bluuebunny/crossref_metadata_2025_split huggingface dataset:
Administration of Venous Thromboembolism Chemoprophylaxis Within 12 Hours of Pelvic and Acetabular Surgery Has No Effect on Estimated Blood Loss, Perioperative Change in Hemoglobin, or Need for Transfusion
Authors: Keil Lukas G. , Flannigan Sean A. , Ostrum Robert F. , Hahn Jesse C. 
Published: September 2021

Objective:
To determine if preoperative administration of venous thromboembolism (VTE) chemoprophylaxis (PPx) before pelvic and acetabular fracture surgery affects estimated blood loss (EBL), perioperative change in hemoglobin (ΔHgb), or transfusion rates.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center, southeastern United States.

Patients/Participants:
All pelvic and acetabular surgeries performed between April 2014 and February 2020.

Main Outcome Measurements:
EBL, immediate and 24-hour postoperative ΔHgb, and intraoperative/postoperative transfusion.

Results:
In all, 267 surgeries were included: 97 prechange and 170 postchange. Median injury severity score was 17 before versus 14 after the change. One surgeon retired and two started during the study, producing differences in acetabular approaches. Median surgical duration was longer postchange. Cohorts were otherwise similar. No differences were observed in EBL, ΔHgb, or transfusion rates. Rates of VTE and surgical site complications were unchanged. No VTE-related deaths occurred. In the as-treated analysis (63 patients given low-molecular-weight heparin <12 hours preoperatively vs. 190 patients not given PPx), no differences were observed.

Conclusions:
Administration of VTE PPx within 12 hours of pelvic and acetabular surgery had no effect on perioperative blood loss. This study is limited by changes in faculty, but it suggests that traumatologists need not advocate for holding VTE PPx before pelvic and acetabular trauma surgery.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reamer Irrigator Aspirator Versus Iliac Crest Bone Grafting and Proximal Tibial Curettage: Is There a Difference in Blood Loss and Transfusion Rates?
Authors: Martella Anthony , Schumaier Adam P. , Sirignano Michael N. , Sagi Henry C. , Wyrick John D. , Archdeacon Michael T. 
Published: September 2021

Objectives:
To compare blood loss and transfusion rates among reamer irrigator aspirator (RIA), iliac crest bone graft (ICBG), and proximal tibial curettage (PTC) for autograft harvest.

Design:
Retrospective comparative study.

Setting:
Level 1 trauma center.

Patients/Participants:
The study included 139 adult patients treated between 2011 and 2018.

Interventions:
Nonunion repair of the femur or tibia using either RIA (n = 64), ICBG (n = 59), or PTC (n = 16) for autograft.

Main Outcome Measurements:
Estimated blood loss and transfusion rates.

Results:
Patient demographics, surgical indications, and medical comorbidities that affect bleeding did not differ among the groups. Estimated blood loss (mL) was significantly higher in the RIA group [RIA: 388 ± 368 (50–2000), ICBG: 286 ± 344 (10–2000), PTC: 196 mL ± 219 (10–700), P < 0.01]. The transfusion rate was also significantly higher in the RIA group (RIA 14%, ICBG 0%, PTC 0%, P < 0.01). The amount of graft obtained was higher in the RIA group (RIA = 48.3 mL, ICBG = 31.0 mL, PTC = 18.8 mL, P < 0.01), and the operative time (hours) was longer in the RIA group (RIA = 2.8, ICBG = 2.6, PTC = 1.9, P = 0.04).

Conclusion:
Estimated blood loss and transfusion rates were significantly higher in patients undergoing RIA compared with those in patients undergoing ICBG and PTC; however, the incidence of transfusion after RIA (14%) was considerably lower than previous reports. These findings suggest that the risk of transfusion after RIA is present and clinically significant but lower than previously believed, and it is likely affected by the amount of graft obtained and complexity of the nonunion repair. The risk of transfusion should be discussed with patients and the choice of RIA carefully evaluated in patients who have anemia or risk factors of bleeding.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Percutaneous Fixation of Posterior Malleolar Fractures in Patients With Unstable Ankle Fractures Treated With a Fibular Intramedullary Nail: A Description of a Technique and Review of Outcomes
Authors: Wordie Sarah J. , Carter Thomas H. , MacDonald Deborah , Duckworth Andrew D. , White Timothy O. 
Published: September 2021

Objectives:
To (1) describe the percutaneous technique used to reduce and fix a posterior malleolar fracture with anteroposterior screws in patients managed with a fibular intramedullary nail, (2) describe the selection of patients to whom this technique can be applied, and (3) report the clinical and patient reported outcome of this intervention.

