bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary Tract Infection after Elective Spine Surgery: Timing, Predictive Factors, and Outcomes
Authors: Pertsch Nathan J. , Darveau Spencer C. , Tang Oliver Y. , Toms Steven A. , Weil Robert J. 
Published: November 2020

Study Design.
Retrospective review of prospectively collected data.

Objective.
The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes.

Summary of Background Data.
Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied.

Methods.
We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing.

Results.
A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05–29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09–18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36–9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62–6.41, P = 0.001), but post-discharge UTI was not.

Conclusion.
Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.

Level of Evidence: 3
Influence of Etiology and Onset of Deformity on Spatiotemporal, Kinematic, Kinetic, and Electromyography Gait Variables in Patients with Scoliosis—A Prospective, Comparative Study
Authors: Garg Bhavuk , Gupta Manish , Mehta Nishank , Malhotra Rajesh 
Published: November 2020

Study Design.
Prospective comparative study.

Objective.
The aim of this study was to compare the spatiotemporal, kinematic, kinetic and electromyographic (EMG) gait variables in patients with adolescent idiopathic scoliosis (AIS) and congenital scoliosis and to compare these gait variables of scoliosis patients with healthy controls.

Summary of Background Data.
Earlier studies have solely focussed on the possibility of altered gait patterns in AIS patients; not much light has been shed on the differences in gait patterns in congenital and adolescent scoliosis patients.

Methods.
Forty scoliosis patients (20 each with AIS and congenital scoliosis) and 20 healthy volunteers were prospectively recruited. After thorough clinical and radiological examination, all patients underwent gait analysis in accordance with standard protocols.
The outcome measures included spatiotemporal, kinetic, kinematic and EMG activity. Composite indices for gait analysis—Gait Profile Score (GPS) and Gait Deviation Index (GDI)—were also calculated. Relevant statistical tests were applied to compare the different groups.

Results.
No significant difference was found between the AIS and congenital scoliosis groups with respect to baseline demographic and radiological parameters. The two subgroups of scoliosis patients (AIS and congenital) did not differ significantly with respect to any of the measured gait analysis parameters. However, when compared to the healthy age-matched control group, the scoliosis patients differed significantly with respect to gait speed, stride length, step length, GDI, GPS and peak EMG activation for erector spinae, biceps femoris, semimembranosus, rectus femoris, gastrocnemious, and tibialis anterior.

Conclusion.
Our findings confirm the previous findings of literature regarding the alteration in gait patterns in scoliosis patients when compared to normal individuals. However, the lack of difference in gait analysis variables between AIS and congenital scoliosis patients suggests that this alteration in gait is secondary to the existence of the deformity and does not correlate with the onset or etiology of deformity.

Level of Evidence: 2
Nonsevere Diabetic Ketoacidosis and Adrenal Insufficiency: Exploring the Impact of Glucocorticoid Replacement on Metabolic Outcomes and ICU Length of Stay
Authors: Sheung Nicole , Beechar Arpita , Belalcazar L. Maria 
Published: November 2020

Background:
There is a paucity of clinical data on corticosteroid replacement in patients with adrenal insufficiency who present with nonsevere noncomplicated diabetic ketoacidosis.

Case Summary:
We analyzed five consecutive admissions for diabetic ketoacidosis of mild/moderate severity due to insulin omission in a 21-year-old man with type 1 diabetes and stable Addison disease. Despite similar presentations, the approach to steroid replacement differed: maintenance/moderate doses of hydrocortisone (< 60 mg/d) or high stress-doses (≥ 120 mg/d). Resolution of diabetic ketoacidosis and ICU and hospital length of stay were prolonged when high-dose versus maintenance/moderate glucocorticoids were provided: 45.5, 47.0, and 63.0 versus 12.0, 24.5, and 31 hours, respectively.

