bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prolonged postoperative cerebral oxygen desaturation after cardiac surgery
Authors: Cioccari Luca , Bitker Laurent , Toh Lisa , Hacking Douglas , Cutuli Salvatore L. , Osawa Eduardo A. , Yanase Fumitaka , Naorungroj Thummaporn , Luethi Nora , Michalopoulos Adrian , Woo Shanan , Wang Judy , Eastwood Glenn M. , Weinberg Laurence , Bellomo Rinaldo 
Published: November 2020

BACKGROUND
Near-infrared spectroscopy (NIRS) is used routinely to monitor cerebral tissue oxygen saturation (SctO2) during cardiopulmonary bypass (CPB) but is rarely employed outside the operating room. Previous studies indicate that patients are at risk of postoperative cerebral oxygen desaturation after cardiac surgery.

OBJECTIVES
We aimed to assess perioperative and postoperative changes in NIRS-derived SctO2 in cardiac surgery patients.

DESIGN
Prospective observational study.

SETTING
The study was conducted in a tertiary referral university hospital in Australia from December 2017 to December 2018.

PATIENTS
We studied 34 adult patients (70.6% men) undergoing cardiac surgery requiring CPB and a reference group of 36 patients undergoing non-cardiac surgical procedures under general anaesthesia.

MAIN OUTCOME MEASURES
We measured SctO2 at baseline, during and after surgery, and then once daily until hospital discharge, for a maximum of 7 days. We used multivariate linear mixed-effects modelling to adjust for all relevant imbalances between the two groups.

RESULTS
In the cardiac surgery group, SctO2 was 63.7% [95% confidence interval (CI), 62.0 to 65.5] at baseline and 61.0% (95% CI, 59.1 to 62.9, P = 0.01) on arrival in the ICU. From day 2 to day 7 after cardiac surgery, SctO2 progressively declined. At hospital discharge, SctO2 was significantly lower than baseline, at 53.5% (95% CI, 51.8 to 55.2, P < 0.001). In the reference group, postoperative SctO2 was not significantly different from baseline. On multivariable analysis, cardiac surgery, peripheral vascular disease and time since the operation were associated with greater cerebral desaturation, whereas higher haemoglobin concentrations were associated with slightly better cerebral oxygenation.

CONCLUSION
After cardiac surgery on CPB, but not after non-cardiac surgery, most patients experience prolonged cerebral desaturation. Such postoperative desaturation remained unresolved 7 days after surgery. The underlying mechanisms and time to resolution of such cerebral desaturations require further investigation.
Adenovirus Infection-associated Central Nervous System Disease in Children
Authors: Zhang Xiao-Fang , Tan Cheng-Bing , Yao Zheng-Xiong , Jiang Li , Hong Si-Qi 
Published: November 2020

Background:
Adenovirus (Adv) is a frequent etiology of acute respiratory tract infections. Although rare, neurologic manifestations are known to occur during Adv infection.

Methods:
We retrospectively analyzed clinical, laboratory, outcome and the relationship between clinical characteristics and viral detection results in the cerebrospinal fluid (CSF) in children with Adv-associated central nervous system (CNS) dysfunction.

Results: Twenty-one
(1.5%) cases had Adv-associated CNS manifestations. The median age was 1.4 years and 20 (95%) were less than 5 years of age. Six (28%) were male. The most frequently cited CNS symptoms were altered consciousness (100%) and seizure (14.3%). Fourteen cases (73.7%) had abnormal electroencephalogram examination and 6 cases (37.5%) had abnormal imaging. None of the patients had received cidofovir administration. Twenty children recovered without sequelae and 1 patient died of respiratory failure. Patients with positive Adv polymerase chain reaction (n = 11) presented lower onset age compared with that of patients with negative Adv polymerase chain reaction (n = 10) in the CSF. Clinical manifestation, laboratory findings, imaging studies and electroencephalogram showed no significant difference between the 2 groups.

