bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHANGES IN THE CHOROIDAL THICKNESS AFTER MACULAR BUCKLING IN HIGHLY MYOPIC EYES
Authors: Tang Ningning , Zhao Xiujuan , Chen Jing , Liu Bingqian , Lu Lin 
Published: January 2021

Purpose:
To assess changes in the choroidal thickness (CT) after macular buckling in eyes with high myopia.

Methods:
Highly myopic eyes that underwent macular buckling surgery were retrospectively analyzed. Data of swept-source optical coherence tomography scanning at baseline and at 1, 3, 6, 12, and 18 months after macular buckling were collected. Subfoveal CT and CT at 750 µm superior, inferior, nasal, and temporal to the fovea were measured. The total choroidal area, vascular area, and stromal area were measured by the binarization method. The choroidal vascularity index was calculated by dividing the vascular area by the total choroidal area.

Results:
Forty-one eyes were included in the final analysis. The subfoveal CT increased from 49.85 ± 31.23 µm preoperatively to 75.74 ± 37.89 µm 1 month after macular buckling (P < 0.001), then decreased over time, coinciding with the trends of parafoveal CT, total choroidal area, vascular area, and stromal area. The subfoveal CT was restored to the preoperative level six months postoperatively (P = 0.202) and remained stable until the end of follow-up. The choroidal vascularity index increased at 1 and 3 months postoperatively (P = 0.001 and 0.005, respectively).

Conclusion:
The choroid thickened in the early postoperative period. The compression force of the buckle implant might disturb microcirculatory drainage and contribute to the thickening. The choroid spontaneously recovered to the preoperative level over time.
Arterial stiffness in regards to kidney function in middle-aged subjects with metabolic syndrome: Lithuanian high-risk cohort
Authors: Laucyte-Cibulskiene Agne , Ryliskyte Ligita , Badaras Ignas , Navickas Petras , Badariene Jolita , Laucevicius Aleksandras 
Published: January 2021

Objective
The current study aimed to check whether early vascular aging, measured as carotid-femoral pulse wave velocity (cfPWV), is related to kidney function, measured as creatinine-based estimated glomerular filtration (eGFR) and urinary albumin-to-creatinine ratio (UACR), in middle-aged subjects with metabolic syndrome.

Methods
Participants were recruited from Lithuanian high-risk cohort (LitHiR). The cohort consists of middle-aged individuals with high cardiovascular risk but without overt cardiovascular disease. Participants underwent baseline and second visit hemodynamics measurement, including aortic mean arterial pressure (MAP), cfPWV, crPWV, carotid-intima media thickness measurement (CIMT) and biochemical analysis and all fulfilled NCEP/ATPIII criteria for metabolic syndrome diagnosis. First of all, we had determined correlations among hemodynamic measurement and eGFR together with albuminuria, expressed as UACR. Then we compared subjects who experienced significant eGFR decline with the remaining population and determining factors influencing this.

Results
A total of 689 subject data were eligible for analysis. We observed relationship between cfPWV and MAP, crPWV, glucose, BMI, C-reactive protein, waist circumference except kidney function measured as eGFR at the baseline and at the second visit. eGFR was not associated with MAP or albuminuria. Baseline but not second visit UACR significantly positively correlated with cfPWV (r-spearman = 0.146, P = 0.003) and MAP (r-spearman = 0.142, P = 0.005). eGFR decline was mainly observed in subjects with higher baseline eGFR and was independently influenced by increase in cfPWV.

Conclusion
In middle-aged subjects with prevalent metabolic syndrome eGFR decline is related to aortic and not peripheral arterial stiffening. Better baseline kidney function could be possibly an effect of glomerular hyperfiltration, and it allows us to conclude that this phenomenon indicates early vascular damage and it should be addressed seriously in metabolic syndrome patients with normal kidney function.
Nutritional Therapy in Children With Spinal Muscular Atrophy in the Era of Nusinersen
Authors: Yerushalmy‐Feler Anat , Levy Dina , Sagi Liora , Fattal‐Valevski Aviva , Shiff Yaffa Elbaum , Brener Avivit , Cohen Shlomi 
Published: January 2021

