bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of Intravenous Immunoglobulin in Necrotizing Autoimmune Myopathy
Authors: Kocoloski Amanda , Martinez Silvia , Moghadam-Kia Siamak , Lacomis David , Oddis Chester V. , Ascherman Dana P. , Aggarwal Rohit 
Published: September 2021

Background/Objective
Immune-mediated necrotizing myopathy (IMNM) is a subtype of myositis that is associated with a refractory phenotype and poorer prognosis. The aim of the study was to provide single large center experience of outcomes of intravenous immunoglobulin (IVIg) for patients with IMNM using longitudinally collected data.

Methods
This case series longitudinally evaluated 4 of the 6 myositis core set measures at baseline and at 3 and 6 months after IVIg on 20 adult IMNM patients from 2014 to 2019 at the University of Pittsburgh. We assessed patients for improvement in core set measures, prednisone dose, adverse effects, and by the “limited” ACR/EULAR 2016 myositis response criteria. The mean differences in CK and manual muscle testing (MMT-8) were compared using a paired t test. A clinically significant response was defined as a >10% absolute improvement in the MMT-8 and a >50% absolute reduction in serum CK at 6 months of IVIg.

Results
Intravenous immunoglobulin treatment was associated with marked improvement in IMNM patients, with 85% of patient meeting clinically significant response. The median (interquartile range) relative percent improvement in CK level was 96% (85%–98%) and in MMT was 29% (14%–36%) at 6 months.
There was a significant reduction in the mean (SD) dose of prednisone at 6 months and had minimal adverse effects. In addition, with IVIg, most (13/14) patients had at least minimal improvement as per ACR/EULAR 2016 myositis response criteria.

Conclusions
Based on objective, meaningful improvement in MMT-8 and CK as well as marked reduction in prednisone doses with acceptable tolerability, early implementation of IVIg should be considered in adult IMNM.
Laparoscopic Totally Extraperitoneal (TEP) Groin Hernia Repair in Patients After Contralateral TEP Groin Hernia Repair
Authors: Zuiki Toru , Ohki Jun , Miyahara Go , Kobayashi Fuyumi , Lefor Alan K. 
Published: September 2021

Background:
The totally extraperitoneal (TEP) repair for groin hernia is considered difficult in patients with a healed surgical scar in the lower abdomen. We reported the feasibility of repair in those patients and found that the most frequent previous procedure in patients for whom the procedure was changed intraoperatively was a contralateral TEP after TEP repair. We now report an expanded patient cohort with a suggested unified treatment strategy.

Materials and Methods:
From 2006 to 2020, 443 patients underwent laparoscopic TEP groin hernia repair. A contralateral TEP after TEP repair was performed in 35 patients. The conversion rate after TEP was compared with that after other operations. Patients were divided into completed contralateral TEP after TEP repair (N=28) and changed procedure groups (N=7). Clinical characteristics were compared including age, body mass index, location and type of hernia, and interval after previous surgery. Multivariate analysis was performed to evaluate risk factors for conversion of the TEP procedure.

Results:
Patients undergoing contralateral TEP after TEP repair were significantly overrepresented among patients for whom the procedure was changed compared with other previous operations (P<0.01), with an odds ratio of 19.91. Comparing completed TEP after TEP repair and changed procedure groups, there were no significant differences regarding age (mean: 67 vs. 69 y old), body mass index (22.4 vs. 22.5 kg/m2), type of hernia (indirect or direct), or duration after previous TEP repair (median: 642 vs. 470 d) and identified no significant risk factors.

Conclusions:
The contralateral TEP after TEP repair for groin hernia is feasible. However, dense adhesions may be present if balloon dissection was performed at the previous TEP repair, and it is necessary to carefully dissect being ready to convert to other procedures such as TAPP repair or an anterior approach.
Is There an Impact of the Duration of Antibiotic Therapy on the Outcome of Nonsurgical Treatment of Complicated Diverticulitis?
Authors: Khaoudy Iman , Sabbagh Charles , Brac Baptiste , Regimbeau Jean-Marc 
Published: September 2021

Background:
Patients treated nonsurgically for complicated diverticulitis are managed by antibiotics. However, there are no recommendations concerning their duration. We aimed to determine the impact of the duration of antibiotic therapy on the risk of failure of nonsurgical treatment of complicated acute diverticulitis.