Conclusions:
Although our findings remain hypothesis-generating, our case study raises awareness on the importance of categorizing diabetic ketoacidosis by severity and complication status when deciding on the intensity of steroid replacement in patients with stable Addison disease. Excessive glucocorticoid administration may delay the resolution of nonsevere and otherwise noncomplicated diabetic ketoacidosis and prolong ICU and hospital stays.
Safety and efficacy of allogeneic natural killer cell immunotherapy on human immunodeficiency virus type 1 immunological non-responders: a brief report
Authors: Xia Huan , Wang Yin , Sun Hua-Li , Gao Li-Ying , Cao Yu , Zaongo Silvere D. , Zeng Rong-Nan , Wu Hao , Zhang Ming-Jie , Ma Ping 
Published: November 2020

Abstract

Background:
Allogeneic natural killer (NK) cell immunotherapy is recognized as a promising anti-tumor strategy, but whether it plays a role in poor CD4 recovery among human immunodeficiency virus type 1 (HIV-1) infected patients is unknown. This study aimed to investigate the safety and effectiveness of allogeneic NK cells immunotherapy on HIV-1 immunological non-responders (INRs) receiving antiretroviral therapy (ART).

Methods:
From February to April 2018, a prospective, randomized, controlled, open-label clinical trial, which enrolled 20 HIV-1 INRs following specific inclusion criteria, was conducted at Nankai University Second People's Hospital. Participants were randomly allocated (simple randomization 1:1) to either the combined treatment (NK + ART) group (n = 10) or the control (ART) group (n = 10). The allogenic highly activated NK cells from killer cell immunoglobulin-like receptor (KIR)/human leukocyte antigen (HLA)-Cw mismatched healthy donor were prepared (108 cells in each injection) and intravenously infused to each recruited patient of NK+ART group in three courses. Key immune parameters (CD4 count, CD8 count, CD4/CD8 ratio), laboratory tests (count of blood cells, biochemistry panel) and symptoms at baseline and at month 1, 3, 6, 9, 12, and 24 were measured/collected to analyze the safety and efficacy of the therapy. Comparisons were between the seven time-points of both groups using repeated measurement analysis of variance (ANOVA) test. Generalized estimating equations (GEE) model was performed to evaluate the overall effect of the NK+ART group vs. the ART group.

Results:
From baseline to 24 months, we noted a mean CD4 count augmentation (139 to 243 cells/μL) in the NK + ART group and (144 to 176 cells/μL) in the ART group (difference, 67; 95% CI, 10 to 124; P = 0.024). Our estimations revealed that NK+ART group could improve CD4 level (β = 54.59, P = 0.006) and CD8 level (β = 322.47, P = 0.010) on average among the six measurements compared with the ART group. Only two (2/10, 20%) participants in the NK+ART group developed a transient mild fever after the first course.

Conclusions:
This preliminary study informs that HIV-1 INRs, allogenic NK cells immunotherapy is safe and could significantly improve CD4 recovery but not CD4/CD8 ratio. The practical effects, however, need long-term follow-up observations. Further study on the potential underlying mechanism is warranted.

Registration info:

www.chictr.org.cn/showproj.aspx?proj=34912 (No. ChiCTR1900020634).
Immune Checkpoint Markers in Superficial Angiosarcomas: PD-L1, PD-1, CD8, LAG-3, and Tumor-Infiltrating Lymphocytes
Authors: Googe Paul B. , Flores Kyle , Jenkins Francie , Merritt Bradley , Moschos Stergios J. , Grilley-Olson Juneko E. 
Published: November 2020

