bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Primary Ileocolic Resection for Pediatric Crohn Disease in the Biologic Era
Authors: Spencer Elizabeth A. , Jarchin Lauren , Rolfes Priya , Khaitov Sergey , Greenstein Alexander , Dubinsky Marla C. 
Published: July 2021

ABSTRACTObjectives:Current clinical algorithms position surgery as the last option in pediatric Crohn disease (CD). Studies suggest improved outcomes with earlier surgery, but pediatric postoperative outcomes data in the biologic era are limited. We aimed to describe the preoperative management and postoperative outcomes in a pediatric CD cohort who underwent ileocolic resection (ICR) at a tertiary care inflammatory bowel disease center over the last decade.Methods:Single‐center, retrospective study of pediatric (<18 years) CD patients who underwent ICR between 2008 and 2019 with primary outcome of rate of endoscopic recurrence (Rutgeerts’ >i2) at 2 years post‐ICR. Key secondary outcomes included endoscopic remission (Rutgeerts’ i0), frequency of 30‐day postoperative complications, anthropometric changes, and histologic recurrence. Uni‐ and multivariable analyses examined associations of clinical/laboratory characteristics with endoscopic recurrence. Factors predictive of 30‐day complications were also analyzed.Results:Seventy‐eight children underwent ICR a median of 17.8 months (interquartile range [IQR] 2.6–53.9) from diagnosis. Median age at diagnosis and surgery was 13.8 (11.1–16.7) and 16.8 years (15.1–17.8), respectively. In the 41 patients with >1 post‐operative endoscopy, the rate of endoscopic recurrence was 46% at 2 years (median time to recurrence: 10 [7–20] months). Histologic recurrence was present in 44% in endoscopic remission (κ = 0.11, P = 0.53). Endoscopic recurrence was associated with younger age at diagnosis and longer disease duration. 30‐day complications occurred at a rate of 18%; only 1% experienced severe complications. All anthropometric measures significantly improved after surgery.Conclusions:Given the inherent risk of postoperative recurrence associated with age and disease duration, children would benefit from postoperative surveillance and effective prophylaxis.
Exsanguination From Superficial Lower Extremity Trauma
Authors: Prahlow Samuel P. , Abadi Arad , Prahlow Joseph A. 
Published: July 2021

Abstract
Deaths related to exsanguination are not rare; however, most are related to large-caliber blood vessel or organ disruption. This article reports 2 deaths from external hemorrhage arising from superficial lower extremity trauma in persons with peripheral vascular disease and anticoagulant therapy. The first involved a 78-year-old woman who was found unconscious in her home by a relative, with a plastic bag tied around her left foot and evidence of profuse hemorrhage arising from a left great toenail partial avulsion injury. The second involved a 48-year-old male resident of an adult group home who was involved in a physical altercation with a group home employee, who reportedly kicked the decedent in the right shin, resulting in extensive hemorrhage and death. The cases highlight the fact that lethal exsanguination can occur from superficial trauma. Persons with peripheral vascular disease and those taking anticoagulants may be at particular risk for such deaths.
The Analysis of Hospital Readmission Rates After the Implementation of Hospital Readmissions Reduction Program
Authors: Muchiri Steve , Azadeh-Fard Nasibeh , Pakdil Fatma 
Published: July 2021

Objectives
This study aims to analyze the impact of Hospital Readmissions Reduction Program (HRRP) on the nationwide optimization efforts of length of stay (LOS) and readmissions in the United States.

Methods
We use the Nationwide Readmission Database between 2010 and 2016 provided in the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality. The study focuses on acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure (CHF), pneumonia monitored by the HRRP and 2 conditions, septicemia, and mood disorders that were not monitored by the HRRP but had among the highest readmissions. Patient demographics and readmissions were analyzed based on insurance type, LOS, and Charlson Comorbidity Index.

Results
The readmissions vary by conditions, LOS, and insurance types. Congestive heart failure has the highest readmissions among the 6 analyzed conditions at approximately 25%. The readmission rate of CHF rises to 30% for the Medicaid patients and varies between 30% and 35% by LOS. Patients with CHF with higher Charlson Comorbidity Index demonstrates the highest readmissions among 6 conditions. The patients with longer LOSs had higher readmissions, and Medicare patients have a higher reduction in readmissions in acute myocardial infarction and mood disorders compared with the other forms of payments.

