bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Duration of Preoperative Opioid Use with Reoperation After One-level Anterior Cervical Discectomy and Fusion in Nonmyelopathic Patients
Authors: Samuel Andre M. , Lovecchio Francis C. , Premkumar Ajay , Vaishnav Avani S. , Kim Han Jo , Qureshi Sheeraz A. 
Published: December 2020

Study Design
Retrospective cohort study.

Objective
The aim of this study was to determine that rates of preoperative opioid use in patients undergoing single-level anterior discectomy and fusion (ACDF) without myelopathy and determine the association with reoperations over 5 years

Summary of Background Data
Preoperative opioid use before cervical spine surgery has been linked to worse postoperative outcomes. However, no studies have determined the association of duration and type of opioid used with reoperations after ACDF.

Methods
Patients undergoing single-level ACDF without myelopathy between 2007 and 2016 with at least 5-year follow-up were identified in one private insurance administrative database. Preoperative opiate use was divided into acute (within 3 months), subacute (acute use and use between 3 and 6 months), and chronic (subacute use and use before 6 months) and by the opiate medication prescribed (tramadol, oxycodone, and hydrocodone). Postoperative rates of additional cervical spine surgery were determined at 5 years and multivariate logistic regression was used to determine the association of preoperative opiates with additional surgery.

Results
Of 445 patients undergoing single-level ACDF without myelopathy, 66.3% were taking opioid medications before surgery. The most commonly used preoperative opioid was hydrocodone (50.3% acute use, 24.7% chronic use). Opioid-naïve patients had a 5-year reoperation rate of 4.7%, compared to 25.0%, 15.5%, and 23.3% with chronic preoperative use of tramadol, hydrocodone, and oxycodone. In multivariate analysis, controlling for age, sex, and Charlson Comorbidity Index, chronic use of hydrocodone (odds ratio [OR] = 2.08, P = 0.05), oxycodone (OR = 4.46, P < 0.01), and tramadol (OR = 4.01, P = 0.01) were all associated with increased reoperations. However, acute use of hydrocodone, oxycodone, and tramadol was not associated with reoperations (P > 0.05).

Conclusion
Both subacute and chronic use of common lower-dose opioid medications is associated with increased reoperations after single-level ACDF in nonmyelopathic patients. This information is critical when counseling patients preoperatively and developing preoperative opioid cessation programs.

Level of Evidence: 3
MASSIVE BILATERAL SEROUS RETINAL DETACHMENT IN A YOUNG PATIENT WITH HYPERTENSIVE CHORIORETINOPATHY AND CHRONIC KIDNEY DISEASE
Authors: Arévalo Simental Diana Esperanza , Sepulveda Tinajero Luis Humberto , Villarreal Contreras Fátima Andrea , Becerra Cota Miriam Guadalupe , Ingolotti Mariana 
Published: December 2020

Purpose:
Report a case of hypertensive chorioretinopathy with massive bilateral serous retinal detachment in a young patient with chronic kidney disease.

Methods:
Observational case report.

Results:
An 18-year-old man with Grade 5 chronic kidney disease, systemic high blood pressure, secondary acute pulmonary edema, and acute uremic syndrome was referred to our service complaining of bilateral decreased vision starting one week ago. The patient was treated at that moment with hemodialysis and losartan. At initial examination, the patient's blood pressure was 170/120 mmHg; dilated fundus examination evidenced optic disk edema, hypertensive chorioretinopathy, and massive serous retinal detachment with best-corrected visual acuity of hand motion in both eyes. The case was diagnosed as undertreated hypertension and was referred to the nephrologist for treatment adjustments. At 1-month follow-up, blood pressure was 160/90 mmHg; there was clinical improvement in both eyes but with ischemic sequelae. At the final follow-up 6 months later, blood pressure was 100/60 mmHg, best-corrected visual acuity was 20/80 in the right eye and count fingers at 2 min the left eye, and there was a complete resolution of the retinal serous detachment in both eyes.

Conclusion:
Patients with massive serous detachments due to systemic hypertension are atypical so it is of immense importance for the ophthalmologists to recognize the ocular manifestations of systemic diseases that put the patient's life at risk as in this case.
Anterior Segment Surgeries Under Topical Fresh Frozen Plasma Treatment in Ligneous Conjunctivitis
Authors: Ozbek-Uzman Selma , Yalniz-Akkaya Zuleyha , Nurozler Tabakci Burcu , Singar Evin , Burcu Ayse 
Published: December 2020

Purpose:
To evaluate the efficacy of topical fresh frozen plasma (FFP) therapy on clinical symptoms, findings, and prognosis after anterior segment surgeries in patients with ligneous conjunctivitis (LC).