ABSTRACTObjectives:Spinal muscular atrophy (SMA) is a genetic motor neuron disorder characterized by progressive muscle atrophy. Our aims were to evaluate the impact of nutritional intervention and nusinersen therapy on the nutritional status of SMA patients.Study design:This prospective study included all children and young adults (<24 years of age) with SMA who attended our multidisciplinary SMA clinic, during January 2017–July 2019. We documented demographic, clinical, anthropometric, and nutritional data at baseline and follow‐up. A nutritional intervention was implemented according to standards of the 2018 Consensus Statement of SMA Management.Results:The cohort included 51 SMA patients with a median age of 7.2 (interquartile range 2.1–15.3) years. Among them, 24 (47%) were SMA type 1, 16 (31.4%) SMA type 2, and 11 (21.6%) SMA type 3 patients. At baseline, 28 (54.9%) patients presented with malnutrition, 20 (71.4%) of whom with severe malnutrition. A decline in the frequency of severe malnutrition of SMA type 1 patients was observed at follow‐up. The body mass index of patients who started nusinersen therapy after the nutritional intervention increased significantly compared with patients that started nusinersen therapy before the nutritional intervention (P = 0.042). There was also a significant increase in total energy and protein consumption in the former group (P = 0.043).Conclusions:Malnutrition is frequent among children with SMA, and the nutritional status of patients that started nusinersen therapy after implementation of a nutritional intervention underwent a more significant improvement. The importance of combining adequate nutritional management with disease‐modifying treatment is highlighted.
Muscular Hemorrhages Around the Scapula Provide Insight on the Manner of Asphyxia
Authors: Oshima Toru , Ohtani Maki , Mimasaka Sohtaro 
Published: January 2021

Abstract
Muscular hemorrhages around the scapula that are caused by upper extremity motion are rarely reported in cases other than drowning. We examined differences in the frequency of muscular hemorrhages around the scapula and stratified them by the cause of death. Muscular hemorrhages were mostly noted in cases of drowning (118/185, 63.8%), followed by cases of asphyxia (23/44, 52.3%). In addition, muscular hemorrhages around the scapula were found in cases of ligature strangulation (8/11, 72.7%), manual strangulation (2/3, 66.7%), choking (11/14, 78.6%), and traumatic asphyxia (2/2, 100%). Muscular hemorrhages were not found in cases of hanging or environmental suffocation, possibly because of the short time interval preceding the loss of consciousness. The distribution of muscular hemorrhages was similar in choking and drowning cases. Muscular hemorrhages due to strangulation were mainly unilateral, whereas those due to choking and drowning were mainly bilateral. During all types of asphyxia, muscular hemorrhages around the scapula were considered to be the result of conscious, active upper extremity motion. Because the frequency and laterality of muscular hemorrhages around the scapula differed based on the type of asphyxia, our findings provide insights into the manner of asphyxia that could be used to aid in the identification of homicidal hangings.
Glyphosate and Polyoxyethyleneamine Ingestion Leading to Renal, Hepatic, and Pulmonary Failure
Authors: Bigner Jessica A. , Fiester Steven E. , Fulcher James W. , Schammel Christine M.G. , Ward Michael E. , Burney Harmonie E. , Wheeler John F. , Wheeler Sandy K. , Teuber Julie M. 
Published: January 2021

Abstract
Glyphosate is an organophosphorus compound and the active ingredient in commonly used herbicides, whereas polyoxyethyleneamine (POEA) is a nonionic surfactant often coupled with glyphosate in these herbicides to increase their efficacy. Cases of glyphosate-POEA ingestion have shown a variety of outcomes, ranging from skin and mucosal surface irritation to death. Here, we report mortality after ingestion of at least 237 mL of an herbicide confirmed to contain both glyphosate and POEA. The decedent's electronic medical record indicates presentation to the emergency department shortly after ingestion and rapid decompensation, with death occurring on the fourth day of admission. The autopsy report showed extensive pulmonary edema and congestion with no alimentary tract abnormalities. Microscopically, airway inflammation, edema, and hemorrhage were shown as well as pericentral necrosis and macrovascular hepatic steatosis. This case is unusual for several reasons including the fatal outcome in a young 30-year-old patient, the large volume of the herbicide consumed, the associated large volume aspirated, and the lung pathology associated with exposure to glyphosate-POEA since inhalation, and in this case, aspiration is an uncommon route of glyphosate-POEA exposure. This report therefore offers rare respiratory tract pathological findings and the clinical course after aspiration of a large volume of glyphosate-POEA.
“I Just Decided to Stop:” Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya
Authors: Ongolly Fernandos K. , Dolla Annabel , Ngure Kenneth , Irungu Elizabeth M. , Odoyo Josephine , Wamoni Elizabeth , Peebles Kathryn , Mugwanya Kenneth , Mugo Nelly R. , Bukusi Elizabeth A. , Morton Jennifer , Baeten Jared M. , O'Malley Gabrielle 
Published: January 2021

Background:
Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up.

Methods:
We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued.

Results:
Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation.