Conclusion:
Adv is a rare cause of CNS disease in children, mainly causing altered consciousness. Adv was detected in more cases in the respiratory tract than the CSF, but the majority of patients had the virus detected in both. The lack of Adv in the CSF does not exclude CNS involvement. Furthermore, the viral detection results in the CSF do not seem useful as an indicator of the severity of CNS disease.
Prediction factors of tolvaptan effectiveness in patients with refractory ascites complicated with hepatocellular carcinoma
Authors: Imai Michitaka , Ishikawa Toru , Kojima Yuichi , Azumi Motoi , Nozawa Yujiro , Sano Tomoe , Iwanaga Akito , Honma Terasu , Yoshida Toshiaki 
Published: November 2020

Objective
Tolvaptan (TVP) is an effective treatment for patients with cirrhotic ascites; however, studies have indicated that a sufficient effect is difficult to obtain in patients with hepatocellular carcinoma (HCC). This study evaluates the efficacy of TVP in patients with HCC with refractory ascites.

Methods
We retrospectively enrolled 32 patients with liver cirrhosis and refractory ascites [mean age: 74 years (range, 47–86 years), men: 78.1% (25/32)]. All patients had HCC and were treated with TVP at our hospital. A TVP responder was defined as a patient who experienced decrease in body weight by ≥1.5 kg within 1 week of treatment. Univariate and multivariate analyses were performed to evaluate clinical and laboratory predictive factors of TVP response.

Results
The TVP response rate was 46.9% (15/32 patients) after 1 week of treatment. HCC treatment (transcatheter arterial chemoembolization and/or radiofrequency ablation) was administered to 11/15 (73.3%) responders. In the multivariate analysis, the reduction of urine osmolality was higher in responders than nonresponders (202 mOsm/l vs. 65 mOsm/l, P = 0.040), and the tumor stage (P = 0.043) was worse in nonresponders. Multivariate Cox proportional hazards regression analysis indicated a significantly better prognosis among responders than among nonresponders (P < 0.01).

Conclusion
The HCC tumor stage and the reduction in urine osmolality can predict the efficacy of TVP in patients with refractory ascites complicated with HCC. TVP may allow therapeutic intervention for HCC and improve prognosis, even in patients with Child–Pugh class C.
Identifying Symptom Information in Clinical Notes Using Natural Language Processing
Authors: Koleck Theresa A. , Tatonetti Nicholas P. , Bakken Suzanne , Mitha Shazia , Henderson Morgan M. , George Maureen , Miaskowski Christine , Smaldone Arlene , Topaz Maxim 
Published: November 2020

Background
Symptoms are a core concept of nursing interest. Large-scale secondary data reuse of notes in electronic health records (EHRs) has the potential to increase the quantity and quality of symptom research. However, the symptom language used in clinical notes is complex. A need exists for methods designed specifically to identify and study symptom information from EHR notes.

Objectives
We aim to describe a method that combines standardized vocabularies, clinical expertise, and natural language processing to generate comprehensive symptom vocabularies and identify symptom information in EHR notes. We piloted this method with five diverse symptom concepts: constipation, depressed mood, disturbed sleep, fatigue, and palpitations.

Methods
First, we obtained synonym lists for each pilot symptom concept from the Unified Medical Language System. Then, we used two large bodies of text (clinical notes from Columbia University Irving Medical Center and PubMed abstracts containing Medical Subject Headings or key words related to the pilot symptoms) to further expand our initial vocabulary of synonyms for each pilot symptom concept. We used NimbleMiner, an open-source natural language processing tool, to accomplish these tasks and evaluated NimbleMiner symptom identification performance by comparison to a manually annotated set of nurse- and physician-authored common EHR note types.

Results
Compared to the baseline Unified Medical Language System synonym lists, we identified up to 11 times more additional synonym words or expressions, including abbreviations, misspellings, and unique multiword combinations, for each symptom concept. Natural language processing system symptom identification performance was excellent.

