bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practice Pattern, Diagnostic Yield, and Long‐Term Prognostic Impact of Coronary Computed Tomographic Angiography
Authors: Cho Min Soo , Roh Jae‐Hyung , Park Hanbit , Cho Sang‐Cheol , Kang Do‐Yoon , Lee Pil Hyung , Ahn Jung‐Min , Koo Hyun Jung , Yang Dong Hyun , Kang Joon‐Won , Park Seung‐Jung , Patel Manesh R. , Park Duk‐Woo 
Published: September 2020

Background
Although guidelines recommend the use of coronary computed tomographic angiography (CTA) in patients with stable pain syndromes, the clinical benefits of the use of coronary CTA in a broad spectrum of patients is unknown. We evaluated the contemporary practice pattern and diagnostic yield of coronary CTA and their impact on the subsequent diagnostic‐therapeutic cascade and clinical outcomes.

Methods and Results

We identified 39 906 patients without known coronary artery disease (CAD) who underwent coronary CTA between January 2007 and December 2013. The patients' demographic characteristics, risk factors, symptoms, results of coronary CTA, the appropriateness of downstream diagnostic and therapeutic interventions, and long‐term outcomes (death or myocardial infarction) were evaluated. The number of coronary CTAs had increased over time, especially in asymptomatic patients. Coronary CTA revealed that 6108 patients (15.3%) had obstructive CAD (23.7% of symptomatic and 9.3% of asymptomatic patients). Subsequent cardiac catheterization was performed in 19.2% of symptomatic patients (appropriate, 80.6%) and in 3.9% of asymptomatic patients (appropriate, 7.9%). The 5‐year rate of death or myocardial infarction was significantly higher in patients with obstructive CAD on CTA than those without (7.2% versus 3.0%;
P
<0.001; adjusted hazard ratio [95% CI], 1.34 [1.17–1.54]). However, obstructive CAD on CTA had limited added value over conventional risk factors for predicting death or myocardial infarction.

Conclusions
Although the use of coronary CTA had substantially increased, CTA had a low diagnostic yield for obstructive CAD, especially in asymptomatic patients. The use of CTA in asymptomatic patients seemed to have led to inappropriate subsequent diagnostic or therapeutic interventions without clinical benefit.
Patterns of Nodal Metastases and Predictors of Occult Disease in HPV‐Associated Oropharynx Cancer
Authors: Stanford‐Moore Gaelen Britton , Ochoa Edgar , Larson Andrew , Han Mary , Hoppe Kathryn , Ryan William R. 
Published: September 2020

ObjectiveFor human papilloma virus–associated oropharynx squamous cell carcinoma (HPV+ OPSCC), we evaluated the distribution of neck‐level lymph node (LN) metastasis, based on postsurgical histopathology, and the incidence of and risk factors for occult LN metastases, as these patterns need clarification for this newer cancer subset.Study DesignRetrospective cohort study.SettingNational Cancer Database (NCDB).MethodsWe analyzed 2358 patients in the NCDB with HPV+ OPSCC who underwent neck dissection (ND) from 2010 to 2015. Incidence and distribution of LN metastases were calculated for neck levels I to V. Variables associated with occult LN metastasis were assessed by multivariate logistic regression.ResultsIn therapeutic NDs (n = 1935), the following proportions of positive LNs were found: level I, 9.0% (n = 175); level II, 81.0% (n = 1568); level III, 29.6% (n = 573); level IV, 11.9% (n = 230); and level V, 4.9% (n = 95). In elective NDs (n = 423), occult‐positive LNs were found in 35.8% (n = 152), with the following proportions by level: level I, 3.3% (n = 14); level II, 26.9% (n = 114); level III, 8.7% (n = 37); level IV, 4.0% (n = 17); and level V, 0.2% (n = 1). The presence of occult LNs was independently associated with a Charlson‐Deyo score of 1 (odds ratio, 2.26; 95% CI, 1.18‐4.31; P =. 014) and lymphovascular invasion (odds ratio, 5.91; 95% CI, 3.21‐11.18; P <. 001). Occult LN metastases were not significantly associated with pT classification, primary site, or number of LNs resected.ConclusionFor HPV+ OPSCC, occult nodal disease is common. Therapeutic NDs should encompass at least levels II, III, and IV and possibly I, whereas elective NDs could possibly encompass levels II and III.Level of Evidence4.
Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery
Authors: Gill Amarbir S. , Virani Farrukh R. , Hwang Joshua C. , Wilson Machelle D. , Beliveau Angela M. , Strong E. Bradley , Steele Toby O. 
Published: September 2020