Design:
Retrospective review.

Setting:
Academic orthopaedic trauma center.

Patients:
Thirty-two consecutive patients with a mean age of 65 years (range, 39–90) over a thirteen-year period identified from a prospective database.

Intervention:
Unstable ankle fractures managed surgically with a fibular nail and percutaneous fixation of the posterior malleolar component.

Main Outcome Measurements:
The primary short-term outcome was complications related to posterior malleolar fracture fixation. The primary mid-term outcome was the Olerud–Molander Ankle Score. Secondary outcomes included the Manchester–Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction.

Results:
Thirty of the 32 (94%) posterior malleolar fractures united uneventfully. Postoperative loss of talar reduction occurred in 2 patients (6.3%), which in 1 patient (3.1%) eventually required a hindfoot nail arthrodesis. There were no soft-tissue complications related to the anteroposterior screws or the fibular nail fixation. At a mean follow-up of 3.7 years (range, 1–8), the median Olerud–Molander Ankle Score, Manchester–Oxford Foot Questionnaire, EuroQol-5D, health, pain, and satisfaction scores were 80.0, 23.4, 0.85, 80.0, 85.0, and 87.5, respectively.

Conclusions:
Percutaneous ankle fracture fixation with a fibular nail and posterior malleolar screws results in reliable fracture stabilization, good patient outcomes, and high treatment satisfaction.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Pilot Study Analysis of Serum Cytokines to Differentiate Pediatric Septic Arthritis and Transient Synovitis
Authors: Clever David , Thompson Dominic , Gosselin Michelle , Brouillet Kirsten , Guilak Farshid , Luhmann Scott J. 
Published: September 2021

Background:
In pediatric patients, the presentation of the nontraumatic acutely painful joint/limb poses a diagnostic dilemma due to the similarity of presentations of the most likely diagnoses [septic arthritis (SA), transient synovitis (TS), osteomyelitis]. Current tools employed to differentiate these diagnoses rely on nonspecific inflammatory markers, radiologic imaging, and arthrocentesis. Diagnostic algorithms utilizing these clinical, radiographic, and biochemical parameters have produced conflicting results. The purpose of this study was to identify a serum-based inflammatory signature which can differentiate SA from TS in pediatric patients.

Methods:
Serum samples were collected from 22 pediatric patients presenting with joint/extremity pain whose working diagnosis included SA or TS. Each sample was analyzed for serum abundance of 72 distinct biomarkers and cytokines using enzyme linked immunosorbent assay based arrays. Linear discriminant analysis was performed to identify a combinatorial biomarker panel to predict a diagnosis of SA or TS. Efficacy of the biomarker panel was compared with definitive diagnoses as based on laboratory tests, arthrocentesis results, and clinical scenario.

Results:
At the time of presentation: (1) mean erythrocyte sedimentation rate in the SA group was 56.6 mm/h and 12.4 mm/h in the TS group (P<0.001), (2) mean C-reactive protein was 55.9 mg/dL in the SA group and 13.7 mg/dL in the TS group (P=0.12), and (3) mean white blood cell was 10.9 k/mm3 in the SA group and 11.0 k/mm3 in the TS group (P=0.95). A combined panel of 72 biomarkers was examined using discriminant analysis to identify a limited set of predictors which could accurately predict whether a patient was diagnosed with SA or TS. A diagnostic algorithm consisting of transforming growth factor alpha, interleukin (IL)-7, IL-33, and IL-28A serum concentration correctly classified 20 of the 22 cases with a sensitivity and specificity of 90.9% (95% confidence interval: 73.9%-100.0%).

