bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Relief After Selective Nerve Root Block as a Predictor of Postoperative Functional Outcome in Patients with Degenerative Lumbar Spinal Stenosis Patients Undergoing Decompressive Surgery
Authors: Ko Sangbong , Jun ChungMu , Min Woo-Kie , Son Eunseok , Lee Sukjoong , Lee Gun Woo , Yoo Hyunseung 
Published: September 2021

Study Design.
Retrospective study of data collected prospectively.

Objective.
To investigate changes in the degree of lower leg radiating pain (LLRP) after selective nerve root block (SNRB) and to evaluate associations of this change with postoperative improvements in symptom severity, functional outcomes, and quality of life.

Summary of Background Data.
SNRB is routinely performed as an initial treatment for lumbar foraminal or lateral recess stenosis with LLRP. The degree of improvement after SNRB has been suggested to predict the improvement in postoperative pain and functional outcomes. However, there have been no studies on the predictive value of this parameter.

Methods.
We enrolled 60 patients who underwent SNRB followed by decompressive surgery. They were divided into three groups. The degree of improvement was evaluated as a percentage of the pre-injection values. Functional outcomes of the spine were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ). Quality of life was assessed using the 36-item Short Form Survey (SF-36) physical component score (PCS) and mental component score (MCS). The degree of LLRP was measured preoperatively and at 6, 12, and 24 months after surgery. These functional outcomes were evaluated preoperatively and at 12 and 24 months after surgery.

Results.
The improvement in LLRP in the short term (6 hours after SNRB) was found to be statistically significantly associated with the improvement in LLRP at 12 months after SNRB (P = 0.044, correlation coefficient = 0.261). No relationship between pain improvement after SNRB and functional outcome was identified.

Conclusion.
The degree of improvement in symptoms 6 hours after SNRB can predict the degree of improvement in LLRP at 12 months after surgery. However, symptomatic improvement after SNRB does not predict postoperative functional outcome or quality of life.

Level of Evidence: 4
Efficacy and Safety of Gemcitabine Plus Cisplatin as Potential Preoperative Chemotherapy in Locally Advanced Intrahepatic, Perihilar, and Mid-Cholangiocarcinoma
Authors: Nooijen Lynn E. , Franken Lotte C. , Belkouz Ali , Oulad Abdennabi Ikrame , Besselink Marc G. , Busch Olivier R. , Swijnenburg Rutger-Jan , Klümpen Heinz-Josef , Erdmann Joris I. 
Published: September 2021

Background:
In this retrospective cohort study, the potential of gemcitabine (gem)/cisplatin (cis) chemotherapy as future preoperative therapy for patients with unresectable locally advanced or borderline resectable intrahepatic, perihilar, and mid-cholangiocarcinoma was investigated.

Methods:
All patients with intrahepatic, perihilar, and mid-cholangiocarcinoma presented at Amsterdam UMC between January 2016 and October 2019 were included. The radiologic response after 3 and/or 6 cycles of gem/cis chemotherapy in patients with unresectable locally advanced or borderline resectable disease was derived from the original radiologic reports and subsequently re-evaluated for surgical exploration by consensus reading of 2 HPB surgeons and 1 radiologist.

Results:
Overall, 65 of 364 patients had a locally advanced or borderline resectable disease. Twenty-eight patients were treated with palliative chemotherapy, including 25 (89.3%) patients who received more than 3 cycles. Twenty-two patients (88.0%) and 13 patients (46.4%) showed RECIST stable disease or partial response after 3 and 6 cycles of chemotherapy, respectively. Three patients experienced grade 3 adverse events. Consensus reading concluded that exploration could have been reconsidered in 7 of 28 patients (25.0%).

Conclusion:
Gem/cis may be a safe and feasible preoperative treatment in initially unresectable locally advanced or borderline resectable cholangiocarcinoma. In addition, the findings of this study support to always rediscuss patients with stable or responsive disease in multidisciplinary team meetings to reconsider resection. Besides, prospective studies are needed to investigate this effect further and, based on these preliminary data, seem feasible in this setting.
Automated Microneedling Versus Fractional CO2 Laser in Treatment of Traumatic Scars: A Clinical and Histochemical Study
Authors: Esmat Samia , Shokeir Hisham Ali , Samy Nevien Ahmed , Mahmoud Sara Bahaa , Sayed Safinaz Salah EL Din , Shaker Enas , Hilal Rana Fathy 
Published: September 2021

BACKGROUND/OBJECTIVES
Microneedling has shown satisfactory effects in scar rejuvenation. Comparisons of its results with fractional laser are limited. This study aims to compare the efficacy and safety of automated microneedling versus fractional carbon dioxide (CO2) laser in treatment of traumatic scars on clinical and histochemical bases.

