bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Accuracy of SSEP Changes During Lumbar Spine Surgery for Predicting Postoperative Neurological Deficit
Authors: Chang Robert , Reddy Rajiv P. , Coutinho Dominic V. , Chang Yue-Fang , Anetakis Katherine M. , Crammond Donald J. , Balzer Jeffrey R. , Thirumala Parthasarathy D. 
Published: May 2021

Study Design.
This study is a meta-analysis of prospective and retrospective studies identified in PubMed, Web of Science, and Embase with outcomes of patients who received intraoperative somatosensory-evoked potential (SSEP) monitoring during lumbar spine surgery.

Objective.
The objective of this study is to determine the diagnostic accuracy of intraoperative lower extremity SSEP changes for predicting postoperative neurological deficit. As a secondary analysis, we evaluated three subtypes of intraoperative SSEP changes: reversible, irreversible, and total signal loss.

Summary of Background Data.
Lumbar decompression and fusion surgery can treat lumbar spinal stenosis and spondylolisthesis but carry a risk for nerve root injury. Published neurophysiological monitoring guidelines provide no conclusive evidence for the clinical utility of intraoperative SSEP monitoring during lumbar spine surgery.

Methods.
A systematic review was conducted to identify studies with outcomes of patients who underwent lumbar spine surgeries with intraoperative SSEP monitoring. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated and presented with forest plots and a summary receiver operating characteristic curve.

Results.
The study cohort consisted of 5607 patients. All significant intraoperative SSEP changes had a sensitivity of 44% and specificity of 97% with a DOR of 22.13 (95% CI, 11.30–43.34). Reversible and irreversible SSEP changes had sensitivities of 28% and 33% and specificities of 97% and 97%, respectively. The DORs for reversible and irreversible SSEP changes were 13.93 (95% CI, 4.60–40.44) and 57.84 (95% CI, 15.95–209.84), respectively. Total loss of SSEPs had a sensitivity of 9% and specificity of 99% with a DOR of 23.91 (95% CI, 7.18–79.65).

Conclusion.
SSEP changes during lumbar spine surgery are highly specific but moderately sensitive for new postoperative neurological deficits. Patients who had postoperative neurological deficit were 22 times more likely to have exhibited intraoperative SSEP changes.

Level of Evidence: 2
Oral Midodrine Administration During the First 24 Hours of Sepsis to Reduce the Need of Vasoactive Agents: Placebo-Controlled Feasibility Clinical Trial
Authors: Lal Amos , Trivedi Vrinda , Rizvi Mahrukh S. , Amsbaugh Amy , Myers Melissa K , Saleh Khaled , Kashyap Rahul , Gajic Ognjen 
Published: May 2021

Objectives:
Our preliminary data and observational studies suggested an increasing “off label” use of oral midodrine as a vasopressor sparing agent in various groups of critically ill patients, including those with sepsis. We designed this clinical trial to evaluate the feasibility of use of midodrine hydrochloride in early sepsis to reduce the duration for IV vasopressors and decrease ICU and hospital length of stay.

Design:
Pilot, two-center, placebo-controlled, double blinded randomized clinical trial.

Setting:
Medical ICUs at Mayo Clinic Rochester and Cleveland Clinic Abu Dhabi were the study sites.

Patients and Methods:
Adult patients (≥ 18 yr old) were included within 24 hours of meeting the Sepsis-3 definition if the mean arterial pressure remained less than 70 mm Hg despite receiving timely antibiotics and initial IV fluid bolus of 30 cc/kg.

Intervention:
Three doses of 10 mg midodrine versus placebo were administered.

Measurements and Main Results:
Total 32 patients were randomized into midodrine (n = 17) and placebo groups (n = 15). There were no major differences in baseline variables between the groups except for higher baseline creatinine in the midodrine group (2.0 ± 0.9 mg/dL) versus placebo group (1.4 ± 0.6 mg /dL), p = 0.03. The median duration of IV vasopressor requirement was 14.5 ± 8.1 hours in midodrine group versus 18.8 ± 7.1 hours in the placebo group, p value equals to 0.19. Patients in the midodrine group needed 729 ± 963 norepinephrine equivalent compared with 983 ± 1,569 norepinephrine equivalent in the placebo group, p value equals to 0.59. ICU length of stay was 2.29 days (interquartile range, 1.65–3.9 d) in the midodrine group, compared with 2.45 days (interquartile range, 1.6–3.2 d) in the placebo group, p value equals to 0.36. No serious adverse events were observed in either group.

