bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Hernia Mesh Explantation following Early Versus Late Onset Skin and Soft Tissue Infection
Authors: O’Brien William J. , Dipp Ramos Radwan , Gupta Kalpana , Itani Kamal M. F. 
Published: October 2021

Objective:
To estimate the relative risk of explantation in patients with skin and soft tissue infection onset within 90 days of hernia surgery, compared with days 91–365 and after 1 year.

Background:
Infectious complications occurring after hernia repair with synthetic mesh require prolonged treatment, and eventual mesh explantation. Little is known whether early versus late onset infection is associated with differential risk of mesh removal, and whether treatment with long-term antibiotics or debridement are associated with mesh salvage.

Methods:
This was a retrospective observational cohort study. We obtained data on all inguinal, umbilical, and ventral hernia repairs with implanted synthetic mesh performed in Veterans Affairs hospitals during 2008–2015. Participants without a 5-year infection after hernia surgery were excluded. Logistic regression estimated the association of mesh explantation with exposure to mesh-related infection during postoperative days 0–90, versus days 91–365 versus after 1 year. Additional covariates included any subsequent abdominal operation, antibiotic administration, and incision and drainage (I&D) or debridement procedures.

Results:
One thousand eight hundred eighty-five patients underwent index hernia repair and developed a skin and soft tissue infection within 5 years. Infection onset during days 91–365 was associated with increased explantation risk (OR, 1.62; 95% CI, 1.04–2.48), as was increased antibiotic use (OR, 1.04; 95% CI, 1.03–1.05) and surgical treatments (OR, 3.74; 95% CI, 3.02–4.67). Subsequent abdominal operation was associated with lower explantation risk (OR, 0.46; 95% CI, 0.33–0.61).

Conclusions:
Early infections may be more suitable for conservative management. Later-onset infections have lower probability of mesh salvage and should be considered for earlier explantation to save the patients prolonged courses of antibiotics and surgical interventions.
Using Narrow Band CE-Chirps to Elicit Cervical Vestibular Evoked Myogenic Potentials
Authors: Mat Quentin , Deggouj Naïma , Duterme Jean-Pierre , Tainmont Sophie , Lelubre Christophe , Manto Mario 
Published: October 2021

Objectives:
To compare the effects of Narrow band CE-Chirps (NB CE-Chirps) and tone bursts (TBs) at 500 Hz and 1000 Hz on the amplitudes and latencies in cervical vestibular evoked myogenic potentials (cVEMPs).

Design:
Thirty-one healthy adult volunteers of varying ages were tested by air conduction at 95 dB nHL. Recording conditions were randomized for each participant and each modality was tested twice.

Results:
NB CE-Chirps showed larger corrected amplitudes than TBs at 500 Hz (p < 0.001) which were themselves larger than NB CE-Chirps and TBs at 1000 Hz (p < 0.001). In older volunteers, NB CE-Chirps 500 and 1000 Hz had significantly higher response rates than TBs 500 Hz (p = 0.039). A negative correlation was observed between the corrected amplitudes and the age of the participants regardless of the stimulus and the frequency studied. The p13 and n23 latencies were not correlated with the age of the subjects.

Conclusions:
NB CE-Chirps at 500 Hz improved the corrected amplitudes of waveforms in cVEMPs as a result of a better frequency specificity compared with TBs. In the elderly, eliciting cVEMPs at a frequency of 1000 Hz might not be necessary to improve response rates with NB CE-Chirps. Additional studies including a higher number of healthy participants and patients with vestibular disorders are required to confirm these observations.
Selective Thoracic Fusion for Idiopathic Scoliosis
Authors: Ruiz John N.M. , Kandwal Pankaj , Lau Leok Lim , Liu Gabriel Ka Po , Thambiah Joseph , Wong Hee-Kit 
Published: October 2021

Study Design.
Single-center retrospective review of outcomes among three surgical techniques in the treatment of thoracic idiopathic scoliosis (T-AIS) with a follow-up of at least 5 years.

Objective.
To investigate how outcomes compare in video-assisted anterior thoracic instrumentation (VATS), all hooks/hook-pedicle screw hybrid instrumentation (HHF), and all pedicle screw instrumentation (PSF) techniques for T-AIS.

Summary of Background Data.
Studies comparing outcomes for anterior versus posterior fusion for T-AIS are few and with short follow-up.

Methods.
Three groups of patients with T-AIS who underwent thoracic fusion were included in this study: 98 patients with mean curve of 49.0° ± 9.5° underwent VATS (Group 1); 44 patients with mean curve of 51.1° ± 7.4° underwent HHF (Group 2); and 47 patients with mean curve of 47.6° ± 9.9° underwent PSF (Group 3). Radiological outcomes were compared at preoperative, and up to 5 years. Surgical outcomes were noted until latest follow-up.

