bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Spine Injuries with Acute Traumatic Spinal Cord Injury
Authors: Liebscher Thomas , Ludwig Johanna , Lübstorf Tom , Kreutzträger Martin , Auhuber Thomas , Grittner Ulrike , Schäfer Benedikt , Wüstner Grit , Ekkernkamp Axel , Kopp Marcel A. 
Published: May 2021

Study Design.
Monocenter case-control study.

Objective.
Effects of spinal surgical adverse events (SSAE) on clinical and functional outcome, length of stay, and treatment costs after traumatic cervical spinal cord injury (SCI).

Summary of Background Data.
Traumatic SCI is a challenge for primary care centers because of the emergency setting and complex injury patterns. SSAE rates of up to 15% are reported for spine fractures without SCI. Little is known about SSAE after traumatic SCI and their outcome relevance.

Methods.
Acute traumatic cervical SCI patients were enrolled from 2011 to 2017. Cases with and without SSAE were compared regarding neurological recovery, functional outcome, secondary complications, mortality, length of stay, and treatment costs. Adjusted logistic regression and generalized estimating equation models were calculated for the endpoints ASIA impairment scale (AIS)-conversion and dysphagia. All analyses were run in the total and in a propensity score matched sample.

Results.
At least one SSAE occurred in 37 of 165 patients (22.4%). Mechanical instability and insufficient spinal decompression were the most frequent SSAE with 13 (7.9%) or 11 (6.7%) cases, respectively. The regression models adjusted for demographic, injury, and surgery characteristics demonstrated a reduced probability for AIS-conversion related to SSAE (OR [95% CI] 0.14 [0.03–0.74]) and additionally to single-sided ventral or dorsal surgical approach (0.12 [0.02–0.69]) in the matched sample. Furthermore, SSAE were associated with higher risk for dysphagia in the matched (4.77 [1.31–17.38]) and the total sample (5.96 [2.07–17.18]). Primary care costs were higher in cases with SSAE (median (interquartile range) 97,300 [78,200–112,300]) EUR compared with cases without SSAE (52,300 [26,700–91,200]) EUR.

Conclusion.
SSAE are an important risk factor after acute traumatic cervical SCI with impact on neurological recovery, functional outcome, and healthcare costs. Reducing SSAE is a viable means to protect the limited intrinsic capacity for recovery from SCI.

Level of Evidence: 4
Transcatheter Aortic Valve Implantation Induces Transient Drop in Platelet Reactivity
Authors: Ostojic Zvonimir , Bulum Josko , Samardzic Jure , Pavasovic Sasa , Sipus Dubravka , Safradin Ivica , Reskovic Luksic Vlatka , Skoric Bosko , Separovic Hanzevacki Jadranka , Milicic Davor 
Published: May 2021

Abstract:
Although recent studies described platelet reactivity (PR) changes in days after transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. The aim of this study was to investigate PR pattern during and after TAVI in multiple time points. Study included 40 consecutive patients undergoing TAVI. All patients underwent the procedure on dual antiplatelet therapy. PR was measured in 7 time points: before induction of anesthesia (T1), after heparin administration (T2), 10 minutes after initial valve implantation (T3), at the end of procedure (T4), and on 3rd, 6th, and 30th postoperative day (T5–T7). PR was measured using impedance aggregometer using 3 different platelet aggregation agonists (arachidonic acid in ASPItest, adenosine diphosphate in ADPtest and thrombin receptor activating peptide 6 in TRAPtest). All patients underwent successful TAVI procedure. Mean PR on T1 was 22.9 ± 23.0 U for ASPItest, 40.5 ± 23.7 U for ADPtest and 91.7 ± 32.5 U for TRAPtest. There was no significant difference in PR on T2. On T3, significant reduction of PR in all 3 tests was observed [ASPI 10.4 ± 11.6 U (P = 0.001), ADP 24.2 ± 14.1 U (P < 0.001) and TRAP 69.3 ± 26.6 U (P < 0.001)]. PR nadir for all tests was reached on T5, with subsequent PR incline. PR values in all tests returned to baseline levels on T7. Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway.
BACILLARY LAYER DETACHMENT: MULTIMODAL IMAGING AND HISTOLOGIC EVIDENCE OF A NOVEL OPTICAL COHERENCE TOMOGRAPHY TERMINOLOGY
Authors: Ramtohul Prithvi , Engelbert Michael , Malclès Ariane , Gigon Edward , Miserocchi Elisabetta , Modorati Giulio , Cunha de Souza Eduardo , Besirli Cagri G. , Curcio Christine A. , Freund K. Bailey 
Published: May 2021