Conclusions:
Phase II clinical trial powered for clinical outcomes (duration of vasopressor use, need for central venous catheter, and ICU and hospital length of stay) is justified.
A Quality Improvement Initiative to Increase Completion and Documentation of Advanced Directives in the ICU at a U.S. Community Teaching Hospital
Authors: Walter Kristin L. , Joehl Hillarie E. , Alrifai Taha , Varghese Thomas G. , Tyler Matthew J. 
Published: May 2021

Objectives:
Advance directives can help guide care in the ICU. As a healthcare quality improvement initiative, we sought to increase the percentage of patients with a healthcare power of attorney and/or practitioner orders for life-sustaining treatment in our ICU and to increase medical resident experience with advance directives through routine screening and documentation of advance directives in the ICU.

Design:
Prospective analysis.

Setting:
Urban U.S. community teaching hospital.

Patients:
All patients admitted to the ICU from September 2018 to February 2019.

Interventions:
Internal medicine residents in the ICU received a lecture about advance directives and instructions to screen their patients for advance directives. For willing and decisional patients, residents facilitated the creation of a healthcare power of attorney and/or practitioner orders for life-sustaining treatment. Residents were anonymously surveyed at the beginning and end of the ICU rotation about their experience and level of comfort with healthcare power of attorney and practitioner orders for life-sustaining treatment completion.

Measurements and Main Results:
Three-hundred seventy-five patients were admitted to the ICU during the study period. Healthcare power of attorney documents were generated by 34% of all ICU patients without a prior healthcare power of attorney, increased from a baseline rate of 10% (p < 0.001). The number of practitioner orders for life-sustaining treatment documents for patients with code status of “no cardiopulmonary resuscitation” did not increase significantly. The percentage of residents who facilitated completion of a healthcare power of attorney document increased significantly from 56% to 100% (p < 0.001), whereas their practitioner orders for life-sustaining treatment experience did not change significantly by the end of their ICU rotation. On a Likert scale of 0–10, mean resident comfort increased significantly both with healthcare power of attorney documentation, rising from 6.14 to 8.84 (p = 0.005) and with practitioner orders for life-sustaining treatment form completion, increasing from 6.00 to 7.84 (p = 0.008).

Conclusions:
Training ICU medical residents to routinely screen for and facilitate completion of advance directives significantly increased the percentage of ICU patients with a healthcare power of attorney and significantly improved medical resident comfort with healthcare power of attorney and practitioner orders for life-sustaining treatment form completion.
Provider and Practice Experience Integrating the Dose-HPV Intervention into Clinical Practice
Authors: Drainoni Mari-Lynn , Biancarelli Dea , Jansen Emily , Bernstein Judith , Joseph Natalie , Eun Terresa J. , Fenton Anny H.T.R. , Clark Jack A. , Hanchate Amresh , Legler Aaron , Schuch Thomas J. , Leschly Karin , Perkins Rebecca B. 
Published: May 2021

Introduction:
Few studies have rigorously evaluated the drivers of successful implementation of interventions to improve human papillomavirus (HPV) vaccination rates. The aim of this study was to evaluate the implementation of Development of Systems and Education for HPV Vaccination (DOSE HPV), a performance improvement intervention.

Methods:
Primary care providers (PCPs), nurses, and individuals with leadership roles from pediatric and family medicine practices who attended DOSE HPV intervention sessions participated in qualitative interviews immediately following intervention completion. The study team professionally transcribed interviews and performed qualitative coding using inductive methods. Final analysis employed the Promoting Action on Research implementation in Health Services (PARiHS) model.

Results:
Twenty-six individuals participated: 12 PCPs, 5 nurses, and 9 individuals with dual leadership and PCP roles. Participants described five factors that they felt contributed to program success: (1) evidence-based, goal-directed education; (2) personalized data feedback; (3) clinical leadership support; (4) collaborative facilitation; (5) repeated contacts/longitudinal structure of the intervention. Barriers to implementing the intervention included: (1) inability to standardize workflow across practices; (2) low pediatric volume, (3) competing priorities/lack of incentives, (4) ineffective involvement of nurses, (5) poor communication between clinical leadership and staff.