Discussion
Using our comprehensive symptom vocabularies and NimbleMiner to label symptoms in clinical notes produced excellent performance metrics. The ability to extract symptom information from EHR notes in an accurate and scalable manner has the potential to greatly facilitate symptom science research.
Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors
Authors: Casale Marisa , Cluver Lucie , Boyes Mark , Toska Elona , Gulaid Laurie , Armstrong Alice , Shenderovich Yulia , Rudgard William E. , Zhou Siyanai , Langwenya Nontokozo 
Published: November 2020

Background:
Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship.

Setting:
This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district.

Methods:
Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach.

Results:
A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B = 0.07; 95% confidence interval (CI): (0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B = 0.52; 95% CI: (0.07 to 0.97) P < 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B = −0.22; 95% CI: (−0.42 to −0.02) P < 0.05].

Conclusions:
These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.
The Calcium Phosphate Modified Titanium Implant Combined With Platelet-Rich Plasma Treatment Promotes Implant Stabilization in an Osteoporotic Model
Authors: Sun Peng , Wang Yan , Xu Dapeng , Gong Kun 
Published: November 2020

Abstract
Osteoporosis as a kind of systemic bone metabolic disease has become one of the most prevalent diseases among the middle- and old-age, characterized with low bone mass and disruptive osseous microenvironment. The poor bone condition both in quantity and quality makes it daunting for osteoporotic patients who are submitted to dental implantation, joint replacement therapy, or orthopedic surgery. Since calcium phosphate (CaP) and platelet-rich plasma (PRP) treatment, all have improving the effect on bone regeneration. Inspired by this fact, the authors introduced a kind of novel implant with CaP modified surface by HPT (hydrothermal & pressure) treatment in this study. After producing, the authors tested its physicochemical properties through scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscope (XPS) and contact-angle measurement. Then the authors desired to investigate the effect of this CaP-modified implant on bone regeneration and stabilization maintenance combined with PRP treatment by establishing an osteoporotic rat model. After 3 months of surgery, the authors collected all the specimens and evaluated new bone formation by micro-computed tomography (micro-CT) analysis, biomechanical test, and histologic assessment. All the results in vivo experiment showed the CaP modified implant combined with PRP treatment could improve the osteoinductive effect under osteoporotic condition, leading to better maintenance for stabilization between bone and implant interface, which might be rendered as a promising clinical method for osteoporotic patients when they receive orthopedic surgeries.
The Use of Crowdsourcing Technology to Evaluate Preoperative Severity in Patients With Unilateral Cleft Lip in a Multiethnic Population
Authors: McCullough Meghan , Auslander Allyn , Nagengast Eric S. , Yao Caroline A. , Swanson Jordan W. , Magee William P. 
Published: November 2020

Abstract
Crowd sourcing has been used in multiple disciplines to quickly generate large amounts of diverse data. The objective of this study was to use crowdsourcing to grade preoperative severity of unilateral cleft lip phenotype in a multiethnic cohort with the hypothesis that crowdsourcing could efficiently achieve similar rankings compared to expert surgeons. Deidentified preoperative photos were collected for patients with primary, unilateral cleft lip with or without cleft palate (CL ± P). A platform was developed with C-SATS for pairwise comparisons utilizing Elo rankings by crowdsource workers through Amazon Mechanical Turk. Images were independently ranked by 2 senior surgeons for comparison. Seventy-six patients with varying severity of unilateral (CL ± P) phenotype were chosen from Operation Smile missions in Bolivia, Madagascar, Vietnam, and Morocco. Patients were an average of 1.2 years’ old, ranging from 3 months to 3.3 years. Each image was compared with 10 others, for a total of 380 unique pairwise comparisons. A total of 4627 total raters participated with a median of 12 raters per pair. Data collection was completed in <20 hours. The crowdsourcing ranking and expert surgeon rankings were highly correlated with Pearson correlation coefficient of R = 0.77 (P = 0.0001). Crowdsourcing provides a rapid and convenient method of obtaining preoperative severity ratings, comparable to expert surgeon assessment, across multiple ethnicities. The method serves as a potential solution to the current lack of rating systems for preoperative severity and overcomes the difficulty of acquiring large-scale assessment from expert surgeons.
Slice Functional Condylectomy and Piezosurgery: A Proposal in Unilateral Condylar Hyperplasia Treatment
Authors: Cascone Piero , Runci Anastasi Michele , Maffia Francesco , Vellone Valentino 
Published: November 2020

