bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy
Authors: Saunders Rebecca , Hughes Faye E. , Evans Jonathan C. , Smart Howard L. , Ghaneh Paula , Ramesh Jayapal , Sutton Robert , Halloran Christopher M. 
Published: May 2021

Objectives:
To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local healthcare providers.

Background:
Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality, and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care; however, endoscopic approaches are now offered preferentially.

Methods:
All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN), and open (OPN) necrosectomy at a single institution from April 2015 to March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient-level costing systems were used to determine inpatient and outpatient costs.

Results:
Eighty-six patients were included: 38 underwent EN, 35 MARPN, and 13 OPN. Preoperative APACHEII was 6 versus 9 versus 9 (P = 0.017) and CRP 107 versus 204 versus 278 (P = 0.012), respectively. Postoperative stay was 19 days for EN versus 41 for MARPN versus 42 for OPN (P = 0.007). Complications occurred in 68.4%, 68.6%, and 46.2% (P = 0.298), whereas mortality was 10.5%, 22.9%, and 15.4% (P = 0.379), respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (P = 0.008), and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9430 vs £14,033, P = 0.024; critical care: £5317 vs £16,648, P = 0.056).

Conclusions:
EN was at least as safe and effective as MARPN and OPN and was associated with markedly reduced hospital stay and cost, although some markers of disease severity were higher in patients undergoing MARPN and OPN. These results support EN as the preferred approach to necrosectomy, but hybrid utilization of all available techniques remains integral to optimal outcomes.
Female-Specific Susceptibility Locus in BOC and SEC16B are Associated with Adolescent Idiopathic Scoliosis
Authors: Dai Zhicheng , Wang Yuwen , Wu Zhichong , Feng Zhenhua , Sun Xu , Qiu Yong , Cheng Jack Chun-Yiu , Xu Leilei , Zhu Zezhang 
Published: May 2021

Study Design.
A genetic case-control study.

Objectives.
To investigate whether the variants in BOC, SEC16B, and SH2D1B are sex-specifically and functionally associated with the susceptibility of adolescent idiopathic scoliosis (AIS) in Chinese Han population.

Summary of Background Data.
A recent genome-wide association study identified three female-specific susceptibility loci of AIS in Japanese population. However, the association of these genes with AIS in other populations remains unclear. Further investigation of the functional role of the three genes was warranted.

Methods.
SNPs rs73235136, rs545608, and rs142502288 were genotyped in 1599 AIS patients and 2985 controls. Paraspinal muscle collected from 40 AIS and 30 lumber disc herniation patients during surgical interventions was used for gene expression analysis. The difference regarding genotype and allele frequency between patients and controls was analyzed by chi-square analysis. Expression of BOC and SEC16B was compared between AIS and lumber disc herniation patients by the Student t test. Pearson correlation analysis was performed to evaluate the relationship between gene expression level and clinical phenotypes.

Results.
SNPs rs73235136 of BOC and rs545608 of SEC16B were found to be remarkably associated with AIS only in females. Allele C of rs73235136 and allele G of rs545608 could significantly add to the risk of female AIS patients, with an odds ratio of 1.087 and 1.033, respectively. However, there was no significant difference between the male patients and controls regarding genotype or allele frequency of rs73235136 and rs545608. No polymorphism at rs142502288 was detected in either patients or controls, and all the subjects had genotype of AA. Moreover, tissue expression of BOC and SEC16B was significantly lower in AIS patients compared with controls. BOC expression was positively associated with bone mineral contents, and expression of SEC16B was negatively correlated with curve severity in AIS patients.

Conclusion.
Female-specific variants in BOC and SEC16B were associated with AIS. Expression of BOC and SEC16B was significantly lower in AIS patients. The role of BOC and SEC16B in the development of AIS is worthy of further investigation.