Patients and Methods:
This was a single-center retrospective study of patients with computer tomography (CT)-diagnosed complicated diverticulitis between January 2015 and April 2020. Treatment failure was defined as early recurrence and/or a persistent abscess by control CT.

Results:
In total, 148 patients fulfilled the inclusion criteria [87 men (58.8%), mean age 55±15 y]. The diverticulitis was classified as Hinchey I in 41.9%, Hinchey II in 9.5%, and pericolic free air in 48.6% of cases. The median abscess size was 2.9±1.7 cm. The median duration of antibiotic treatment was 10±4.2 days. The median follow-up was 64±60 months. The rate of failure was 12.8%. In univariate analysis, treatment >10 days (P=0.015) and an abscess >3 cm (P=0.032) were associated with a risk of treatment failure. In multivariate analysis, only the diameter of the abscess remained associated with a risk of failure (odds ratio: 1.6, 95% confidence interval: 1.09-2.4, P=0.01).

Conclusion:
This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.
Laparoscopic Remnant Cholecystectomy With CBD Exploration: A Tertiary Center Experience
Authors: Sahoo Manash R. , Panigrahi Sanhita , Sethi Mahesh K. , Kumar Bodda A. 
Published: September 2021

Background:
After partial cholecystectomy, the remnant gallbladder can become symptomatic requiring surgical intervention. This study aims at assessing feasibility and safety of laparoscopic remnant cholecystectomy with common bile duct (CBD) exploration in patients having remnant gallbladder stones with choledocholithiasis.

Materials and Methods:
This retrospective observational study includes data obtained over a period of 10 years, from 2010 to 2020, in 2 tertiary care centers performing advanced laparoscopic surgery. Patients with remnant gallbladder stones with choledocholithiasis were include in this study. All of them underwent laparoscopic remnant cholecystectomy with CBD exploration. Demographic, perioperative and follow up data were collected and analyzed.

Results:
A total of 18 patients with a mean age of 47 years, male to female ratio of 1:3.5, with cholecystectomy done 10 months to 15 years back, were diagnosed with remnant gallbladder stones with choledocholithiasis during the period of 2010 to 2020. Five patients had undergone endoscopic retrograde cholangiopancreatography stenting of CBD 3 months to 2 years back. All of them underwent laparoscopic remnant cholecystectomy with CBD exploration. Trans cystic approach for CBD exploration was performed in 11 patients. In 7 patients, transductal CBD exploration was done, out of which, 1 patient needed T-tube placement. Median hospital stay was for 3 days. Morbidity rate was 5.56% at 30 days after operation. There was no recurrence of symptoms or mortality after a median follow up of 24 months (range: 5 to 60 mo).

Conclusion:
Concurrent laparoscopic remnant cholecystectomy with CBD exploration is feasible, safe, and reproducible when performed in centers with experience in advanced laparoscopic surgery.
Long-term Outcome of Per-oral Endoscopic Myotomy Performed in the Endoscopy Unit With Trainees
Authors: Abdelfatah Mohamed M. , Calderon Lucie F. , Koldhekar Amol , Kapil Neil , Noll Alan , Shah Rush , Mekaroonkamol Parit , Patel Vaishali , Dacha Sunil , Philips George , Shahnavaz Nikrad , Keilin Steve , Willingham Field F. , Christie Jennifer , Cai Qiang 
Published: September 2021

Introduction:
Per-oral endoscopic myotomy (POEM) has been widely adopted for the treatment of achalasia as it provides a precise, tailored myotomy in a minimally invasive endoscopic procedure. Several short-term studies and a few long-term studies have confirmed that POEM is a safe and effective treatment for achalasia. However, the long-term outcome of POEM performed by trainees is unknown.

Materials and Methods:
We conducted a retrospective study of all patients who underwent POEM for achalasia at our tertiary care center during December 2012 and January 2019. All procedures performed with trainees were included. The primary outcome was the clinical response to POEM, defined as an Eckardt score of <3 after POEM. Trainees were trained in performing mucosotomy and submucosal dissection, creating a submucosal tunnel, identifying gastroesophageal junction, and performing myotomy and closure of mucosal incision in a step-by-step fashion. Trainees’ performance was evaluated by the mentor based on several key points in each step.