ObjectiveTo determine the efficacy of preoperative gabapentin on patient‐reported pain levels and postoperative opioid requirements following sinonasal surgery.Study DesignRetrospective review.SettingAcademic institution.MethodsPatients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi‐square test and Wilcoxon test were used for data analysis.ResultsFifty‐seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test–22 scores between the groups. The total MED, postoperative day (POD) 1‐2 MED, POD 3‐4 MED, and POD 5‐6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups (P =. 98,. 25,. 16,. 44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups (P =. 81). The mean daily VAS score decreased significantly in both groups with each successive POD (P =. 004).ConclusionPreoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.
Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database
Authors: Wardlow Robert D. , Bernstein Isaac A. , Orlov Cinthia P. , Rowan Nicholas R. 
Published: September 2020

ObjectiveTo evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery.Study DesignRetrospective cohort study.SettingDatabase of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018.MethodsThe NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi‐square analysis and multivariable logistic regression.ResultsObese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P <. 001), rate of diabetes (18.2% vs 7.2%, P <. 001), and rate of hypertension requiring medication (43.1% vs 23.0%, P <. 001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P =. 02) and have disseminated cancer (<1% vs 3.2%, P <. 001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P =. 027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P =. 022). There was no statistical difference in medical complications (P =. 775), unplanned readmissions (P =. 286), unplanned reoperations (P =. 053), or 30‐day mortality (P >. 999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329‐0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239‐0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566‐0.968).ConclusionObesity does not increase the risk of 30‐day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.
Four Risk Factors for Arthrofibrosis in Tibial Spine Fractures: A National 10-Site Multicenter Study
Authors: Bram Joshua T. , Aoyama Julien T. , Mistovich R. Justin , Ellis Henry B. , Schmale Gregory A. , Yen Yi-Meng , McKay Scott D. , Fabricant Peter D. , Green Daniel W. , Lee R. Jay , Cruz Aristides I. , Kushare Indranil V. , Shea Kevin G. , Ganley Theodore J. 
Published: September 2020

Background: Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development. Purpose: To identify risk factors for arthrofibrosis and required MUA or lysis of adhesions in the largest known cohort of patients with TSFs. Study Design: Case-control study; Level of evidence, 3. Methods: This was a multicenter study of 249 patients ≤18 years old who had a TSF between January 2000 and February 2019. Patients were separated into cohorts based on whether they developed arthrofibrosis, defined as a 10° deficit in extension and/or 25° deficit in flexion at postoperative 3 months or a return to the operating room for manipulation under anesthesia (MUA) and/or lysis of adhesions. Results: A total of 58 (23.3%) patients developed postoperative arthrofibrosis, with 19 (7.6%) requiring a return to the operating room for MUA. Patients with arthrofibrosis were younger (mean ± SD, 11.3 ± 2.7 vs 12.3 ± 2.8 years; P = .029). They were more likely to have a nonsport, trauma-related injury (65.4% vs 32.1%; P < .001) and a concomitant ACL injury (10.3% vs 1.1%; P = .003). Those with arthrofibrosis had longer operative times (135.0 vs 114.8 minutes; P = .006) and were more likely to have been immobilized in a cast postoperatively (30.4% vs 16.6%; P = .043). In multivariate regression, concomitant anterior cruciate ligament (ACL) injury (odds ratio [OR], 20.0; P = .001), traumatic injury (OR, 3.8; P < .001), age <10 years (OR, 2.2; P = .049), and cast immobilization (OR, 2.4; P = .047) remained significant predictors of arthrofibrosis. Concomitant ACL injury (OR, 7.5; P = .030) was additionally predictive of a required return to the operating room for MUA. Conclusion: Surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.
Soaking of Autologous Tendon Grafts in Vancomycin Before Implantation Does Not Lead to Tenocyte Cytotoxicity
Authors: Xiao Michelle , Leonardi Erika A. , Sharpe Orr , Sherman Seth L. , Safran Marc R. , Robinson William H. , Abrams Geoffrey D. 
Published: September 2020