Abstract:
Cutaneous angiosarcomas may express programmed death ligand-1 (PD-L1) and PD-L1 expression, and the presence of tumor-infiltrating lymphocytes (TILs) correlates with outcome. These observations provide a basis for PD-1/PD-L1 inhibitor therapy. Lymphocyte activation gene 3 (LAG-3) is an inhibitory receptor that interacts with the PD-L1 axis and is considered to be a marker of immune exhaustion. The presence of LAG-3–positive lymphocytes in cutaneous angiosarcoma has not been established. We reviewed 10 cases of treatment naive angiosarcoma of skin and superficial soft tissue and assessed for PD-L1 (ZR3) expression, presence of TILs, and expression of CD8, PD1, and LAG-3 by tumor-associated inflammatory cells by immunohistochemistry. All 10 angiosarcomas were positive for PD-L1: 7 with high expression and 3 with low expression. TILs were present in all tumors: brisk in 7 and nonbrisk in 3. CD8 lymphocytes were present in all tumors with a range of 212–1274 cells per square millimeter (mean 557 CD8 cells/mm2). LAG-3–positive lymphocytes were present in 9 of 10 angiosarcomas with a range of 0–728 cells/mm2 (mean 146 LAG-3 cells cells/mm2). The ratio of LAG-3 lymphocytes to CD8 lymphocytes was 0%–59% (mean 27%). The PD1 cell counts were intermediate between CD8 and LAG3 counts. Cutaneous angiosarcomas frequently express PD-L1, have prominent numbers of CD8 positive, and have smaller numbers of LAG-3–positive and PD-1–positive TILs. Our findings provide further evidence of PD-L1 expression in cutaneous angiosarcoma and the promise for immune checkpoint inhibitor therapy.
Topical Erythropoietin as a Novel Treatment for Necrotizing Scleritis After Pterygium Surgery: A Pilot Study
Authors: Feizi Sepehr , Javadi Mohammad Ali 
Published: November 2020

Purpose:
To share our initial experience with the innovative use of topical erythropoietin for the treatment of necrotizing scleritis manifesting immediately after pterygium excision surgery.

Methods:
This study enrolled 3 patients who developed necrotizing scleritis immediately after undergoing pterygium excision. All cases with pterygium were primary, and topical mitomycin C and conjunctival autografts were used at the time of surgery. Noninvasive therapy that included ophthalmic lubricants and topical and systemic corticosteroids failed to improve the avascular scleral lesions. The patients were prescribed erythropoietin-containing drops (3000 U/mL) every 6 hours in addition to topical antibiotics and lubricant. The effect of topical erythropoietin on the healing process of avascular scleral lesions was investigated, and its ocular and systemic side effects were evaluated.

Results:
The mean age of the participants was 69.0 ± 14.8 years, and 2 of the 3 eyes belonged to male subjects. The time between pterygium surgery and presentation to our clinic was 33.0 ± 14.7 days. There were no infectious causes or underlying systemic diseases in any of the cases. After treatment with topical erythropoietin for an average of 34.3 ± 20.3 days, the lesions were completely vascularized in all 3 eyes without any ocular or systemic adverse effects. The patients were followed up for an average of 126 ± 94 days after discontinuation of erythropoietin. There was no evidence of recurrence during the last examination in any of the eyes.

Conclusions:
Topical erythropoietin might be a safe and an effective method for treating cases of necrotizing scleritis that manifests immediately after pterygium surgery.
Novel Evidence Concerning Lacrimal Sac Movement Using Ultra-High-Frequency Ultrasound Examinations of Lacrimal Drainage Systems
Authors: Bohman Elin , Berggren Johanna , Bunke Josefine , Albinsson John , Engelsberg Karl , Dahlstrand Ulf , Hult Jenny , Hasegawa Hideyuki , Cinthio Magnus , Sheikh Rafi 
Published: November 2020

Purpose:
Current hypothesis regarding the mechanism of active tear drainage is based on studies performed ex vivo or under nonphysiological conditions. Novel ultra-high-frequency ultrasound has the advantage of generating images with superior resolution, enabling measurements of low flow in small vessels, and the tracking of tissue motion in real time. The purpose of this study was to investigate the lacrimal drainage system and active drainage using this modality.

Methods:
The upper lacrimal drainage system was investigated with 40–70 MHz ultrasound in 22 eyes in 13 patients. Irrigation confirmed a lacrimal obstruction in 10 eyes. Motion tracking was used to map movement of the lateral lacrimal sac wall and to measure flow when possible.