Methods:
Retrospective case note review.

Results:
Eleven eyes of 7 cases whose remission was not achieved after medical treatment such as topical corticosteroids, cyclosporine A, and heparin were included in the study. The median age of admission was 19 (1–49) years, median duration of FFP treatment was 48 (15–79) months, median follow-up period was 62 (16–114) months, and median age at symptom onset was 12 (4–252) months. Diagnosis was made according to clinical presentations, plasminogen activities, and response to treatment. Topical FFP that was prepared in our clinic was used in all cases. Surgeries (membrane excision, eyelid surgery, deep anterior lamellar keratoplasty, and cataract surgery) were performed after at least 1 month of FFP treatment. Prosthetic contact lens was applied to one eye. During the follow-up period, recurrences requiring membrane excision and side effects from topical FFP were not observed.

Conclusions:
LC is a rare membranous conjunctivitis that proceeds with remissions and recurrences. When it was shown that the etiology of LC is plasminogen deficiency, FFP became the only treatment option targeting the etiology. In this study, we observed that the topical FFP is an effective treatment method that prevents recurrence and ensures regression of membranes and safer anterior segment surgeries in LC.
Supply and Demand of Domestic Corneal Tissue and Its Implications on Export Potential—Using Australia as an Example
Authors: Machin Heather , Buckland Lisa , Georges Pierre , Ghabcha Mona , Golding-Holbrook Tamme , Leighton Candice , Mackey Adrienne , Weinel Luke , Whiting Victoria , Sutton Gerard , Baird Paul N. 
Published: December 2020

Purpose:
Corneal tissue importation is only possible if another country is able to export corneas without impacting its own domestic demand. Currently, there is little evidence to indicate whether export nations have such surplus capacity and in a position to export. To explore this concept, we examined our nation, Australia, which is reported to routinely decline donations because of its ability to meet domestic corneal transplant demand. Our research offers insights and opportunities for Australia and other nations to evaluate their domestic and international supply and allocation of corneal tissue in this space.

Method:
We collated 12 months of data on collected and noncollected donations, through participating Australian Eye Banks. The explanation of why some known donors were declined or not pursued indicated if demand was met and potential surplus-for-export levels.

Results:
There were 7.5% (n = 11,889) of deaths in Australia that were notified to Australian Eye Banks during our reporting period. Of those, 9.3% (n = 1106/11,889) were recovered and allocated, 15.7% (n = 1863/11,889) were known but declined, and 75% (n = 8920/11,889) were not pursued. Of those that were declined, 64.3% (n = 1197/1863) were declined because of limitations with service/manpower at the eye bank, whereas 35.7% (n = 666/1863) were declined because demand was met.

Conclusions:
Australia did not meet demand all the time, during our data period. There were adequate quantities of potential donors to support increasing recovery for domestic allocation and provide for exportation without hindrance to Australian demand. Further examination of domestic supply and demand cycles and the export process is required before routine exportation.
Association between inter-arm difference in SBP and central blood pressure in a Beijing community cohort
Authors: Ma Wei , Qi Litong , Fan Fangfang , Yang Ying , Zhang Baowei , Jia Jia , Li Min , Zhang Yan , Huo Yong 
Published: December 2020

Objective
The inter-arm SBP difference (IASBPD) can serve as a predictor of cardiovascular disease (CVD). In this study, we aimed to determine the relationship between IASBPD and central blood pressure (CBP).

Methods
The study cohort comprised of 7842 eligible individuals. Their BPs were assessed simultaneously in both arms using an Omron BP-203RPEIII vascular profiler, and the IASBPD was measured as the absolute difference in these values (absolute value of left minus right). The CBP was noninvasively measured using an Omron HEM-9000AI device. Multivariate regression analysis was used to assess the association between the central SBP (cSBP) and the IASBPD.

