bluuebunny/crossref_metadata_2025_split huggingface dataset:
Admission Hemoglobin Levels Are Associated With Functional Outcome in Spontaneous Intracerebral Hemorrhage
Authors: Acosta Julián N. , Leasure Audrey C. , Kuohn Lindsey R. , Both Cameron P. , Petersen Nils H. , Sansing Lauren H. , Matouk Charles C. , Testai Fernando , Langefeld Carl D. , Woo Daniel , Kamel Hooman , Murthy Santosh B. , Qureshi Adnan , Mayer Stephan A. , Sheth Kevin N. , Falcone Guido J. 
Published: February 2021

OBJECTIVES:
To test the hypothesis that admission hemoglobin levels are associated with outcome in primary, nontraumatic intracerebral hemorrhage.

DESIGN:
Individual patient data meta-analysis of three studies of intracerebral hemorrhage.

SETTING:
Two randomized clinical trials and one multiethnic observational study.

PATIENTS:
Patients with spontaneous, nontraumatic intracerebral hemorrhage.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Our exposure of interest was admission hemoglobin levels and the primary outcome was 3-month postintracerebral hemorrhage-dichotomized modified Rankin Scale (0–3 vs 4–6). Intermediate outcomes were admission hematoma volume and hematoma expansion defined as 6 mL or 33% increase in hemorrhage size on repeat CT. A total of 4,172 intracerebral hemorrhage patients were included in the study (mean age 63 [sd = 14]; female sex 1,668 [40%]). Each additional g/dL of admission hemoglobin was associated with 14% (odds ratio, 0.86; 95% CI, 0.82–0.91) and 7% (odds ratio, 0.93; 95% CI, 0.88–0.98) reductions in the risk of poor outcome in unadjusted and adjusted analyses, respectively. Dose-response analyses indicated a linear relationship between admission hemoglobin levels and poor outcome across the entire evaluated range (test-for-trend p < 0.001). No consistent associations were found between the admission hemoglobin levels and hematoma volume or hematoma expansion.

CONCLUSIONS:
Higher hemoglobin levels are associated with better outcome in intracerebral hemorrhage. Further research is needed to evaluate admission hemoglobin levels as both a therapeutic target and predictor of outcome.
Myasthenia Symptom Burden, Fatigue, and Sleep: Are They Related?
Authors: Yang Sarah , Miglis Mitchell G. , Jaradeh Safwan , Muppidi Srikanth 
Published: February 2021

Abstract

Objective:
Our aim is to explore the relationship between myasthenia gravis (MG)-related symptom burden, sleep quality, and fatigue in a diverse group of self-identified MG patients.

Methods:
Patients provided relevant myasthenia disease data and completed the MG QOL-15, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, and fatigue severity score (FSS) online. MG activities of daily living scale (MG-ADL) was completed on a follow-up telephone interview.

Results:
One hundred ninety-six patients completed the online survey and 99 provided MG-ADL data. The mean age was 52 ± 15.34 years, 88 were acetylcholine receptor antibody positive, and 21 were muscle specific kinase positive. The mean MG-ADL was 6.81, indicating a moderate MG disease burden. Forty-seven (24%) reported high Epworth sleepiness scale scores, 152 (77%) reported high Pittsburgh Sleep Quality Index scores, and 162 (82%) reported high FSS scores. Correlation analysis correcting for body mass index and sleep apnea revealed a moderate positive correlation between MGQOL-15, MG-ADL, and FSS.

Conclusions:
There is a moderate positive correlation between various MG-specific outcome measures and fatigue severity.
Delivery of Nusinersen Through an Ommaya Reservoir in Spinal Muscular Atrophy
Authors: Iannaccone Susan T. , Paul Dustin , Castro Diana , Weprin Bradley , Swift Dale 
Published: February 2021

Abstract

Objective:
Spinal muscular atrophy (SMA) is a common rare neuromuscular disease responsible for very high mortality during infancy and high morbidity during childhood and adolescence. It is caused by autosomal recessive mutations in the survival motor neuron gene. In 2016, the Food and Drug Administration approved the first disease modifying therapy for use in all patients of any age. Nusinersen is an antisense oligonucleotide that showed dramatic benefits with achievement of motor milestones in infants and improved gross motor function in children.

Methods:
This was a retrospective chart review of all SMA patients seen at a single site between 2016 and 2020 for treatment with nusinersen.

Results:
We report 8 patients who underwent placement of an Ommaya reservoir and lumbosacral catheter for drug delivery. Complications included infection and revisions due to catheter separation. One patient required fluoroscopy for injections because of location of port site.