Results.
Group 1 had less blood loss, less fusion levels, longer surgical time, and longer hospital stay compared with the other groups (P < 0.01). Groups 1 and 3 were comparable in all time periods with 78.8% and 78.2% immediate curve correction, and 72.9% and 72.1% at 5 years, respectively. Group 2 had lower correction in all time periods (P < 0.0001). Thoracic kyphosis and lumbar lordosis decreased in Group 3, but improved in both Groups 1 and 2 (P < 0.0001). Group 1 had more respiratory complications. The posterior groups had more deep wound infections. Two patients in Group 1 and one patient in Group 2 required revision surgery for implant-related complications. Reoperations for deep wound infections were noted only in the posterior groups.

Conclusion.
This is the first report comparing 5 year outcomes between anterior and posterior surgery for T-AIS. All three surgical methods resulted in significant and durable scoliosis correction; however, curve correction using HHF was inferior to both VATS and PSF with the latter two groups achieving similar coronal correction. However, VATS involved fewer segments, kyphosis improvement, and no deep wound infection, whereas PSF has less surgical time, shorter hospital stays, and no revision surgery from implant-related complications.

Level of Evidence: 3
Prognostic and Predictive Biomarkers in Patients With Coronavirus Disease 2019 Treated With Tocilizumab in a Randomized Controlled Trial*
Authors: Tom Jennifer , Bao Min , Tsai Larry , Qamra Aditi , Summers David , Carrasco-Triguero Montserrat , McBride Jacqueline , Rosenberger Carrie M. , Lin Celia J. F. , Stubbings William , Blyth Kevin G. , Carratalà Jordi , François Bruno , Benfield Thomas , Haslem Derrick , Bonfanti Paolo , van der Leest Cor H. , Rohatgi Nidhi , Wiese Lothar , Luyt Charles Edouard , Kheradmand Farrah , Rosas Ivan O. , Cai Fang 
Published: October 2021

OBJECTIVES:
To explore candidate prognostic and predictive biomarkers identified in retrospective observational studies (interleukin-6, C-reactive protein, lactate dehydrogenase, ferritin, lymphocytes, monocytes, neutrophils, d-dimer, and platelets) in patients with coronavirus disease 2019 pneumonia after treatment with tocilizumab, an anti–interleukin-6 receptor antibody, using data from the COVACTA trial in patients hospitalized with severe coronavirus disease 2019 pneumonia.

DESIGN:
Exploratory analysis from a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial.

SETTING:
Hospitals in North America and Europe.

PATIENTS:
Adults hospitalized with severe coronavirus disease 2019 pneumonia receiving standard care.

INTERVENTION:
Randomly assigned 2:1 to IV tocilizumab 8 mg/kg or placebo.

MEASUREMENTS AND MAIN RESULTS:
Candidate biomarkers were measured in 295 patients in the tocilizumab arm and 142 patients in the placebo arm. Efficacy outcomes assessed were clinical status on a seven-category ordinal scale (1, discharge; 7, death), mortality, time to hospital discharge, and mechanical ventilation (if not receiving it at randomization) through day 28. Prognostic and predictive biomarkers were evaluated continuously with proportional odds, binomial or Fine-Gray models, and additional sensitivity analyses. Modeling in the placebo arm showed all candidate biomarkers except lactate dehydrogenase and d-dimer were strongly prognostic for day 28 clinical outcomes of mortality, mechanical ventilation, clinical status, and time to hospital discharge. Modeling in the tocilizumab arm showed a predictive value of ferritin for day 28 clinical outcomes of mortality (predictive interaction, p = 0.03), mechanical ventilation (predictive interaction, p = 0.01), and clinical status (predictive interaction, p = 0.02) compared with placebo.

CONCLUSIONS:
Multiple biomarkers prognostic for clinical outcomes were confirmed in COVACTA. Ferritin was identified as a predictive biomarker for the effects of tocilizumab in the COVACTA patient population; high ferritin levels were associated with better clinical outcomes for tocilizumab compared with placebo at day 28.
Prevalence of pre-sarcopenia among postmenopausal women younger than 65 years
Authors: Orprayoon Nalina , Wainipitapong Peerapraut , Champaiboon Jirapa , Wattanachanya Lalita , Jaisamrarn Unnop , Chaikittisilpa Sukanya 
Published: October 2021

Abstract

Objective:
Sarcopenia is associated with high morbidity and mortality in older women. Early detection and intervention during the postmenopausal period were hypothesized to help maintain muscle mass and performance. Although the Asian Working Group has developed guidelines for sarcopenia management, the condition has not been sufficiently investigated in the middle-aged cohort of the Asian population. This study aimed to measure the prevalence of pre-sarcopenia and sarcopenia in middle-aged postmenopausal women and to determine the factors associated with low muscle mass.

