bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Halo-Gravity Traction for Patients with Severe Focal Kyphosis in the Upper Thoracic Spine
Authors: Li Yang , Shi Benlong , Zhu Zezhang , Liu Zhen , Liu Dun , Shi Bo , Sun Xu , Qiu Yong 
Published: November 2020

Study Design.
Retrospective review.

Objective.
To evaluate the effect of preoperative Halo-gravity traction (HGT) in the treatment of severe focal kyphosis in the upper thoracic spine (UTS), and to propose the indications that HGT could serve as an alternative for three-column osteotomy (3CO) among these patients.

Summary of Background Data.
The HGT has been proven to be effective for severe kyphoscoliosis secondary to multiple etiologies. However, the safety and efficacy of HGT in severe focal kyphosis in UTS was still unclear.

Methods.
Patients with focal kyphosis in UTS undergoing HGT and without 3CO operation were reviewed. The sagittal focal kyphosis was measured at pre-, posttraction, and postoperation. The neurologic function at pretraction, posttraction, and postoperation were assessed according to the American Spinal Injury Association (ASIA) grading. The complications during HGT, operation, and follow-up were recorded. The comparison between pretraction and posttraction was performed using paired samples t test.

Results.
A total of 19 patients were included in this study, with a mean age of 13.2 ± 5.8 years. The average duration of HGT was 62.6 ± 8.4 days, during which the average kyphosis decreased from 95.3 ± 16.4° to 64.1 ± 19.2° (P < 0.001). After HGT, the ASIA grade improved from C to D in three patients and from C to E in three patients, from D to E in seven patients, from B to D in one patient. No deterioration in neurologic function was observed during HGT. The neurological status in one patient improved from ASIA C at pretraction to ASIA E at postoperation, but deteriorated to C at 4 years follow-up.

Conclusion.
Preoperative HGT could help to correct deformity and improve neurological deficit. 3CO procedure might be unnecessary in patients with severe focal kyphosis in UTS with the utilization of HGT.

Level of Evidence: 4
Age as a Predictor for Complications and Patient-reported Outcomes in Multilevel Transforaminal Lumbar Interbody Fusions
Authors: Claus Chad F. , Tong Doris , Lytle Evan , Bahoura Matthew , Garmo Lucas , Li Chenxi , Park Paul , Carr Daniel A. , Easton Richard , Abdulhak Muwaffak , Chang Victor , Houseman Clifford , Bono Peter , Richards Boyd , Soo Teck M. 
Published: November 2020

Study Design.
Retrospective review of a multi-institutional data registry.

Objective.
The authors sought to determine the association between age and complications & patient-reported outcomes (PRO) in patients undergoing multilevel transforaminal interbody lumbar fusion (MTLIF).

Summary of Background Data.
Elderly patients undergoing MTLIF are considered high risk. However, data on complications and PRO are lacking. Additionally, safety of multilevel lumbar fusion in the elderly remains uncertain.

Methods.
Patients ≥50-year-old who underwent MTLIF for degenerative lumbar spine conditions were analyzed. Ninety-day complications and PROs (baseline, 90-d, 1-y, 2-y) were queried using the MSSIC database. PROs were measured by back & leg visual analog scale (VAS), Patient-reported Outcomes Measurement Information System (PROMIS), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Patient Satisfaction Index. Univariate analyses were used to compare among elderly and complication cohorts. Generalized estimating equation (GEE) was used to identify predictors of complications and PROs.

Results.
A total of 3120 patients analyzed with 961 (31%) ≥ 70-y-o and 2159 (69%) between 50–69. A higher proportion of elderly experienced postoperative complications (P = .003) including urinary retention (P = <.001) and urinary tract infection (P = .002). Multivariate analysis demonstrated that age was not independently associated with complications. Number of operative levels was associated with any (P = .001) and minor (P = .002) complication. Incurring a complication was independently associated with worse leg VAS and PROMIS scores (P = <.001). Preoperative independent ambulation was independently associated with improved PROMIS, and EQ5D (P = <.001). Within the elderly, preoperative independent ambulation and lower BMI were associated with improved PROMIS (P = <.001). Complications had no significant effect on PROs in the elderly.