Level of Evidence: 3
Facilitated Umbilical Positioning in Abdominoplasty Using the 15/10 Rule and the “Flap Flipping” Technique
Authors: Rysin Roman , Wolf Yoram 
Published: May 2021

Summary:
First described by Gaudet and Morestin, abdominoplasty with umbilical preservation dates as far back as 1905. Navel position was described on the transverse axis by Rohrich, and on the median longitudinal axis, by Vernon, Baroudi and Pitanguy. The aim of this article is to validate the 15/10 rule of umbilical positioning in abdominoplasty with the “flap flipping” technique, as an intraoperative aid to simplify umbilical repositioning. Between October 2019 and March 2020, 18 consecutive patients underwent full abdominoplasty, using the 15/10 rule for umbilical positioning. Patients’ average age was 47.9, with body mass index 27.5 kg/m2 and height 1.63 m. An “expected zone” of umbilical position was delineated by 2 horizontal lines, 15 cm from the bra line and 10 cm from the pubic level. The umbilicus was accurately positioned by using the flap flipping technique before closure of the inferior abdominal incision line. It was then examined to determine whether the umbilicus was situated in the expected zone. In 14 of 18 patients, intraoperative and postoperative measurements of umbilical position were in the expected zone. An average 15.19 cm was measured between the bra line and the new umbilical positioning, and 12.02 cm from the new umbilicus to the pubic inferior suture line. We find that the 15/10 rule of umbilical positioning with the flap flipping technique is an important, intuitive, and easy-to-use guide for precise umbilical positioning in abdominoplasty.
FOVEAL DISPLACEMENT IN EYES WITH EPIRETINAL MEMBRANE AFTER VITRECTOMY AND MEMBRANE PEELING
Authors: Tung Hsiao-Fan , Chen Yi-Ling , Tung Hsiao-Yu , Tung Hsiao-Wei , Chen San-Ni 
Published: May 2021

Purpose:
To investigate the foveal movement in eyes with epiretinal membrane after vitrectomy and membrane peeling.

Methods:
A retrospective review of 85 eyes with epiretinal membrane treated with vitrectomy, membrane peeling, and internal limiting membrane removal. Using a self-designed computer program to compare the preoperative and postoperative images of optical coherence tomography to measure the amount of foveal movement. Analyze the relationships between foveal displacement, preoperative and postoperative best-corrected visual acuity, central foveal thickness, and the stage of epiretinal membrane.

Results:
Most of the fovea were nasally shifted. More movement happened in the first month and almost finished in the first year. The greater degree of foveal displacement was correlated with poorer initial visual acuity and thicker central foveal thickness. In considering with the ectopic inner foveal layer staging of epiretinal membrane by structural optical coherence tomography, the foveal realignment is greatest in Stage 4 (394.47 ± 171.44 µm), followed by Stage 1 (251.21 ± 135.40 µm), Stage 2 (235.70 ± 147.51 µm), and Stage 3 (219.86 ± 117.91 µm) at the postoperative 1 month.

Conclusion:
Most eyes of epiretinal membrane had the foveal moved nasally after membrane peeling and internal limiting membrane peeling. The larger amount of foveal movement was correlated with poorer initial best-corrected visual acuity. Dystopia fovea may be another factor affecting visual acuity in addition to other biomarkers in optical coherence tomography.
Child Sexual Assault Nurse Examinations and Prosecutorial Decisions to Accept or Reject Cases of Child Sexual Abuse
Authors: Bracewell Tammy E. , Greenwood Lynn M. 
Published: May 2021

ABSTRACT

Introduction
Prosecution of child sexual abuse (CSA) cases provides safety for communities and justice for victims. Prosecutorial decisions are multifactorial and include the presence of a structured coordinated community response to outcries and access to skilled healthcare providers. This study examines the impact forensic nurse sexual assault examinations (SAEs) have on prosecution in a population of children seen at a child advocacy center (CAC).

Methods
The authors examined case data from 553 cases of reported CSA, seen by a forensic nurse in a CAC.

Results
Statistical analysis focused on prosecution decisions with and without SAE, with and without physical findings. Logistic regression determined prosecution occurred more often when SAE had been conducted (p = 0.026, OR = 1.732, 95% CI [1.068, 2.808]), regardless of examination findings.

Limitations
The limitations include a single location for data and the multifactorial reasons for prosecution of cases.