Conclusion:
Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
Secular Trends in Breast Cancer Risk Among Women With HIV Initiating ART in North America
Authors: Coburn Sally B. , Shiels Meredith S. , Silverberg Michael J. , Horberg Michael A. , Gill M. John , Brown Todd T. , Visvanathan Kala , Connor Avonne E. , Napravnik Sonia , Marcus Julia L. , Moore Richard D. , Mathews W. Chris , Mayor Angel M. , Sterling Timothy R. , Li Jun , Rabkin Charles S. , D'Souza Gyspyamber , Lau Bryan , Althoff Keri N. ,   for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International Epidemiology Databases to Evaluate AIDS
Published: January 2021

Background:
Studies suggest lower risk of breast cancer in women with HIV versus without HIV. These estimates may be biased by lower life expectancy and younger age distribution of women with HIV. Our analysis evaluated this bias and characterized secular trends in breast cancer among women with HIV initiating antiretroviral therapy. We hypothesized breast cancer risk would increase over time as mortality decreased.

Setting:
Women with HIV prescribed antiretroviral therapy in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1997 through 2016.

Methods:
We estimated breast cancer hazard (cause-specific hazard ratios) and cumulative incidence accounting for competing risks (subdistribution hazard ratios) to assess changes in breast cancer risk over time. This was assessed overall (1997–2016) and within/across calendar periods. Analyses were adjusted for race/ethnicity and inverse probability weighted for cohort. Cumulative incidence was graphically assessed by calendar period and race/ethnicity.

Results:
We observed 11,587 women during 1997–2016, contributing 63 incident breast cancer diagnoses and 1,353 deaths [73,445 person-years (median follow-up = 4.5 years)]. Breast cancer cumulative incidence was 3.2% for 1997–2016. We observed no secular trends in breast cancer hazard or cumulative incidence. There were annual declines in the hazard and cumulative incidence of death (cause-specific hazard ratios and subdistribution hazard ratios: 0.89, 95% confidence interval: 0.87 to 0.91) which remained within and across calendar periods.

Conclusions:
These findings contradict the hypothesis of increasing breast cancer risk with declining mortality over time among women with HIV, suggesting limited impact of changing mortality on breast cancer risk. Additional inquiry is merited as survival improves among women with HIV.
Skin manifestations of Pseudomonas aeruginosa infections
Authors: Spernovasilis Nikolaos , Psichogiou Mina , Poulakou Garyfallia 
Published: January 2021

Purpose of review

Pseudomonas aeruginosa is an opportunistic pathogen with considerable morbidity and mortality, particularly in vulnerable hosts. Skin manifestations are common, either representing local inoculation or secondary skin seeding following bloodstream infections. As patients with various predisposing conditions are expanding, we sought to review the most recent published evidence regarding epidemiology, risk factors and diagnosis of skin manifestations of P. aeruginosa.

Recent findings
New data exist on epidemiology and diagnosis of skin infections; systemic infections are impacted by multidrug-resistance issues and host immune status.

Summary
Green nail syndrome, toe web infection, hot tub folliculitis, hot hand-foot infection and external otitis are the most common infections originating from the skin per se. Local treatments are the cornerstone and prognosis is favorable in immunocompetent hosts. Ecthyma gangrenosum and P. aeruginosa subcutaneous nodules are usually associated with bloodstream infections and occur primarily in immunocompromised hosts. Necrotizing skin and soft tissue infections occur in diabetic, alcoholic and immunocompromised patients; management requires a multidisciplinary team with surgical approach. Burn wound infections may also be challenging, requiring a specialized team. In all the four latter types of P. aeruginosa skin infections portending significant morbidity and mortality, systemic antibiotics are an integral part of the treatment.
Anorectal Transplantation
Authors: Araki Jun , Nishizawa Yuji , Fujita Naoki , Sato Tomoyuki , lizuka Tomoya , Komata Masatoshi , Hatayama Naoyuki , Yakura Tomiko , Hirai Shuichi , Tashiro Kensuke , Galvão Flavio H. F. , Nakamura Tatsuo , Nakagawa Masahiro , Naito Munekazu 
Published: January 2021

Objective:
Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function.

Summary Background Data:
We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation.

Methods:
In the pudendal nerve function study, 6 dogs were randomly divided into 2 groups, transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination. In the anorectal transplantation model, 4 dogs were assigned to 4 groups: autotransplant, allotransplant with immunosuppression, allotransplant without immunosuppression, and normal control. Long-term function was evaluated by defecography, videography, and histological examination.