Conclusions.
Age was not associated with complications nor predictive of functional outcomes in patients who underwent MTLIF. Age alone, therefore, may not be an appropriate surrogate for risk. Furthermore, baseline preoperative independent ambulation was associated with better clinical outcomes and should be considered during preoperative surgical counseling.

Level of Evidence: 3
Preoperative Hounsfield Units at the Planned Upper Instrumented Vertebrae May Predict Proximal Junctional Kyphosis in Adult Spinal Deformity
Authors: Yao Yu-Cheng , Elysee Jonathan , Lafage Renaud , McCarthy Michael , Louie Philip K. , Alshabab Basel Sheikh , Weissmann Karen , Lafage Virginie , Schwab Frank , Kim Han Jo 
Published: November 2020

Study Design.
Retrospective cohort study.

Objective.
To investigate the association between Hounsfield units (HU) measured at the planned upper instrumented vertebra (UIV) and UIV+1 and proximal junctional kyphosis (PJK) in patients with adult spinal deformity (ASD).

Summary of Background Data.
PJK is a common complication following surgery for ASD and poor bone quality is noted to be one of the risk factors. HUs from standard computed tomography (CT) scans can be used for evaluating regional bone quality.

Methods.
Sixty-three patients were included from a single institution. The demographic characteristics and radiographic parameters were recorded. Local vertebral HUs at the planned UIV and UIV+ 1 were measured using preoperative CT scans. The patients were divided into three groups: no PJK, non-bony PJK, and bony PJK. The risk factors between the three groups and the correlation between the mean HU and increase in the PJK angle were analyzed.

Results.
The incidence of PJK was 36.5%. The mean HU was significantly lower in the bony PJK group (HU: 109.0) than in the no PJK group (HU: 168.7, P = 0.038), and the mean HU in the non-bony PJK group (HU: 141.7) was not different compared to the other two groups. There was a significant negative correlation between the mean HU values and the increase in the PJK angles (r = −0.475, P < 0.01). The cutoff value for the mean HU used to predict bony PJK was 120 and a HU value less than 120 was a significant risk factor for bony PJK (OR: 5.74, 95% CI [1.01–32.54], P = 0.04).

Conclusions.
We noted a significant inverse relationship between the mean HUs at the UIV and UIV+ 1 and increase in the PJK angles postoperatively. In ASD patients, the HUs may be used preoperatively to identify patients with a higher risk of bony PJK.

Level of Evidence: 3
Ventilator-Weaning Pathway Associated With Decreased Ventilator Days in Pediatric Acute Respiratory Distress Syndrome*
Authors: Mehta Sanjiv D. , Martin Kelly , McGowan Nancy , Dominick Cheryl L. , Madu Chinonyerem , Denkin Blair Kraus , Yehya Nadir 
Published: November 2020

Objectives:
There is limited evidence on the impact of protocolized ventilator weaning in pediatric acute respiratory distress syndrome, despite utilization in clinical trials and clinical care. We aimed to determine whether protocolized ventilator weaning shortens mechanical ventilation duration and PICU length of stay in pediatric acute respiratory distress syndrome survivors.

Design:
Secondary analysis of a prospective pediatric acute respiratory distress syndrome (Berlin definition) cohort from July 2011 to June 2019 analyzed using interrupted time series analysis pre- and postimplementations of a ventilator-weaning pathway. We compared duration of invasive ventilation and PICU length of stay in survivors before and after implementation of a ventilator-weaning pathway. We excluded PICU nonsurvivors and subjects with greater than 100 ventilator days.

Setting:
Large academic tertiary-care PICU.

Patients:
Children with acute respiratory distress syndrome who survived to PICU discharge with less than or equal to 100 days of invasive mechanical ventilation.

Interventions:
Implementation of a ventilator-weaning pathway on May 2016.

