bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis
Authors: Feuerstadt Paul , Boules Mena , Stong Laura , Dahdal David N , Sacks Naomi C , Lang Kathleen , Nelson Winnie W 
Published: January 2021

Objective: Clostridioides difficile infection and recurrent C. difficile infection result in substantial economic burden and healthcare resource use. Sepsis and bowel surgery are known to be serious complications of C. difficile infection. This study evaluated clinical complications in patients with C. difficile infection and recurrent C. difficile infection during a 12-month period following the primary C. difficile infection. Methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus™ database was conducted for patients aged 18–64 years with an index C. difficile infection episode requiring inpatient stay or an outpatient visit for C. difficile infection followed by a C. difficile infection treatment. Each C. difficile infection episode ended after a 14-day C. difficile infection-claim-free period was observed. Recurrent C. difficile infection was defined as a further C. difficile infection episode within an 8-week window following the claim-free period. Clinical complications were documented over 12 months of follow-up and stratified by the number of recurrent C. difficile infection episodes (0 rCDI, 1 rCDI, 2 rCDI, and 3+ rCDI). Results: In total, 46,571 patients with index C. difficile infection episode were included. During the 6-month pre-index, the mean (standard deviation) baseline Charlson comorbidity index score, by increasing the recurrent C. difficile infection group, was 1.2 (1.9), 1.5 (2.2), 1.8 (2.3), and 2.3 (2.5). During the 12-month follow-up, sepsis occurred in 16.5%, 27.3%, 33.1%, and 43.3% of patients, and subtotal colectomy or diverting loop ileostomy was performed in 4.6%, 7.3%, 8.9%, and 10.5% of patients, respectively, by increasing the recurrent C. difficile infection group. Conclusions: Reduction in recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.
Novel MIS 3D NAV Single Step Pedicle Screw System (SSPSS): Workflow, Accuracy and Initial Clinical Experience
Authors: Schmidt Franziska A. , Lekuya Hervé M. , Kirnaz Sertac , Hernandez Robert Nick , Hussain Ibrahim , Chang Louis , Navarro-Ramirez Rodrigo , Wipplinger Christoph , Rawanduzy Cameron , Härtl Roger 
Published: January 2021

Study Design: Prospective case series. Objective: SSPSS (single step pedicle screw system) was developed for minimally invasive spine surgery. We performed this study to report on safety, workflow, and our initial clinical experience with this novel technique. Methods: The prospective study was conducted on patients who underwent pedicle screw fixation between October 2017 and April 2018 using a novel single step 3D navigated pedicle screw system for MIS. Outcome measurements were obtained from intraoperative computerized tomography. The images were evaluated to determine pedicle wall penetration. We used a grading system to assess the severity of the pedicle wall penetration. Breaches were classified as grade 1 (<2 mm), grade 2 (2-4 mm), or grade 3 (<4 mm), 1 and as cranial, caudal, medial, and lateral. Results: Our study includes 135 screws in 24 patients. SSPSS eliminated K-wires and multiple steps traditionally necessary for MIS pedicle screw insertion. The median time per screw was 2.45 minutes. 3 screws were corrected intraoperatively. Pedicle wall penetration occurred in 14 screws (10%). Grade 1 breaches occurred in 4 screws (3%) and grade 2 breaches occurred in 10 screws (7%). Lateral breaches were observed more often than medial breaches. The accuracy rate in our study was 90% (Grade 0 breach). No revision surgeries were needed and no complications occurred. Conclusions: Our study suggests that SSPSS could be a safe, accurate, and efficient tool. Our accuracy rate is comparable to that found in the literature.
What Are Risk Factors for an Ileus After Posterior Spine Surgery?—A Case Control Study
Authors: Yilmaz Emre , Benca Eric , Patel Akil P. , Hopkins Sarah , Blecher Ronen , Abdul-Jabbar Amir , O’Lynnger Thomas M. , Oskouian Rod J. , Norvell Daniel C. , Chapman Jens 
Published: January 2021

