bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inappropriate practice in tumor marker requests at a university hospital in Western Saudi Arabia: A 3-year retrospective study
Authors: Al-Mughales Jamil A. , Alahwal Mahmood Shaheen 
Published: November 2020

Objectives: This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use. Methods: A retrospective review of patients’ electronic records was conducted over a 3-year period (2015–2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution. Results: A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year. Conclusion: Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.
Positive role of continuous positive airway pressure for intensive care unit patients with severe hypoxaemic respiratory failure due to COVID-19 pneumonia: A single centre experience
Authors: Wozniak Dariusz R , Rubino Antonio , Tan Aileen LW , Jones Nicola L , Webb Stephen T , Vuylsteke Alain , Palas Earl , Quinnell Timothy G , Smith Ian E , Davies Michael G 
Published: November 2020

Objectives Continuous positive airway pressure (CPAP) may be a useful treatment strategy for patients with severe COVID-19 pneumonia but its effectiveness in preventing mechanical ventilation is unknown. We aimed to evaluate the outcomes of COVID-19 patients treated with CPAP and determine predictors of CPAP response. Design This was a retrospective observational cohort study. Setting The study took place in the intensive care unit (ICU) at Royal Papworth Hospital (RPH) in Cambridge, UK. Patients We included all consecutive patients with confirmed COVID-19 pneumonia who were transferred from neighbouring hospitals between 14th March and 6th May, 2020 for consideration of ventilatory support. Intervention We instituted the use of CPAP for all patients who arrived in RPH not intubated and were not making satisfactory progress on supplemental oxygen alone. Measurements and main results Of 33 self-ventilating patients included in this study, 22 (66.7%) were male and the mean age was 54 ± 13.23 patients received CPAP. They were more hypoxaemic than those treated with oxygen alone (PaO2/FiO2 ratio; 84.3 ± 19.0 vs 170.0 ± 46.0 mmHg, p = 0.001). There was a significant improvement in PaO2/FiO2 ratio 1–2 hours after CPAP initiation (167.4 ± 49.0 from 84.3 ± 19.0 mmHg, p = 0.001). 14 (61%) patients responded to CPAP and 9 required intubation. There was no difference between these two groups in terms of the severity of baseline hypoxaemia (PaO2/FiO2 ratio; 84.5 ± 16.0 vs 83.9 ± 23.0 mmHg, p = 0.94) but CPAP responders had significantly lower C-reactive protein (CRP) (176 ± 83 vs 274 ± 63 mg/L, p = 0.007), interleukin-6 (IL-6) (30 ± 47 vs 139 ± 148 pg/mL, p = 0.037), and D-dimer (321 ± 267 vs 941 + 1990 ng/mL, p = 0.003). CT pulmonary angiogram was performed in 6 out of 9 intubated patients and demonstrated pulmonary emboli in 5 of them. All patients were discharged from ICU and there were no fatalities. Conclusions In this cohort, CPAP was an effective treatment modality to improve hypoxaemia and prevent invasive ventilation in a substantial proportion of patients with severe respiratory failure. Accepting the small sample size, we also found raised biomarkers of inflammation (CRP and IL-6) and coagulopathy (D-Dimer) to be more useful predictors of CPAP responsiveness than the severity of hypoxaemia, and could help to guide intubation decisions in this clinical setting.
Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis
Authors: Yeh Jen-Hao , Huang Ru-Yi , Lee Ching-Tai , Lin Chih-Wen , Hsu Ming-Hung , Wu Tsung-Chin , Hsiao Po-Jen , Wang Wen-Lun 
Published: November 2020

Aim: The aim of this study was to investigate the long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cancer. Methods: A literature search was conducted using PubMed, ProQuest and Cochrane Library databases. Primary outcomes were overall survival, disease-specific survival and recurrence-free survival at 5 years. Secondary outcomes included adverse events, recurrence and metastasis. Hazard ratios were calculated based on time to events for survival analysis, and odds radios were used to compare discrete variables. Results: A total of 3796 patients in 21 retrospective studies, including 5 comparative studies for ESD and esophagectomy were enrolled. The invasion depth was 52.0% for M1–M2, 43.2% for M3–SM1 and 4.7% for SM2 or deeper. The 5-year survival rate was: overall survival 87.3%, disease-specific survival 97.7%, and recurrence-free survival 85.1%, respectively. Pooled local recurrence of ESD was 1.8% and metastasis was 3.3%. In terms of the comparison between ESD and esophagectomy, there was no difference in the overall survival (86.4% versus 81.8%, hazard ratio = 0.66, 95% CI = 0.39–1.11) as well as disease-specific and recurrence-free survival. In addition, ESD was associated with fewer adverse events (19.8 % versus 44.0%, odds ratio = 0.3, 95% CI = 0.23–0.39). Conclusions: For superficial esophageal squamous cancer, ESD may be considered as the primary treatment of for mucosal lesions, and additional treatment should be available for submucosal invasive cancers.
An operating room audit to examine for patterns of staff entry/exit: pattern sequencing as a method of traffic reduction
Authors: Anderson Rachel L , Lipps Jodi A , Pritchard Carrie L , Venkatachalam Aardhra M , Olson DaiWai M 
Published: November 2020