Purpose:To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging.Methods:The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions.Results:A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the photoreceptor inner segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual photoreceptors can shed inner segments. Furthermore, detachment of the entire layer of inner segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of photoreceptor outer segments to the retinal pigment epithelium exceed the tensile strength of the photoreceptor inner segment myoid.Conclusion:This review serves to strengthen the OCT nomenclature “bacillary layer detachment,” based on specific reflectance information obtained by OCT and previously published histologic observations.
Impact of the COVID-19 Pandemic on Keratoplasty and Corneal Eye Banking
Authors: Ballouz Dena , Sawant Onkar B. , Hurlbert Susan , Titus Michael S. , Majmudar Parag A. , Kumar Ashok , Zhou Yunshu , Musch David C. , Mian Shahzad I. 
Published: May 2021

Purpose:
The purpose of this study was to assess the impact of COVID-19 guidelines for corneal donor tissue screening and the utility of routine postmortem COVID-19 testing of donors intended for surgical use at a single eye bank.

Methods:
A retrospective analysis of referrals to and eligible donors from an eye bank between March 1, 2020, and June 30, 2020, was performed, with the same time period in 2019 as a control. Referrals who were not procured because of Eye Bank Association of America COVID-19 guidelines and eye bank–specific restrictions were noted. The results of 1 month of routine postmortem testing performed by the eye bank were examined. Analysis of variance tests were performed to assess the change between donors from 2019 to 2020.

Results:
There was a significant reduction in both the number of total referrals to the eye bank (P = 0.044) and donors eligible for surgical transplantation (P = 0.031). Eye Bank Association of America COVID-19 guidelines reduced the number of referrals over this period by 4% to 14%. Of the 266 surgically eligible donors who received postmortem COVID-19 testing in June by the eye bank, 13 resulted positive (4.9%).

Conclusions:
Despite a reduction in referrals and eligible corneal transplant donors at a single eye bank, there was a surplus of surgically suitable corneal tissue during the first wave of the COVID-19 pandemic. Eye banks should consider routine postmortem COVID-19 testing to identify asymptomatic infected donors although the risk of transmission of COVID-19 from infected donors is unknown.
Herpes Zoster: A Brief Definitive Review
Authors: Cohen Elisabeth J. , Jeng Bennie H. 
Published: May 2021

Abstract:
This brief definitive review of herpes zoster (HZ) will cover the current state of knowledge and questions that remain to be answered regarding HZ in general and HZ ophthalmicus in particular. A question-and-answer format will be used to address various important topics related to this common and serious disease. Questions to be addressed relate to common misconceptions, contagiousness of infection, unknowns regarding pathogenesis, rising incidence, risk factors and complications, relationship with temporal arteritis, vaccination, and current and future antiviral treatment. In addition, the importance of the Zoster Eye Disease Study to determine the efficacy of suppressive valacyclovir treatment in preventing complications of HZ ophthalmicus and the need to support enrollment will be discussed.
Implementing a Robust Process Improvement Program in the Neonatal Intensive Care Unit to Reduce Harm
Authors: Nether Klaus G. , Thomas Eric J. , Khan Amir , Ottosen Madelene J. , Yager Lauren 
Published: May 2021

ABSTRACT

Introduction:
Preventable harm continues to occur with critically ill neonates despite efforts by hospital neonatal intensive care units (NICUs) to improve processes and reduce harm. Attaining significant and sustainable improvements will require training including leadership support, mentoring, and patient family engagement to improve care processes. This paper describes the implementation of a robust process improvement (RPI) program in the NICU to reduce harm.

Methods:
Leaders, staff, and parents were trained in RPI concepts and tools. Multidisciplinary teams including parent members applied the training and received regular mentorship for their improvement initiatives.

Results:
Participants (N = 67) completed pretraining and post-training surveys. Training scores (0–10 scale) improved from an average of 4.45–7.60 (p < .001) for confidence in leading process improvement work, 2.36 to 7.49 (p < .001) for RPI knowledge, and 2.19 to 7.30 (p < .001) for confidence in using RPI tools; relative improvement of 71%, 217%, and 233% respectively. Participants applied their RPI training on improvement initiatives that resulted in improvements of central line blood stream infections, very low birth weight infant nutrition, and unplanned extubations.

Conclusions:
Implementing an RPI program in the NICU to reduce harm resulted in significant and sustainable improvements on their improvement initiatives.
No Significant Difference in Post-ERCP Bleeding Rates Between Dual Antiplatelet Agents and Aspirin Alone
Authors: Bhurwal Abhishek , Mutneja Hemant , Goel Akshay , Bansal Vikas , Patel Anish , Brahmbhatt Bhaumik , Sarkar Avik 
Published: May 2021

Background:
Several professional society guidelines suggest holding antiplatelet agents before high-risk procedures. However, there is lack of high-grade evidence to support the recommendation as most of the studies have been single center with small sample sizes. We aimed to perform the first systematic review and meta-analysis comparing dual antiplatelet therapy (DAPT) versus aspirin alone in terms of postendoscopic retrograde cholangiopancreatography (ERCP) bleeding.