Study design: Case-Control Study. Objective: The purpose of this retrospective study is to evaluate risk factors for developing a postoperative ileus after posterior spine surgery. Methods: Patient charts, including radiographs were evaluated retrospectively. Diagnosis of an ileus was confirmed radiographically by a CT scan in all cases. The control group was retrieved by selecting a random sample of patients undergoing posterior spine surgery who did not develop bowel dysfunction postoperatively. Results: A total of 40 patients had a postoperative ileus. The control group consisted of 80 patients. Both groups did not differ significantly in age, gender, BMI, tobacco use, comorbidities or status of previous abdominal surgery. Significant differences between the 2 groups was the length of stay (5.9 vs. 11.2; p = 0.001), surgery in the lumbar spine (47.5% vs. 87.5%; p < 0.001) and major spine surgery involving > 3 levels (35.0% vs. 57.5%; p = 0.019). Patients who suffered from an ileus were more likely to be treated in ICU (23.8% vs. 37.5%; p = 0.115), being re-admitted (0.0% vs 5.0%; p = 0.044) and having a delayed discharge (32.5% vs. 57.5%; p = 0.009). Multivariable analysis demonstrated that lumbar spine surgery compared to thoracic and/or cervical spine surgery (p = 0.00, OR 8.7 CI 2.9-25.4) and major spine surgery involving > 3 levels (p = 0.012; OR 3.0, CI 1.3-7.2) are associated with developing an ileus postoperatively. Conclusion: Surgeries of the lumbar spine as well as those involving > 3 levels are associated with developing a postoperative ileus. Further studies are needed to expand on possible risk factors and to better understand the mechanism underlying postoperative ileus in spine surgery patients.
Evaluation of the Connective Tissue Wall in Sporadic Cases of Keratocystic Odontogenic Tumor (KCOT) Using MMP-9 and Confocal Microscopy: A Retrospective Study
Authors: Jayaraj Merlin , Ramani Pratibha , Sherlin Herald J. 
Published: January 2021

Background: Keratocystic odontogenic tumor (KCOT) is an odontogenic lesion which manifests distinct biological behavior. Predominant studies in KCOT attribute this behavior to high epithelial proliferative capacity. Besides, a few studies facet loosely arranged collagen can contribute to the behavior of KCOT. Matrix metalloproteinases (MMP) are enzymes that degrade extracellular matrix components under both physiologic and pathologic conditions. The loosely arranged collagen in connective tissue wall of KCOT could be related to the degree of MMP-9 expression. Aim: To evaluate the arrangement of collagen fibers along with immunoexpression of MMP-9 and to relate to its neoplastic biologic behavior in sporadic cases of KCOT. Materials and Methods: KCOT ( n = 23) and dentigerous cyst (DC) ( n = 15) samples were processed for the following techniques: Masson’s trichrome stain for light microscopy, PMA-PSR stain for confocal microscopy, and MMP-9 for immunohistochemistry. Results: In Masson’s trichrome analysis, correlation of collagen fiber arrangement in the deeper regions with color intensity for KCOT was found to be statistically significant ( P = .033). In confocal microscopy, there was no difference between intensities in KCOT ( P = .990) and DC ( P = .233), respectively. The immunoexpression of MMP-9 in the connective tissue wall of DC (73.3%) was relatively higher than that of KCOT (60.8%). However, on comparison between KCOT and DC in the presence of inflammation, the immunoexpression of MMP-9 was higher in DC (100%) than KCOT (69.9%) and was statistically significant ( P = .028). Conclusion: It was concluded that the loose connective tissue wall in KCOT is because of the inherent nature of the lesion that could facilitate its biologic behavior. If inflammation is present, this could further aggravate the tumorigenic behavior.
Proximal, Local, and Distal Muscle Morphology in Women With Patellofemoral Pain
Authors: Pompeo Klauber Dalcero , da Rocha Emmanuel Souza , Melo Mirella Ayres , de Oliveira Nathalia Trevisol , Oliveira Daniel Fernandes , Sonda Francesca Chaida , dos Santos Patrícia Freitas , Rodrigues Rodrigo , Vaz Marco Aurélio 
Published: January 2021