Background: Surgical site infections (SSIs) are estimated at over 16,000 annually and cost hospitals an estimated $1.6 billion per year. Therefore, most operating rooms (ORs) seek methods to reduce the risk of SSI, especially during the intraoperative period. Prior work has established a link between excess traffic through the OR and increased microbial counts, which create a higher risk for SSIs. Aim/Objectives: To identify patterns of staff entry into the OR to further reduce the risk of SSIs after total joint arthroplasties. Methods: Researchers directly observed 31 total joint arthroplasties, recording every instance the door to the OR suite opened and the personnel, reason for opening and timing during surgical incision. Researchers then utilised the sequential data analysis to search for patterns. Results: Despite expected patterns in staff movement during the patterned surgery, researchers found no significant patterns to staff movement during total joint arthroplasty. Discussion: This study’s results suggest purposeful education targeted to circulating registered nurses could induce purposeful creation of traffic flow patterns to further decrease traffic and risk of SSI. Conclusion: There is no singular pattern to entering and exiting the OR during surgery. Thus, a single-solution approach is not recommended.
Early Catastrophic Failure of a Synthetic Cartilage Implant for Hallux Rigidus
Authors: Reddy Sudheer C. 
Published: November 2020

Hallux rigidus is a common arthritic disorder of the foot. Surgical treatments are varied, from isolated cheilectomy to arthrodesis. A synthetic cartilage implant has been embraced recently as a joint-sparing alternative to arthrodesis, with good early and midterm outcomes. However, early clinical failures have been described relating to implant subsidence. This case report focuses on another mode of failure consisting of early catastrophic wear resulting in conversion to a lengthening arthrodesis at short-term follow-up. Levels of Evidence: Level V
Self-Reported Pain Tolerance and Opioid Pain Medication Use After Foot and Ankle Surgery
Authors: Sokil Laura E. , Rogero Ryan G. , McDonald Elizabeth L. , Corr Daniel , Fuchs Daniel , Winters Brian S. , Pedowitz David I. , Daniel Joseph N. , Raikin Steven M. , Shakked Rachel J. 
Published: November 2020

Background: Orthopaedic surgeons must consider their postoperative pain management strategies to minimize harm from prescription opioid use. Patients often reference their pain threshold to predict how they will tolerate surgical pain and the need for postoperative analgesia, but the direct relationship between these factors has not yet been studied. The purpose of this study was to determine the relationship between patients’ self-reported pain tolerance and prescription opioid usage after foot and ankle surgery. Methods: This is a retrospective follow-up of a prospective cohort study of adult patients who underwent outpatient foot and ankle surgeries. Patient and procedural demographics, opioid pills dispensed, and opioid pills consumed by the first postoperative visit were obtained. Patients were contacted at a mean of 13.1 ± 4.0 months postoperatively and asked to respond to the qualitative statement “Pain doesn’t bother me as much as it does most people.” Patients were also asked their quantitative pain threshold (0-100), with 0 being “very pain intolerant” and 100 being a “very high pain tolerance,” as well other questions regarding past surgical and narcotic consumption history. Results: Of the 700 survey respondents, the average age was 50.9 years and 34.7% were male. Bivariate analysis determined that predictors of lower postoperative opioid consumption included higher quantitative ( P = .047) and qualitative ( P = .005) pain tolerance scores. Multivariate analysis for the entire cohort demonstrated that higher qualitative pain threshold was associated with lower postoperative opioid consumption ( P = .005) but this did not meet statistical significance as an independent predictor of the top quartile of pill consumers. Conclusion: Assessment of both qualitative and quantitative score of patients’ pain threshold prior to surgery may assist the surgeon in tailoring postoperative pain control. Additionally, asking this question can create an opportunity for educating patients regarding responsible utilization of narcotic medication. Levels of Evidence: Level III
Preparation and In Vitro Analysis of Craniofacial Titanium Implants Surfaces Produced by Additive 3D Printing and Conventional Manufacturing
Authors: Hatamleh Muhanad M. 
Published: November 2020