Discussion
The multifactorial elements contributing to prosecutorial decisions are diverse. The formalized approaches in CACs historically show increased prosecution. Teasing out the impact of an SAE in a CAC may be reflective of positive CAC approaches. Regardless, a statistically significant finding of association uniquely with the SAE, with or without findings, implies more studies are needed to support the role of the forensic nurse in successful prosecutions of CSA cases.
Opioid-Prescribing Practices Between Total Knee and Hip Arthroplasty in an Outpatient Versus Inpatient Setting
Authors: Nouraee Cyrus M. , McGaver Rebecca Stone , Schaefer Jacob J. , O'Neill Owen R. , Anseth Scott D. , Lehman-Lane Justina , Uzlik Rachel M. , Giveans M. Russell 
Published: May 2021

ABSTRACT
Despite trends showing increases in the utilization of outpatient (OP) ambulatory surgery centers (ASCs) and decreases in the utilization of inpatient (IP) facilities for total knee arthroplasty (TKA) and total hip arthroplasty (THA), little is known about opioid prescribing for these procedures between each setting. This study evaluated differences in opioid prescribing and consumption between OP ASC and IP settings for elective TKA and THA surgeries over a 1-year period. Data collection also included pain and satisfaction of pain control postsurgery. In an OP ASC, analysis revealed a significant decrease in pills prescribed (p < .001, p < .001) and consumed (p < .001, p < .001) for TKA and THA, respectively. There was a significant decrease in the morphine equivalence units prescribed (p < .001, p < .001) and consumed (p < .001, p < .001) for TKA and THA, respectively. For TKA, pain was significantly lower (p = .018) and satisfaction of pain control was significantly higher (p = .007). For THA, pain (p = .374) and satisfaction of pain control (p = .173) were similar between the settings. Benefits of performing these surgeries in an OP ASC setting are patients having similar or lower levels of pain and having similar or higher satisfaction of pain control. Patients are also prescribed and consume less opioids. This has important implications for healthcare systems.
Prevalence of Elevated Blood Pressure and Risk Factors for Hypertension in College Athletes
Authors: Petek Bradley J. , Drezner Jonathan A. , Harmon Kimberly G. 
Published: May 2021

Objective:
To compare the prevalence and risk factors for hypertension (HTN) in college athletes using the new (≥130/80 mm Hg) versus prior (≥140/90 mm Hg) US hypertension guidelines.

Design:
Retrospective cohort study.

Setting:
Eleven Pacific-12 Conference institutions.

Participants:
Of the 8602 athletes enrolled in the primary study, 4977 (57.9%) met inclusion criteria. Athletes were included in the study if age <30 and blood pressure (BP), baseline demographics (age, weight, height, sex, and race), and primary sport were available.

Independent Variables:
Age, sex, race, height, weight, body mass index, and primary sport.

Main Outcome Measures:
Elevated BP of ≥130/80 mm Hg and/or ≥140/90 mm Hg.

Results:
Normal BP (<130/80) was present in 3214 (64.6%) athletes and 1763 (35.4%) had BP ≥ 130/80, including 460 (9.2%) with BP ≥ 140/90. Male athletes had a higher prevalence of BP ≥ 130/80 (46.7% vs 21.5%; P < 0.001) and BP ≥ 140/90 (14.2% vs 3.1%; P < 0.001) compared to female athletes. Independent risk factors from multivariate analyses for BP ≥ 130/80 included: older age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.00-1.11, P = 0.04), male sex (OR = 1.97, 95% CI 1.65-2.35, P < 0.001), heavier weight (OR = 1.03, 95% CI 1.02-1.03, P < 0.001), and baseball as the primary sport (OR = 1.47, 95% CI 1.14-1.90, P < 0.01). Independent risk factors for BP ≥ 140/90 mm Hg included: male sex (OR = 3.54, 95% CI 2.55-4.97, P < 0.001) and heavier weight (OR = 1.03, 95% CI 1.02-1.04, P < 0.001).