Objective: The objective of this study was to compare proximal, local, and distal muscle morphology in women with and without patellofemoral pain (PFP). Materials and Methods: Proximal, local, and distal muscle thicknesses (MTs) were obtained with B-mode sonography in healthy (control group [CG], n = 20) and PFP (PFP group, n = 20) women. In addition, muscle mass was measured by the sum of the synergistic MTs. Data were analyzed by independent t-test, Mann-Whitney U test, and effect size. Results: PFP women had smaller gluteus medius ( P = .02, d = 0.7), vastus medialis ( P < .01, d = 1.0), and flexor digitorum brevis ( P < .01, d = 1.0) MT and greater gastrocnemius medialis ( P = .04, d = 0.6) MT than CG. Quadriceps muscle mass ( P = .01, d = 0.8) and foot muscle mass ( P = .008, d = 0.9) were smaller, while plantar flexor muscle mass was greater in the PFP group than in CG ( P = .01, d = 0.8). Conclusion: PFP women have proximal, local, and distal MT alterations in comparison with CG, which may explain possible changes in muscle strength and functionality.
Active surveillance of primary extranodal marginal zone lymphoma of bronchus-associated lymphoid tissue
Authors: Joffe Erel , Leyfman Yan , Drill Esther , Rajeeve Sridevi , Zelenetz Andrew D. , Palomba M. Lia , Moskowitz Craig H. , Portlock Carol , Noy Ariela , Horwitz Steven M. , Gerecitano John F. , Moskowitz Alison , Hamlin Paul , Matasar Matthew J. , Kumar Anita , Batlevi Connie L. , Younes Anas , Straus David J. 
Published: January 2021

Abstract
Although patients with bronchus-associated lymphoid tissue (BALT) lymphoma show an indolent clinical course, appropriate disease management at diagnosis is not well defined. This study aimed to compare 3 treatment strategies for patients with BALT lymphoma: active surveillance, systemic chemotherapy or immunotherapy at diagnosis, or complete surgical resection at diagnosis. We conducted a retrospective study of all patients with new diagnoses of marginal zone lymphoma (MZL) involving the lung who were treated at the Memorial Sloan Kettering Cancer Center between 1995 and 2017. Primary BALT lymphoma was defined as disease confined to the lungs and adjacent lymph nodes. Active surveillance was defined as a documented observation plan and ≥3 months of follow-up before initiating treatment. Overall survival (OS) and event-free survival (EFS) were compared between treatment groups. We reviewed 200 consecutive patients with MZL involving the lung; 123 met the inclusion criteria and were managed by active surveillance (47%), complete surgical resection (41%), or systemic chemotherapy or immunotherapy (11%). With a median follow-up of &gt;60 months, surgical resection was associated with a superior EFS compared with active surveillance and systemic treatment (6-year EFS: 74% vs 65% vs 62%, respectively; P = .013). Larger lesions and thrombocytopenia were associated with shorter EFS. All groups had excellent OS at 6 years (93%), albeit with a slight superiority for surgical resection (100%) over active surveillance (91%) and systemic treatment (76%) (P = .024). BALT lymphoma is an indolent disease that can often be managed expectantly and not require therapy for many years.
Genome-wide identification and comprehensive analysis of NAC family genes involved in fruit development in kiwifruit (Actinidia)
Authors: Jia Dongfeng , Jiang Zhiqiang , Fu Haihui , Chen Lu , Liao Guanglian , He Yanqun , Huang Chunhui , Xu Xiaobiao 
Published: January 2021