Methods:
In this cross-sectional study conducted in the Menopause Clinic, King Chulalongkorn Memorial Hospital, we used the bioelectrical impedance analysis method to determine the appendicular muscle mass using a body composition analyzer (TANITA MC980 Plus). Appendicular muscle mass index, handgrip strength, and 6-m gait speed were measured in 340 women aged 45 to 65 years. Hormonal profiles, anthropometric data, and relevant history were recorded.

Results:
The mean age of the study participants and time since menopause were 57.8 ± 4.5 years and 9.4 ± 5.5 years, respectively. The proportion of pre-sarcopenic, sarcopenic, and nonsarcopenic women were 11.8%, 2.7%, and 85.6%, respectively. A body mass index ≤ 20 kg/m2 had the strongest correlation with low muscle mass (odds ratio 7.1; 95% confidence interval 3.0-16.8, P < 0.001).

Conclusion:
Nearly 12% of Thai middle-aged postmenopausal women were pre-sarcopenic. Early detection of symptoms of pre-sarcopenia and maintenance of a healthy body mass index may reduce the burden of this condition for middle-aged and older women.
Sex-specific associations of brachial–ankle pulse wave velocity with adverse cardiac remodeling and long-term cardiovascular outcome
Authors: Kwak Soongu , Kim Hack-Lyoung , Lim Woo-Hyun , Seo Jae-Bin , Kim Sang-Hyun , Zo Joo-Hee , Kim Myung-A 
Published: October 2021

Background:
It remains unclear whether the cardiovascular consequences of arterial stiffness differ by sex. This study aimed to investigate the sex-specific association of brachial–ankle pulse wave velocity (baPWV) with adverse cardiac remodeling and cardiovascular outcome.

Method:
We studied 11 767 patients (57.6% men) with cardiovascular risk factors, whose baPWV was measured. The primary endpoint was composite cardiovascular events. Restricted cubic spline (RCS) analyses were performed to delineate the association of baPWV with echocardiography parameters and risks of cardiovascular events.

Results:
RCS curves showed that structural/functional echocardiography parameters gradually worsened with increasing baPWV more prominently in women than in men. The prevalence of left ventricular hypertrophy and diastolic dysfunction increases with baPWV increase more steeply in women (P-for-interaction by sex <0.001). During the median follow-up of 3.64 years (interquartile interval, 1.56–5.38 years), 350 cardiovascular events (3.0%) and 155 deaths (1.3%) occurred. Cumulative cardiovascular events and deaths were significantly higher in patients with elevated baPWV in both sexes (P < 0.001). Cox analyses showed that the increase in baPWV was associated with the higher risks of cardiovascular events and deaths more strongly in women [cardiovascular events: men, adjusted hazard ratio 1.10, 95% confidence interval (1.08–1.13), P < 0.001; women, adjusted hazard ratio 1.18, 95% confidence interval (1.13–1.24), P < 0.001 by 100 cm/s increase in baPWV; P-for-interaction by sex = 0.022].

Conclusion:
The detrimental effects of baPWV on adverse cardiac remodeling and cardiovascular outcome were stronger in women than in men. The prognostic information provided by baPWV may be particularly crucial for women.
Transforming the Degradation Rate of β-tricalcium Phosphate Bone Replacement Using 3-Dimensional Printing
Authors: Shen Chen , Wang Maxime M. , Witek Lukasz , Tovar Nick , Cronstein Bruce N. , Torroni Andrea , Flores Roberto L. , Coelho Paulo G. 
Published: October 2021

