bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiological study of osteonecrosis of the femoral head using the national registry of designated intractable diseases in Japan
Authors: Sato Ryuichi , Ando Wataru , Fukushima Wakaba , Sakai Takashi , Hamada Hidetoshi , Takao Masaki , Ito Kazuya , Sugano Nobuhiko 
Published: October 2021

ABSTRACT

Objectives
We aimed to investigate the epidemiological characteristics of osteonecrosis of the femoral head (ONFH) using the designated intractable diseases (DID) database in Japan.

Methods
Data on patients who had received public subsidies for medical costs due to ONFH from 2012 to 2013 were extracted from the DID database. The incidence and prevalence of ONFH, distribution of gender, age, and the prevalence of associated risk factors were assessed. These epidemiological characteristics were compared with those of another nationwide ONFH survey conducted during a similar period.

Results
Data on 3264 newly diagnosed patients (incident cases) and 20,042 patients registered until 2013 (prevalent cases) were evaluated. The corrected annual incidence and prevalence of ONFH per 100,000 were 3.0 and 18.2–19.2, respectively. The ratio of males to females was 1.4 in 2012 and 1.2 in 2013, respectively. Peak distribution was observed at ages 40s and 60s in males and females, respectively. The prevalence of the risk factors were steroid-associated: 39%, alcohol-associated: 30%, both: 4%, and none: 27%.

Conclusions
The DID database data showed a similar distribution of gender and age to that in other nationwide surveys but lower incidence and prevalence of ONFH. Sampling bias may affect the epidemiological characteristics of ONFH.
Geographical distribution of the associated factors of osteonecrosis of the femoral head, using the designated intractable disease database in Japan
Authors: Ando Wataru , Takao Masaki , Tani Tetsuro , Uemura Keisuke , Hamada Hidetoshi , Sugano Nobuhiko 
Published: October 2021

ABSTRACTObjectivesOsteonecrosis of the femoral head (ONFH) is a designated intractable disease (DID) in Japan. The Ministry of Health, Labour, and Welfare launched an online registry system for DIDs. We aimed to investigate the epidemiological characteristics of patients with ONFH using the DID database.MethodsData of patients with ONFH registered in the DID database between January 2004 and December 2013 were extracted. The incidence of new cases and distributions of sex, age, and associated risk factors were investigated. The prevalence of the two categories, ‘steroid-associated’ and ‘alcohol-associated’ risk factors, was estimated for each prefecture.ResultsNew 15,049 cases of ONFH were investigated. The mean registration rate-corrected annual ONFH incidence per 100,000 individuals was 1.77. The male-to-female ratio was 1.33. Age distribution peaked in the 40s and 50s for male and 60s for female. The prevalence of steroid-associated ONFH was lower in males (28.6%) than in females (49.8%), while that of alcohol-associated ONFH was higher in males (47.2%) than in females (9.3%). No clear region was identified for the steroids. The incidence of alcohol-associated ONFH was significantly higher in Tokyo and Okinawa, regardless of sex.ConclusionsAlcohol-associated ONFH incidence varies geographically across Japan, suggesting that it has regional characteristics.
Suboccipital Transhorizontal Fissure Approach for Posterior Cranial Fossa Lesions: A Cadaveric Study and First Clinical Experience
Authors: Tamura Ryota , Katayama Makoto , Yamamoto Kohsei , Horiguchi Takashi 
Published: October 2021

Abstract

BACKGROUND
Surgical treatment of pathological lesions in the deep cerebellar hemisphere, cerebellopontine angle (CPA), and fourth ventricle of the posterior cranial fossa (PCF) is challenging. Conventional neurosurgical approaches to these lesions are associated with risk of various complications. Mastery of efficient fissure dissection is imperative when approaching deep-seated lesions. The horizontal fissure (HF) is the largest and deepest fissure of the cerebellum.

OBJECTIVE
To conduct an anatomical study and introduce a novel suboccipital trans-HF (SOTHF) approach to access lesions of the deep cerebellar hemispheres, CPA, and upper fourth ventricle of the PCF.

METHODS
We performed a cadaveric dissection study focusing on anatomical landmarks and surgical feasibility of the SOTHF approach then implemented it in 2 patients with a deep cerebellar hemispheric tumor.