AbstractBackgroundNAC transcription factors (TFs) are plant-specific proteins encoded by a large gene family. They play important roles in diverse biological processes, such as plant growth and development, leaf senescence, and responses to biotic or abiotic stresses. Functions of a number of NAC TFs have been identified mainly in model plants. However, very few studies on NAC TFs have been conducted in the fruit tree of kiwifruit.ResultsGenome-wideNACgenes were identified and their phylogeny, genomic structure, chromosomal location, synteny relationships, protein properties and conserved motifs were analyzed. In addition, the fruit developmental process was evaluated in a new kiwifruit cultivar ofActinidia eriantha‘Ganlu 1’. And expressions for all thoseNACgenes were analyzed by quantitative real-time PCR method in fruits of ‘Ganlu 1’ during its developmental process. Our research identified 142 NAC TFs which could be phylogenetically divided into 23 protein subfamilies. The genomic structures of thoseNACgenes indicated that their exons were between one and ten. Analysis of chromosomal locations suggested that 116 out of 142NACs distributed on all the 29 kiwifruit chromosomes. In addition, genome-wide gene expression analysis showed that expressions of 125 out of 142NACgenes could be detected in fruit samples.ConclusionOur comprehensive study provides novel information onNACgenes and expression patterns in kiwifruit fruit. This research would be helpful for future functional identification ofNACgenes involved in kiwifruit fruit development.
Evaluate construct validity of the Revised American Pain Society Patient Outcome Questionnaire in gynecological postoperative patients using confirmatory factor analysis
Authors: Chaw Sook Hui , Lo Yoke Lin , Lee Jia Yin , Wong Jia Wing , Zakaria Wan Aizat Wan , Ruslan Shairil Rahayu , Tan Wei Keang , Shariffuddin Ina Ismiarti 
Published: January 2021

Abstract
Background
The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) evaluates the patient-reported quality of pain management in adults. A validated APS-POQ-R is pivotal to guide effective pain management with better patient satisfaction. Previous studies revealed that subscales of “patients’ perception of pain management” were unstable cross-culturally. This study aims to evaluate the construct validity of the APS-POQ-R in gynecological postoperative patients with a multi-cultural background using confirmatory factor analysis to allow comparisons among different a priori models at the latent factor level.

Methods
Patients aged 18 years old or above and who were scheduled for gynecology surgery were selected. Three different models with a combination of latent factors were based on a priori hypotheses from previous studies. The root-mean-squared error of approximation, comparative fit index, Tucker-Lewis Index, Chi-squared test, and change in Chi-squared statistic given a change in degrees of freedom between models were used to assess the model fit to the present data.

Results
A total of 302 patients completed the questionnaire. The five-factor model which was based on Gordon’s study has an acceptable fit for the data and was superior when compared to the one-factor baseline model. Although the four-factor model, which originated from Botti’s study, also demonstrates a good model fit, the “perception of care” construct was excluded in this model. The “perception of care” construct is conceptually important as patient-centered care has become the focus of quality improvement of pain service.

Conclusions
The APS-POQ-R is easy to administer and is useful for quality evaluation in postoperative pain management. The present study demonstrates that a five-factor structure of the APS-POQ-R is the best fitting model in our patient sample. The results of this study provide further evidence to support the use of APS-POQ-R as a measurement tool for pain management evaluation in acute postoperative patients with a multi-cultural background.
Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
Authors: Tian Xinyi , Niu Kaifan , Cao Hong , Zhan Gonghao , Zhang Yan , Xu Feng , Shangguan Wangning , Gao Ye 
Published: January 2021

AbstractBackgroundPruritus is one of the most common side effects of epidural morphine administered for post-surgery analgesia, and pregnant women tend to be highly susceptible. The relative contributions of morphine concentration, local anesthetics, and level of pain to pruritus after epidural morphine for post-cesarean delivery analgesia remain unclear. Accordingly, the present study aimed to identify risk factors for pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia.MethodsThis case control study was based on routinely collected clinical data. Participants included women who had undergone cesarean section and adopted a patient-controlled analgesia pump for postoperative analgesia. A series of logistic regression analyses were performed. Interaction terms were added to explore the moderation effects of combined local anesthetics and pain level on associations between morphine concentration and pruritus. Robustness of the results was checked through sensitivity analysis using propensity scores matching approach.ResultsHigher morphine concentration, assisted reproductive treatment, and multipara and cesarean section history were significantly more prevalent in the pruritus group than in the control group. The probabilities of pruritus at morphine concentrations of 10, 15, 20, 25, 30 and 40 μg/mL increased sequentially from 0.05, 0.1, 0.2, 0.35, 0.54 to 0.84, respectively. The trend remained steep in the ropivacaine stratum and became flatter when combined with levobupivacaine. At mild pain combined with levobupivacaine, the incidence of pruritus increased from 0.33 (95% confidence interval [CI] 0.1–0.68) in the 10 μg/mL morphine group to 0.48 (95% CI 0.1–0.88) in the 40 μg/mL morphine group. In the stratum of moderate pain combined with levobupivacaine, the incidence increased from 0.4 (95% CI 0.04–0.92) to 0.56 (95% CI 0.03–0.98). The results in the sensitivity analysis were in consistent with above findings.ConclusionsHigher concentrations of morphine, multipara, and assisted reproductive treatment were factors associated with a higher probability of pruritus. Pain level or combined local anesthetics could moderate the association between morphine concentration and pruritus.
Severe pneumonia in adults caused by Tropheryma whipplei and Candida sp. infection: a 2019 case series
Authors: Li Wei , Zhang Qun , Xu Yanling , Zhang Xiyue , Huang Qian , Su Zhenzhong 
Published: January 2021