MATERIALS AND METHODS
Thirty patients with traumatic facial scars were randomized to treatment with 4 monthly sessions of either automated microneedling or fractional CO2 laser. Assessment of scars was performed at baseline and 3 months after the last treatment session, clinically by the modified Vancouver Scar Scale (mVSS) and histochemically by quantitative assessment of collagen and elastic fibers.

RESULTS
Both groups showed improvement in mVSS, collagen, and elastin contents after treatment. Percentage improvement of collagen and elastin content was higher after treatment by a laser compared with microneedling, in case of the collagen content. Percentage increase in the collagen content after treatment was higher in atrophic scars of the laser group than those of the microneedling group.

CONCLUSION
In this small study, microneedling was as safe as fractional CO2 laser for rejuvenation of traumatic scars with comparable clinical effects. Fractional CO2 laser is more powerful in stimulating neocollagenesis. Automated microneedling is effective for treatment of hypertrophic scars.
Posterior Placenta Accreta Spectrum Disorders: Risk Factors, Diagnostic Accuracy, and Surgical Management
Authors: Palacios-Jaraquemada José Miguel , D’Antonio Francesco 
Published: September 2021

Abstract
Posterior placenta accreta spectrum (PAS) disorders are infrequent but potentially associated with significant maternal mortality and morbidity, especially if not diagnosed prenatally. Analysis of published literature is problematic since most experiences included only a few cases. Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies. Ultrasound has poor diagnostic accuracy in detecting posterior PAS, while magnetic resonance imaging better delineates the posterior uterine wall. In comparison, prenatal imaging's diagnostic performance in detecting posterior PAS is significantly lower than anterior placenta invasion. Management of posterior PAS depends on several factors, including maternal hemodynamic status, available resources, clinical presentation, and invasion severity. For accreta or increta cases, a compression suture is habitually enough to perform hemostasis. Nevertheless, organ involvement habitually requires a multidisciplinary team with the assistant of a general or coloproctology surgeon. The present article aims to update the risk factors, prenatal diagnosis, and surgical management of pregnancies complicated by posterior PAS.
Scleral Lens–Induced Corneal Edema After Radial Keratotomy
Authors: Arnold Thomas P. , Vincent Stephen J. 
Published: September 2021

Abstract:
This case series examines the magnitude and regional variation in scleral lens–induced corneal edema in postradial keratotomy (RK) eyes. Scheimpflug imaging was used to measure corneal thickness across the central 6 mm before and after scleral lens wear in nine post-RK eyes (median age 64 years). Variations in corneal edema were examined as a function of distance from the corneal center (six 0.5-mm annuli) and from 0° to 360°. The median central corneal edema was 2.19% (interquartile range 1.03%–3.18%; P=0.02) and increased in magnitude and variability further from the central cornea (from 1.30% in the central 0–0.5 mm to 3.12% in the 2.5–3.0 mm midperiphery) (P=0.02). Scleral lens–induced corneal edema in post-RK eyes was greater in magnitude further from the corneal center and at the approximate location of corneal incisions.
High-Dose Oral Posaconazole for the Treatment of Recalcitrant Fungal Keratitis
Authors: Ferguson Tanner J. , Downes Rachel A. , Isada Carlos M. , Goshe Jeff M. 
Published: September 2021

Purpose:
To report the successful treatment of 3 cases of recalcitrant fungal keratitis (FK) with high-dose oral posaconazole.

Methods:
This is a series of 3 patients from a single academic center with a culture-positive FK who were treated with oral posaconazole after failing to respond to conventional treatments.

Results:
All 3 patients had a history of contact lens wear. Two of the 3 cases were culture positive for Fusarium and the other for Paecilomyces. The infections of all 3 failed to respond to conventional antifungal therapies including varying combinations of topical, systemic, and intraocular antifungal therapies. All 3 cases rapidly responded to high-dose oral posaconazole ranging from 500 to 600 mg once daily. In 1 case, multiple courses of high-dose therapy were required to treat delayed recurrences of a latent infection. There were no significant adverse effects with the elevated dose, and treatment was administered with the guidance of an infectious disease specialist.