RESULTS
Anatomical feasibility of the SOTHF approach was demonstrated and compared with conventional approaches in the cadaveric study. Opening the suboccipital surface of the HF to create medial, intermediate, and lateral surgical corridors provided optimal viewing angles and wide access to the deep cerebellar hemispheres, CPA, and upper fourth ventricle without heavy cerebellar retraction. Sacrificing cerebellar neural structures and complex skull base techniques were not required to obtain adequate exposure. The SOTHF approach was successfully applied without complication in 2 patients with a deep cerebellar hemispheric tumor.

CONCLUSION
The HF is an important cerebellar fissure that provides a gateway to deep areas of the PCF. Further studies are needed to define and expand applications of the SOTHF approach.
Descriptivism and the Determination Thesis: an Untenable Marriage in the Metaontology of Art
Authors: Puy Nemesio G C 
Published: October 2021

AbstractThe determination thesis is the idea that art-ontological facts are determined by the folk ontological conception of artworks embedded in our artistic practices. From this thesis, descriptivism in the metaontology of art has been often characterized as the view that the task of art-ontology is to describe that folk conception. Amie Thomasson and Andrew Kania provide two paradigmatic accounts within this path. In this paper, I argue that this descriptivist approach is ungrounded because the determination thesis suffers from presupposition failure. It presupposes that, whenever there is a practice of producing and appreciating artworks, there is also a folk ontological conception about those artworks. This presupposition, an implicit premise in Thomasson's and Kania's accounts, will be revealed as false, paying attention to the way artistic practices have evolved. I will conclude that descriptivism should abandon this approach and embrace metaontological realism if it aims to be a plausible view.
Fast, simple and cheap: method modified from conventional cultivation for tuberculosis diagnosis allows seeding on Löwenstein–Jensen of any swab-embedded pulmonary samples decontaminated with sodium hydroxide
Authors: Rodrigues da Costa Ronaldo , Silva Marcio Roberto , Augusto Claudio Jose , Gonçalves Leite Isabel Cristina 
Published: October 2021

Abstract

Background
Few tuberculosis (TB) control programmes in low-income countries have access to culture facilities in their primary care diagnostic centres and this scenario may have worsened with the coronavirus disease 2019 pandemic. Thus the aim was to develop and evaluate a simpler TB test that allows seeding on Löwenstein–Jensen (LJ) medium of several swab-embedded samples decontaminated with sodium hydroxide (NaOH).

Methods
A cotton swab containing each sample was decontaminated in NaOH before being dipped into a slightly acidic solution to neutralize the pH in order to allow the culture to develop on LJ medium. Samples (n=543) from suspected or confirmed pulmonary TB were analysed in two phases: standardization (n=167) and evaluation of the study method (n=376).

Results
The study method showed sensitivity &gt;95% and specificity &gt;93% using Ogawa–Kudoh (OK) and modified Petroff (MP) as standards and was comparable to MP-LJ (p&gt;0.05) and slightly superior to OK (p=0.03) for sputum culture and more comprehensive than the latter for other pulmonary specimens.

Conclusions
This article reports a more comprehensive, simpler and less costly method for diagnosing TB in the laboratory with fewer economic resources and biosafety equipment. Thus a patent application was filed (BR1020190103841).
Subacromial Erosion After Hook Plate Fixation in Acute Acromioclavicular Joint Dislocation
Authors: Kim Jung Youn , Rhee Sung-Min , Ko Young Wan , Rhee Yong Girl 
Published: October 2021

Objectives:
To determine the incidence of subacromial erosion, perform quantitative analysis, and identify risk factors after locking hook plate fixation for acute acromioclavicular joint injury.

Design:
A retrospective case series study.

Setting:
A single tertiary university hospital.

Patients/Participants:
The study was conducted on 35 patients who had acute acromioclavicular joint injury.

Intervention:
Patients underwent the locking hook plate fixation.

Main Outcome Measurements:
The computed tomography (CT) was conducted to measure the subacromial erosion. The acromioclavicular slope (AC slope) of the unaffected side, the acromion-hook angle, the acromioclavicular anteroposterior distance (AC-AP distance), and the preoperative acromioclavicular interval of the affected side were analyzed to identify the risk factors of subacromial erosion.

Results:
According to the CT findings, subacromial erosion was found in all cases, and the mean value was 5.0 mm, which is 53% of the entire acromion thickness. The AC slope (B = −0.159, P < 0.001) and AC-AP distance (B = 0.233, P = 0.004) were found to have a significant influence on postoperative subacromial erosion. The AC slope showed a negative correlation with the amount of erosion, whereas the AC-AP distance showed a positive correlation with erosion.