Methods
Three independent reviewers performed a comprehensive review of all original articles published from inception to May 2020, evaluating the post-ERCP bleeding rate in setting of DAPT. Primary outcomes were the overall post-ERCP bleeding rate with the use of dual antiplatelet therapy; comparison of post-ERCP bleeding rate in patients with DAPT versus aspirin alone. Secondary outcomes were comparison of immediate and delayed post-ERCP bleeding outcomes in the 2 cohorts.

Results:
Six studies were included after a thorough search was concluded using the key words. The pooled analysis of studies revealed an overall post-ERCP bleeding rate of 5.7% (95% confidence interval: 3-10.6) on sustained DAPT. Post-ERCP bleeding in DAPT Cohort was not significantly higher as compared with aspirin only Cohort (odds ratio: 1.14, 95% confidence interval: 0.46-2.81). The immediate bleeding and delayed bleeding rates cannot be generalized due to low number of studies.

Conclusions:
The first systematic review and meta-analysis showed that post-ERCP bleeding rates are not significantly higher in DAPT cohort as compared with aspirin alone. Therefore, the risk of bleeding is less likely related to the antiplatelet agents and more likely related to the procedure itself.
Comparison Between Real-time Ammonium and pH Measurement, Immunohistochemistry, and Histochemistry for the Diagnosis of Helicobacter pylori
Authors: Carretero-Barrio Irene , Rodajo-Fernandez Tania , Romio Estefanía , Sanchez-Rodriguez Eugenia , Vázquez-Sequeiros Enrique , Perna Cristian , Caminoa-Lizarralde Alejandra 
Published: May 2021

Background:

Helicobacter pylori (HP) infection has been implicated in several malignant and nonmalignant conditions. The confirmatory diagnosis of HP requires an endoscopic biopsy, followed by a rapid urease test, culture, and/or histopathologic examination using hemotoxylin and eosin, histochemical stains, or immunohistochemistry against HP. EndoFaster is a novel device that can perform real-time ammonium and pH measurements in gastric juice, allowing a diagnosis of HP during gastroduodenal endoscopy.

Goal:
This study aimed to validate the accuracy of EndoFaster and to compare different histochemical and immunohistochemical techniques for the diagnosis of HP infection.

Study:
Consecutive patients who underwent upper endoscopy at our center were prospectively enrolled. During the endoscopy procedure, gastric juice was aspirated to perform an automatic analysis by EndoFaster and gastric biopsies were taken. Histologic sections were reviewed to assess the histopathologic features. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the EndoFaster test, Diff-Quick (DQ), and immunohistochemistry against HP (anti-HP) using Warthin-Starry as the gold standard for HP detection.

Results:
Overall, 80 patients were enrolled. In 19 cases (23,75%), histology was normal. In the remaining cases, varying degrees of inflammation were found. The sensitivity, specificity, positive predictive value, and negative predictive value were 73.33%, 86.00%, 75.86%, and 84.31% for the EndoFaster test using 67 ppm/mL as the positive threshold; 73.33%, 100%, 100%, and 86.21% for DQ; and 79.31%, 88.00%, 79.31%, and 88.00% for anti-HP, respectively.

Conclusions:
The EndoFaster test has good sensitivity and specificity for the diagnosis of HP during the gastroscopy procedure. DQ and anti-HP are excellent alternatives to Warthin-Starry for the detection of HP.
Direct-to-Consumer Sexually Transmitted Infection Testing Services: A Position Statement from the American Sexually Transmitted Diseases Association
Authors: Exten Cara , Pinto Casey N. , Gaynor Anne M. , Meyerson Beth , Griner Stacey B. , Van Der Pol Barbara ,   on behalf of the Board of Directors of the American Sexually Transmitted Diseases Association
Published: May 2021

Abstract
Direct-to-consumer test services have gained popularity for sexually transmitted infections in recent years, with substantially increased use as a result of the SARS-CoV-2 (CoVID-19) global pandemic. This method of access has been variously known as “self-testing,” “home testing,” and “direct access testing.” Although these online services may be offered through different mechanisms, here we focus on those that are consumer-driven and require self-collected samples, and sample shipment to a centralized laboratory without involvement of health care providers and/or local health departments. We provide the American Sexually Transmitted Diseases Association's position on utilization of these services and recommendations for both consumers and health care providers.
Ultrasound Assessment of Quadriceps Femoris Muscle Thickness in Critically Ill Children*
Authors: Hoffmann Robert M. , Ariagno Katelyn A. , Pham Ivy V. , Barnewolt Carol E. , Jarrett Delma Y. , Mehta Nilesh M. , Kantor David B. 
Published: May 2021

OBJECTIVES:
Evaluate the reliability of ultrasound to measure quadriceps femoris muscle thickness in critically ill children and to describe serial changes in quadriceps femoris muscle thickness in relation to fluid balance and nutritional intake.