Study Design: Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol. Objectives: This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium implants following non-contact 3D laser profile-meter analysis. Methods: Seven groups of titanium specimens (n = 10) were prepared and their surfaces were treated differently and included sole or combined treatment of mechanical polishing, gritting with 50 micron AL2O3, cold acid treatment using nitric acid for 20 hours (70% w/w), etching using acidic solution (69% nitric and 48% hydrofluoric acids) for 10 minutes and then electro-chemically anodized in another acidic solution (85% orthophosphoric and 98%sulphuric acid). Eighth group included specimens that were 3D printed. 3D micro-roughness parameters Sa, Sp, Sv, and Sz were determined (μm) for each specimen. Data was analyzed using one way ANOVA and Dunett T3 post-hoc tests (p < 0.05). Results: There were statistically significant effects of surface finishing protocols (p < 0.05). Sa values were 2.72-13.75 and specimens which were electroplated or mechanically polished and acid treated were the smoothest (p < 0.05). Sp was in the range 9.07-43.56 as sandblasting significantly roughened surfaces (p < 0.05). The same inferior effect was evident for the Sv (p < 0.05). The Sz values were 19.46-107.05 and was the highest for sandblasted surfaces (p < 0.05) and the lowest for surfaces of electro-chemical treatment (p < 0.05). Conclusion: Titanium surfaces are affected by the finishing procedure and electro-chemical treatment or mechanical polishing combined with acid treatment produced clinically-favorable smooth surfaces.
Effects of Omalizumab Treatment in Patients With Recalcitrant Nasal Polyposis and Mild Asthma: A Multicenter Retrospective Study
Authors: Armengot-Carceller Miguel , Gómez-Gómez María José , García-Navalón Carmen , Doménech-Campos Encarna , Muñoz-Fernández Noelia , Miguel Ainhoa García-Lliberós de , Marco-Algarra Jaime , Palop-Cervera Marta , Piñero Alfonso García 
Published: November 2020

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a clinical entity with specific features that impacts significantly on patient quality of life (QoL). CRSwNP is often associated with asthma and is difficult to control and manage despite pharmacological and/or surgical treatment. Omalizumab, a monoclonal anti-IgE antibody, has emerged as a putative therapeutic option. Objective To evaluate the effects of omalizumab on nasal polyp (NP) size and QoL assessed by Sino-Nasal Outcome Test-22 (SNOT-22) in patients with recalcitrant CRSwNP and mild asthma. Methods A multicenter retrospective analysis of patient data from the Community of Valencia (Spain) was performed. Adult patients with recalcitrant CRSwNP and comorbid mild asthma receiving compassionate use of omalizumab were included. NP size measured by total nasal endoscopic polyp score (TPS) and QoL evaluated through the SNOT-22 questionnaire were assessed at baseline and monthly over 12 months. An ordinal regression model was built to analyze the results. Results A total of 23 CRSwNP patients with a mean age (± SD) of 54.78 ± 9.46 years were included. Nineteen suffered from aspirin-exacerbated respiratory disease (AERD). In all patients, a significant and sustained reduction in TPS was observed over time, accompanied by improvements in QoL reflected in lower SNOT-22 scores. In the ordinal regression model, time but not total IgE, age or tissue eosinophilia impacted on NP size and SNOT-22 outcomes. Additionally, improvements in QoL were not explained by reductions in the size of polyps. Conclusion Omalizumab was effective for the treatment of patients with recalcitrant CRSwNP and mild asthma, even when AERD was present, by reducing NP size and improving QoL; treatment time was a key factor. SNOT-22 improvements were not explained by decreases in TPS, indicating that omalizumab may be effective in all patients, regardless of polyp size.
Diagnostic performance of virtual fractional flow reserve derived from routine coronary angiography using segmentation free reduced order (1-dimensional) flow modelling
Authors: Mohee Kevin , Mynard Jonathan P , Dhunnoo Gauravsingh , Davies Rhodri , Nithiarasu Perumal , Halcox Julian P , Obaid Daniel R 
Published: November 2020

Introduction Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model. Methods Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC). Results QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = −0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity – 58% and specificity – 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity – 92% and specificity - 29% at a 1D-vFFR of 0.7). Conclusions 1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation.
Influence of the degree of conversion and Bis-GMA residues of bulk fill resins on tissue toxicity in an subcutaneous model in rats
Authors: Barreto Girão Liliana , Ohana de Lima Martins Joyce , Lemos José Vitor Mota , Pinto Marcílio Rodrigues , Rolim Juliana Paiva Marques Lima , Alves e Silva Francisco Cláudio Fernandes , Saboia Vicente de Paulo Aragão , Bitu Sousa Fabrício , de Barros Silva Paulo Goberlânio 
Published: November 2020