Results:
A total of 153 consecutive patients with a median age of 57±18 years were analyzed in this study. Of the total patients, 69 (45%) were male. The median length of follow-up after POEM was 32 months (range: 7 to 77 mo). A clinically significant response to POEM was achieved in 95% of patients at year 1, 84% at year 2, 80% at year 3, 79% at year 4, 78% at year 5, and 78% at year 6 and above. All trainees obtained competence within 6 cases for each step and could perform the procedure alone after 20 supervised cases.

Conclusions:
Overall, 78% of patients maintained positive clinical response at 6 years following POEM procedure. The recurrence rate of symptoms following POEM was 22% at a 6-year follow-up. This long-term outcome of POEM performed with trainees was comparable to those without trainees in other studies. To our knowledge, this is the longest follow-up and the largest number of patients after the POEM procedure performed with trainees.
Methane flux measurements along a floodplain soil moisture gradient in the Okavango Delta, Botswana
Authors: Gondwe M. J. , Helfter C. , Murray-Hudson M. , Levy P. E. , Mosimanyana E. , Makati A. , Mfundisi K. B. , Skiba U. M. 
Published: September 2021

Data-poor tropical wetlands constitute an important source of atmospheric CH4in the world. We studied CH4fluxes using closed chambers along a soil moisture gradient in a tropical seasonal swamp in the Okavango Delta, Botswana, the sixth largest tropical wetland in the world. The objective of the study was to assess net CH4fluxes and controlling environmental factors in the Delta's seasonal floodplains. Net CH4emissions from seasonal floodplains in the wetland were estimated at 0.072 ± 0.016 Tg a−1. Microbial CH4oxidation of approximately 2.817 × 10−3 ± 0.307 × 10−3 Tg a−1in adjacent dry soils of the occasional floodplains accounted for the sink of 4% of the total soil CH4emissions from seasonal floodplains. The observed microbial CH4sink in the Delta's dry soils is, therefore, comparable to the global average sink of 4–6%. Soil water content (SWC) and soil organic matter were the main environmental factors controlling CH4fluxes in both the seasonal and occasional floodplains. The optimum SWC for soil CH4emissions and oxidation in the Delta were estimated at 50% and 15%, respectively. Electrical conductivity and pH were poorly correlated (r2 ≤ 0.11,p < 0.05) with CH4fluxes in the seasonal floodplain at Nxaraga.This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part1)'.
Atmospheric methane removal: a research agenda
Authors: Jackson Robert B. , Abernethy Sam , Canadell Josep G. , Cargnello Matteo , Davis Steven J. , Féron Sarah , Fuss Sabine , Heyer Alexander J. , Hong Chaopeng , Jones Chris D. , Damon Matthews H. , O'Connor Fiona M. , Pisciotta Maxwell , Rhoda Hannah M. , de Richter Renaud , Solomon Edward I. , Wilcox Jennifer L. , Zickfeld Kirsten 
Published: September 2021

Atmospheric methane removal (e.g.in situmethane oxidation to carbon dioxide) may be needed to offset continued methane release and limit the global warming contribution of this potent greenhouse gas. Because mitigating most anthropogenic emissions of methane is uncertain this century, and sudden methane releases from the Arctic or elsewhere cannot be excluded, technologies for methane removal or oxidation may be required. Carbon dioxide removal has an increasingly well-established research agenda and technological foundation. No similar framework exists for methane removal. We believe that a research agenda for negative methane emissions—‘removal' or atmospheric methane oxidation—is needed. We outline some considerations for such an agenda here, including a proposed Methane Removal Model Intercomparison Project (MR-MIP).This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
Atmospheric methane and nitrous oxide: challenges alongthe path to Net Zero
Authors: Nisbet Euan G. , Dlugokencky Edward J. , Fisher Rebecca E. , France James L. , Lowry David , Manning Martin R. , Michel Sylvia E. , Warwick Nicola J. 
Published: September 2021