Conclusion:
We conclude that placement of an Ommaya port is a viable option for patients who have challenges for access to intrathecal space. Practical innovations have the potential to control administration costs, achieve therapeutic value, and promote patient safety.
Myotonic Muscular Dystrophy Type 2 in CT, USA: A Single-Center Experience With 50 Patients
Authors: Roy Bhaskar , Wu Qian , Whitaker Charles H. , Felice Kevin J. 
Published: February 2021

Abstract
Myotonic dystrophy type 2 (DM2) is an autosomal dominant disorder due to a (CCTG)n repeat expansion in intron 1 of the CNBP gene. In this article, we report the clinicopathologic findings in 50 patients seen at a single site over a 27 year period. DM2 was the fifth most common type of muscular dystrophy seen at our center with a 5-fold lower frequency as compared to DM1. Age of symptom onset ranged from 15 to 72 years, and the mean duration between symptom onset and diagnosis was 7.4 years. Weakness referable to the proximal lower extremities was the presenting symptom in 62% of patients. The degree of generalized weakness varied from severe in 30% to no weakness in 20% of patients. Clinical myotonia was noted in 18% and myotonic discharges on electromyography in 97% of patients. Pain symptoms were uncommon in our cohort. A significant correlation was noted between limb weakness and degree of muscle pathologic changes. There was no correlation between CCTG repeat size and other clinicopathologic findings. Six patients (12%) had cardiac abnormalities including one who developed progressive nonischemic dilated cardiomyopathy ultimately leading to cardiac transplantation. In 21 patients followed for 2 or more years, we noted a mean rate of decline in total Medical Research Council score of about 1% per year.
Combining Effect Estimates Across Cohorts and Sufficient Adjustment Sets for Collaborative Research
Authors: Hamra Ghassan B. , Lesko Catherine R. , Buckley Jessie P. , Jensen Elizabeth T. , Tancredi Daniel , Lau Bryan , Hertz-Picciotto Irva ,   on behalf of program collaborators for Environmental influences on Child Health Outcomes
Published: February 2021

Background:
Collaborative research often combines findings across multiple, independent studies via meta-analysis. Ideally, all study estimates that contribute to the meta-analysis will be equally unbiased. Many meta-analyses require all studies to measure the same covariates. We explored whether differing minimally sufficient sets of confounders identified by a directed acyclic graph (DAG) ensures comparability of individual study estimates. Our analysis applied four statistical estimators to multiple minimally sufficient adjustment sets identified in a single DAG.

Methods:
We compared estimates obtained via linear, log-binomial, and logistic regression and inverse probability weighting, and data were simulated based on a previously published DAG.

Results:
Our results show that linear, log-binomial, and inverse probability weighting estimators generally provide the same estimate of effect for different estimands that are equally sufficient to adjust confounding bias, with modest differences in random error. In contrast, logistic regression often performed poorly, with notable differences in effect estimates obtained from unique minimally sufficient adjustment sets, and larger standard errors than other estimators.

Conclusions:
Our findings do not support the reliance of collaborative research on logistic regression results for meta-analyses. Use of DAGs to identify potentially differing minimally sufficient adjustment sets can allow meta-analyses without requiring the exact same covariates.
Tropical Cyclone Exposures and Risks of Emergency Medicare Hospital Admission for Cardiorespiratory Diseases in 175 Urban United States Counties, 1999–2010
Authors: Yan Meilin , Wilson Ander , Dominici Francesca , Wang Yun , Al-Hamdan Mohammad , Crosson William , Schumacher Andrea , Guikema Seth , Magzamen Sheryl , Peel Jennifer L. , Peng Roger D. , Anderson G. Brooke 
Published: February 2021

Background:
Although injuries experienced during hurricanes and other tropical cyclones have been relatively well-characterized through traditional surveillance, less is known about tropical cyclones’ impacts on noninjury morbidity, which can be triggered through pathways that include psychosocial stress or interruption in medical treatment.

Methods:
We investigated daily emergency Medicare hospitalizations (1999–2010) in 180 US counties, drawing on an existing cohort of high-population counties. We classified counties as exposed to tropical cyclones when storm-associated peak sustained winds were ≥21 m/s at the county center; secondary analyses considered other wind thresholds and hazards. We matched storm-exposed days to unexposed days by county and seasonality. We estimated change in tropical cyclone-associated hospitalizations over a storm period from 2 days before to 7 days after the storm’s closest approach, compared to unexposed days, using generalized linear mixed-effect models.

Results:
For 1999–2010, 175 study counties had at least one tropical cyclone exposure. Cardiovascular hospitalizations decreased on the storm day, then increased following the storm, while respiratory hospitalizations were elevated throughout the storm period. Over the 10-day storm period, cardiovascular hospitalizations increased 3% (95% confidence interval = 2%, 5%) and respiratory hospitalizations increased 16% (95% confidence interval = 13%, 20%) compared to matched unexposed periods. Relative risks varied across tropical cyclone exposures, with strongest association for the most restrictive wind-based exposure metric.