Conclusions:
In cases of recalcitrant FK failing to respond to conventional therapies, high-dose posaconazole, in the delayed-release tablet formulation, can be an effective treatment option.
Corneal Remodeling After Myopic SMILE Versus FS-LASIK: A Spatial Analysis of Short- and Mid-Term Corneal Thickness, Volume, and Shape Changes
Authors: Lazaridis Apostolos , Spiru Bogdan , Giallouros Elefterios , Droutsas Konstantinos , Messerschmidt-Roth Anke , Sekundo Walter 
Published: September 2021

Purpose:
To evaluate the short- and mid-term changes of corneal thickness spatial profile (CTSP), corneal volume distribution (CVD), and corneal asphericity after small-incision lenticule extraction (SMILE) for correction of myopia and astigmatism and compare the results with femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK).

Method:
Thirty eyes of 18 patients who underwent SMILE were compared with a group of 30 eyes of 16 patients who underwent FS-LASIK. The groups were matched for preoperative central corneal thickness and lenticule thickness/ablation depth. Scheimpflug corneal tomography was performed preoperatively and postoperatively at 2 months and 3 years. The CTSP was evaluated on 4 concentric rings (2, 4, 6, and 8 mm). The CVD was evaluated at 3 concentric zones (3, 5, and 7 mm). Changes in the anterior and posterior asphericity at a 6-mm zone were also evaluated.

Results:
Between the 2-month and 3-year examination, the CTSP showed a similar increase for both groups at all measured points and rings (P ≥ 0.168). The CVD also showed a similar increase for both groups at all measured zones (P ≥ 0.278). The anterior corneal asphericity remained stable after SMILE (2-mo Q = 0.46 ± 0.27; 3-yr Q = 0.45 ± 0.27; P = 0.711) but decreased significantly after FS-LASIK (2-mo Q = 0.52 ± 0.47; 3-yr Q = 0.47 ± 0.44; P = 0.028). Similarly, the posterior corneal asphericity remained stable after SMILE (2-mo Q = −0.11 ± 0.15; 3-yr Q = −0.11 ± 0.13; P = 0.902) but decreased significantly after FS-LASIK (2-mo Q = −0.13 ± 0.14; 3-yr Q = −0.16 ± 0.15; P = 0.034).

Conclusions:
CTSP and CVD between the 2-month and 3-year examination showed a similar increase after SMILE and FS-LASIK. During the postoperative course, the anterior and posterior corneal asphericity remained more stable after SMILE compared with FS-LASIK.
Epidemiology of Pemphigus: A Single Center Experience in Morocco
Authors: El Hadadi Farah , Mezni Line , Senouci Karima , Benzekri Laila , Ismaili Nadia , Meziane Mariame 
Published: September 2021

Abstract

Objective:
Pemphigus is a life threatening autoimmune bullous disease which involves the skin and mucous membranes of the stratified squamous epithelium. The global distribution of Pemphigus varies according to genetic, ethnic, socioeconomic, and cultural backgrounds. The purpose of our study is to evaluate the epidemiological features of pemphigus a single center in Morocco and compare our results with those reported elsewhere.

Methods:
A retrospective analysis was conducted of 302 pemphigus patients seen between 1990 and 2020 in the Dermatology Department of Ibn Sina Hospital (Rabat, Morocco). We further collected all the Moroccan scientific researches published by now to compare.

Results:
The average annual incidence was 0.32/100,000 inhabitants. The incidence doubled to 0.72 in 2020. The most common variant was pemphigus vulgaris (125 cases) followed by pemphigus erythematosus (99 cases), pemphigus foliaceous (40 cases), and vegetans (27 cases). The female to male ratio was 0.75, the average age at onset was 53years old and the mean duration of the disease before diagnosis was 13.36months.

Conclusion:
This study joins the main characteristics of pemphigus in the Maghreb and around the world (pemphigus vulgaris most frequent subtype). In 2020, an epidemiological peak occurred during the coronavirus disease 2019 pandemic; probably related to stress and delayed time consultation for fear of contracting the severe acute respiratory syndrome coronavirus 2.
Describing cognitive function and psychosocial outcomes of COVID-19 survivors: A cross-sectional analysis
Authors: Henneghan Ashley M. , Lewis Kimberly A. , Gill Eliana , Franco-Rocha Oscar Y. , Vela Ruben D. , Medick Sarah , Kesler Shelli R. 
Published: September 2021

ABSTRACT

Background:
Neurological and psychological symptoms are increasingly realized in the post-acute phase of COVID-19.