Results:
The anatomy of the upper lacrimal drainage system was mapped in vivo, including the proximal canaliculi, which have not previously been imaged. The lacrimal sac lumen is slit shaped in its resting state but is distended when irrigated or if a nasolacrimal duct obstruction is present. Thus, the healthy lacrimal sac is not a cavity, and the medial retinaculum does not act against a stretched structure. Motion tracking visualized the “lacrimal pump,” showing that the direction of motion of the lateral lacrimal sac wall is mainly in the sagittal plane during blinking.

Conclusions:
Ultra-high-frequency ultrasound allows detailed physiological monitoring of the upper lacrimal drainage system in vivo. Our findings suggest that current theories of active tear drainage need to be reappraised.
Frontalis Suspension Using Autologous Fascia Lata in Children Under 3 Years Old
Authors: García-Cruz Ignacio , Barrancos Constanza , Alonso-Formento Nieves , Albandea Ana Rosa , Losada-Bayo Diego , García-Ruiz Oscar Andree , Sales-Sanz Marco 
Published: November 2020

Purpose:
To analyze functional results and complications of the use of autologous fascia lata in frontalis suspension in children under 3 years old and to confirm its technical viability.

Methods:
A retrospective review of 8 patients (12 eyes) who underwent frontalis suspension using autologous fascia lata sling.

Results:
Twelve eyes of 8 patients were analyzed, with an average age of 1.8 ± 0.6 years. Preoperatively, the mean margin-to-reflex distance 1 was −0.17 ± 0.577 mm. Postoperatively the mean margin-to-reflex distance 1 was 2.66 ± 0.492 mm without any graft donor site or corneal complications. No recurrence was recorded in the follow-up period (mean follow-up period 28.5 ± 32.33 months).

Conclusions:
Autologous fascia lata is an eligible material in frontalis suspension in children under 3 years old, despite the traditional oculoplastic dogma that advises against.
Ophthalmic Presentation of Undiagnosed Sinonasal Masses
Authors: Vahdani Kaveh , Rose Geoffrey E. 
Published: November 2020

Aims:
To evaluate clinical features of patients who first present with orbital symptoms and signs due to undiagnosed sinonasal pathology.

Patients and methods:
Retrospective chart review for patients seen at Moorfields Eye Hospital between 1969 and 2020. Patient demographics and clinical features were reviewed.

Results:
Four hundred and forty-eight patients (250 males; 56%) presented to ophthalmologists with undiagnosed sinonasal pathologies, the patients attending at an average age of 47 years and having first symptoms at an average age of 46 years. The commonest presenting symptoms were proptosis (153 patients; 34%), orbital ache or pain (133; 31%), periorbital swelling (130; 29%), and diplopia (98; 22%). Eighty-seven patients (20%) had a corrected acuity of 6/18 or worse, and 66 (16%) had an ipsilateral relative afferent pupillary defect. There was 2.3 mm relative exophthalmos (median 2 mm; range 0–17 mm) in patients with unilateral disease, an orbital mass was palpable in 218 patients (49%), ocular movements were reduced in 252/448 (56%), and nonaxial displacement of the globe was recorded in 296/424 (74%). The commonest pathologies were sinus mucoceles (38%), sinus carcinoma (11%), and granulomatous polyangiitis (10%). Multivariate regression analysis of mass lesions identified periorbital pain (odds ratio, 6.0; 95% confidence interval, 1.7–21.5; P = 0.005) and reduced motility (odds ratio, 3.2; 95% confidence interval, 1.1–9.0; P = 0.03) as features most predictive for undiagnosed sinonasal malignancy.

Conclusion:
This study describes a large group of patients in whom unknown midfacial masses presented initially to the ophthalmologist: Mucoceles and sinonasal malignancy were the commonest lesions, and nonaxial globe displacement—particularly inferolateral, lateral, or upward—is commonly associated with sinonasal pathology. Pain and reduced ocular movements significantly favor a malignant, rather than benign, tumor.
Malignant Cutaneous Adnexal Tumor in Posterior Occipital Region of a Child: A Case Report
Authors: Zhu Jian-Jian , Li Xin , Long Jian , He Ping 
Published: November 2020

Introduction:
The most common cutaneous adnexal tumors in children were follicular, especially pilomatricoma, and a few were predominant glandular/ductal differentiation, malignant forms are occasionally encountered. Here, a case of a malignant cutaneous adnexal tumor with eccrine differentiation was reported.