Conclusions
Our figures show that targeted programs, such as HRRP, may have a positive impact on readmission rates. We, however, observe some graphical evidence that nontargeted conditions could exhibit similar trends. Because of heterogeneity in hospital and patient characteristics, it is pivotal for researcher to consider them in formal analyses.
Use of Dental Impression Silicone to Fabricate Simple Surgical Guides in Mandibular Reconstruction∗
Authors: Matsui Chihiro , Mizuno Hiroshi , Roche Nathalie 
Published: July 2021

Background:
Several recent reports have described the development and use of three-dimensional (3D) printed surgical osteotomy guides. However, these methods: are usually costly. Here, we introduce a novel method of manufacturing surgical guides built from inexpensive, easy-to-use, and sterilizable dental impression silicone.

Methods:
Mandibular and fibular models were prepared using a 3D printer for 10 patients undergoing free fibula flap transfer after mandibular resection. During preoperative simulation surgery, Protesil labor, a dental silicone, was molded to the same size as the fibular models to act as surgical guides.

Results:
The authors compared pre- and post-operative bone angles and bone lengths for all cases using simulation surgery models and postoperative 3D computed tomography. Mean bone angle difference was 2.6° and mean bone length difference was 1.7 mm. Cost of the dental silicone was approximately US$5/patient.

Conclusions:
In our series this method allowed the surgeon to perform an accurate osteotomy, inexpensively and time-efficiently.
Cerebellum Tumor Presenting Itself With Positional Vertigo and Benign Paroxysmal Positional Vertigo
Authors: Kinar Abdullah , Günebakan Ceren , Kinar Ayşe Kübra Şap 
Published: July 2021

Abstract
The purpose of this case is to describe the positional vertigo observed in a patient diagnosed with cerebellar arteriovenous malformation, pay attention to the importance of medical history taking and physical examination in vertigo patients.
A 51-year-old patient went to the Ear, Nose, and Throat clinic with a complaint of vertigo. His vertigo was like peripheral vertigo at the beginning. Dizziness was triggered by head movements. He experienced tinnitus in the left ear during vertigo attacks. The patient also had neck pain. In physical examination, natural bilateral tympanic membrane and facial examination were observed. Other physical examinations were normal. In the positional vertigo tests, the right Dix-Hall Pike test was positive and a downbeating geotropic nystagmus was found. The patient was treated with canalith repositioning maneuver (Epley maneuver). Oral medical treatment started and after 4 days, the patient reported that his gait balance was disturbed and his neck pain continued. After that magnetic resonance imaging was requested. Magnetic resonance imaging was consistent with cerebellar arteriovenous malformation. The patient was consulted to the neurology service.
Cerebellar arteriovenous malformation had features like to peripheral vertigo, and the correct diagnosis is made due to suspected headache and other neurological symptoms.
Risk Factors for Occipital Step-Off Deformities in Posterior Vault Distraction Osteogenesis
Authors: Zapatero Zachary D. , Carlson Anna R. , Card Elizabeth B. , Kosyk Mychajlo S. , Kalmar Christopher L. , Swanson Jordan W. , Bartlett Scott P. , Taylor Jesse A. 
Published: July 2021

Purpose:
The goal of this study was to investigate patient specific factors and surgical techniques that affect occipital step-off deformity in children undergoing posterior vault distraction osteogenesis (PVDO).

Methods:
Patients who underwent PVDO were retrospectively reviewed and included if a high resolution three-dimensional computed tomography scan was available 1-year post-distractor removal. Two craniofacial surgeons were blinded to individual subjects and presented with 3 still images of three-dimensional bone reconstructions and asked to rate the degree of step off: none, mild, moderate, or severe. The data were analyzed with multinomial logistic regressions and other appropriate statistics.

Results:
Forty-one patients met inclusion criteria. All patients had multisuture or bicoronal craniosynostosis. Multinomial logistic regression identified age at PVDO (Cox and Snell = 0.487, P < 0.001) as a predisposing factor and one potentially protective factor, height of osteotomy (Cox and Snell = 0.394, P = 0.004) in univariate models. Post-hoc pairwise Mann–Whitney U test revealed there was decreased step-off rating when comparing osteotomy below torcula (median 0, [IQR 0, 3]) and above torcula (median 3 [IQR 1, 4]; P = 0.036) as well as a decreased step-off when below inion (median 0 [IQR 0, 1]; P = 0.001) was compared to above the torcula.