Background: Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity because of tenocyte toxicity. Purpose: To examine the in vitro toxicity of varying doses of vancomycin on human tenocytes. Study Design: Controlled laboratory study. Methods: Human patellar tenocytes were isolated and expanded in vitro. Tenocytes in culture were exposed to vancomycin at 5 different concentrations (400, 1600, 3200, 6400, and 12,800 μg/mL) and 3 time intervals (2, 6, and 24 hours). The control for all series was tenocyte exposure to only culture medium for each time interval. After treatment, a 10% Cell Counting Kit-8 solution in cellular growth medium was applied to the cells to examine cytotoxicity. A live/dead assay was used to assess tenocyte viability through fluorescence microscopy and flow cytometry. Results were analyzed statistically using multivariable logistic regression models with Tukey honest significant difference post hoc tests. Results: Vancomycin did not cause significant changes in tenocyte viability after 2 and 6 hours of incubation at any concentration between 0 and 12,800 µg/mL. Incubation with vancomycin for 24 hours led to a significant decrease in cell viability at higher concentrations. Conclusion: Tenocytes derived from human patellar tendons exposed to relatively high concentrations of vancomycin for short periods of time do not demonstrate significant cell death and toxicity. Clinical Relevance: Exposing tendons to vancomycin for a short period of time, such as before ACL reconstruction, is not likely to cause tenocyte toxicity because of vancomycin administration.
Sterilization regret in India: Is quality of care a matter of concern?
Authors: Bansal Anjali , Dwivedi Laxmi Kant 
Published: September 2020

Abstract
Background
According to United Nations, 19% of females in the world relied only on the permanent method of family planning, with 37% in India according to NFHS-4. Limited studies tried to measure the sterilization regret, and its correlated factors. The study tried to explore the trend of sterilization regret in India from 1992 to 2015 and to elicit the determining effects of various factors on sterilization regret, especially in context to perceived quality of care in the sterilization operations and type of providers.

Data and methods
The pooled data from NFHS-1, NFHS-3 and NFHS-4 was used to explore the regret by creating interaction between time and all the predictors. Predicted probabilities were calculated to show the trend of sterilization regret amounting to quality of care, type of health provider at the three time periods.

Results
The sterilization regret was increased from 5 % in NFHS-1 to 7 % in NFHS-4. According to NFHS-4, for those whose sterilization was performed in private health facility the regret was found to be less (OR-0.937; 95% CI- (0.882–0.996)) compared to public health facility. Also, the results show a two-fold increase in regret when women reported bad quality of care. The results from predicted probabilities provide enough evidence that the regret due to bad quality of care in sterilization operation had increased with each subsequent round of NFHS.