Backgroundβ-Tricalcium phosphate (β-TCP) is one of the most common synthetic bone grafting materials utilized in craniofacial reconstruction; however, it is limited by a slow degradation rate. The aim of this study was to leverage 3-dimensional (3D) printing in an effort to accelerate the degradation kinetics of β-TCP.MethodsTwenty-two 1-month-old New Zealand white rabbits underwent creation of calvarial and alveolar defects, repaired with 3D-printed β-TCP scaffolds coated with 1000 μM of osteogenic agent dipyridamole. Rabbits were euthanized after 2, 6, and 18 months after surgical intervention. Bone regeneration, scaffold degradation, and bone mechanical properties were quantified.ResultsHistological analysis confirmed the generation of vascularized and organized bone. Microcomputed tomography analysis from 2 to 18 months demonstrated decreased scaffold volume within calvarial (23.6% ± 2.5%, 5.1% ± 2.2%;P< 0.001) and alveolar (21.5% ± 2.2%, 0.2% ± 1.9%;P< 0.001) defects, with degradation rates of 54.6%/year and 90.5%/year, respectively. Scaffold-inducted bone generation within the defect was volumetrically similar to native bone in the calvarium (55.7% ± 6.9% vs 46.7% ± 6.8%;P= 0.064) and alveolus (31.4% ± 7.1% vs 33.8% ± 3.7%;P= 0.337). Mechanical properties between regenerated and native bone were similar.ConclusionsOur study demonstrates an improved degradation profile and replacement of absorbed β-TCP with vascularized, organized bone through 3D printing and addition of an osteogenic agent. This novel additive manufacturing and tissue engineering protocol has implications to the future of craniofacial skeletal reconstruction as a safe and efficacious bone tissue engineering method.
Current Evidence in Migraine Surgery
Authors: Henriques Sara , Almeida Alexandre , Peres Helena , Costa-Ferreira António 
Published: October 2021

Introduction
Migraine headache is a widespread neurovascular disorder with an enormous social and economic impact. A subgroup of patients cannot be managed with pharmacological therapy. Although surgical decompression of extracranial sensory nerves has been proposed as a valid alternative treatment option, the medical community remains reluctant to accept it.

Materials and Methods
This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. An electronic search was performed in September 2020 on PubMed, ScienceDirect, CENTRAL, and Google Scholar databases for original articles reporting outcomes on migraine surgery.

Results
The search strategy revealed a total of 922 studies, of which 52 were included in the review. Significant improvement was reported in 58.3% to 100% and complete elimination in 8.3% to 86.8% of patients across studies. No major complications were reported.

Discussion
This systematic review demonstrates that migraine surgery is an effective and safe procedure, with a positive impact in patients' quality of life and a reduction in long-term costs.

Conclusion
There is considerable scientific evidence suggesting extracranial migraine surgery is an effective and safe procedure. This surgery should be considered in properly selected migraineurs refractory to medical treatment.
Free Flap Reconstruction of Oncologic Gluteal Defects
Authors: Arikawa Masaki , Akazawa Satoshi , Kagaya Yu , Kawai Akira , Miyamoto Shimpei 
Published: October 2021

Abstract
A number of studies have already examined gluteal reconstruction with free flaps. Thus, the aim of this study was to investigate the reliability of free flap reconstruction for oncologic gluteal defects. This retrospective cohort study included 23 patients who underwent immediate soft tissue reconstruction for an oncologic gluteal defect. Fifteen patients underwent reconstruction with a free flap and 8 with a regional flap. The postoperative results were compared between the free and regional flaps. In the free flap group, the latissimus dorsi musculocutaneous flap was used in 12 patients, the thoracodorsal artery perforator flap in 2 patients, and the anterolateral thigh flap in 1 patient. Recipient vessels were the inferior gluteal vessels or their branches in 8 patients and the superior gluteal vessels or their branches in 7 patients. All flaps have fully survived in both groups without vascular compromise. Dehiscence of the gluteal wound tended to be more common in the regional flap group; however, the difference between the groups was not statistically significant. The use of free flap reconstruction for large oncologic defects in the gluteal region is a feasible and reliable option. Tension-free wound closure and simplified suture lines can provide reliable wound coverage irrespective of the postoperative patient's position or movement. Because of the risk of postoperative compression on the vascular pedicle, selecting the appropriate recipient vessel and type of microvascular anastomosis is key for the success of free flap transfer in this region.
Characterizing the spatiotemporal heterogeneity of the COVID-19 vaccination landscape
Authors: Tiu Andrew , Susswein Zachary , Merritt Alexes , Bansal Shweta 
Published: October 2021

AbstractIt is critical that we maximize vaccination coverage across the United States so that SARS-CoV-2 transmission can be suppressed, and we can sustain the recent reopening of the nation. Maximizing vaccination requires that we track vaccination patterns to measure the progress of the vaccination campaign and target locations that may be undervaccinated. To improve efforts to track and characterize COVID-19 vaccination progress in the United States, we integrate CDC and state-provided vaccination data, identifying and rectifying discrepancies between these data sources. We find that COVID-19 vaccination coverage in the US exhibits significant spatial heterogeneity at the county level and statistically identify spatial clusters of undervaccination, all with foci in the southern US. Vaccination progress at the county level is also variable; many counties stalled in vaccination into June 2021 and few recovered by July, with transmission of the Delta variant rapidly rising. Using a comparison with a mechanistic growth model fitted to our integrated data, we classify vaccination dynamics across time at the county scale. Our findings underline the importance of curating accurate, fine-scale vaccination data and the continued need for widespread vaccination in the US, especially in the wake of the highly transmissible Delta variant.
Changes in ischemic stroke presentations and associated workflow during the first wave of the COVID-19 pandemic: A population study in Alberta, Canada
Authors: Ganesh Aravind , Stang Jillian M. , McAlister Finlay A. , Shlakhter Oleksandr , Holodinsky Jessalyn K. , Mann Balraj , Hill Michael D. , Smith Eric E. 
Published: October 2021