Conclusion:
This study identifies a novel serum-based 4-cytokine panel that accurately differentiates SA from TS in pediatric patients with joint/limb pain.

Level of Evidence:
Level II—diagnostic study.
Development and validation of a deep learning model to screen hypokalemia from electrocardiogram in emergency patients
Authors: Wang Chen-Xi , Zhang Yi-Chu , Kong Qi-Lin , Wu Zu-Xiang , Yang Ping-Ping , Zhu Cai-Hua , Chen Shou-Lin , Wu Tao , Wu Qing-Hua , Chen Qi 
Published: September 2021

Abstract

Background:
A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients.

Methods:
We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V1–6) to detect patients with serum potassium concentrations <3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University. The blood draw was completed within 10 min before and after the ECG examination, and there was no new or ongoing infusion during this period.

Results:
We used 6904 ECGs and 1726 ECGs as development and internal validation data sets, respectively. In addition, 1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets. Using 12 ECG leads (leads I, II, III, aVR, aVL, aVF, and V1–6), the area under the receiver operating characteristic curve (AUC) of the DLM was 0.80 (95% confidence interval [CI]: 0.77–0.82) for the internal validation data set. Using an optimal operating point yielded a sensitivity of 71.4% and a specificity of 77.1%. Using the same 12 ECG leads, the external validation data set resulted in an AUC for the DLM of 0.77 (95% CI: 0.75–0.79). Using an optimal operating point yielded a sensitivity of 70.0% and a specificity of 69.1%.

Conclusions:
In this study, using 12 ECG leads, a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80. Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.
Persistent inflammatory residual risk despite aggressive cholesterol-lowering therapy: what is next?
Authors: Arnold Natalie , Koenig Wolfgang 
Published: September 2021

Purpose of review
To briefly summarize recently published evidence on the possible therapeutic modulation of inflammatory processes in atherosclerotic cardiovascular disease (ASCVD), focusing on the rationale for an additional randomized clinical trial, targeting both persistently elevated cholesterol and inflammatory residual risk and critically discuss still open issues and future perspectives with regard to treatment allocation.

Recent findings
Several large-scale clinical trials over the past few years have advanced our understanding of the role of inflammation in atherosclerosis, demonstrating that targeting the NLRP3 inflammasome and the IL-1β pathway indeed represent a new avenue to reduce residual risk in patients with ASCVD. However, despite optimal lipid-lowering therapy and novel options to modulate residual inflammatory risk, there are still a large number of individuals, being at high risk for recurrent ASCVD events.

Summary
The integration of a dual target strategy aimed at lowering the inflammatory burden in combination with aggressive lipid-modifying for those at high/very high ASCVD risk may hold potential to significantly improve patient care. However, a number of questions related to the design of such 2 × 2 factorial trial still needs to be answered.
What does complete revascularization mean in 2021? – Definitions, implications, and biases
Authors: Hosoyama Katsuhiro , Maeda Kay , Saiki Yoshikatsu 
Published: September 2021

Purpose of review
Coronary revascularization is known to be an excellent treatment for coronary artery disease. However, whether incomplete myocardial revascularization compromises long-term outcomes, as compared to complete revascularization (CR), remains contentious. Herein, we review the concept of and evidence on CR/incomplete revascularization (ICR) and discuss future perspectives.

Recent findings
When possible, achieving CR in coronary artery bypass grafting is desirable; nonetheless, ICR is also a reasonable option to balance the therapeutic benefits against the risks.

Summary
Although angiography-based assessment currently remains the standard of care, fractional flow reserve guidance may reduce the number of lesions requiring revascularization, which may be helpful for an appropriate surgical revascularization strategy. In particular, utilizing this approach may refine hybrid revascularization procedures, especially among high-risk patients.
A moderated moderation analysis of perceived adaptivity and organizational support for innovation in the relationship between role overload and emotional exhaustion
Authors: Apenteng Bettye A. , Boakye Kwabena G. , Opoku Samuel T. 
Published: September 2021

Background
Collectively, an individual’s ability and willingness to adjust to uncertain and complex changes in the workplace and an environment that supports employee problem-solving may facilitate individual-level adaptation to changes in the workplace and help mitigate the negative impact of work-related stressors on health care professionals’ work-related behavior and mental health outcomes.