Conclusions:
Older age at PVDO predict increased risk of developing an occipital step-off deformity after PVDO, while design of the occipital osteotomy below the inion is protective. Barrel staves with greenstick outfracture did not lower the risk of occipital step-off in this sample, the reasons for which are unclear.
Orbital Septum Fat Flap Transfer for Upper Eyelid Depression
Authors: Zhang Shan , Ding Kun , Bai Xinran , Cao Zhe , Liang Xiaoqin 
Published: July 2021

Background:
Sunken upper eyelid makes people's eyes look gaunt and aging. At present, more and more people are paying attention to eye rejuvenation, and more and more people are asking for correction of sunken upper eyelid. Orbital septum fat plays an important role in the display of eye contour. Therefore, the position of orbital septum fat can be adjusted surgically to improve the upper eyelid depression.

Objective:
This article discusses the clinical effect of orbital septum fat flap transfer in the upper eyelid depression of mild to moderate.

Methods:
Thirty patients with single eyelid depression in our hospital from April to September 2020 were selected. After blepharoplasty, the orbital septum fat was fully released and the lateral orbital fat transfer was fixed to the mid-medial upper eyelid depression.

Results:
After the operation, 29 patients were satisfied with the results, with good incision healing, bilateral basic symmetry no obvious scar, and negative effect of non-convex and concave eyelid inequality. One patient did not achieve the expected results and was treated with a second autologous fat filling.

Conclusions:
For patients with mild to moderate sunken upper eyelid, orbital septal fat flap metastasis during blepharoplasty has not only good effect, natural appearance, and smooth upper eyelid skin, but also only 1 incision for upper eyelid formation, which has high acceptance and satisfaction of patients and can be widely used in clinical practice.
Revisiting the Cervicodeltopectoral Flap for Reconstruction of Cutaneous Head and Neck Defects: Technique Description and Clinical Presentation Correlates
Authors: Parrish Andrew J. , Anderson Spencer R. , Mulenga Musunga A. , Wimalawansa Sunishka M. , Kadakia Sameep P. 
Published: July 2021

Study Design:
Technique Description with clinical presentation Correlates.

Purpose:
Revisit and discuss the advantages of the cervicodeltopectoral flap (CDP) as an alternative to microvascular reconstruction for head and neck cutaneous defects.

Methods:
Retrospective chart review was performed on 2 patients with prior large cutaneous facial defects after tumor resection followed by cervicodeltopectoral flap reconstruction. These cases were performed at a single institution. The tumor resections, flap reconstructions, and postoperative management were led by the listed senior author (SPK).

Results:
A 78-year-old (Clinical presentation 1) and 62-year-old (Clinical presentation 2) were evaluated for large nonmelanoma skin cancers of the face. Due to significant comorbidities, neither patient was an ideal candidate for microsurgical reconstruction. In both cases, lesion resection and CDP flap reconstruction was performed. The reconstruction allowed for successful coverage without significant donor site morbidity for each patient.

Conclusions:
The authors propose the addition of the CDP flap to the armamentarium of the head and neck reconstructive surgeon as a safe and reliable alternative to microvascular reconstruction.
Impact of Immune Response in Short-term and Long-term Outcomes After Minimally Invasive Surgery for Colorectal Liver Metastases: Results From a Randomized Study
Authors: Lopez-Lopez Victor , Gómez Ruiz Alvaro , Pelegrin Pablo , Abellán Beatriz , Lopez-Conesa Asunción , Brusadin Roberto , Cayuela Valentin , García Ana , Robles Campos Ricardo 
Published: July 2021

Background:
The potential benefit related to laparoscopic liver surgery (LLS) for colorectal liver metastases outcomes is not well known.

Materials and Methods:
Serum cytokines associated with Th1 (tumor necrosis factor-α) and Th2 [interleukin (IL)-10 and IL-6] phenotypes were measured in 36 patients operated on for colorectal liver metastases by open liver surgery (OLS) and LLS. Measurements were performed at 3 time points: 1 day before surgery, day 3 postoperative, and 1 month postoperative. We compared the postoperative inflammatory response influence between LLS and OLS on long-term outcomes.