Purpose:
To examine and characterize cognitive and related psychosocial symptoms in adults (21–75 years) who tested positive for or were treated as positive for COVID-19.

Methods:
In this cross-sectional study, data collection included a cognitive testing battery (Trails B; Digit Symbol; Stroop; Immediate and Delayed Verbal Learning) and surveys (demographic/clinical history; self-reported cognitive functioning depressive symptoms, fatigue, anxiety, sleep disturbance, social role performance, and stress). Results were compared with published norms, rates of deficits (more than 1 standard deviation (SD) from the norm) were described, and correlations were explored.

Results:
We enrolled 52 participants (mean age 37.33 years; 78.85% female) who were, on average, 4 months post illness. The majority had a history of mild or moderate COVID-19 severity. Forty percent of participants demonstrated scores that were 1 SD or more below the population norm on one or more of the cognitive tests. A subset had greater anxiety (21.15%), depressive symptoms (23.07%), and sleep disturbance (19.23%) than population norms. Age differences were identified in Stroop, Digit Symbol, and Trails B scores by quartile (p < .01), with worse performance in those 28–33 years old.

Conclusions:
Cognitive dysfunction and psychological symptoms may be present in the weeks or months after COVID-19 diagnosis, even in those with mild to moderate illness severity.

Implications for practice:
Clinicians need to be aware and educate patients about the potential late/long-term cognitive and psychological effects of COVID-19, even in mild to moderate disease.
Acute Movement Disorders in Childhood
Authors: Benrhouma Hanene , Nasri Amina , Klaa Hedia , Ben Achour Nedia , Rouissi Aida , Kraoua Ichraf , Turki Ilhem 
Published: September 2021

Objectives
Acute movement disorders (AMD) are frequent in neurological and pediatric emergencies. Few studies analyzed AMD in children, none in Tunisia or other African country. The purpose of this study was to describe the peculiarities of AMD in a Tunisian pediatric population with a literature review.

Methods
We conducted a retrospective descriptive study over 8 years including 80 children (sex ratio, 1.05; mean age of onset, 4.8 years) with AMD, followed in tertiary referral Child Neurology Department in North Tunisia.

Results
Acute movement disorders were mainly hyperkinetic (n = 67 with dystonia (n = 33; mostly due to inherited metabolic diseases (IMD) in 11; with status epilepticus in 10 children), chorea (n = 14; with Sydenham chorea in 5); myoclonus (n = 14; mostly with opsoclonus-myoclonus syndrome in 10) and tremor (n = 6; of posttraumatic origin in half). Hypokinetic movement disorder (MD) included acute parkinsonism in 5 children of infectious (n = 3), postinfectious (n = 1, malaria) and posttraumatic origin (n = 1). Mixed MD, found in 8 children, were mainly due to IMD in half of them, and to familial lupus in two. Paroxysmal MDs were seen in 2 children, one with multiple sclerosis and one of idiopathic origin. Psychogenic MDs were found in 7 patients mainly of dystonic type. Management of AMD comprised symptomatic treatment according to the phenomenology of the MD and causative treatment depending on its etiology.

Conclusions
Our study illustrated the broad range of AMD in children and the wide spectrum of their etiologies. In our series, we described some exceptional findings and etiologies of AMD in children. These findings may denote a specific profile in of AMD in our country with predominant infectious, postinfectious, and IMD.
Childhood Socioeconomic Status and Polygenic Scores for Cognition Have Independent Associations with Cognitive Performance During Middle Childhood
Authors: Paul S.E. , Elsayed N.M. , Bogdan R. , Colbert S.M.C. , Hatoum A.S. , Barch D.M. 
Published: September 2021