Conclusion:
The CT findings revealed that subacromial erosion occurred in all cases, and the mean erosion depth was about 50% of the acromial thickness. If the preoperative AC slope of the unaffected side was more acute and the AC-AP distance was larger, the incidence of subacromial erosion was higher.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Intratympanic Administration of OTO-313 Reduces Tinnitus in Patients With Moderate to Severe, Persistent Tinnitus: A Phase 1/2 Study
Authors: Maxwell Kenneth S. , Robinson James M. , Hoffmann Ines , Hou Huiying J. , Searchfield Grant , Baguley David M. , McMurry Gordon , Piu Fabrice , Anderson Jeffery J. 
Published: October 2021

Objective:
To evaluate the safety and exploratory efficacy of intratympanic administration of OTO-313 in patients with tinnitus.

Study Design:
Single intratympanic injection of OTO-313 evaluated in a randomized, double-blind, placebo-controlled Phase 1/2 clinical study.

Setting:
Tertiary referral centers.

Patients:
Patients with unilateral tinnitus (moderate–severe) with tinnitus duration 1 to 6 months.

Interventions:
Intratympanic OTO-313.

Main Outcome Measures:
Safety and change from baseline in tinnitus functional index (TFI), daily ratings of tinnitus loudness and annoyance, and patient global impression of change (PGIC).

Results:
OTO-313 was well-tolerated with lower incidence of adverse events than placebo. Mean TFI reduction from baseline favored OTO-313 at Week 2, 4, and 8. A clinically meaningful, 13-point improvement on the TFI was observed in 43% (6/14) of OTO-313 patients at both Weeks 4 and 8 versus 13% (2/16) of placebo patients (ad hoc responder analysis, p-value < 0.05). Reductions in daily ratings of tinnitus loudness and annoyance favored OTO-313 compared with placebo. In OTO-313 responders, a strong correlation existed between change from baseline in TFI score and changes in tinnitus loudness, tinnitus annoyance, and PGIC.

Conclusions:
OTO-313 was well-tolerated and demonstrated a higher proportion of responders than placebo across consecutive visits (Weeks 4 and 8) supporting further clinical development of OTO-313 for the treatment of tinnitus.
Can prediction scores be used to identify patients at risk of Clostridioides difficile infection?
Authors: Rao Krishna , Dubberke Erik R. 
Published: October 2021

Purpose of review
To describe the current state of literature on modeling risk of incident and recurrent Clostridioides difficile infection (iCDI and rCDI), to underscore limitations, and to propose a path forward for future research.

Recent findings
There are many published risk factors and models for both iCDI and rCDI. The approaches include scores with a limited list of variables designed to be used at the bedside, but more recently have also included automated tools that take advantage of the entire electronic health record. Recent attempts to externally validate scores have met with mixed success.

Summary
For iCDI, the performance largely hinges on the incidence, which even for hospitalized patients can be low (often <1%). Most scores fail to achieve high accuracy and/or are not externally validated. A challenge in predicting rCDI is the significant overlap with risk factors for iCDI, reducing the discriminatory ability of models. Automated electronic health record-based tools show promise but portability to other centers is challenging. Future studies should include external validation and consider biomarkers to augment performance.
Can SARS-CoV-2 be transmitted via faeces?
Authors: Moura Ines B. , Buckley Anthony M. , Wilcox Mark H. 
Published: October 2021

Purpose of review
COVID-19 patients can present gastrointestinal symptoms, being diarrhoea one of the most frequent, suggesting intestinal health can be impacted by COVID-19. Here, we will discuss whether there is a correlation between the presence of SARS-CoV-2 RNA in faeces and diarrhoea, the relevance of gastrointestinal symptoms in disease diagnosis and transmission, and how COVID-19 can impact the gut microbial balance.

Recent findings
SARS-CoV-2 RNA has been reported in faeces or rectal swabs of COVID-19 patients with and without diarrhoea, suggesting faecal shedding can occur independently of gastrointestinal symptoms. However, the presence of the virus in the intestine can persist beyond its presence in the respiratory tract, with some reports suggesting that SARS-CoV-2 in the faeces can be infectious.
COVID-19 can impact the gut microbiota causing an enhancement of biosynthesis pathways that favour the expansion of bacterial pathogens in the inflamed gut, and causing a decline in commensals involved in the human immune response.