Results:
In both groups, only IL-6 levels on day 3 postoperative were higher than those measured preoperatively and at 1 month. Comparing the tumor necrosis factor-α levels between the LLS and OLS groups, preoperative (7.28 vs. 2.36), day 3 (7.99 vs. 4.08) and 1 month (7.39 vs. 1.99) postoperative levels were higher in the OLS group (P<0.01, <0.01, and <0.01, respectively). In contrast, IL-10 levels were higher in the LLS group preoperatively (7.51 vs. 4.57) and on day 3 postoperative (13.40 vs. 4.57) (P=0.03 and 0.01, respectively). A cut-off IL-6 level of ≥4.41 in the first month was associated with a higher risk of recurrence (logrank=4.8, P=0.02).

Conclusions:
Both LLS and OLS induce an initial increase in IL-6 that normalizes one month after surgery, showing a similar pattern. In addition, a cut-off IL-6 value of 4.41 pg/mL was established, with a higher concentration at 1 month postoperative possibly related to a higher risk or recurrence.
Elevated levels of the cytokine LIGHT in Crohn’s disease
Authors: Cardinale Christopher J. , Abrams Debra J. , Mentch Frank D. , Cardinale John A. , Kao Charlly , Sleiman Patrick M.A. , Hakonarson Hakon 
Published: July 2021

AbstractLIGHT, encoded by the TNFSF14 gene, is a cytokine belonging to the tumor necrosis factor superfamily. Upon binding to its receptors, HVEM and LTBR, it activates inflammatory responses. We used a single-molecule immunoassay to determine the circulating levels of free LIGHT in plasma from pediatric patients with Crohn’s disease (N = 183) and a panel of healthy pediatric reference samples (N = 9). LIGHT levels were greatly elevated in Crohn’s disease (average of 305 pg/ml versus 57 pg/ml in controls, P < 0.0001). We performed correlational analyses between LIGHT levels and the clinical characteristics of the Crohn’s cohort, including age, Montreal classification, family history, medical/surgical therapy, and routine blood test parameters. We found statistically significant correlation between white blood cell count and free LIGHT (P < 0.046). Our results support the hypothesis that elevated levels of the cytokine contribute to the pathology of Crohn’s disease and that therapies to neutralize free LIGHT with antibodies may be beneficial.
Leveraging of SARS-CoV-2 PCR cycle thresholds values (Ct) to forecast COVID-19 trends
Authors: Yin Nicolas , Dellicour Simon , Daubie Valery , Franco Nicolas , Wautier Magali , Faes Christel , Van Cauteren Dieter , Nymark Liv , Hens Niel , Gilbert Marius , Hallin Marie , Vandenberg Olivier 
Published: July 2021

AbstractIntroductionWe assessed the usefulness of SARS-CoV-2 RT-PCR cycle thresholds (Ct) values trends produced by the LHUB-ULB (a consolidated microbiology laboratory located in Brussels, Belgium) for monitoring the epidemic’s dynamics at local and national levels and for improving forecasting models.MethodsSARS-CoV-2 RT-PCR Ct values produced from April 1, 2020, to May 15, 2021, were compared with national COVID-19 confirmed cases notifications according to their geographical and time distribution. These Ct values were evaluated against both a phase diagram predicting the number of COVID-19 patients requiring intensive care and an age-structured model estimating COVID-19 prevalence in Belgium.ResultsOver 155,811 RT-PCR performed, 12,799 were positive and 7,910 Ct values were available for analysis. The 14-day median Ct values were negatively correlated with the 14-day mean daily positive tests with a lag of 17 days. In addition, the 14-day mean daily positive tests in LHUB-ULB were strongly correlated with the 14-day mean confirmed cases in the Brussels-Capital and in Belgium with coinciding start, peak and end of the different waves of the epidemic. Ct values decreased concurrently with the forecasted phase-shifts of the diagram. Similarly, the evolution of 14-day median Ct values was negatively correlated with daily estimated prevalence for all age-classes.ConclusionWe provide preliminary evidence that trends of Ct values can help to both follow and predict the epidemic’s trajectory at local and national levels, underlining that consolidated microbiology laboratories can act as epidemic sensors as they gather data that are representative of the geographical area they serve.
Deep Optical Blood Analysis: COVID-19 Detection as a Case Study in Next Generation Blood Screening
Authors: Cooke Colin L. , Kim Kanghyun , Xu Shiqi , Chaware Amey , Yao Xing , Yang Xi , Neff Jadee , Pittman Patricia , McCall Chad , Glass Carolyn , Jiang Xiaoyin Sara , Horstmeyer Roarke 
Published: July 2021