Conclusion
Many socio-economic and demographic factors have influenced the regret, but the poor quality of care contributed maximum to the regret from 1992 to 2015. The health facilities have seriously strayed from improving the health and well-being of women in providing the family planning methods. In addition, to public facilities, the regret amounting to private facilities have also increased from NFHS-1 to 4. The quality of care provided in the family planning operation should be standardized in every hospital to strengthen the health systems in the country. The couple should be motivated to adopt more of spacing methods.
Evaluation of the prognostic value of the neutrophil to lymphocyte ratio, lactate dehydrogenase enzyme, and proteinuria in patients with acute pancreatitis admitted at Assiut University Hospitals and its correlation with Ranson’s criteria scoring system
Authors: Ahmed Lobna Abdel-wahid , Kelani Abd-Alla Ismail Ali , Nasr-Allah Fady Refaat Edwar 
Published: September 2020

Abstract
Background
Acute pancreatitis is a relatively common acute medical presentation that may progress beyond the pancreas to cause multi-organ failure or death. It is associated with high morbidity and mortality with mortality rates changing little in the past few decades despite advances in intensive care and surgical management. Early evaluation of acute pancreatitis severity is essential to allow the clinician to predict the patient’s clinical course, estimate the prognosis, determine the need for intensive care unit admission, and prevent complications. So, the purpose of our study is to evaluate the prognostic value of the neutrophil to lymphocyte ratio, lactate dehydrogenase enzyme, and proteinuria in patients with acute pancreatitis and its correlation with Ranson’s criteria scoring system as new, rapid, and easy parameters to predict severity of acute pancreatitis.

Results
The mean age of patients in years was 47.97, and the median was 52 with a range of ages between 18 and 87; 38% of the patients included were males, and 61% were females. The mean Ranson’s score was 2.77 ± 1.4, and the median was 3 with a range of 0–6; 44.5% of patients included have low severity, 42.4% have mild severity, and 13.1% of patients have high severity. Neutrophil to lymphocyte ratio both at the time of admission and after 48 h of admission was significantly increasing with an increase in disease severity with a P value of < 0.001 that was statistically significant. Lactate dehydrogenase enzyme at the time of admission was also significantly increasing with diseased severity with a P value of 0.001 that was statistically significant and the same for lactate dehydrogenase enzyme level after 48 h of admission with a P value of 0.002 that was also statistically significant. Proteinuria is positive only in 15.2% of patients and with the same result after 48 h of admission.

Conclusion
The neutrophil to lymphocyte ratio gives a rapid impression of the extent of the inflammatory process, and it can effectively predict severity at the time of admission and even after 48 h of admission and can also differentiate between patients with mild and severe acute pancreatitis in both calcular and non-calcular cause-dependent acute pancreatitis patients. Lactate dehydrogenase can be used to predict severity in calcular cause-dependent acute pancreatitis patients only at the time of admission and after 48 h of admission. Proteinuria in urine analysis on admission and after 48 h does not seem to be a reliable predictor for disease severity in acute pancreatitis.
Subclinical hepatitis C virus infection in Egyptian patients with rheumatic diseases: a multi-center study
Authors: Mahran Safaa Ali , Mohamed Alaa A. A. , Nigm Dalia A. , Rahma M. Z. A. Abu , Abd-Elsalam S. , Hamoud Hesham , Hamdy M. , Risha M. I. , Hamdy Ahmad , Abdelkareem Mohamed M. , Ghanem Saad , Hanafy Mohamed , Moshrif Abdelhafeez , Fehr A. , ElNouby Fatma H. , Osman A. , Hassanien Manal M. 
Published: September 2020

Abstract
Background
Hepatitis C virus (HCV) infection is highly prevalent in Egypt. It was found to be 7.0% in a study done in 2015. There are some studies on the prevalence of HCV in rheumatoid arthritis, but to our knowledge, no previous study was done to detect it in other rheumatologic diseases. This study aims at detecting the prevalence of subclinical HCV infection in Egyptian patients with different rheumatic diseases. In the current study, eight hundred and three patients with different rheumatic diseases collected from five—geographically different—Egyptian rheumatology departments were studied. Patients with known current or previous HCV infection were excluded from the study. Screening for the positive anti-HCV antibodies was done for all patients. Screening for the presence of HCV ribonucleic acid (RNA) was done in patients with positive serology by reverse transcriptase-polymerase chain reaction.