Results:
In the pudendal nerve function study, anorectal manometry indicated that the anastomosis group recovered partial function 6 months postoperatively. Microscopically, the pudendal nerve and the sphincter muscle regenerated in the anastomosis group. Anorectal transplantation was technically successful with a 3-stage operation: colostomy preparation, anorectal transplantation, and stoma closure. The dog who underwent allotransplantation and immunosuppression had 2 episodes of mild rejection, which were reversed with methylprednisolone and tacrolimus. The dog who underwent allotransplantation without immunosuppression had a severe acute rejection that resulted in graft necrosis. Successful dogs had full defecation control at the end of the study.

Conclusions:
We describe the critical role of the pudendal nerve in anorectal function and the first long-term success with anorectal transplantation in a canine model. This report is a proof-of-concept study for anorectal transplantation as a treatment for patients with an ostomy because of anorectal dysfunction.
Learning From England's Best Practice Tariff
Authors: Zogg Cheryl K. , Metcalfe David , Judge Andrew , Perry Daniel C. , Costa Matthew L. , Gabbe Belinda J. , Schoenfeld Andrew J. , Davis Kimberly A. , Cooper Zara , Lichtman Judith H. 
Published: January 2021

Objective:
The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan.

Summary Background Data:
Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative.

Methods:
Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved.

Results:
A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7–3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries’ mortality and >38,000 potential annual US lives saved.

Conclusions:
Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.
The Cost of Quarantine
Authors: Bose Sourav K. , Dasani Serena , Roberts Sanford E. , Wirtalla Chris , DeMatteo Ronald P. , Doherty Gerard M. , Kelz Rachel R. 
Published: January 2021

Objective:
We sought to quantify the financial impact of elective surgery cancellations in the US during COVID-19 and simulate hospitals’ recovery times from a single period of surgery cessation.

Background:
COVID-19 in the US resulted in cessation of elective surgery—a substantial driver of hospital revenue—and placed patients at risk and hospitals under financial stress. We sought to quantify the financial impact of elective surgery cancellations during the pandemic and simulate hospitals’ recovery times.

Methods:
Elective surgical cases were abstracted from the Nationwide Inpatient Sample (2016–2017). Time series were utilized to forecast March–May 2020 revenues and demand. Sensitivity analyses were conducted to calculate the time to clear backlog cases and match expected ongoing demand in the post-COVID period. Subset analyses were performed by hospital region and teaching status.

Results:
National revenue loss due to major elective surgery cessation was estimated to be $22.3 billion (B). Recovery to market equilibrium was conserved across strata and influenced by pre- and post-COVID capacity utilization. Median recovery time was 12–22 months across all strata. Lower pre-COVID utilization was associated with fewer months to recovery.

Conclusions:
Strategies to mitigate the predicted revenue loss of $22.3B due to major elective surgery cessation will vary with hospital-specific supply-demand equilibrium. If patient demand is slow to return, hospitals should focus on marketing of services; if hospital capacity is constrained, efficient capacity expansion may be beneficial. Finally, rural and urban nonteaching hospitals may face increased financial risk which may exacerbate care disparities.
Outpatient Opioid Prescriptions are Associated With Future Substance Use Disorders and Overdose Following Adolescent Trauma
Authors: Bell Teresa M. , Raymond Jodi L. , Mongalo Alejandro C. , Adams Zachary W. , Rouse Thomas M. , Hatcher LeRanna , Russell Katie , Carroll Aaron E. 
Published: January 2021

Objective:
This study aims to determine if outpatient opioid prescriptions are associated with future SUD diagnoses and overdose in injured adolescents 5 years following hospital discharge.

Summary of Background Data:
Approximately, 1 in 8 adolescents are diagnosed with an SUD and 1 in 10 experience an overdose in the 5 years following injury. State laws have become more restrictive on opioid prescribing by acute care providers for treating pain, however, prescriptions from other outpatient providers are still often obtained.

Methods:
This was a retrospective cohort study of patients ages 12–18 admitted to 2 level I trauma centers. Demographic and clinical data contained in trauma registries were linked to a regional database containing 5 years of electronic health records and prescription data. Regression models assessed whether number of outpatient opioid prescription fills after discharge at different time points in recovery were associated with a new SUD diagnosis or overdose, while controlling for demographic and injury characteristics, and depression and posttraumatic stress disorder diagnoses.

Results:
We linked 669 patients (90.9%) from trauma registries to a regional health information exchange database. Each prescription opioid refill in the first 3 months after discharge increased the likelihood of new SUD diagnoses by 55% (odds ratio: 1.55, confidence interval: 1.04–2.32). Odds of overdose increased with ongoing opioid use over 2–4 years post-discharge (P = 0.016–0.025).

Conclusions:
Short-term outpatient opioid prescribing over the first few months of recovery had the largest effect on developing an SUD, while long-term prescription use over multiple years was associated with a future overdose.