Conclusions:
In a large, diverse cohort of matriculating college athletes from multiple institutions, over one-third presented with elevated BP ≥ 130/80 mm Hg, which was more common in older male athletes with larger body size and baseball players.
Successful urethral reconstruction with scrotal skin island flap and pudendal thigh flap for urethral stricture and urethrocutaneous fistula
Authors: Li Chiao-Ching , Tang Shou-Hung , Li Chiao-Zhu , Wang Chih-Hsin , Wu Sheng-Tang , Cha Tai-Lung , Meng En , Kao Chien-Chang 
Published: May 2021

Abstract

Introduction:
One of the complications following transurethral resection of the prostate is urethral stricture formation. There are several treatment methods for urethral obstructions, such as urethral dilation with urethral sounds, direct vision internal urethrotomy with a cold knife or laser, and urethral reconstruction. However, urethrocutaneous fistulae, periurethral and scrotal abscesses are complications that result from urethral dilation and direct vision internal urethrotomy.

Patient concerns:
A 66-year-old male patient complained of difficulty in voiding for 3 years accompanied by urinary frequency and incomplete emptying. He had no underlying chronic diseases. He underwent transurethral resection of the prostate, however, urinary frequency and a weak urine stream persisted for 2 weeks.

Diagnoses:
According to physical examination and cystoscopy, the patient was diagnosed with urethrocutaneous fistula and urethral stricture.

Interventions:
Initially, urethral sounding and direct vision internal urethrotomy were performed, however, complications such as urethrocutaneous fistula, periurethral and scrotal abscesses occurred. Urethral reconstruction was performed as a two staged procedure involving urethral fistulectomy, cutaneous urethrotomy, debridement and suprapubic cystostomy in the first stage followed by reconstruction using scrotal skin island and pudendal thigh flaps six months later.

Outcomes:
Improved voiding and no wound dehiscence were observed on postoperative day 56. After a follow-up period of 2 years, there was no evidence of urinary retention nor incomplete emptying. However, there was minimal residual paresthesia from the medial thigh to the left hemi-scrotal skin.

Conclusion:
Urethral reconstruction with scrotal skin island and pudendal thigh flaps can be a successful treatment method owing to abundant blood supply and less skin tension.
The Effect of Abdominal Anatomy on the Measurement of Bone Mineral Density With Dual-Energy X-Ray Absorptiometry
Authors: Başaloğlu Can , Güngör Özlem , Balcı Ali 
Published: May 2021

Objective
This study aimed to assess the effects of abdominal fat content and anatomical changes on the measurement of bone mineral density using dual-energy X-ray absorptiometry (DXA).

Materials and Methods
The bone mineral density measurements were performed with quantitative computed tomography for patients who underwent DXA and abdominal CT on the same day. The effects of abdominal fat content and anatomic changes on the results of DXA were assessed.

Results
Of the 43 patients, 88.3% were women, 11.7% were men, and the mean age was 55.6 years (range, 32–72). There was a significant relationship between the error in the measurement of T-scores with DXA and osteophytic new bone formation (P = 0.011). There were significant relationships between the error in detecting osteoporosis with DXA and osteophytic new bone formation, facet joint degeneration, and aortic calcification (P < 0.05).

Conclusions
Abdominal fat content does not significantly affect T-scores. However, DXA can give false-negative results in detecting osteoporosis, especially in patients with osteophyte new bone formation, facet joint degeneration, and aortic calcifications, all conditions primarily in elderly patients. In these cases, it is more appropriate to use quantitative computed tomography instead of DXA.
Clinical, Radiographic, Pathologic Characterization and Survival Outcomes of Nuclear Protein of the Testis Carcinoma
Authors: Virarkar Mayur , Mallery Marcelle , Saleh Mohammed , Ramani Nisha S. , Morani Ajaykumar C. , Bhosale Priya 
Published: May 2021

Introduction
Nuclear protein of the testis (NUT) carcinoma (formerly NUT midline carcinoma) is an aggressive tumor with characteristic BRD4-NUTM1 translocation and a poor prognosis. The primary objective of this study was to describe the clinical and radiologic features, treatment response, and survival of NUT carcinoma (NC).

Materials and Methods
This retrospective single-center study was based on the review of medical records of NC patients with a specific genetic rearrangement or positive anti-NUT nuclear staining. Overall survival (OS) was analyzed according to primary tumor location.