The causes of methane's renewed rise since 2007, accelerated growth from 2014 and record rise in 2020, concurrent with an isotopic shift to values more depleted in13C, remain poorly understood. This rise is the dominant departure from greenhouse gas scenarios that limit global heating to less than 2°C. Thus a comprehensive understanding of methane sources and sinks, their trends and inter-annual variations are becoming more urgent. Efforts to quantify both sources and sinks and understand latitudinal and seasonal variations will improve our understanding of the methane cycle and its anthropogenic component. Nationally declared emissions inventories under the UN Framework Convention on Climate Change (UNFCCC) and promised contributions to emissions reductions under the UNFCCC Paris Agreement need to be verified independently by top-down observation. Furthermore, indirect effects on natural emissions, such as changes in aquatic ecosystems, also need to be quantified. Nitrous oxide is even more poorly understood. Despite this, options for mitigating methane and nitrous oxide emissions are improving rapidly, both in cutting emissions from gas, oil and coal extraction and use, and also from agricultural and waste sources. Reductions in methane and nitrous oxide emission are arguably among the most attractive immediate options for climate action.This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.
Clinical Annotations for Prostate Cancer Research: Defining Data Elements, Creating a Reproducible Analytical Pipeline, and Assessing Data Quality
Authors: Keegan Niamh M. , Vasselman Samantha E. , Barnett Ethan S. , Nweji Barbara , Carbone Emily A. , Blum Alexander , Morris Michael J. , Rathkopf Dana E. , Slovin Susan F. , Danila Daniel C. , Autio Karen A. , Kantoff Philip W. , Abida Wassim , Stopsack Konrad H. 
Published: September 2021

AbstractBackgroundRoutine clinical data from clinical charts are indispensable for retrospective and prospective observational studies and clinical trials. Their reproducibility is often not assessed.ObjectiveTo develop a prostate cancer-specific database with a defined source hierarchy for clinical annotations in conjunction with molecular profiling and to evaluate data reproducibility.Design, setting, and participantsFor men with prostate cancer and clinical-grade paired tumor–normal sequencing, we performed team-based retrospective data collection from the electronic medical record at a comprehensive cancer center. We developed an open-source R package for data processing. We assessed reproducibility using blinded repeat annotation by a reference medical oncologist.Outcome measurements and statistical analysisWe evaluated completeness of data elements, reproducibility of team-based annotation compared to the reference, and impact of measurement error on bias in survival analyses.Results and limitationsData elements on demographics, diagnosis and staging, disease state at the time of procuring a genomically characterized sample, and clinical outcomes were piloted and then abstracted for 2,261 patients (with 2,631 samples). Completeness of data elements was generally high. Comparing to the repeat annotation by a medical oncologist blinded to the database (100 patients/samples), reproducibility of annotations was high to very high; T stage, metastasis date, and presence and date of castration resistance had lower reproducibility. Impact of measurement error on estimates for strong prognostic factors was modest.ConclusionsWith a prostate cancer-specific data dictionary and quality control measures, manual clinical annotations by a multidisciplinary team can be scalable and reproducible. The data dictionary and the R package for reproducible data processing are freely available to increase data quality in clinical prostate cancer research.Patient summaryInformation in the medical record is the backbone for clinical research on prostate cancer. The tools provided in this study can increase quality and efficiency of this research.
Trends in Cognitive Function Pre- and Post- Stroke: Finding from the China Health and Retirement Longitudinal Study
Authors: Hua Jianian , Dong Jianye , Shen Yueping 
Published: September 2021

AbstractIntroductionThe magnitude of changes in cognitive function after stroke among the Chinese population is not clear. We aimed to learn the trajectories of cognitive function before and after incident stroke among Chinese participants.MethodsData were obtained from a nationally representative study. A total of 13311 Chinese participants aged 45 years or older and without a history of stroke were assessed at baseline between June 2011 and March 2012 and in at least one cognitive test between Wave 2 to Wave 4. Cognitive function was assessed by a global cognition score, which included episodic memory, visuospatial abilities, and executive function. A linear mixed model was developed to explore the repeated measurements.ResultsDuring the seven-year follow-up, we observed 610 (4.6%) participants experienced the first stroke. The baseline mean (SD) age was 58.6 (9.2) years. 47.3% of them were male. There was no difference in the baseline cognitive function and decline rate of pre-stroke cognition between stroke survivors and stroke-free participants after adjusting for covariates. Among the stroke survivors, the acute decline was -0.123, -0.169, and -0.135 SD/y in cognitive domains of episodic memory, visuospatial ability, and global cognition, respectively. The executive function did not decline acutely after stroke. In the years following stroke, the decline rate of executive function was 0.056 SD/y faster than the rate before stroke. The decline rate of episodic memory, visuospatial ability, and global cognition did not accelerate after stroke.ConclusionBefore stroke onset, the cognitive function of Chinese stroke survivors was similar to that of stroke-free participants. Incident stroke was associated with acute decline in global cognition, episodic memory, and visuospatial abilities, and accelerated decline in orientation, attention, and calculation abilities. The cognitive trajectories revealed by our study highlights the need to care for the cognitive decline among Chinese stroke survivors.
Intravenous Immunoglobulin (IVIG) in Treating Non-ventilated COVID-19 Patients with Moderate to Severe Hypoxia is Pharmacoeconomically Favorable When Appropriately Targeted
Authors: Poremba Matthew , Dehner Matthew , Perreiter Alexandra , Semma Ashley , Mills Kimberly , Sakoulas George 
Published: September 2021