Results
An IASBPD of ≥10 mmHg was positively associated with the cSBP (β = 2.26; 95% confidence interval, 1.04–3.48; P < 0.001). The interaction test showed no significant interactions between the IASBPD and any of the assessed covariates (age group; sex; BMI; smoking status; heart rate group; the presence of hypertension, diabetes, or CVD; and antihypertensive drug use) when the cSBP was used as the outcome in the subgroup analysis.

Conclusion
The mechanism underlying the ability of the IASBPD to predict CVD may partly involve an increase in the CBP.
Timing of Cleft Palate Repair in Patients With and Without Robin Sequence
Authors: Skolnick Gary B. , Keller Matthew R. , Baughman Ethan J. , Nguyen Dennis C. , Nickel Katelin B. , Naidoo Sybill D. , Olsen Margaret A. , Patel Kamlesh B. 
Published: December 2020

Background:
This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims.

Methods:
Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair: Robin Sequence into 2 groups: age ≤10 months or >10 months; non-Robin cleft palate into 3 groups: age ≤10 months, >10–14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models.

Results:
A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09–0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10–14 months (adjusted HR 0.40, 95%CI 0.31–0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57–0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty.

Conclusions:
In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.
Reproducible breath metabolite changes in children with SARS-CoV-2 infection
Authors: Berna Amalia Z. , Akaho Elikplim H. , Harris Rebecca M. , Congdon Morgan , Korn Emilie , Neher Samuel , M’Farrej Mirna , Burns Julianne , John Audrey R. Odom 
Published: December 2020

ABSTRACTSARS-CoV-2 infection is diagnosed through detection of specific viral nucleic acid or antigens from respiratory samples. These techniques are relatively expensive, slow, and susceptible to false-negative results. A rapid non-invasive method to detect infection would be highly advantageous. Compelling evidence from canine biosensors and studies of adults with COVID-19 suggests that infection reproducibly alters human volatile organic compounds (VOCs) profiles. To determine whether pediatric infection is associated with VOC changes, we enrolled SARS-CoV-2-infected and -uninfected children admitted to a major pediatric academic medical center. Breath samples were collected from children and analyzed through state-of-the-art GCxGC-ToFMS. Isolated features included 84 targeted VOCs. Candidate biomarkers that were correlated with infection status were subsequently validated in a second, independent cohort of children. We thus find that six volatile organic compounds are significantly and reproducibly increased in the breath of SARS-CoV-2-infected children. Three aldehydes (octanal, nonanal, and heptanal) drew special attention, as aldehydes are also elevated in the breath of adults with COVID-19. Together, these biomarkers demonstrate high accuracy for distinguishing pediatric SARS-CoV-2 infection and support the ongoing development of novel breath-based diagnostics.
Sulodexide in the treatment of patients with early stages of COVID-19: a randomised controlled trial
Authors: Gonzalez-Ochoa Alejandro J. , Raffetto Joseph D. , Hernández Ana G. , Zavala Nestor , Gutiérrez Obed , Vargas Arturo , Loustaunau Jorge 
Published: December 2020

AbstractBackgroundTargeting endothelial cells has been suggested for the treatment of patients with COVID-19 and sulodexide has pleiotropic properties within the vascular endothelium that can prove beneficial to the same. We aimed to evaluate the effect of sulodexide when used in the early clinical stages of COVID-19.MethodsWe conducted a single-centre, outpatient setting, randomised controlled trial with a parallel-group design in Mexico. Including patients within three days of clinical symptom onset, who were at a high risk of severe clinical progression due to chronic comorbidities. Participants were randomly allocated to receive an oral dose of sulodexide (500 LRU twice a day) or the placebo for 21 days. Primary outcomes were need and length of hospitalisation, need and length of oxygen support.ResultsBetween June 5 and August 30, 2020, 243 patients were included in the “per-protocol” analysis. One hundred twenty-four of them received sulodexide, while 119 received placeboes. At 21 days follow-up, 22 of 124 patients required hospitalisation in the sulodexide group compared to 35 of 119 in the placebo group [relative risk (RR), 0·6; 95% confidence interval (CI), 0·37-0·96; p=0·03]. Fewer patients required oxygen support in the sulodexide group [37 of 124 vs. 50 of 119; RR, 0·71; 95% CI, 0·5 to 1; p=0·05], and for fewer days (9±7·2 in the sulodexide group vs. 11·5±9·6 in the placebo group; p=0·02). There was no between-group difference concerning the length of hospital stay.InterpretationEarly intervention in COVID-19 patients with sulodexide reduced hospital admissions and oxygen support requirements, although with no significant effect on mortality. This has beneficial implications in the patient well-being, making sulodexide a favourable medication until an effective vaccine or an antiviral becomes available.FundingResearcher independently initiated, partially funded by Alfasigma, Mexico.Listed in the ISRCTN registry under ID ISRCTN59048638.
The prognostic value of lymph node involvement after neoadjuvant chemotherapy is different among breast cancer subtypes
Authors: Laot Lucie , Laas Enora , Girard Noemie , Dumas Elise , Daoud Eric , Grandal Beatriz , Pierga Jean-Yves , Coussy Florence , Kirova Youlia , Alam Elsy el , Bataillon Guillaume , Lae Marick , Llouquet Florence , Reyal Fabien , Hamy Anne-Sophie 
Published: December 2020