Measurements and Main Results:
Of 723 children with acute respiratory distress syndrome, 132 subjects died and six subjects with ventilation greater than 100 days were excluded. Of the remaining 585 subjects, 375 subjects had acute respiratory distress syndrome prior to pathway intervention and 210 after. Patients in the preintervention epoch were younger, more likely to have infectious acute respiratory distress syndrome, and had increased use of alternative ventilator modes. Pathway adoption was rapid and sustained. Controlling for temporality, pathway implementation was associated with a decrease of a median 3.6 ventilator days (95% CI, –5.4 to –1.7; p < 0.001). There was no change in the reintubation rates. Results were robust to multiple sensitivity analyses adjusting for confounders.

Conclusions:
Ventilator-weaning pathway implementation shortened invasive ventilation duration in pediatric acute respiratory distress syndrome survivors with no change in reintubation. The effect size of this intervention was comparable with those targeted in acute respiratory distress syndrome trials.
Two-Step Imputation and AdaBoost-Based Classification for Early Prediction of Sepsis on Imbalanced Clinical Data
Authors: Baniasadi Atefeh , Rezaeirad Sepideh , Zare Habil , Ghassemi Mohammad M. 
Published: November 2020

OBJECTIVES:
Sepsis is a life-threatening response to infection that causes tissue damage, organ failure, and death. Effective early prediction of sepsis would improve patients’ diagnosis and reduce the cost associated with late-stage sepsis infection by applying appropriate early intervention. However, effective early prediction is challenging because sepsis biomarkers are neither obvious nor definitive, and sepsis datasets are heavily imbalanced against positive diagnosis of sepsis while containing significant missing values. Early prediction of sepsis in ICUs using clinical data is the objective of the PhysioNet/Computing in Cardiology Challenge 2019.

DESIGN:
In this article, we proposed a machine learning algorithm to aid in the early detection of sepsis.

SETTING:
We applied linear interpolation and implemented a sample weighted AdaBoost model to predict sepsis 6 hours before clinical diagnosis.

PATIENTS:
Medical data contains more than 40,000 patients gathered from three geographically distinct U.S. hospital systems that consisted of a combination of hourly vital sign, lab values, and static patient descriptions.

INTERVENTIONS:
The challenge metric, however, did not directly reward models for their generalizability across institutions.

MEASUREMENTS AND MAIN RESULTS:
The article is evaluated using a new metric called Utility Score that is defined as Official scoring criteria. Our approach was among the top 10% of entries to the Challenge on a hidden test set.

CONCLUSIONS:
Herein, we demonstrate that our proposed approach was the most effective of the Challenge entrants when such generalizability is explicitly accounted for in model evaluation.
External Corroboration That Corticosteroids May Be Harmful to Septic Shock Endotype A Patients
Authors: Wong Hector R. , Hart Kimberly W. , Lindsell Christopher J. , Sweeney Timothy E. 
Published: November 2020

OBJECTIVES:
We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested the efficacy of vasopressin as initial vasopressor therapy for septic shock among adult patients, when compared with norepinephrine. Patients who reached a prespecified dose of either vasopressor were further randomized to receive hydrocortisone or placebo. A proportion of patients in the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial had transcriptomic data generated at baseline using whole blood-derived messenger RNA. We used the publicly available transcriptomic data from the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial to assign the study subjects to pediatric septic shock endotype A or B, and tested the hypothesis that hydrocortisone treatment is associated with increased mortality among patients in endotype A.

DESIGN:
Secondary analysis of publicly available transcriptomic data.

SETTING:
Multiple adult ICUs.

PATIENTS:
Adults with septic shock randomized to hydrocortisone (n = 47) or placebo (n = 50).

INTERVENTIONS:
Randomization to the Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial experimental arms.

MEASUREMENTS AND MAIN RESULTS:
Endotype A patients receiving hydrocortisone had a mortality rate of 46%, whereas endotype A patients receiving placebo had a mortality rate of 22% (p = 0.105). In contrast, the mortality rates for endotype B patients receiving hydrocortisone or placebo were 19% and 22%, respectively. The odds of death were more than three times greater in endotype A patients receiving hydrocortisone than endotype A patients receiving placebo (p = 0.05).