Abstract
Condylar hyperplasia is a temporomandibular joint progressive disease characterized by an excessive growth of the mandibular condyle. Condylar overgrowth represents one of the most common causes of facial asymmetry in early adulthood. To date, there is not a clearly established origin of the disease: genetic, traumatic, infective, vascular, and functional factors are involved hypotheses. Clinically, condylar hyperplasia presentation is characterized by an asymmetry of the lower third of the face, deviation of the chin, inclination of the labial line and malocclusion. Several treatments have been proposed over the years in the treatment of mandibular condyle hyperplasia, but to date a gold standard has not been defined. Two are the main approaches: condylectomy and orthognathic surgery, isolated or in a combination. Many condylectomy technique differentiations have been developed: high, low, and proportional, are the most performed. In this technical note, the Slice Functional Condylectomy (SFC), a modification of the proportional condylectomy is presented.
Alloplastic Total Temporomandibular Joint Reconstruction: A 10-Year Experience of the University of the Witwatersrand, Johannesburg
Authors: Rikhotso Risimati E. , Sekhoto Mmathabo G. 
Published: November 2020

Aim:
This study aimed to retrospectively analyze our 10-year experience with total alloplastic reconstruction of the temporomandibular joint prostheses. Indications and clinical outcomes were also evaluated.
Methodology: This was a cross-sectional study in which 31 patients who had alloplastic total Temporomandibular Joint prosthesis implanted between 2007 and 2017 were reviewed.

Objective:
Outcomes (maximum mouth opening distance and occlusion), subjective outcomes (pain, diet consistency and chewing, quality of life), and complications were evaluated.

Results:
There were 16 females and 15 males with a mean age of 36.94 years (range 11–72 years). In total, 51 prostheses (20 bilateral, 11 unilateral) were implanted. The stock prostheses were used in 28 patients (90.32%) and only 3 (9.68%) were of custom-made type. Fifty-eight percent of patients were diagnosed with temporomandibular joint ankylosis, 22.58% had degenerative conditions, 9.68% had pathology (hemifacial microsomia, synovial chondromatosis, and osteochondroma), and 9.68% had malocclusion.
The results showed that there was a significant improvement in maximum mouth opening distance (P-value < 0.0001), particularly in patients who had ankylosis.
There was improvement in diet consistency (P-value < 0.0001) and quality of life (P-value 0.013). Postoperative complications ranged from facial nerve injuries (n = 4), keloids (n = 2), and heterotopic bone formation (n = 2).

Conclusion:
TMJ alloplasts provide satisfactory clinical and functional outcomes for patients with end-stage TMJ diseases, evidenced by overall improvement in maximum mouth opening, chewing ability and quality of life and reduction in pain. Previously operated joints and a preoperative diagnosis of ankylosis increase the risk of occurrence of complications postimplantation of total alloplastic joints.
An Anatomical Landmark for Retromandibular Transparotid Approach to Treat Subcondylar Fractures
Authors: Liu Pan , Li Fujun , Peng Liwei 
Published: November 2020