Purpose
This study uses an interactionist perspective to assess how resources such as perceived adaptivity and organizational support for innovation serve as contextual boundary conditions of role overload in mitigating emotional exhaustion among health care workers.

Methodology
A cross-sectional survey design was used to collect data from rural health care workers (n = 310). A moderated moderation analysis was performed to address the aims of the study.

Results
The results indicate that role overload has a significant positive effect on emotional exhaustion. Furthermore, a statistically significant three-way interaction effect of perceived adaptivity, organizational support for innovation, and role overload on emotional exhaustion was observed. Organizational support for innovation was found to mitigate the negative impact of role overload on emotional exhaustion for employees with high perceived adaptivity, but not for those with low perceived adaptivity levels.

Conclusions
The findings from this study suggest that in high-stress work environments, integrating and appropriately matching personal and organizational resources could serve as a buffer against the effects of work stressors on emotional exhaustion.

Practical Implications
Effective strategies to enhance employee emotional well-being may require the joint consideration of individual and organizational factors.
Comparing ProKera With Amniotic Membrane Transplantation: Indications, Outcomes, and Costs
Authors: Zhou Tianwei Ellen , Robert Marie-Claude 
Published: September 2021

Purpose:
The aim of this study was to compare the outcomes of ProKera versus amniotic membrane transplantation (AMT) in managing ocular surface disease.

Methods:
This study is a retrospective case series of patients who received either ProKera or sutured AMT for ocular surface disease. Patient demographics, treatment indications, retention time, percentage healed area, changes in visual acuity, and costs to the health care system were analyzed.

Results:
Fourteen patients were identified and analyzed for each group. The main indications for using ProKera and AMT were similar, including corneal ulcer or epithelial defect due to chemical burns, neurotropic state, or herpes zoster keratitis. The average time to dissolution or removal was 24.8 days in the ProKera group, compared with 50.1 days in the AMT group. The average percentage of healed corneal area was 59% for ProKera and 73% for AMT. There was no significant difference between the initial and the final visual acuity within groups and when comparing both groups. In our expense analysis, ProKera had a total cost of 699.00 Canadian dollars (CAD), whereas the cost of suture AMT was 1561.52 CAD. ProKera priced at 11.85 CAD for each percentage healed surface area and at 21.39 CAD for AMT.

Conclusions:
ProKera allowed for a faster corneal healing than sutured AMT, although its total healed area was less than the latter. Moreover, ProKera is more cost-effective than AMT, thus reducing financial burden to our health care system.
Impact of Scleral Lens on Corneal Curvature and Pachymetry in Keratoconic Eyes
Authors: Iqbal Asif , Mahadevan Rajeswari 
Published: September 2021

Purpose:
The aim of this study was to evaluate the influence of scleral lens on corneal curvature and corneal thickness in keratoconic patients.

Methods:
Scheimpflug imaging was captured before lens insertion, immediately after removal at 6 hours, and, again, the next day morning. Anterior flat, steep, and maximal keratometry (Kflat, Ksteep, and Kmax, respectively) and pachymetry values were compared.

Results:
Minimal corneal flattening was observed for all 3 curvature parameters immediately after lens removal but was not statistically significant. The average Kflat was 0.28 ± 0.31 (D) flatter (P = 0.37), Ksteep was 0.37 ± 0.09 (D) flatter (P = 0.11), and Kmax was 0.19 ± 0.24 (D) flatter (P = 0.53), which returned to baseline level after one night of lens removal. After 6 hours of a 16-mm scleral lens wear, central corneal pachymetry showed that a marginal thickening of 7.76 ± 3.00 μm (P = 0.06) was causing 1.77 ± 0.67% of corneal edema, which returned to baseline after one night of lens removal. There was no significant correlation noted between corneal flattening and change in corneal thickness (r = 0.09, P = 0.78) and between central corneal clearance and change in corneal curvature (r = −0.23, P = 0.51).