Conclusions:
In this study, tropical cyclone exposures were associated with a short-term increase in cardiorespiratory hospitalization risk among the elderly, based on a multi-year/multi-site investigation of US Medicare beneficiaries ≥65 years.
For nasotracheal intubation, which nostril results in less epistaxis: right or left?
Authors: Tan Ying-Lun , Wu Zhu-Hao , Zhao Bao-Jian , Ni Yan-Hong , Dong Ying-Chun 
Published: February 2021

BACKGROUND
Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear.

OBJECTIVE
When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia.

DESIGN
A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time.

DATA SOURCES
PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020.

ELIGIBILITY CRITERIA
The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia.

RESULTS
Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference −7.28 (−14.40 to −0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference −0.59 (−1.95 to 0.77) s, P = 0.40.

CONCLUSION
On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time.

TRIAL REGISTRATION
The study protocol has been registered in PROSPERO (CRD42020169949).
Recovery of lower oesophageal barrier function: a pilot study comparing a mixture of atropine and neostigmine and sugammadex
Authors: Suganuma Emiri , Ishikawa Teruhiko , Kitamura Yuji , Hayashida Taiichiro , Matsumura Tomoaki , Fujie Mai , Nozaki-Taguchi Natsuko , Sato Yasunori , Isono Shiroh 
Published: February 2021

BACKGROUND
The lower oesophageal sphincter (LOS) barrier serves to prevent regurgitation of gastric contents. Although general anaesthesia depresses its function, its recovery process during emergence from anaesthesia has not been systematically examined.

OBJECTIVE
To explore whether recovery of lower oesophageal barrier function differed between patients receiving a mixture of 1 mg atropine and 2 mg neostigmine and those receiving 2 mg kg−1 sugammadex during emergence from anaesthesia.

DESIGN
An unblinded randomised controlled pilot study.

SETTING
A single university hospital from January 2016 to December 2018.

PATIENTS
A total of 20 non-obese adult females undergoing minor surgery.

INTERVENTION
The patients were randomly assigned to a group either receiving atropine and neostigmine or sugammadex for reversal of rocuronium.

MAIN OUTCOME MEASURES
Through use of the high-resolution manometry technique, the lower oesophageal barrier pressure (PBAR: primary variable) defined as a pressure difference between pressures at the LOS and the stomach was measured at five distinguishable time points during emergence from total intravenous anaesthesia. A mixed effects model for repeated measures was used to test the hypothesis.

RESULTS
In all patients baseline PBAR values were positive even under muscle paralysis and general anaesthesia before administration of reversal agents, and did not differ between the groups (P = 0.299). During recovery from muscle paralysis and general anaesthesia, PBAR (mean ± SD) significantly increased (P = 0.004) from 17.0 ± 2.9 to 21.0 ± 5.0 mmHg in the atropine and neostigmine group (n = 8) and from 19.1 ± 9.0 to 24.5 ± 12.7 mmHg in the sugammadex group (n = 11). PBAR significantly increased immediately after return of consciousness in both groups, whereas return of muscle tone, lightening of anaesthesia and tracheal extubation did not change it.

CONCLUSION
Recovery of the lower oesophageal barrier function does not differ between patients receiving either atropine and neostigmine or sugammadex and is completed after recovery of consciousness from general anaesthesia.

TRIAL REGISTRATION
UMIN Clinical Trials Registry: UMIN000020500: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000023594&type=summary&language=E
Body position and the effectiveness of mask ventilation in anaesthetised paralysed obese patients
Authors: Chang Jee-Eun , Seol Taikyung , Hwang Jin-Young 
Published: February 2021

BACKGROUND
Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics.

OBJECTIVE
The aim of this study was to evaluate the 25° semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients.

DESIGN
A randomised, cross-over study.

SETTING
Medical centre managed by a university tertiary hospital.

PATIENTS
Thirty-eight obese adults scheduled for general anaesthesia.

METHODS
After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25° semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH2O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight.

MAIN OUTCOMES
Exhaled tidal volume (ml kg−1), respiratory minute volume (ml kg−1 min−1), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg−1, or absence of end-tidal CO2 recording.

RESULTS
Exhaled tidal volume (mean ± SD) in the 25° semi-sitting position was higher than in the supine position, 9.3 ± 2.7 vs. 7.6 ± 2.4 ml kg−1; P less than 0.001. Respiratory minute volume was improved in the 25° semisitting position compared with that in the supine position, 139.6 ± 40.7 vs. 113.4 ± 35.7 ml kg−1 min−1; P less than 0.001.