Abstract
Although the retromandibular transparotid approach (RTA) has been widely used to treat mandibular subcondyle fractures, the transient facial nerve injury (FNI) caused by this approach is not uncommon. The purpose of this paper was to present an anatomical landmark for RTA to treat subcondylar fractures, aiming to minimize FNI caused by the surgery. A total of 25 patients with subcondylar fractures but no FNI underwent RTA surgery. Intraoperatively, the plane of angulus oris was utilized as a reference to open the parotid and masseter tissues for exposing the fracture site. Postoperatively, FNI and other surgical complications were counted. The results showed that except for 2 cases of hematoma, no FNI or other complications occur. As a conclusion, utilization of plane of angulus oris as a reference for RTA to treat subcondylar fractures might make the surgery safer and less invasive.
The Effects of Alar Base Augmentation in Secondary Unilateral Cleft Lip Nasal Deformity
Authors: Kim Yong Bae , Nam Seung Min , Park Eun Soo , Choi Chang Yong , Kang Moon Seok , Cha Han Gyu 
Published: November 2020

Abstract
In unilateral cleft lip and palate patients, the alar base is displaced inferoposterolaterally due to the depression of the pyriform aperture in the cleft side, and the drooping of the nostril rim is provoked by displacement of the alar base. This study was conducted between May 1998 and December 2012. In total, 82 patients with secondary unilateral cleft lip nasal deformities were treated using alar base augmentation. The patients were divided into two groups according to the degree of their preoperative alar base asymmetry. Patients with alar base asymmetry <3 mm were treated with a soft tissue augmentation procedure. Those with alar base asymmetry >3 and <6 mm were treated with a bony augmentation procedure. Soft tissue augmentation was conducted in 42 patients, and bony augmentation was conducted in 40 patients. In the soft tissue augmentation group, the degree of alar base asymmetry was improved from 2.42 ± 0.38 mm preoperatively to 0.45 ± 0.21 mm postoperatively (P
< 0.05). In the bony augmentation group, the degree of alar base asymmetry was improved from 4.33 ± 0.50 mm preoperatively to 0.81 ± 0.20 mm postoperatively (P
< 0.05). In the amount of alar base augmentation, there were statistically significant differences between the soft tissue augmentation group and the bony augmentation group (P
< 0.05). This clinical study shows that secondary cleft lip nasal deformities can be corrected with alar base augmentation using soft tissue and bony augmentation and that these procedures can provide reliable, satisfactory, and safe clinical outcomes.
Sublobar Resection Versus Lobectomy for Early-Stage Pulmonary Carcinoid Tumors ≤3 cm in Size
Authors: Xu Song , Li Xiongfei , Ren Fan , He Jinling , Zhao Shikang , Wang Yanye , Ren Dian , Zhu Shuai , Lei Xi , Chen Gang , Chen Jun 
Published: November 2020

Objective:
This study aimed to determine the optimal surgical procedure for early-stage pulmonary carcinoids (PCs).

Background:
PCs, comprising typical carcinoids (TCs) and atypical carcinoids (ACs), are rare low-grade malignant tumors. We determine the optimal surgical management for early-stage PCs using data from the Surveillance, Epidemiology, and End Results registry.

Methods:
Clinical and survival data of patients with early-stage PC tumors with a diameter ≤3 cm were retrieved. The Kaplan-Meier method and logrank tests were used to assess the differences in overall survival (OS). Subgroup analyses were also performed. To reduce the inherent bias of retrospective studies, two propensity score matching (PSM) analysis with (PSM2) or without (PSM1) consideration of lymph node assessment were performed.

Results:
In total, 2934 patients with PCs, including 2741 (93.42%) with TCs and 193 (6.58%) with ACs, were recruited. After PSM1 analysis, TC patients in the lobectomy group had a significantly better OS than those in the sublobar resection group (P = 0.0067), which is more remarkable for patients with a tumor diameter of 2 cm <T ≤ 3 cm (P = 0.0345) and those aged <70 years (P = 0.0032). However, survival benefits were not found after PSM2 analysis which balanced lymph node assessment. In multivariate cox analysis, age <70 years, female, TC histology and adequate lymph node assessment were associated with better OS.

Conclusions:
Sublobar resection may not significantly compromise the longterm oncological outcomes in early-stage PCs ≤3 cm in size if lymph node assessment is performed adequately. Further validation in large randomized clinical trials is warranted.