Discussion:
Although many HPV testing interventions have been implemented, findings have been mixed. It is clear that having an effective, evidence-based intervention by itself is not enough to get it into practice. Rather, it is crucial to consider implementation factors to ensure consistent implementation and sustainability. Key factors for the success of the DOSE HPV intervention appear to include a collaborative approach, provision of useful evidence to motivate behavior change, and repeated contacts to ensure accountability for implementing changes. Workflow issues, ineffective lines of communication, and competing priorities at both the visit and the patient and population management levels can hinder implementation.
Does the type of cryoprobe affect oncological and functional outcomes in men with clinically localized prostate cancer treated with primary whole gland prostate cryoablation?
Authors: Taha Tarek , Tan Wei Phin , Elshafei Ahmed , Aminsharifi Alireza , Given Robert , Cher Michael L. , Polascik Thomas J. 
Published: May 2021

Abstract

Background:
This study aimed to compare the oncological and functional outcomes of primary whole gland cryoablation of the prostate using the variable ice cryoprobe (V-Probe®) and the conventional fixed-size ice probe.

Materials and methods:
We reviewed the Cryo On-Line Data Registry for men who were treated with primary whole gland prostate cryoablation from 2000 through 2017. A multivariate Cox proportional hazards model was used to compare timing to biochemical recurrence between the V-Probe® and fixed-size ice probe after adjusting for preoperative prostate-specific antigen (PSA), neoadjuvant androgen deprivation therapy, preoperative Gleason score, and preoperative T stage.

Results:
A total of 1124 men were included. Median age, Gleason score, and pretreatment PSA were 70 years (interquartile range [IQR]: 65–74 years), 7 (IQR: 6–7) and 5.9 ng/mL (IQR: 4.6–8.1 ng/mL), respectively. The median follow-up time was 25.0 months (IQR: 11.2–48.6 months). V-Probes® were used in 269 (23.9%) cases and fixed-size ice probes in 858 (76.1%) cases. After adjusting for clinical T stage, PSA, neoadjuvant androgen deprivation therapy and preoperative Gleason score, on the multivariate Cox regression model, we found that there was no significant difference between the type of probe and timing to biochemical recurrence (p = 0.35). On multivariate logistic regression, using the V-Probe® was associated with a 91% increase in postoperative urinary retention compared to the fixed-size ice probe (p = 0.003).

Conclusions:
The use of the V-Probe® versus conventional fixed-size ice probe was not associated with a difference in biochemical recurrence in patients undergoing primary cryoablation of the prostate.
Primary Cutaneous Aspergillosis in Immunocompetent Patients Due to Aspergillus niger: A Report of 4 Cases
Authors: Pincelli Marcella S. , García Jesús Pérez , Sangueza Omar P. , Sangueza Martin 
Published: May 2021

Abstract:Primary cutaneous aspergillosis is a cutaneous fungal infection due to the direct inoculation of spores ofAspergillusspecies into the disrupted skin. Primary cutaneous aspergillosis presents with a variety of localized cutaneous lesions, such as erythematous macules, papules, plaques, or nodules that can progress to necrosis, erosion, ulceration, or fistulization. Many species ofAspergilluscan cause the disease, and one of them isAspergillus nigerthat rarely affects immunocompetent patients and that has peculiar characteristics on the histopathological examination. We present a series of 4 cases of immunologically competent patients presenting with primary cutaneous aspergillosis caused byA. niger.
Primary Cutaneous Enteric Duplication Cyst: A Novel Entity
Authors: Mastin Murphy R. , Swanson Leah A. , Smyrk Thomas C. , Wieland Carilyn N. , Guo Ruifeng 
Published: May 2021

Abstract:Enteric duplication cysts (EDCs) are rare congenital malformations consisting of double-walled cystic or tubular structures lined by gastrointestinal type epithelium. EDCs share a common muscular wall and blood supply with the adjacent duplicated bowel with very rare exceptions. The majority of EDCs are intraabdominal with cases less commonly intrathoracic or thoracoabdominal. To the best of our knowledge, we present the first reported case of primary cutaneous EDC to occur outside the abdominal and thoracic cavities. A 17-year-old male without a significant medical or surgical history underwent excision of a cystic nodule on the left hip. On histopathology, a dermal to subcuticular cyst exhibited an epithelial lining with 2 distinct components including cuboidal to columnar mucinous cells (CK7+, CK20−, and CDX2−) and complex glandular colonic-type mucosa (CK7−, CK20+, and CDX2+). A thick muscular wall resembling muscularis mucosa and muscularis propria surrounded the cyst. Findings supported a primary cutaneous enteric duplication cyst of uncertain developmental etiology. The novel nature of this entity could represent a diagnostic challenge.
Genetic Associations With Stable Warfarin Dose Requirements in Han Chinese Patients
Authors: Xu Qingqing , Zhang Suli , Wu Chaoneng , Xiong Yuyu , Niu Jiamin , Li Fengzhen , Zhu Jinhang , Shen Lu , Zhu Bin , Xing Qinghe , He Lin , Chen Luan , Li Mo , Li Hua , Ge Junbo , Qin Shengying 
Published: May 2021