Summary
Gastrointestinal symptoms may be the first indication of COVID-19. SARS-CoV-2 in faeces can potentiate routes of disease transmission, particularly as the high viral loads reported in patients with severe illness suggest virus replication in the intestine may be possible.
Fatty Pancreas Represents a Risk Factor for Acute Pancreatitis
Authors: Sbeit Wisam , Khoury Tawfik 
Published: October 2021

Objectives
Fatty pancreas (FP), previously believed to be without clinical significance, recently has been shown to be associated with comorbid diseases. We aimed to explore whether FP predispose to acute pancreatitis.

Methods
Patients who underwent endoscopic ultrasound for hepatobiliary indications were included. Patients with pathological pancreato-biliary findings other than FP were excluded. The cohort was divided into patients with a history of pancreatitis (within 6 months of endoscopic ultrasound, group A) and patients without (group B).

Results
Overall, 189 patients were included. Sixty-one (32.3%) patients were in group A, and 128 (67.7%) patients were in group B. The average age in group A was 55.5 (standard deviation, 17.7) versus 58.5 (standard deviation, 13.5) in group B. The prevalence of FP in group A (37.7%) was higher compared with group B (4.7%) (P = 0.001). On univariate analysis, FP showed significant correlation with a history of acute pancreatitis [odds ratio (OR), 5.14, P = 0.006] and hyperlipidemia (OR, 4.19; P = 0.002). On multivariate analysis, FP remained significantly associated with a history of acute pancreatitis after stratification for obesity and hyperlipidemia (OR, 10.78; 95% confidence interval, 3.75–30.89; P < 0.0001).

Conclusions
Fatty pancreas was associated with acute pancreatitis. Clinicians should be aware of this association.
Blowout Fracture Assessment Based on Computed Tomography and Endoscopy: The Effectiveness of Endoscopy for Fracture Repair
Authors: Hong Suji , Kim Joohyun , Baek Sehyun 
Published: October 2021

Abstract
The purpose of this study was to compare the configuration of blowout fracture observed through orbital computed tomography (CT) and endoscopy, then present the effectiveness of using an endoscope in reconstruction surgery of blowout fracture. We retrospectively reviewed the clinical records of 337 patients who underwent reconstruction surgery of blowout fracture between January 2017 and December 2020 in the Department of Ophthalmology at Korea University Guro Hospital. The patients were categorized into 3 groups based on preoperative CT findings as follows: combined orbital medial and floor wall fractures, trapdoor fractures, and large blowout fractures. The images obtained through CT and endoscopy were compared among the 3 groups. Endoscopy helped identify herniated soft tissue and posterior fracture margins, and it also provides better magnification and a brighter view of the posterior aspects of the fracture site. Furthermore, endoscopy can also provide educational opportunities to visualize the fracture site and help trainees understand the surgical procedure approach or orbital anatomy. Based on our results, we suggest using an endoscope during blowout fracture surgery as an effective approach to reduce postoperative complications due to endoscopy's advantages in clear visualization of the fracture site during operation.
Combined Treatment of High-Flow Scalp Arteriovenous Malformations
Authors: Janssen Pierce L. , Taub Peter J. , Marayati Naoum Fares , Shigematsu Tomoyoshi , Berenstein Alejandro 
Published: October 2021

Introduction:
Appropriate treatment of scalp arteriovenous malformations (SAVMs) remains largely unclear given the rarity of reported cases. This single-institution case series presents consecutive patients with extracranial SAVMs and long-term follow up.
The primary aim of this study was to review treatment decisions, evaluate clinical outcomes, and compare our experience to available literature in order to better understand SAVMs and improve future outcomes.

Materials and Methods:
A retrospective review of consecutive patients with extracranial SAVMs between January 2015 and December 2019 was performed. Treatment factors of interest included embolization method, embolic agents, and decision to proceed with surgical resection. Relevant clinical outcomes included recurrence rates, cure rates, and complications.

Results:
Seven patients were included in the present series. Satisfactory outcomes were ultimately achieved for all 7 patients using embolization with or without combined surgical resection. Embolizations performed in combination with resection were curative in 4 of 4 cases (100%). Embolizations performed without resection were curative in 0 of 4 cases (0%), satisfactory in 2 of 4 cases (50%), and unsatisfactory in 2 of 4 cases (50%).