Results
In the studied population, 675 (84.1%) patients were women. The mean age [± SD] was 44.2 [± 12.9] years. Hepatitis C antibody positivity was found in 73 (9.1%) of the patients, while 67 (8.3%) were having positive HCV-RNA quantitative PCR tests. The highest prevalence of seropositive HCV was found in drug-induced vasculitis (DIV) and cryo-vasculitis (100%), while in RA, HCV antibodies and PCR were found to be positive in 9.1% and 8.3% of patients, respectively.

Conclusions
Detection of the presence of HCV infection in 9.1 % of the studied middle-aged Egyptian patients with rheumatologic conditions points to the importance of screening for HCV in such population for early detection and intervention especially for those patients that are planned to start biologic therapy.
Using a Chatbot to Assess Hereditary Cancer Risk
Authors: Welch Brandon M. , Allen Caitlin G. , Ritchie Jordon B. , Morrison Heath , Hughes-Halbert Chanita , Schiffman Joshua D. 
Published: September 2020

PURPOSE We developed a Web-based chatbot (ItRunsInMyFamily.com) to help individuals collect their family health history (FHx) and determine their risk for hereditary cancer. The purpose of the current study was to assess the characteristics of users and identify opportunities to improve the FHx collection tool. METHODS During Family Health History Month (November 2019) we launched an FHx campaign using social media advertisements to raise awareness about hereditary cancers and encourage individuals in the general population to use ItRunsInMyFamily to collect their FHx. Through this campaign, we were able to gather information about users and identify opportunities to improve the tool. RESULTS We reached 14,140 users in November 2019 through online marketing campaigns—Facebook, Google, previous ItRuns users, and Web site marketing. Of those, 3,204 completed the full FHx assessment and received risk recommendations. The campaign targeted women between age 40 and 60 years. Users came from 3,783 counties around the United States, 48 unique cancers were reported among probands, and 79 unique cancers were reported among family members, an average of two and a half cancers per family. CONCLUSION Our results demonstrate that it is possible to gather FHx information at the population level, with high levels of engagement and interest in the topic. There is room for future enhancements and improvements to ItRunsInMyFamily to broaden its reach and encourage individuals to learn about and record their health information.
A novel hypomorphic allele of Spag17 causes primary ciliary dyskinesia phenotypes in mice
Authors: Abdelhamed Zakia , Lukacs Marshall , Cindric Sandra , Omran Heymut , Stottmann Rolf W. 
Published: September 2020

ABSTRACT
Primary ciliary dyskinesia (PCD) is a human condition of dysfunctional motile cilia characterized by recurrent lung infection, infertility, organ laterality defects and partially penetrant hydrocephalus. We recovered a mouse mutant from a forward genetic screen that developed many of the hallmark phenotypes of PCD. Whole-exome sequencing identified this primary ciliary dyskinesia only (Pcdo) allele to be a nonsense mutation (c.5236A&gt;T) in the Spag17 coding sequence creating a premature stop codon (K1746*). The Pcdo variant abolished several isoforms of SPAG17 in the Pcdo mutant testis but not in the brain. Our data indicate differential requirements for SPAG17 in different types of motile cilia. SPAG17 is essential for proper development of the sperm flagellum and is required for either development or stability of the C1 microtubule structure within the central pair apparatus of the respiratory motile cilia, but not the brain ependymal cilia. We identified changes in ependymal ciliary beating frequency, but these did not appear to alter lateral ventricle cerebrospinal fluid flow. Aqueductal stenosis resulted in significantly slower and abnormally directed cerebrospinal fluid flow, and we suggest that this is the root cause of the hydrocephalus. The Spag17Pcdo homozygous mutant mice are generally viable to adulthood but have a significantly shortened lifespan, with chronic morbidity. Our data indicate that the c.5236A&gt;T Pcdo variant is a hypomorphic allele of Spag17 that causes phenotypes related to motile, but not primary, cilia. Spag17Pcdo is a useful new model for elucidating the molecular mechanisms underlying central pair PCD pathogenesis in the mouse.
This article has an associated First Person interview with the first author of the paper.