatic cancer completed the Barriers Questionnaire-II (BQ-II) and measures of pain and analgesic use. We identified 7 comparison studies published between 2002 and 2020 that reported patient-related barriers using the BQ-II. Significant linear relationships were found between later year of publication and greater fear of addiction (harmful effect subscale score, B = 0.0350, R
2 = 0.0347, F1,637 = 23.19, P < 0.0001) and between year of publication and more pain management barriers overall (total BQ-II score, B = 0.039, R
2 = 0.065, F1,923 = 73.79, P < 0.0001). Relationships between BQ-II scores (harmful effect and total) and pain outcomes did not change over time. Despite worsening in patient-related barriers, the proportion of patients with adequate vs inadequate analgesic use did not differ over time. Notably, 40% of participants reported inadequate analgesic use, a statistic that has not improved in 20 years. Additional research is necessary to clarify factors contributing to changing beliefs. Findings indicate a continuing need for clinical and possibly system/policy-level interventions to support adequate cancer pain management.
Auditory Brainstem Implant in Adult Patient With Cochlear Ossification From Otosclerosis
Authors: Christopher Laura H. , Noonan Kathryn , Barnard Zachary , Mehta Gautum , Rock Jordan , Slattery William H. , Lekovic Gregory P. 
Published: December 2020

Objective:
The objective is to describe auditory brainstem implantation in a case of extensive cochlear otosclerosis.

Patient, Intervention, and Results:
A case is presented of a 65-year-old male with bilateral cochlear otosclerosis and profound sensorineural hearing loss. Imaging studies showed distorted cochlear anatomy bilaterally and ossification of cochlear ducts. He underwent successful placement of an auditory brainstem implant using a retrosigmoid craniotomy approach.

Conclusions:
Extensive cochlear otosclerosis may distort cochlear anatomy such that cochlear implantation is expected to have a poor outcome. Auditory brainstem implantation may be an additional treatment option in these patients.
Precise Evaluation of the Cochlear Duct Length by Flat-panel Volume Computed Tomography (fpVCT)—Implication of Secondary Reconstructions
Authors: Schendzielorz Philipp , Ilgen Lukas , Mueller-Graff Tassilo , Noyalet Laurent , Völker Johannes , Taeger Johannes , Hagen Rudolf , Neun Tilmann , Zabler Simon , Althoff Daniel , Rak Kristen 
Published: December 2020

Hypothesis:
Flat-panel volume computed tomography (fpVCT) and secondary reconstruction allow for more accurate measurements of two-turn length (2TL), cochlear duct length (CDL), and angular length (AL).

Background:
Cochlear geometry is a controversially debated topic. In the meantime, there are many different studies partly reporting highly divergent values. Our aim is to discuss the differences and to propose a radiological possibility to improve cochlear measurements using 3D-curved multiplanar reconstruction and fpVCT.

Methods:
Performing different image modalities and settings, we tried to find a clinically usable option that allows for a high degree of accuracy. Therefore, we tested them against reference values of high-definition micro-computed tomography.

Results:
Comparison of 99 μm slice thickness secondary reconstruction of fpVCT and reference showed no significant differences for 2TL and CDL (p ≥ 0.05). Accordingly, ICC (intraclass correlation) values were excellent (ICC ≥ 0.75; lower limit of confidence interval [CI] ≥ 0.75; Cronbach's alpha [α] ≥ 0.9). Evaluating AL, there was a significant difference (difference: −17.27°; p = 0.002). The lower limit of the CI of the ICC was unacceptable (ICC = 0.944; lower limit of CI = 0.248; α = 0.990). Regarding the Bland-Altman plots, there were no clinically unacceptable errors, but a systematic underestimation of AL.

Conclusion:
Secondary reconstruction is a suitable tool for producing reliable data that allow the accurate measurement of 2TL and CDL. The option of generating these reconstructions from raw data limits the need for higher radiation doses. Nevertheless, there is an underestimation of AL using secondary reconstructions.
Cochlear Implantation in Adults With Single-sided Deafness: Outcomes and Device Use
Authors: Deep Nicholas L. , Spitzer Emily R. , Shapiro William H. , Waltzman Susan B. , Roland J. Thomas , Friedmann David R. 
Published: December 2020

Objective:
To describe our experience with adults undergoing cochlear implantation (CI) for treatment of single-sided deafness (SSD).

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Fifty-three adults with SSD.

Intervention(s):
Unilateral CI.