Results
This series of 22 patients had a mean age of 36.27 ± 2.68 years with 68% women and 32% men. The median age at diagnosis was 34 years (range, 17–55 years). The primary tumor was located in the chest (n = 12/22; 55%), head and neck (n = 9/22; 40%), and 1 patient had a renal tumor. About 68% (n = 15/22) patients presented with regional lymph nodal involvement and 77% (n = 17/22) had distant metastases. All the bone metastases were lytic (100%) with mixed lytic and sclerotic metastases in 5 patients. Only 18% (n = 4/22) of the patients showed response to treatment, with progression in the remaining 18 patients. The median OS was 7 months. The OS was significantly (P = 0.024) more in patients with primary head and neck NC (n = 9; OS, 16 months) versus those with pulmonary and other locations (n = 13; OS, 6 months).

Conclusions
Nuclear protein of the testis carcinoma is an aggressive disease refractory to conventional therapy. Imaging with the complementary use of computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography is important for staging, guiding management, assessing the treatment response, and surveillance.
Travel-driven emergence and spread of SARS-CoV-2 lineage B.1.620 with multiple VOC-like mutations and deletions in Europe
Authors: Dudas Gytis , Hong Samuel L. , Potter Barney , Calvignac-Spencer Sébastien , Niatou-Singa Frédéric S. , Tombolomako Thais B. , Fuh-Neba Terence , Vickos Ulrich , Ulrich Markus , Leendertz Fabian H. , Khan Kamran , Watts Alexander , Olendraitė Ingrida , Snijder Joost , Wijnant Kim N. , Bonvin Alexandre M.J.J. , Martres Pascale , Behillil Sylvie , Ayouba Ahidjo , Maidadi Martin Foudi , Djomsi Dowbiss Meta , Godwe Celestin , Butel Christelle , Šimaitis Aistis , Gabrielaitė Miglė , Katėnaitė Monika , Norvilas Rimvydas , Raugaitė Ligita , Jonikas Rimvydas , Nasvytienė Inga , Žemeckienė Živilė , Gečys Dovydas , Tamušauskaitė Kamilė , Norkienė Milda , Vasiliūnaitė Emilija , Žiogienė Danguolė , Timinskas Albertas , Šukys Marius , Šarauskas Mantas , Alzbutas Gediminas , Juozapaitė Dovilė , Naumovas Daniel , Pautienius Arnoldas , Vitkauskienė Astra , Ugenskienė Rasa , Gedvilaitė Alma , Čereškevičius Darius , Lesauskaitė Vaiva , Žemaitis Lukas , Griškevičius Laimonas , Baele Guy 
Published: May 2021

ABSTRACTMany high-income countries have met the SARS-CoV-2 pandemic with overwhelming sequencing resources and have identified numerous distinct lineages, including some with notably altered biology. Over a year into the pandemic following unprecedented reductions in worldwide human mobility, distinct introduced lineages of SARS-CoV-2 without sequenced antecedents are increasingly discovered in high-income countries as a result of ongoing SARS-CoV-2 genomic surveillance initiatives. We here describe one such SARS-CoV-2 lineage, carrying many mutations and deletions in the spike protein shared with widespread variants of concern (VOCs), including E484K, S477N and deletions HV69Δ, Y144Δ, and LLA241/243Δ. This lineage – designated B.1.620 – is known to circulate in Lithuania and has now been found in several European states, but also in increasing numbers in central Africa owing to important recent increases in genome sequencing efforts on the continent. We provide evidence of likely ongoing local transmission of B.1.620 in Lithuania, France, Germany, Spain, Belgium and the Central African Republic. We describe the suite of mutations this lineage carries, its potential to be resistant to neutralising antibodies, travel histories for a subset of the European cases, and evidence of local B.1.620 transmission in Europe. We make a case for the likely Central African origin of this lineage by providing travel records as well as the outcomes of carefully crafted phylogenetic and phylogeographic inference methodologies, the latter of which is able to exploit individual travel histories recorded for infected travellers having entered different European countries.