AbstractBackgroundPrior studies have shown that intravenous immunoglobulin (IVIG) can improve outcomes in patients with COVID-19, but the high costs of IVIG leave questions as to its pharmacoeconomic value.MethodsThe hospital costs of 2 IVIG vs. non-IVIG COVID-19 patient groups were compared. The first cohort was a case-control analysis of 10 non-ventilated moderately to severely hypoxic COVID-19 patients who received IVIG (Privigen) matched 1:2 with 20 control patients of similar age, body mass index (BMI), degree of hypoxemia, and co-morbidities. The second cohort consisted of patients enrolled in a previously published randomized open-label prospective study of 14 COVID-19 patients receiving standard of care (SOC) versus 13 patients who received SOC plus IVIG (Octagam 10%).ResultsAmong the first case control population, mean total direct costs including IVIG for the treatment group was $21,982 per IVIG-treated case versus $42,431 per case for matched non-IVIG receiving controls, representing a net cost reduction of $20,449 (48%) per case. For the second (randomized) group, mean total direct costs including IVIG for the treatment group was $28,268 per case versus $62,707 per case for untreated controls, representing a net cost reduction of $34,439 (55%) per case. 24% of the non-IVIG patients had hospital costs exceeded $80,000, as compared to none of the IVIG patient host (p=0.016, Fisher exact test).ConclusionWhen allocated to the appropriate patient type (moderate to severe illness without end-organ comorbidities and age <70 years), IVIG can significantly reduce hospital costs in COVID-19 care. More importantly, it may reduce the demand on scare critical care resources during the COVID-19 pandemic.
A Neuromuscular Model of Human Locomotion Combines Spinal Reflex Circuits with Voluntary Movements
Authors: Ramadan Rachid , Geyer Hartmut , Jeka John , Schöner Gregor , Reimann Hendrik 
Published: September 2021

AbstractExisting models of human walking use low-level reflexes or neural oscillators to generate movement. While appropriate to generate the stable, rhythmic movement patterns of steady-state walking, these models lack the ability to change their movement patterns or spontaneously generate new movements in the specific, goal-directed way characteristic of voluntary movements. Here we present a neuromuscular model of human locomotion that bridges this gap and combines the ability to execute goal directed movements with the generation of stable, rhythmic movement patterns that are required for robust locomotion. The model represents goals for voluntary movements of the swing leg on the task level of swing leg joint kinematics. Smooth movements plans towards the goal configuration are generated on the task level and transformed into descending motor commands that execute the planned movements, using internal models. The movement goals and plans are updated in real time based on sensory feedback and task constraints. On the spinal level, the descending commands during the swing phase are integrated with a generic stretch reflex for each muscle. Stance leg control solely relies on dedicated spinal reflex pathways. Spinal reflexes stimulate Hill-type muscles that actuate a biomechanical model with eight internal joints and six free-body degrees of freedom. The model is able to generate voluntary, goal-directed reaching movements with the swing leg and combine multiple movements in a rhythmic sequence. During walking, the swing leg is moved in a goal-directed manner to a target that is updated in real-time based on sensory feedback to maintain upright balance, while the stance leg is stabilized by low-level reflexes and a behavioral organization switching between swing and stance control for each leg. With this combination of reflex-based stance leg and voluntary, goal-directed control of the swing leg, the model controller generates rhythmic, stable walking patterns in which the swing leg movement can be flexibly updated in real-time to step over or around obstacles.