Case presentation:
A 10-year-old male child was presented with a nodular in posterior occipital for half a year with no symptoms. Histopathology showed there was acanthosis in epidermis, partially with local ulceration and crusting; and in the dermis, there was irregular scattered or agglomerated infiltration of diffused epithelial cells, partly presenting as basaloid, but no obvious peripheral palisading arrangement; and in the center there was extensive necrosis; cellular pleomorphism, scattered mitotic figures, focal clear cell areas, and adenoid differentiation can also be seen, there was scattered infiltration of mixed inflammatory cells in the stroma. Immunohistochemistry showed cytokeratin (CK) 5/6+, CK 8/18+, epithelial membrane antigen +, gata3 transcription factor 3+, cell adhesion15 (focal +), Ki67 (+, 30%), carcinoembryonic antigen (focal+), CK 7 (focal+), gross cystic disease fluid protein-15−, P63+, S-100−. Final diagnosis was the malignant cutaneous adnexal tumor with eccrine differentiation, most likely the nodular clear cell hidradenocarcinoma. The patient has no special discomfort follow-up observation after extended resection and lymph node examination.

Discussion:
The histopathology showed infiltrative growth pattern, deep extension, necrosis, nuclear pleomorphism, mitoses, desmoplastic stromal reaction and the clear cell area and adenoid differentiation. Immunohistochemistry was positive for CK8/18, EMA, CK5/6, P63, gata3 transcription factor 3 and negative for S-100 and GCDFP-15, some gland-derived markers such as CK7, CEA were focal positive, and we have not found the preexisting benign poroma and porocarcinoma in situ, so we preferred the diagnosis of hidradenocarcinoma. The differential diagnosis such as porocarcinoma, clear cell squamous cell carcinoma, and basal cell carcinoma were taken into account.

Conclusion:
The diagnosis was challenging by clinical manifestations. Histopathology and immunohistochemistry should be combined with clinical presentation, history to reach the final diagnose.
Clinical Retrospective Analysis of 340 Inpatients with Malignant Skin Tumors in Western Inner Mongolia
Authors: Jia Min-Xin , Li Dong-Xia , Liu Yu-Lei 
Published: November 2020

Abstract

Objective:
This study was performed to evaluate the clinical and epidemiological characteristics of inpatients with malignant skin tumors in western Inner Mongolia during the past 10 years.

Methods:
We collected the clinical data of inpatients with histopathologically diagnosed malignant skin tumors admitted to the Affiliated Hospital of Inner Mongolia Medical University from June 2008 to December 2018. Morbidity was compared using the Chi-square test.

Results:
In total, 340 inpatients with malignant skin tumors were evaluated, including 163 (47.94%) patients with basal cell carcinoma, 134 (39.41%) with squamous cell carcinoma, 5 (1.47%) with malignant melanoma, 21 (6.18%) with Bowen disease, and 6 (1.76%) with Paget's disease. Four (1.18%) patients had metastatic skin cancer and seven (2.06%) had other malignant skin tumors. The patients comprised 132 (38.8%) men and 208 (61.1%) women, and there were no statistically significant sex-related differences among the skin malignancies (x
2 = 5.006, P > 0.05). Among the 340 patients, 314 (92.4%) were of Han nationality and 26 (7.6%) were of ethnic minorities. Statistically significant differences were found in the various types of malignant skin tumors between the Han and minority groups (x
2 = 19.446, P < 0.05). Among the selected patients, 61.76% were farmers and herdsmen, and the sites mainly affected were the head, face, neck, trunk, limbs, and vulva.

Conclusion:
The incidence of malignant skin tumors in western Inner Mongolia has substantially increased during the past decade, especially in the past 2 years. Therefore, we should increase the awareness of prevention and treatment of malignant skin tumors to achieve early diagnosis and treatment effects.