Abstract:
Warfarin is a commonly prescribed anticoagulant for valvular heart disease that plays an important role in clinical management to prevent thrombotic events. In this study, we aim to perform a comprehensive study to investigate the genetic biomarkers of stable warfarin dose in the Han Chinese population. We performed an integrative study on 211 Han Chinese patients with valvular heart disease. A total of 40 single nucleotide polymorphisms (SNPs) in 10 important genes (CYP2C9, VKORC1, ABCB1, CYP4F2, APOE, PROC, GGCX, EPHX1, CALU, and SETD1A) which are involved in the warfarin metabolic pathway and equilibrium of coagulation and anticoagulation were selected. We applied MassARRAY technology to genotype the 40 SNPs identified in these Han Chinese patients. Our results showed that 13 SNPs on 6 genes (CYP2C9, VKORC1, ABCB1, PROC, EPHX1, and SETD1A) were associated with the individual stable warfarin dose. Two VKORC1 SNPs (rs9934438 and rs2359612) were the strongest genetic factors determining warfarin dose requirements (P = 8 × 10−6 and 9 × 10−6, respectively). Rs4889599 in SETD1A was first reported to be associated with warfarin dose at a significant level of 0.001 in our study (P
adjust = 0.040 after Bonferroni correction). We discovered that genetic variants in CYP2C9, VKORC1, ABCB1, PROC, EPHX1, and SETD1A may affect the stable warfarin dose requirement in Han Chinese patients with valvular disease. The discovery of these potential genetic markers will facilitate the development of advanced personalized anticoagulation therapy in Han Chinese patients.
Optimizing Breast Reconstruction through Integration of Plastic Surgery and Radiation Oncology
Authors: Arnautovic Aska , Olafsson Sigurast , Wong Julia S. , Agarwal Shailesh , Broyles Justin M. 
Published: May 2021

Background:
Post-mastectomy radiation therapy (PMRT) is an important adjunct to improve oncologic outcomes and survival in select breast cancer patients at increased risk for local recurrence. As recommendations for PMRT broaden, an increasing number of patients will have it included as part of their breast cancer treatment plan.

Methods:
This overview of the literature strives to broaden the exposure of the plastic surgeon to PMRT and describe the indications, guidelines, and considerations relevant to reconstructive surgery. The primary targets and dosing considerations will also be reviewed. Finally, the short- and long-term toxicities are outlined with the goal of providing the plastic surgeon insights with which to recognize certain toxicities in the clinic during follow up and to develop the fluency to be able to talk to patients about the potential for certain toxicities.

Results:
Generally, PMRT is safe and well tolerated. Considerations in breast reconstruction should be made on a patient-by-patient basis. Plastic surgeon familiarity with PMRT, its indications, and complications will amplify the surgeon’s ability to optimize outcomes.

Conclusions:
As more women undergo breast reconstruction, an increasing number of patients will have PMRT as part of their breast cancer treatment plan. By understanding the basic principles of PMRT, plastic surgeons can engage patients in conversations of shared decision-making and maximize outcomes.
ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTIONS DURING THE COVID-19 PANDEMIC WITH IMPLEMENTATION OF UNIVERSAL MASKING
Authors: Naguib Mina M. , Ghauri Sophia , Mukhopadhyay Anirudh , Schefler Amy C. 
Published: May 2021

Purpose:
To evaluate the rates of postintravitreal injection–related endophthalmitis during the COVID-19 pandemic with institution of both physician and patient face masking.

Methods:
All eyes receiving intravitreal injections of any kind from a single large tertiary retina practice in Houston, TX before (August 2017–March 22, 2020) and after (March 23, 2020–September 2020) COVID-19 pandemic universal masking protocols. The total number of injections and cases of acute injection-related endophthalmitis were determined from billing records and subsequent retrospective chart review. The primary outcome was the rate of endophthalmitis after intravitreal injection. Secondary outcomes included visual acuity, time until initial presentation, patient age, and differences in the overall number of injections performed monthly pre–COVID-19 and post–COVID-19.