AbstractA wide variety of diseases are commonly diagnosed via the visual examination of cell morphology within a peripheral blood smear. For certain diseases, such as COVID-19, morphological impact across the multitude of blood cell types is still poorly understood. In this paper, we present a multiple instance learning-based approach to aggregate high-resolution morphological information across many blood cells and cell types to automatically diagnose disease at a per-patient level. We integrated image and diagnostic information from across 236 patients to demonstrate not only that there is a significant link between blood and a patient’s COVID-19 infection status, but also that novel machine learning approaches offer a powerful and scalable means to analyze peripheral blood smears. Our results both backup and enhance hematological findings relating blood cell morphology to COVID-19, and offer a high diagnostic efficacy; with a 79% accuracy and a ROC-AUC of 0.90.
Heart-centered positioning and tailored beam-shaping filtration for reduced radiation dose in coronary artery calcium imaging: a MESA study
Authors: Colvert Brendan , Rigoli Marzia , Craine Amanda , Criqui Michael , Contijoch Francisco 
Published: July 2021

ABSTRACTPurposeCardiac CT has a clear clinical role in the evaluation of coronary artery disease and assessment of coronary artery calcium (CAC) but the use of ionizing radiation limits clinical use. Beam shaping “bow-tie” filters determine the radiation dose and the effective scan field-of-view diameter (SFOV) by delivering higher X-ray fluence to a region centered at the isocenter. A method for positioning the heart near the isocenter could enable reduced SFOV imaging and reduce dose in cardiac scans. However, a predictive approach to center the heart, the extent to which heart centering can reduce the SFOV, and the associated dose reductions have not been assessed. The purpose of this study is to build a heart-centered patient positioning model, to test whether it reduces the SFOV required for accurate CAC scoring, and to quantify the associated reduction in radiation dose.MethodsThe location of 38,184 calcium lesions (3,151 studies) in the Multi-Ethnic Study of Atherosclerosis (MESA) were utilized to build a predictive heart-centered positioning model and compare the impact of SFOV on CAC scoring accuracy in heart-centered and conventional body-centered scanning. Then, the positioning model was applied retrospectively to an independent, contemporary cohort of 118 individuals (81 with CAC>0) at our institution to validate the model’s ability to maintain CAC accuracy while reducing the SFOV. In these patients, the reduction in dose associated with a reduced SFOV beam-shaping filter was quantified.ResultsHeart centering reduced the SFOV diameter 25.7% relative to body centering while maintaining high CAC scoring accuracy (0.82% risk reclassification rate). In our validation cohort, imaging at this reduced SFOV with heart-centered positioning and tailored beam-shaping filtration led to a 26.9% median dose reduction (25-75th percentile: 21.6 to 29.8%) without any calcium risk reclassification.ConclusionsHeart-centered patient positioning enables a significant radiation dose reduction while maintaining CAC accuracy.
State-dependent patterns and coupling between the vaccination schedule, population mobility and the COVID epidemic outline, in the US states
Authors: Rǎdulescu Anca , Alonso Tatiana , Reid Norman , Sanchez Johanna 
Published: July 2021

AbstractWe study the evolution of the COVID-19 epidemic in the US, since January 2020 until May 2021. Our primary goal is to understand some of the complex coupled dynamics between factors that ultimately regulate the epidemic case load. As potentially crucial factors, we focus on population mobility and vaccination patters (both related to risk of contracting the SARS-Cov2 virus). These factors may in turn depend on demographic parameters (which are unrelated to the epidemic evolution), but also on the population response to the epidemic outbreak itself. In our work, we use correlation analyses, in conjunction with open source data from US states, to investigate the type and strength (1) of the relationships between demographic measures and epidemic, mobility and vaccination timelines during our established time window; (2) of the bidirectional coupling between these timelines.We showed that the wide between-state differences in epidemic outcome correspond to between-state differences in demographic measures (such as density, income, political affiliation). As a potential underlying mechanism, we found that demographic measures are also predictive of the degree of coupling between epidemic timelines (on one hand) and vaccination and mobility timelines (on the other hand), coupling which can be broadly interpreted as the population’s behavioral response to the epidemic. In support of this idea, our analysis shows this response to be tightly correlated with epidemic outcome.This suggests that a state’s demographic profile may be invaluable to generating predictions on the epidemic evolution in the respective state, and that this information may be used to understand the weaknesses of a state and how to compensate for them to improve epidemic outcome (e.g., via state centralized incentives, and customized mitigation strategies).