AbstractIntroductionThe three different breast cancer subtypes (Luminal,HER2-positive and triple negative (TNBCs) display different natural history and sensitivity to treatment, but little is known about whether residual axillary disease after neoadjuvant chemotherapy (NAC) carries a different prognostic value by BC subtype.MethodsWe retrospectively evaluated axillary involvement (0, 1 to 3 positive nodes, ≥ 4 positive nodes) on surgical specimens from a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012. We analyzed the association between nodal involvement (ypN) binned into 3 classes (0; [1-3];4 or more), relapse-free survival (RFS) and overall survival (OS) among the global population, and according to BC subtypes.Results1197 patients were included in the analysis (luminal (n = 526, 43.9%), TNBCs (n = 376, 31.4%),HER2-positive BCs (n = 295, 24.6%)). After a median follow-up of 110.5 months, ypN was significantly associated with RFS, but this effect was different by BC subtype (Pinteraction= 0.004), and this effect was nonlinear. In the luminal subgroup, RFS was impaired in patients with 4 or more nodes involved (HR=2.8; 95% CI [1.93;4.06],p<0.001) when compared with ypN0, while it was not in patients with 1 to 3 nodes (HR=1.24, 95% CI = [0,86;1.79]). In patients with TNBC, both 1-3N+ and ≥ 4 N+ classes were associated with a decreased RFS (HR=3.19, 95%CI= [2.05; 4.98] and HR=4.83, 95%CI= [3.06; 7.63], respectivelyversusypN0,p< 0.001). Similar decreased prognosis were observed among patients withHER2-positive BC (1-3N+: HR=2.7, 95%CI= [1.64; 4.43] and ≥ 4 N+: HR=2.69, 95%CI= [1.24; 5.8] respectively,p=0.003).ConclusionThe prognostic value of residual axillary disease should be considered differently in the 3 BC subtypes to accurately stratify patients with a high risk of recurrence after NAC who should be offered second line therapies.
Antibacterial consumption in the context of COVID-19 in Pakistan: an analysis of national pharmaceutical sales data for 2019-20
Authors: Orubu Ebiowei Samuel F. , Malik Farrukh , Figueras Albert , Ching Carly , Fuzail Ahsan M , Wirtz Veronika J. , Zaman Muhammad H. 
Published: December 2020

AbstractObjectivesUncertainties in the pharmaceutical management of COVID-19 have led to reports of increased indiscriminate uses of antibiotics. The aim of this study was to investigate this at a national level in Pakistan.MethodsWe used IQVIA pharmaceutical sales volume data to analyze antibiotic consumption for January-April 2020 in Pakistan. The consumption of 77 antibiotics for systemic use in 2020 was calculated, and compared against the same period in 2019 to track changes in total consumption and consumption pattern by six assigned therapeutic groups: tetracyclines, quinolones, beta-lactam penicillins, other-beta-lactams, macrolides and “others” – comprising the remaining groups.ResultsThe total consumption for January-April 2020 was 17.76 Defined Daily Doses per 1000 population per day (a 18.8% decrease from 2019). Quinolones, beta-lactam penicillins, other-beta-lactams, and macrolides constituted 80% of total consumption. There were increases between February-April 2020 of macrolides and “others”. In March 2020, 112768 more people consumed a macrolide per day compared to March 2019; mostly azithromycin.ConclusionsTotal consumption decreased in the first four months of 2020 compared to 2019, possibly arising from a combination of several pre-existing and concurrent economic conditions as well as the lockdown situation. However, the results suggest an increase in the consumption of the macrolide class of antibiotics during the early phase of COVID-19 in Pakistan.
What is the probability that this patient, who presents to a UK hospital, will be diagnosed with Covid-19? Prospective validation of the open-source CovidCalculatorUK resource
Authors: Chapman George , Mundell Lewis , Harrison Charlotte H. , Cargill Tamsin , Keating Odhran , Johnson Mark , Smith Andrew 
Published: December 2020