CONCLUSIONS:
This exploratory analysis provides further evidence that corticosteroid exposure may be associated with increased mortality among septic shock endotype A patients.
Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis: a 2-year retrospective analysis
Authors: Song Wei , Shen Yin-Zhong , Wang Zhen-Yan , Qi Tang-Kai , Liu Li , Zhang Ren-Fang , Wang Jiang-Rong , Tang Yang , Chen Jun , Sun Jian-Jun , Lu Hong-Zhou 
Published: November 2020

Abstract

Background:
Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.

Methods:
Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.

Results:
Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm3, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25–12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ
2 = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166–13.269, P = 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548–35.974, P = 0.001) were associated with higher mortality at 8 weeks.

Conclusion:
This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.
Medical Missions
Authors: Johanson Linda 
Published: November 2020

ABSTRACT:
Participating in medical mission work can have incomparable spiritual value. Experiencing a foreign culture via sounds, sights, tastes, smells, and textures is a unique avenue for caring for people's physical needs that opens opportunities for spiritually-focused interactions. Nurses can gain cultural competency and humility as they help envision future ministry possibilities with local residents and mission team members. Practical preparation suggestions and a reading list are provided.
On the Horizon: Biologics and Nutrients for Neurotrophic Keratitis
Authors: Gumus Koray 
Published: November 2020

Abstract:
Neurotrophic keratitis (NK), a potentially sight-threatening corneal disease, still does not have a specific treatment. The reduction or complete loss of corneal sensation, the most important factor in its pathogenesis, is one of the most important factors that complicate the treatment of corneal wound healing. In addition, the visual outcome may be adversely affected because of aggressive stromal fibrosis in severe NK cases. Basically, the current management of NK aims to accelerate wound healing and prevent the progression. However, new therapeutic agents, particularly developed depending on cell type-specific healing mechanisms are required for better visual outcomes. In recent years, several studies have started to use new promising areas of translational research, including gene therapy, stem cell therapy, miRNA, and bioengineering. Evidence has emerged that future treatment strategies for NK will be designed by the results of these studies. In this review, it is aimed to summarize scientific data of new treatment modalities for NK.
Successful Outcome of Simultaneous Allogeneic Simple Limbal Epithelial Transplantation With Therapeutic Penetrating Keratoplasty (PKP) for Limbal Stem Cell Deficiency and Sterile Keratolysis After Chemical Injury
Authors: Kunapuli Anuradha , Fernandes Merle 
Published: November 2020

Purpose:
To describe the successful outcome of simultaneous allogeneic simple limbal epithelial transplantation (SLET) combined with therapeutic penetrating keratoplasty (PKP) for limbal stem cell deficiency (LSCD) with sterile keratolysis after bilateral chemical injury.

Methods:
A 37-year-old man presented with total LSCD and sterile keratolysis with perforation in the left eye after amniotic membrane transplantation for bilateral chemical injury before 3 months. The right eye had a stable ocular surface, absence of palisades of Vogt, and minimal anterior stromal scarring. To salvage the left eye, emergency therapeutic PKP combined with allogeneic SLET was performed. He was given oral steroids for 8 weeks and mycophenolate mofetil for 1 year to prevent allograft rejection.

Results:
At the last follow-up, 2 years later, with miniscleral contact lens, his best corrected visual acuity was 20/20 with a clear graft and an intact ocular surface.

Conclusions:
To the best of our knowledge, this is the first report of successful outcome of emergency PKP with simultaneous allogeneic SLET managed by systemic immunosuppression for corneal perforation with LSCD.
Urethral Orifice Genital Herpes Caused by HSV-1 in a Female Patient: A Case Report
Authors: Yang Jia-Yi , Mo Xiao-Hui , Wang Xiu-Li 
Published: November 2020

Abstract

Introduction:
Genital herpes is one of the most common sexually transmitted infections worldwide. Most genital herpes occur on the genitalia, perineum, buttocks, upper thighs, or perianal areas. However, there were reports of rare cases of genital herpes on urethral orifice.
Herein, we report a case of a patient who was diagnosed with urethral orifice genital herpes, a place likely to be ignored.