Aim: To analyse the influence of the degree of conversion (DC) and light curing residues of different bulk fills (BFs) composites on the inflammatory profile in the subcutaneous tissue of rats. Materials and methods: Resin disks of BF-resins and their active conventional resins (CR; 3M®, Ivoclar®, and Kerr®) were light-cured at 2 mm (BF-superficial) and 4 mm (BF-deep) thicknesses and analyzed by infrared spectroscopy (FTIR; n = 3/group; DC and light curing residues). Then, the disks were implanted in four quadrants in the subcutaneous tissue of Wistar rats (sham, CR, BF-superficial and RF-deep), and after 7, 14, and 28 days, the animals ( n = 6/day) were euthanized for histological analysis of the intensity of the inflammatory process (scores 0–3). Kruskal–Wallis/Dunn and ANOVA/Bonferroni tests were used ( p < 0.05, Graph Pad Prism 5.0). Results: The DC of CR 3M® did not differ significantly compared to BF-superficial and BF-deep resins ( p = 0.235). The Ivoclar® and Kerr® resins showed a higher DC with CR and BF-superficial compared to the BF-deep ( p = 0.005 and p = 0.011, rctively). Kerr® resins showed a higher Bis-GMA/UDMA ratio, especially in BF-deep resin ( p < 0.05). 3M® and Ivoclar resins did not show high inflammation scores, but for Kerr® BF resins (superficial and deep), the inflammatory process was significantly higher than that in the CR and sham quadrants ( p = 0.031). Conclusion: The tissue inflammatory response after resin inoculation depends on the DC and light curing residues of Bis-GMA.
Folate-conjugated hydrophobicity modified glycol chitosan nanoparticles for targeted delivery of methotrexate in rheumatoid arthritis
Authors: Wu Zhongqing , Xu Kanna , Min Jikang , Chen Minchang , Shen Liping , Xu Jianxue , Jiang Qi , Han Guohong , Pan Le , Li Haidong 
Published: November 2020

Background: Targeted delivery to the Rheumatoid arthritis (RA) which is characterized by destruction and degeneration of bones due to chronic inflammation is of great need. RA being a chronic autoimmune disorder might result in severe disability and morbidity. A targeted delivery system is designed to deliver methotrexate (MTX) for RA. Methods: Here, we synthesized folic acid (FA) conjugated hydrophobically modified glycol chitosan (GC) self-assembled nanoparticles (FA-GC-SA) for the targeted delivery of MTX to RA. The FA conjugation and hydrophobic modification of GC by stearic acid (SA) was confirmed by Fourier-transform infrared spectroscopy (FTIR). The FA-GC-SA was exploited for developing targeted nanoparticles encapsulating MTX by the ionic gelation method. The particles were characterized and evaluated for their targeting potential in in vitro cell culture studies. Further their in vivo efficacy in arthritis induced rats using collagen was also evaluated. Results: FTIR confirms the successful modification of GC-SA and FA-GC-SA. The FA-GC-SA-MTX of size 153 ± 9 nm were prepared with high encapsulation efficiency of MTX. The FA-GC-SA-MTX size was further confirmed by transmission electron microscopy (TEM). In vitro cell studies revealed the superior efficacy of FA-GC-SA-MTX in cell cytotoxicity. Also, significantly higher cellular uptake of FA functionalized FA-GC-SA-MTX was observed in comparison to non-functionalized GC-SA-MTX attributed to folate receptors (FRs) mediated endocytosis. In vivo results confirms the potential of FA-GC-SA-MTX which reduces reduces the pro-inflammatory cytokines, paw thickness, and arthritis score in collagen induced rats. Conclusion: The results shows that FRs targeted FA-GC-SA-MTX has superior efficacy in the treatment of RA.
Comparing Pharyngeal Airway Dimensions and Hyoid Bone Position in the Subgroups of Skeletal Class III Malocclusions: A Cephalometric Study
Authors: Buyukcavus MH , Kocakara G 
Published: November 2020

Aim: To examine pharyngeal airway dimensions and hyoid bone position according to the subgroups of Class III malocclusion. Materials and Methods: This retrospective study consisted of patients divided into three subgroups with skeletal Class III malocclusion. The study included a total of 151 individuals (61 females and 90 males). The authors divided individuals with skeletal Class III malocclusion into three subgroups: maxillary retrognathia, mandibular prognathia, and combined. The study’s cephalometric analysis used eight nasopharyngeal, seven oropharyngeal, two hypopharyngeal, nine hyoid, and four area measurements. One-way analysis of variance was used to evaluate patients. Tukey’s post-hoc tests were used for bilateral comparisons of significant parameters. The results were considered statistically significant at a P < .05 significance level. Results: The study found no significant differences between the groups’ pharyngeal airway and area measurements ( P > .05). When the authors evaluated hyoid bone position, a statistically significant difference was found between the three groups’ Hy-A (mm), Hy-S (mm), Hy-SN (mm), and Hy-FH (mm) measurements ( P < .05). Conclusion: Linear and areal pharyngeal airway dimensions are similar in subgroups of Class III malocclusions, while the hyoid bone is vertically higher in individuals with maxillary retrognathia.