AbstractIntroductionThe novel coronavirus SARS-CoV2 and the associated disease, Covid-19, continue to pose a global health threat. The CovidCalculatorUK is an open-source online tool (covidcalculatoruk.org) that estimates the probability that an individual patient, who presents to a UK hospital, will later test positive for SARS-CoV2. The objective is to aid cohorting decisions and minimise nosocomial transmission of SARS-CoV2.MethodsThis n = 500 prospective, observational, multicentre, validation study compared the CovidCalculatorUK’s estimated probability of Covid-19 with the first SARS-CoV2 oropharyngeal/nasopharyngeal swab result for individual patients admitted to hospital during the study period (01.04.20 − 18.05.20). A comparison with senior clinicians’ estimates of the probability of Covid-19 was also made.ResultsPatients who were prospectively grouped, by the CovidCalculatorUK, into 0-30% estimated probability, 30-60% and 60-100% estimated probability went on to have first swab SARS-CoV2 positive results in: 15.7%, 30.5% and 61.9% of cases, respectively. CovidCalculatorUK performance demonstrated an area under the curve of 0.76 (95% CI 0.71 – 0.81) (p < 0.001). Senior clinician stratification of the estimated probability of Covid-19 performed similarly to the CovidCalculatorUK.ConclusionThe CovidCalculatorUK provides a reasonably accurate estimate of the probability of an individual testing positive on their first SARS-CoV2 nasopharyngeal/oropharyngeal swab. The CovidCalculatorUK output performs similarly to a senior clinician’s estimate. Further evolution of the calculator may improve performance.
Optimizing SARS-CoV-2 molecular diagnostic using N gene target: insights about reinfection
Authors: Klein Raphael Contelli , Klein Mary Hellen Fabres , Barbosa Larissa Gomes , Knnup Lívia Vasconcelos Gonzaga , Venâncio Larissa Paola Rodrigues , Lima Jonilson Berlink , Araújo-Santos Théo 
Published: December 2020

AbstractIntroductionMolecular diagnosis of SARS-CoV-2 is a huge challenge to many countries around the world. The cost of tests to check infected people is inaccessible since specialized teams and equipment are not disposable in remote locations. Herein, we compared the fitness of two primers sets to the SARS-CoV-2 N gene in the molecular diagnosis of COVID-19.Materials and MethodsThe 1029 patient samples were tested to presense/abscence molecular test using in house US CDC protocol. We compared the fitness of two primers sets to two different regions of N gene targets.ResultsBoth targets, N1 and N2 displayed similar fitness during testing with no differences between Ct or measurable viral genome copies. In addition, we verified security ranges Cts related to positive diagnostic with Ct above 35 value failuring in 66,6% after retesting of samples.Main conclusionOur data suggest that it is secure to use just one primer set to the N gene to identify SARS-CoV-2 in samples and the labs should be careful to set positive samples in high Ct values using high cutoffs.
The Testing Multiplier: Fear vs Containment
Authors: Furno Francesco 
Published: December 2020

AbstractThis paper studies the economic effects of testing during the outbreak of a novel epidemic disease. I propose a model where testing permits isolation of the infected and provides agents with information about the prevalence and lethality of the disease. Additional testing reduces the perceived lethality of the disease, but might increase the perceived risk of infection. As a result, more testing could increase the perceived risk of dying from the disease - i.e. “stoke fear” - and cause a fall in economic activity, despite improving health outcomes. Two main insights emerge. First, increased testing is beneficial to the economy and pays for itself if performed at a sufficiently large scale, but not necessarily otherwise. Second, heterogeneous risk perceptions across age-groups can have important aggregate consequences. For a SARS-CoV-2 calibration of the model, heterogeneous risk perceptions across young and old individuals mitigate GDP losses by 50% and reduce the death toll by 30% relative to a scenario in which all individuals have the same perceptions of risk.