Results:
A total of 134, 097 intravitreal injections were performed during the study period (111,679 pre–COVID-19 and 22,418 post–COVID-19 masking protocols). A total of 41 cases of acute endophthalmitis occurred in the pre-COVID group (0.04%, one in 2,500) and 7 cases in the post-COVID group (0.03%, one in 3,333) P = 0.85.

Conclusion:
In this single center, retrospective study, the implementation of universal patient and physician masking as practiced during the COVID-19 pandemic did not significantly affect the rate of postintravitreal injection endophthalmitis.
FACTORS ASSOCIATED WITH REACTIVATION AFTER INTRAVITREAL BEVACIZUMAB OR RANIBIZUMAB THERAPY IN INFANTS WITH RETINOPATHY OF PREMATURITY
Authors: Iwahashi Chiharu , Utamura Shoko , Kuniyoshi Kazuki , Sugioka Koji , Konishi Yuhei , Wada Norihisa , Kusaka Shunji 
Published: May 2021

Purpose:
To investigate the efficacy and risk factors of intravitreal antivascular endothelial growth factor injection (anti-VEGF therapy) for retinopathy of prematurity (ROP).

Methods:
We retrospectively reviewed 80 consecutive eyes of 43 patients with Type 1 ROP or worse who received anti-VEGF therapy during January 2012–February 2018. Patients were divided into those who were injected with 0.25 mg of bevacizumab (IVB group, 37 eyes) and 0.25 mg of ranibizumab (IVR group, 43 eyes). Serum VEGF concentrations of 18 patients were measured before and after IVR.

Results:
Antivascular endothelial growth factor injection therapy reduced ROP activity in all eyes; however, 14 eyes (17.5%) exhibited reactivation. The reactivation rates of the IVB and IVR groups were 13.5% and 20.9%, respectively (P = 0.556). Multivariate logistic regression analysis showed that postmenstrual age ≤35 weeks at anti-VEGF therapy (P = 0.014) and aggressive posterior ROP (P = 0.044) was significantly associated with reactivation. Serum VEGF was significantly suppressed at Days 1 (P < 0.001) and 7 (P = 0.012) after IVR and returned to the preinjection level by Day 14 (P = 0.210).

Conclusion:
Both IVR and IVB seemed effective in reducing ROP activity. Reactivation after anti-VEGF therapy may be associated with younger postmenstrual age at anti-VEGF therapy and aggressive posterior ROP.
Kappa opioid receptor blockade in the nucleus accumbens shell prevents sex-dependent alcohol deprivation effect induced by inflammatory pain
Authors: Lorente Jesús D. , Cuitavi Javier , Campos-Jurado Yolanda , Montón-Molina Raquel , González-Romero Jose L. , Hipólito Lucía 
Published: May 2021

Abstract
Pain-induced negative affect reduces life quality of patients by increasing psychiatric comorbidities, including alcohol use disorders (AUDs). Indeed, clinical data suggest pain as a risk factor to suffer AUDs, predicting relapse drinking in abstinent patients. Here, we analyse the impact of pain on alcohol relapse and the role of kappa opioid receptor (KOR) activation in mediating these pain-induced effects because KORs play an important role in pain-driven negative affect and AUD. Female and male Sprague-Dawley rats underwent 2 alcohol intermittent access periods separated by a forced abstinence period. The complete Freund adjuvant model of inflammatory pain was introduced during abstinence, and alcohol intake before and after alcohol reintroduction was assessed. In addition, we used behavioural approaches to measure stress and memory impairment and biochemical assays to measure KOR expression in abstinence and reintroduction periods. Only female CFA-treated rats increased alcohol intake during the reintroduction period. Concomitantly, this group showed enhanced anxiety-like behaviour and increased KOR expression in the nucleus accumbens shell that was developed during abstinence and remained during the reintroduction period. Finally, KOR antagonist norbinaltorphimine was administered in the nucleus accumbens shell during abstinence to prevent a pain-induced alcohol deprivation effect, a phenomenon observed in CFA-female rats. The administration of norbinaltorphimine effectively blocked a pain-induced alcohol deprivation effect in female rats. Our data evidenced that inflammatory pain constitutes a risk factor to increase alcohol consumption during a reintroduction phase only in female rats by the rise and maintenance of stress probably mediated by KOR signalling in the nucleus accumbens.