Abstract
Background
Whipple’s disease is a chronic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei (TW), which not only affects the gastrointestinal tract and causes malabsorption of nutrients, but several other systems, such as the cardiovascular system, central nervous system, the joints, and the vascular system, can also be simultaneously involved. The aim of this report was to be able to alert the clinician to severe pneumonia caused by TW combined with Candida sp.

Case presentation
The case study was conducted on patients in September and November 2019. After routine examination and treatment, the results were not satisfactory. A bronchoalveolar lavage (BAL) using metagenomics next-generation sequencing was conducted on two adults who presented with fever, cough, and progressive dyspnea and who had no history of gastrointestinal symptoms, immunodeficiency diseases, or use of immunosuppressive agents. TW and Candida sp. were detected in in BAL.

Conclusions
This is a report of life-threatening pneumonia caused by TW combined with Candida sp. in a Chinese population.
Optimal timing of ureteroscopic lithotripsy after the initial drainage treatment and risk factors for postoperative febrile urinary tract infection in patients with obstructive pyelonephritis: a retrospective study
Authors: Itami Yoshitaka , Miyake Makito , Owari Takuya , Iwamoto Takashi , Gotoh Daisuke , Momose Hitoshi , Fujimoto Kiyohide , Hirao Shuya 
Published: January 2021

Abstract
Background
A history of preoperative obstructive pyelonephritis has been reported as a risk factor for febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). But there is no clear evidence of risk factors for developing fUTI including the optimal timing of URSL after obstructive pyelonephritis treatment.

Methods
Of the 1361 patients, who underwent URSL at our hospital from January 2011 to December 2017, 239 patients had a history of pre-URSL obstructive pyelonephritis. The risk factors were analyzed by comparing the patients’ backgrounds with the presence or absence of fUTI after URSL. The factors examined were age, gender, body mass index, comorbidity, presence or absence of preoperative ureteral stent, stone position, stone laterality, stone size, Hounsfield unit (HU) value on computed tomography scan, history of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, ureteral stenting period, operation time, and presence or absence of access sheath at URSL. In addition, the stone components and renal pelvic urinary culture bacterial species during pre-URSL pyelonephritis were also examined.

Results
Post-URSL fUTI developed in 32 of 239 patients (13.4%), and 11 of these 32 cases led to sepsis (34.4%). Univariate analysis showed that stone position, stone maximum HU value, presence of sepsis during obstructive pyelonephritis, period from antipyresis to URSL, pre-URSL ureteral stent placement, operation time were risk factors of fUTI. Stone components and urinary cultures during pyelonephritis were not associated with risk of fUTI. Multivariate analysis showed that renal stone position, pre-URSL ureteral stent placement > 21 days, and operation time > 75 min were independent risk factors of fUTI following the URSL.

Conclusions
F-UTI following the URSL could be avoided by ureteral stent placement period 21 days or less and operation time 75 min or less in patients with obstructive pyelonephritis.
More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy
Authors: Carpagnano Giovanna E. , Migliore Giovanni , Grasso Salvatore , Procacci Vito , Resta Emanuela , Panza Francesco , Resta Onofrio 
Published: January 2021

AbstractBackgroundSome studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management.MethodsIn the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020).ResultsWith improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 daysvs. who survived 6.4 ± 3.3 days). TConclusionsThe present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.