Conclusions:
Minimal transient alteration in the anterior corneal curvature and corneal thickness was observed after 6 hours of scleral lens wear. These temporary changes regressed to baseline after overnight discontinuation of the lens.
Acute-on-Chronic Liver Failure Precipitated by Severe Acute Respiratory Syndrome Coronavirus 2 Infection in a Patient with Hepatitis B Virus-Related Cirrhosis: A Case Report
Authors: Chen Wanling , Zhang Qiran , Li Shijun , Liang Ruiting , Liang Haiqun , Yu Yiqi , Qiu Chao , Lv Jiannan , Zhang Wenhong 
Published: September 2021

Abstract
We present a case of acute-on-chronic liver failure (ACLF) in a patient with hepatitis B virus (HBV)-related decompensated cirrhosis and coronavirus disease 2019 (COVID-19). A 58-year-old woman with HBV-related and decompensated cirrhosis without any anti-viral treatment previously was admitted to the hospital due to a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. On admission, she was in stable condition. Thoracic computed tomography (CT) and laboratory findings showed no significant abnormalities. Entecavir was initiated promptly for HBV, while antiviral therapy and supportive treatment were initiated for COVID-19. Her lung infection exacerbated after 10 days of recurrent fever despite treatments, and there were signs of HBV reactivation. ACLF and multiple organ dysfunction syndrome developed rapidly from day 10 to day 19. The patient's clinical deterioration was also consistent with pneumonia progression and elevated interleukin 6 levels. SARS-CoV-2 likely precipitated ACLF in cirrhotic patients, either by inducing HBV flare or serving as an acute insult directly. This study discussed the underlying mechanisms of this process and management details. Monitoring HBV status is necessary, and inflammatory parameters might be valuable. HBV suppression should be initiated early, and variceal hemorrhage primary prevention might be beneficial in COVID-19 patients with cirrhosis.
Short- and long-term prognosis of acute critically ill patients with systemic rheumatic diseases
Authors: Chabert Paul , Danjou William , Mezidi Mehdi , Berthiller Julien , Bestion Audrey , Fred Abla-Akpene , Guerin Claude , Argaud Laurent , Piriou Vincent , Bonnefoy-Cudraz Eric , Lehot Jean-Jacques , Fellahi Jean-Luc , Rimmele Thomas , Aubrun Frederic , Richard Jean-Christophe , Gallay Laure , Hot Arnaud 
Published: September 2021

Abstract
Patients with systemic rheumatic disease (SRD) share the risks of multi-organ flare-up, cardiovascular diseases, and immunosuppression. Such situations can lead to an acute critical illness. The present study describes the clinical features of SRD patients admitted to the intensive care unit (ICU) and their short- and long- term mortality.
We performed a multicentre retrospective study in 10 French ICU in Lyon, France. Inclusion criteria were SRD diagnosis and admission for an acute organ failure. The primary endpoint was ICU mortality.
A total of 271 patients were included. SRD included systemic lupus erythematosus (23.2% of included patients), vasculitis (10.7%), systemic sclerosis (10.7%), idiopathic inflammatory myopathy (6.3%), and other connective tissue disorders (rheumatoid arthritis, Sjögren and Sharp syndromes; 50.9%). Initial organ failure(s) were shock (43.5% of included patients), acute kidney injury (30.5%), and acute respiratory failure (23.2%). The cause(s) of ICU admission included sepsis (61.6%), cardiovascular events (33.9%), SRD-flare up (32.8%), and decompensations related to comorbidities (28%). The ICU mortality reached 14.3%. The factors associated with ICU mortality were chronic cardiac failure, invasive ventilation and admission in ICU for another reason than sepsis or SRD flare-up. The median follow-up after ICU discharge was 33.6 months. During follow-up, 109 patients died. The factors associated with long-term mortality included age, Charlson comorbidity index, and ICU admission for sepsis or SRD flare-up.
The ICU mortality of patients with SRD was low. Sepsis was the first cause of admission. Cardiovascular events and comorbidities negatively impacted ICU mortality. Admission for sepsis or SRD flare-up exerted a negative effect on the long-term outcome.