CONCLUSION
The 25° semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients.

TRIAL REGISTRY NUMBER
ClinicalTrials.gov (NCT03996161).
Use of Flap Salvage for Lower Extremity Chronic Wounds Occurs Most Often in Competitive Hospital Markets
Authors: Fan Kenneth L. , Singh Tanvee , Bekeny Jenna C. , Zolper Elizabeth G. , Dekker Paige K. , Attinger Christopher E. , Evans Karen K. , DeLia Derek 
Published: February 2021

Background:
Wounds in the comorbid population require limb salvage to prevent amputation. Extensive health economics literature demonstrates that hospital activities are influenced by level of market concentration. The impact of competition and market concentration on limb salvage remains to be determined.

Methods:
Admissions for chronic lower extremity wounds in nonrural hospitals were identified in the 2010–2011 National Inpatient Survey using ICD-9-CM diagnosis codes. The study cohort consisted of admitted patients receiving amputations, salvage without flap techniques (eg, skin grafts), or salvage with flap techniques. The all-service Herfindahl–Hirschman Index (HHI), which is a commonly used tool for market and antitrust analyses, was used to measure hospital competition. Multinomial regression analysis accounting for the complex survey design of the NIS was used to determine the relationship between the HHI and hospital adoption of limb salvage controlling for patient, hospital, and market factors.

Results:
The study cohort represents 124,836 admissions nationally: 89,880 amputations, 26,715 salvage without flap techniques, and 8241 salvage flap techniques. Diabetics accounted for 64.1% of all study admissions. Hospitals in highly competitive markets performed more flaps for chronic lower extremity wounds than noncompetitive markets. Controlling for other factors, hospitals in highly competitive markets, relative to those in highly concentrated markets, were 2.48 percentage points more likely to perform limb salvage with flaps (P < 0.01). Other factors were less predictive.

Conclusion:
Increased hospital competition is the strongest systems-level predictor of receipt of lower extremity flaps among patients with chronic wounds. Improving access to reconstructive limb services must consider the competitive structure of hospital markets.
Preoperative Long-term Therapeutic Subcutaneous Heparin Administration into Abdomen: Possible Cause for Nonobstructive Microvascular Flap Failure
Authors: Rhobaye Saif , Malahias Marco N. , Youssif Sherif , Alsharkawy Kareem , Kalkat Maninder , Khalil Haitham H. 
Published: February 2021

Summary:
The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. The authors report a case of nonobstructive microvascular failure of a free muscle sparing transverse rectus abdominis muscle utilized for soft tissue coverage following resection of a chest wall breast cancer recurrence on a background of portacath-induced deep venous thrombosis of the axillary and subclavian vein whilst on chemotherapy. History of long-term therapeutic low molecular weight heparin administration in the abdomen resulted in microangiopathic densities evident on computerized tomography scan with subsequent flap failure due to possible jeopardization of the flap microvasculature and perfusion. Following exclusion of common local and systemic factors that can cause vascular compromise, a debridement and salvage re-reconstruction procedure utilizing a contralateral free latissimus dorsi flap was performed. Reconstructive surgeons should be cautious when planning to utilize free abdominal-based flaps on the background of long-term therapeutic low molecular weight heparin administration in the abdomen and may possibly explore other alternative options of using non-abdominal free flaps from the reconstructive armamentarium within this unique context.
EARLY DESCRIPTIONS OF VITREOUS SURGERY
Authors: Grzybowski Andrzej , Kanclerz Piotr 
Published: February 2021

Background:
Vitreoretinal surgical techniques have evolved during the last decades because of the development and evolution of pars plana vitrectomy. The introduction of modern vitrectomy is credited to Robert Machemer (1933–2009). The aim of this review is to characterize the early developments of vitreous removal.

Methods:
We used the PubMed web platform to search the terms: complications of cataract surgery, vitrectomy, vitreous body, vitreous humor, vitreous humour, vitreous tap, and vitreous transplantation. Other publications were also considered as a potential source of information when referenced in relevant articles.

Results:
The first description of vitreous removal for treatment of eye disorders dates the 17th century; it was conducted by a Dutch surgeon Anton Nuck (1650–1692) in a case of hydrophthalmia. In English literature, the first description of vitrectomy is attributed to the American surgeon John Collins Warren (1778–1856). This method was implemented in the spontaneous dislocation of the crystalline lens. As the fibrillar structure of the vitreous once destroyed could not be regenerated, the researchers aimed to restore the chemical composition of the vitreous. For several decades, vitreous transplantation was performed for the treatment of vitreous hemorrhages and retinal detachment.

Conclusion:
Although the achievements of vitreoretinal surgery preceding Machemer's inventions are uncommonly reported, they have contributed to the concept and understanding of the treatment modalities.