Case presentation:
A 53-year-old woman presented with vagina pruritus at first, with subsequent burning sensation around urethra. Mycostatin and mycospor were administered for the treatment of the pruritus. Then levofloxacin was prescribed. Finally, the patient was given treatment with acyclovir. Different from other cases, the investigation showed herpes simplex virus type 1 DNA positive and herpes simplex virus type 2 DNA negative by PCR. The patient was therefore diagnosed with genital herpes.

Discussion:
Most genital herpes happen on the genitalia, perineum, buttocks, upper thighs, or perianal areas. Few cases have been reported that genital herpes occurred on urethral orifice till now.

Conclusion:
If there is no typical symptoms that patient present with herpes simplex virus type 1 or 2 positive, urethral orifice genital herpes should be considered.
Capsaicin Regulates Mitochondrial Fission to Promote Melanoma Cell Apoptosis
Authors: Ma Jing-Jing , Yang Yu-Qi , Guo Sen , Wang Hui-Na , Yi Xiu-Li , Zhao Tao , Liu Lin , Yue Qiao , Liu Yu , Shi Qiong , Gao Tian-Wen , Guo Wei-Nan , Li Chun-Ying 
Published: November 2020

Abstract

Objective:
Capsaicin (CPS) is a major component of the red pepper, and its anti-tumor property has been confirmed. However, the underlying mechanism of this anti-tumor effect has not been fully clarified, so we conducted this study to evaluate the role of mitochondrial fission and subsequent mitochondrial dysfunction in CPS-induced apoptosis of melanoma cells.

Methods:
Two melanoma cell lines and melanocytes were treated with CPS alone or in combination with ruthenium red (a transient receptor potential vanilloid 1 [TRPV] antagonist), Z-VAD-FMK (a pan-caspase inhibitor), or N-acetyl-L-cysteine (an antioxidant). Cell vitality was tested using a cell counting kit-8 assay. The expression levels of related proteins were examined by Western blotting. Apoptosis, intracellular reactive oxygen species, mitochondrial membrane potential, adenosine triphosphate levels, and mitochondrial dynamics were analyzed by flow cytometry, luminometry, and confocal laser microscopy, respectively, and compared between groups.

Results:
CPS treatment significantly inhibited the vitality of melanoma cells (For A2058 cells: 0 vs. 120 μmol/L: [100.00% ± 0%] vs. [51.02% ± 6.40%], P < 0.05; For WM35 cells: 0 vs. 120 μmol/L: [100.00% ± 0%] vs. [51.80% ± 3.45%], P < 0.05) but exerted less impact on normal melanocytes. CPS promoted melanoma cell apoptosis through TRPV channels and the caspase cascade. CPS treatment then led to TRPV channel-dependent mitochondrial dysfunction with an increase in reactive oxygen species generation (For A2058 cells: CPS vs. CPS+RR: [2.34 ± 0.30] vs. [1.34 ± 0.12], P < 0.05; For WM35 cells: CPS vs. CPS+RR: [2.25 ± 0.25] vs. [1.65 ± 0.13], P < 0.05), dissipation of the mitochondrial membrane potential (Control vs. CPS: [1.00 ± 0] vs. [0.61 ± 0.08], P < 0.05), and adenosine triphosphate reduction (P < 0.05). In addition, reactive oxygen species generation contributed to CPS-induced melanoma cell apoptosis. Mitochondrial fission was subsequently proved to connect CPS treatment to mitochondrial dysfunction, which was also TRPV channel-dependent, thereby inducing melanoma cell apoptosis.

Conclusion:
Our study highlights the role of mitochondrial fission and its related mitochondrial dysfunction in mediating the pro-apoptotic effect of CPS in melanoma. These findings deepen our understanding of the mechanisms underlying the anti-tumor activity of CPS and indicate the clinical relevancy of extending the use of this agent for cancer therapy.