Main Outcome Measure(s):
Speech perception testing in quiet and noise, tinnitus suppression, and device usage from datalogs.

Results:
The mean age at CI was 53.2 years (SD 11.9). The mean duration of deafness was 4.0 years (SD 7.8). The most common etiology was idiopathic sudden SNHL (50%). Word recognition improved from 8.7% (SD 15) preoperatively to 61.8% (SD 20) at a mean follow-up of 3.3 years (SD 1.8) (p < 0.0001). Adaptive speech recognition testing in the “binaural with CI” condition (speech directed toward the front and noise toward the normal hearing ear) revealed a significant improvement by 2.6-dB SNR compared to the preoperative unaided condition (p = 0.0002) and by 3.6-dB SNR compared to when a device to route sound to the contralateral side was used (p < 0.0001). Tinnitus suppression was reported to be complete in 23 patients (43%) and improved in 20 patients (38%) while the device was on. The addition of the CI did not lead to a decrement in hearing performance in any spatial configuration. Device usage averaged 8.7 (SD 3.7) hours/day.

Conclusions:
Cochlear implantation in adult SSD patients can suppress tinnitus and achieve speech perception outcomes comparable with CI in conventional candidates. Modest improvements in spatial hearing were also observed and primarily attributable to the head shadow effect. Careful patient selection and counseling regarding potential benefits are important to optimize outcomes.
Are opioids necessary in post sinus surgery care?
Authors: Karkos Petros D. , Constantinidis Jannis 
Published: December 2020

Purpose of review
The aim of the review is to review the recent literature on the use of opioids in post sinus surgery care.

Recent findings
Research regarding the use of opioids in post sinus surgery over the past two years support previous thinking that there is an overprescription of opioids for an operation which is not particularly painful, resulting in the potential for narcotic abuse and misuse.

Summary
Large randomized controlled trials with detailed pain recording scoring systems are needed to assess the opioid requirements – if any – after sinus surgery.
TikTok, Tide Pods and Tiger King: health implications of trends taking over pediatric populations
Authors: Kriegel Elana R. , Lazarevic Bojan , Athanasian Christian E. , Milanaik Ruth L. 
Published: December 2020

Purpose of review
With children and adolescents constantly connected to their devices in an ever-changing technological landscape, new and emerging trends in entertainment media have created potential health implications for pediatric patients. The purpose of this review is to provide pediatricians with explanations of specific trends on streaming services, the popular new mobile application TikTok, recent widespread ‘Internet Challenges’ that include pediatric participants, and new technologies. These emerging trends can pose potential harms to the health and wellbeing of children and adolescents.

Recent findings
Recent reports and news articles have discussed popular technological trends and the adverse effects that can occur. Although technology provides access to information and social connection for youth, it also creates platforms where children can be exposed to disturbing content, peer pressure, cyberbullying, and encouragement to participate in activities that could cause potential physical harm or even death.

Summary
Pediatricians need to be aware of trends to best understand the implications of these technologies, especially in clinical practice. Pediatricians play an important role in educating parents and patients about the risks of these trends, in facilitating conversations about related topics including self-esteem, cyberbullying and peer pressure to promote healthy internet use, and providing necessary resources.
Pediatric Abdominal Tuberculosis With Calcified Intra-abdominal Lymph Nodes Identified by Point-of-Care Ultrasound
Authors: James Vigil , Samuel John , Ong Gene Yong-Kwang 
Published: December 2020

Background
Tuberculosis of the abdomen is one of the most common extrapulmonary manifestations of tuberculosis. Even in areas where tuberculosis is endemic, intra-abdominal tuberculous can pose a diagnostic and management challenge because of the lack of presence of overt clinical signs and availability of expertise for point of care diagnostics. Point-of-care ultrasound (POCUS) of the abdomen performed by emergency physicians is increasingly being used for a variety of clinical presentations to facilitate accurate diagnoses in the emergency department.

Case Report
We describe the case of a patient presenting to the pediatric emergency department with acute abdominal pain, in whom POCUS helped expedite the diagnosis of abdominal tuberculosis.

Conclusions
In the right clinical setting, the concurrent presence of intra-abdominal lymphadenopathy, ascites, mesenteric thickening, ileocecal thickening, and splenic microabscesses on ultrasound imaging should lead to consideration of the diagnosis of intra-abdominal tuberculosis. Although typically diagnosed on computed tomography or magnetic resonance imaging, in our case, POCUS helped facilitate the bedside diagnosis of abdominal tuberculosis in the emergency department.