ABSTRACTChildhood cognitive abilities are heritable and influenced by malleable environmental factors such as socioeconomic status (SES). As cognition and SES share genetic architecture, it is critical to understand the extent to which SES is associated with cognition beyond genetic propensity to inform the potential benefit of SES-based interventions. Previous investigations conducted in small samples have suggested that SES is linked with cognitive ability independent of polygenic prediction for educational attainment. Here, we extend this work to a large sample (total n = 4,650) of children (ages 9-10) of genomically-confirmed European ancestry. We find that an SES composite (i.e., family income-to-needs, caregiver education, and neighborhood median income) and a polygenic cognition score composite created using genomic structural equation modeling (COG PGS; Educational Attainment, Intelligence, and Executive Function) are associated with cognitive performance indices (i.e., general ability, executive function, learning/memory, fluid intelligence) that are largely independent of one another. SES x COG PGS interactions are not associated with cognition. These findings provide further evidence for the significant role of modifiable environmental factors in the development of cognitive abilities in youth.
Too many yet too few caesarean section deliveries in Bangladesh: an ongoing public health challenge to improve maternal and child health
Authors: Khan Md Nuruzzaman , Kabir Md Awal , Shariff Asma Ahmad , Rahman Md Mostafizur 
Published: September 2021

AbstractBackgroundCaesarean section (CS) use is on the rise in Bangladesh, particularly among women in improved socio-economic condition. However, the deficit use of CS remains common among disadvantage women in terms of employment, education, wealth quintile, and place of residence. This increases risks of long-term obstetric complications as well as maternal and child deaths. We aimed to determine the interaction effects of women’s disadvantage characteristics on CS use in Bangladesh.MethodsTotal of 27,093 women data analysed extracted from five rounds of Bangladesh Demographic and Health Survey, conducted between 2004 and 2017/18. The inclusion criteria used to select these women were: (i) having at least one child within three prior to the survey, (ii) reported delivery methods and place, and (iii) do not have twin or more ordered pregnancy for the most recent live birth. The major exposure variables were type of health facilities, divisions, place of residence, economic status, and maternal education. Other factors considered were factors at the individual and household level. The outcome variable was CS use, coded as use (1) and non-use (0). Multilevel logistic regression model was used to determine association of CS with socio-demographic characteristics and the interactions of the working status and wealth quintile with place of residence.ResultsWe reported a 751% increase of CS use over the last 13 years — from 3.88% in 2004 to 33% in 2017/18. Nearly, 80% of these occurred in the private health facilities followed by the government health facilities (15%). Rural women with no engagement of formal income generating activity showed 11% (OR, 0.89, 95% CI, 0.71-0.99) lower use of CS in 2004. This association was further strengthened with the year passes, and a 51% (OR, 0.49, 0.03-0.65) lower in CS use was reported in 2017/18. Similarly, around 12%-83% lower likelihoods of CS use were found among rural poor and poorer women.ConclusionBangladesh is facing a double burden of CS, that is a group of women with improved socio-economic condition using this life saving procedure without medical necessity while their counterpart of disadvantage characteristics could not access this service. Improved monitoring from the government along with support to use CS services for the disadvantage groups on necessity are important.
Viral loads of Delta-variant SARS-CoV2 breakthrough infections following vaccination and booster with the BNT162b2 vaccine
Authors: Levine-Tiefenbrun Matan , Yelin Idan , Alapi Hillel , Katz Rachel , Herzel Esma , Kuint Jacob , Chodick Gabriel , Gazit Sivan , Patalon Tal , Kishony Roy 
Published: September 2021

AbstractThe BNT162b2 vaccine showed high real-life effectiveness both at preventing disease and in reducing viral loads of breakthrough infections, but coincidental with the rise of the Delta-variant SARS-CoV2, these protective effects have been decreasing, prompting a third, booster, vaccine inoculation. Here, analyzing viral loads of over 11,000 infections during the current wave in Israel, we find that even though this wave is dominated by the Delta-variant, breakthrough infections in recently vaccinated patients, still within 2 months post their second vaccine inoculation, do have lower viral loads compared to unvaccinated patients, with the extent of viral load reduction similar to pre-Delta breakthrough observations. Yet, this infectiousness protection starts diminishing for patients two months post vaccination and ultimately vanishes for patients 6 months or longer post vaccination. Encouragingly, we find that this diminishing vaccine effectiveness on breakthrough infection viral loads is restored following the booster vaccine. These results suggest that the vaccine is initially effective in reducing infectiousness of breakthrough infections even with the Delta variant, and that while this protectiveness effect declines with time it can be restored, at least temporarily, with a booster vaccine.