DESIGN:
Prospective observational study.

SETTING:
Tertiary care children’s hospital.

PATIENTS:
Inpatients age 3 months to 18 years recently admitted to the ICU who were sedated and mechanically ventilated at the time of the first ultrasound scan.

METHODS:
Prospective observational study to examine the reliability of averaged ultrasound measurements of quadriceps femoris muscle thickness. Change in average quadriceps femoris muscle thickness over time was correlated with fluid balance and nutritional intake.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Averaged quadriceps femoris muscle thickness demonstrated good to excellent reliability when comparing pediatric critical care providers to pediatric radiologists and when comparing between different pediatric critical care providers. We found no significant association between fluid balance over 1 or 3 days and change in quadriceps femoris muscle thickness over the same time frame. However, there was a significant association between percent of goal calories (p < 0.001) or percent of goal protein (p < 0.001) over 6 days and change in quadriceps femoris muscle thickness over the same time frame.

CONCLUSIONS:
Averaged ultrasound measurements of quadriceps femoris muscle thickness demonstrate good to excellent reliability, are not confounded by fluid balance, and are useful for tracking changes in muscle thickness that are associated with nutritional intake. Ultrasound-based assessment of quadriceps femoris is a clinically useful tool for evaluating muscle mass and may be a proxy for nutritional status.
Characterizing Sleep Disruption and Delirium in Children After Cardiac Surgery: A Feasibility Study
Authors: Gregory Jillian L. , Brown Anna T. , Kudchadkar Sapna R. 
Published: May 2021

OBJECTIVES:
Patients in the pediatric cardiac ICU are frequently exposed to pharmacologic and environmental factors that predispose them to sleep disturbances and may increase the risk of delirium. In this pilot study, we sought to demonstrate the feasibility of actigraphy monitoring in pediatric cardiac ICU patients to investigate the association between sleep characteristics and delirium development.

DESIGN:
Prospective observational pilot study.

SETTING:
Pediatric cardiac ICU in an academic children’s hospital in the United States.

PATIENTS:
Children admitted to the pediatric cardiac ICU after cardiac surgery.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Nineteen enrolled patients wore actigraphy watches that provided data for a total of 63 pediatric cardiac ICU days. The median pediatric cardiac ICU length of stay was 2 days (interquartile range, 1–3 d). The median sleep episode among all patients was 37 minutes in duration (interquartile range, 18–46 min), and the longest sleep episode was a median of 117 minutes (interquartile range, 69–144 min). Sixty-one percent of patients (95% CI, 36–83%) screened positive for delirium at least once during admission, and the median number of delirious days among those who were positive was 2 days (interquartile range, 1–3 d). The median percent sleep time was 43% for delirious patients and 49% for those with no delirium, with similar median sleep and longest sleep episodes. The median ratio of daytime activity/24-hr activity was 54% (interquartile range, 49–59%) in both groups.

CONCLUSIONS:
Actigraphy monitoring in conjunction with delirium screening is feasible in infants and children admitted to the pediatric cardiac ICU after cardiac surgery. Our data suggest that most children in the pediatric cardiac ICU experience severe sleep disruption and delirium is common. These pilot data provide important insights for the design of a large-scale observational study to investigate potential causal relationships between sleep disruption and delirium in the pediatric cardiac ICU.
The Efficacy of a Home-Based, Self-Administered Hand Exercise Program for Patients With Systemic Sclerosis
Authors: Gokcen Neslihan , Badak Suade Ozlem , Sarpel Tunay , Sertdemir Yasar , Erken Eren 
Published: May 2021

Background
For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc.

Methods
This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire–Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status.

Results
Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength.

Conclusions
The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.
131I Ablation of an Entire Thyroid Gland in Locally Invasive Differentiated Thyroid Cancer Without Surgery
Authors: Yung Grace , Forwood Nicholas , Russo Robert , Ganda Kirtan , Mansberg Robert 
Published: May 2021

Abstract
A 79-year-old man with locally metastatic papillary thyroid cancer to left-sided cervical lymph nodes was referred for radioiodine therapy. He was considered unfit for thyroidectomy due to extensive local involvement and severe interstitial lung disease requiring continuous oxygen. The patient was treated with low doses of radioiodine (approximately 30 mCi) every 6 months with corticosteroid cover for 3 years with good effect. Sequential 131I scanning and serum thyroglobulin levels confirmed virtual complete ablation of the thyroid gland. The patient remained well on thyroid hormone replacement.