ABSTRACTBackgroundPandemics may promote hospital avoidance among patients with emergencies, and added precautions may exacerbate treatment delays. There is a paucity of population-based data on these phenomena for stroke. We examined the effect of the COVID-19 pandemic on the presentation and treatment of ischemic stroke in an entire population.MethodsWe used linked provincial administrative data and data from the Quality Improvement and Clinical Research Alberta Stroke Program – a registry capturing stroke-related data on the entire population of Alberta(4.3 million)– to identify all patients presenting with stroke in the pre-pandemic(1-January-2016 to 27-February-2020, n=19,531) and pandemic(28-February-2020 to 30-August-2020, n=2,255) periods. We examined changes in thrombolysis and endovascular therapy(EVT) rates, workflow, and in-hospital outcomes.ResultsHospitalizations/presentations for ischemic stroke dropped (weekly adjusted-incidence-rate-ratio[aIRR]:0.48, 95%CI:0.46-0.50, adjusted for age, sex, comorbidities, pre-admission care needs), as did population-level incidence of thrombolysis(aIRR:0.49,0.44-0.56) or EVT(aIRR:0.59,0.49-0.69). However, the proportions of presenting patients receiving acute therapies did not decline (e.g. thrombolysis:11.7% pre-pandemic vs 13.1% during-pandemic, aOR:1.02,0.75-1.38). Onset-to-door times were prolonged; EVT recipients experienced longer door-to-reperfusion times (median door-to-reperfusion:110-minutes, IQR:77-156 pre-pandemic vs 132.5-minutes, 99-179 during-pandemic; adjusted-coefficient:18.7-minutes, 95%CI:1.45-36.0). Hospitalizations were shorter but stroke severity and in-hospital mortality did not differ.InterpretationThe first COVID-19 wave was associated with a halving of presentations and acute therapy utilization for ischemic stroke at a population level, and greater pre-hospital and in-hospital treatment delays. Our data can inform public health messaging and stroke care in current and future waves. Messaging should encourage attendance for emergencies and stroke systems should re-examine “code stroke” protocols to mitigate inefficiencies.
Model-based meta-analysis to optimise S. aureus-targeted therapies for atopic dermatitis
Authors: Miyano Takuya , Irvine Alan D , Tanaka Reiko J 
Published: October 2021

ABSTRACTBackgroundSeveral clinical trials of Staphylococcus aureus (S. aureus)-targeted therapies for atopic dermatitis (AD) have demonstrated conflicting results regarding whether they improve AD severity scores. This study performs a model-based meta-analysis to investigate possible causes of these conflicting results and suggests how to improve the efficacies of S. aureus-targeted therapies.MethodsWe developed a mathematical model that describes systems-level AD pathogenesis involving interactions between S. aureus and Coagulase Negative Staphylococcus (CoNS). The model was calibrated to reproduce time course data of S. aureus levels, EASI scores, and EASI-75 in response to dupilumab, S. hominis A9 (ShA9) and flucloxacillin from published clinical trials. We simulated efficacies of hypothetical S. aureus-targeted therapies on virtual patients using the model.ResultsOur model simulation reproduced the clinically observed detrimental effects that application of ShA9 and flucloxacillin had on AD severity and showed that these effects disappeared if the bactericidal activity against CoNS was removed. A hypothetical (modelled) eradication of S. aureus by 3.0 log10 CFU/cm2, without killing CoNS, achieved comparable EASI-75 to dupilumab. This efficacy was potentiated if dupilumab was administered in conjunction with S. aureus eradication (EASI-75 at week 16; S. aureus eradication: 66.7%, dupilumab 61.6% and combination: 87.8%). The improved efficacy was also seen for virtual dupilumab poor responders.ConclusionOur model simulation suggests that killing CoNS worsens AD severity and that S. aureus-specific eradication without killing CoNS could be effective for AD patients, including dupilumab poor responders. This study will contribute to design promising S. aureus-targeted therapy.