Discussion:
All SAVM patients in this series were treated satisfactorily using embolization with or without operative resection. This study strongly suggests that embolization combined with surgical resection during the same admission yields the best treatment outcomes for SAVMs, specifically demonstrating lower rates of recurrence and embolization-related complications. Decisions on whether or not to proceed with resection should be made by the interventional radiologist, the plastic surgeon, and the patient together.
The Impact of Magnetic Sphincter Augmentation (MSA) on Esophagogastric Junction (EGJ) and Esophageal Body Physiology and Manometric Characteristics
Authors: Ayazi Shahin , Schwameis Katrin , Zheng Ping , Newhams Kirsten , Myers Brittney M. , Grubic Andrew D. , Hoppo Toshitaka , Jobe Blair A. 
Published: October 2021

Objective:
To evaluate the impact of MSA on lower esophageal sphincter (LES) and esophageal body using high resolution impedance manometry.

Background:
MSA is an effective treatment in patients with gastroesophageal reflux disease, but there is limited data on its impact on esophageal functional physiology.

Methods:
Patients who underwent MSA were approached 1-year after surgery for objective foregut testing consists of upper endoscopy, esophagram, high resolution impedance manometry, and esophageal pH-monitoring. Postoperative data were then compared to the preoperative measurements.

Results:
A total of 100 patients were included in this study. At a mean follow up of 14.9(10.1) months, 72% had normalization of esophageal acid exposure. MSA resulted in an increase in mean LES resting pressure [29.3(12.9) vs 25(12.3), P < 0.001]. This was also true for LES overall length [2.9(0.6) vs 2.6(0.6), P = 0.02] and intra-abdominal length [1.2(0.7) vs 0.8(0.8), P < 0.001]. Outflow resistance at the EGJ increased after MSA as demonstrated by elevation in intrabolus pressure (19.6 vs 13.5 mmHg, P < 0.001) and integrated relaxation pressure (13.5 vs 7.2, P < 0.001). MSA was also associated with an increase in distal esophageal body contraction amplitude [103.8(45.4) vs 94.1(39.1), P = 0.015] and distal contractile integral [2647.1(2064.4) vs 2099.7(1656.1), P < 0.001]. The percent peristalsis and incomplete bolus clearance remained unchanged (P = 0.47 and 0.08, respectively).

Conclusions:
MSA results in improvement in the LES manometric characteristics. Although the device results in an increased outflow resistance at the EGJ, the compensatory increase in the force of esophageal contraction will result in unaltered esophageal peristaltic progression and bolus clearance.
Antiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery
Authors: Smith Stephen Ridley , Gani Jon , Carroll Rosemary , Lott Natalie , Hampton Jacob , Oldmeadow Christopher , Clapham Mathew , Attia John 
Published: October 2021

Objective:
To compare SSI rates between the skin preparation agents: PI-Aq, povidone-iodine with alcohol (PI-Alc), and chlorhexidine with alcohol (C-Alc).

Background:
Guidelines suggest that alcohol-containing chlorhexidine solutions are the gold standard for skin preparation before surgery. It remains difficult to determine whether it is the chlorhexidine component or the addition of alcohol that confers the most benefit.

Methods:
We conducted a multicenter, prospective, combined non-inferiority (PI-Alc vs C-Alc) and superiority (PI-Alc vs PI-Aq) randomized clinical trial. Participants were randomized 1:1:1 to receive either C-Alc, PI-Alc, or PI-Aq. The primary outcome was SSI rate as defined by the Centers for Disease Control. Secondary outcomes were complication rates, length of hospital stay, readmissions, and skin reactions.

Results:
Between January 2015 and December 2018, 3213 patients were randomized (C-Alc: 1076, PI-Alc: 1075, and PI-Aq: 1062). Mean age of participants was 57% and 55% were female. SSI rates were: C-Alc 11.09%, PI-Alc 10.88%, and PI-Aq 12.56%. PI-Alc was found to be non-inferior to C-Alc (mean difference, −0.21%; 95% confidence interval, −2.85 to 2.44; P = 0.0009 non-inferiority), whereas PI-Alc was not superior to PI-Aq (mean difference, −1.68%; 95% confidence interval, −4.40 to 1.05; P = 0.2302). There were no differences seen in secondary outcomes between groups and no treatment related adverse events or deaths occurred.

Conclusions:
PI-Alc is non-inferior to C-Alc and not superior to PI-Aq. This is at odds with current guidelines that suggest alcohol-based chlorhexidine solutions should routinely be used for surgical skin preparation.

Trial Registration:
Australia and New Zealand Clinical Trials Registry: ANZCTRN12615000021571. www.anzctr.org.au