bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endothelial cell loss after accelerated corneal crosslinking using pachymetry-guided hypo-osmolar riboflavin dosing in thin keratoconic corneas
Authors: Yurttaser Ocak Serap , Mangan Mehmet Serhat 
Published: June 2021

Purpose:
To report the intraoperative changes in corneal pachymetry, as well as the efficacy and safety of accelerated corneal crosslinking (A-CXL) treatment using only hypo-osmolar riboflavin (HO-RF) solution in progressive keratoconus patients with thin corneas.

Setting:
University of Health Sciences, Prof. Dr. Cemil Tascioglu Education and Research Hospital, Istanbul, Turkey

Design:
Retrospective study.

Methods:
Thin keratoconic corneas (<400 m without epithelium) who had A-CXL (9 mW/cm2-10 minutes) with HO-RF solution application were enrolled in the study. Intraoperative corneal pachymetric changes and uncorrected and corrected distance visual acuities (UDVA and CDVA), refraction power values, topographic values, and endothelial cell density (ECD) measurements were recorded preoperatively and at 1st, 3rd, 6th, and 12th month follow-up postoperatively.

Results:
31 eyes of 25 patients (mean age: 24.17 ± 3.07 years) included in this study. The mean thickness increased to 438 μm (P = .001) after the application of HO-RF solution, and it was reduced to 424 μm (P = .001) after ultraviolet irradiation. At all postoperative visits after month 1, there was a significant increase in both UDVA (P < .05) and CDVA (P < .01) values and a significant decrease in both maximum keratometry (P < .05) and ECD (P < .01) values.

Conclusions:
Accelerated CXL with only HO-RF solution application throughout the procedure in thin corneas was effective but seemed to result in a significant ECD decrease postoperatively.
Repeated Annual Health Risk Assessments With Intervention Did Not Reduce 10-year Cardiovascular Disease Risk
Authors: Hene Nceba , Wood Paola , Schwellnus Martin , Jordaan Esme , Laubscher Ria 
Published: June 2021

Objective:
To determine if repeat annual health risk assessments (RAHRAs) with intervention reduce 10-year cardiovascular disease (CVD) risk in financial sector employees.

Methods:
Retrospective analysis from RAHRAs in 13,737 employees over 4 years. We report changes in 10-year FRS for CVD (%) and risk factors after 1 (GR1), 2 (GR2), and 3 (GR 3) RAHRAs.

Results:
Mean FRS increased with RAHRAs (GR1: +0.4%; GR2: +0.7%; GR3: +0.8%) (P < 0.001) and was higher for GR3 versus GR1 (P < 0.001) and GR2 (pairwise: P < 0.0355). RAHRAs were associated with increased inadequate fruit/vegetable intake (GR1: +5.4%; GR2: +9.8%; GR3: +15.8%) (all pairwise: P < 0.001) and overweight (GR1: +5.4% vs GR2: +9.8%) (P < 0.001) and only hypercholesterolemia decreased (GR1: −4.4% vs GR3: −9.6%) (P < 0.001).

Conclusion:
RAHRAs did not reduce 10-year CVD risk in financial sector employees. Role of RAHRAs in chronic disease management requires further study.
Evaluation of prognostic value of neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure or severe liver injury from chronic HBV infection
Authors: Sun Jian , Guo Hongying , Yu Xueping , Chen Jingwen , Zhu Haoxiang , Qi Xun , Zhang Xueyun , Han Jiajia , Liu Xiaoqin , Yang Jianghua , Wang Jiefei , Qian Zhiping , Huang Yuxian , Mao Richeng , Zhang Jiming 
Published: June 2021

Background and aims
Acute-on-chronic liver failure (ACLF) is associated with bacterial infection and poor outcome. Neutrophil-to-lymphocyte ratio (NLR) is used to assess bacterial infection and immune dysfunction in numerous diseases. We aimed to evaluate NLR as a prognostic biomarker and to explore its combination with accepted prognostic models in ACLF patients.

Methods
This retrospective study included patients with ACLF or severe liver injury from chronic HBV infection admitted to three tertiary academic hospitals in China from 2013 to 2019. Baseline NLR was correlated with ACLF grade, bacterial infection, survival and accepted ACLF scores.

Results
Baseline NLR values were significantly increased in nonsurvivors and patients with bacterial infection at or after admission and were unaffected by cirrhotic status in 412 transplant-free patients included in three cohorts. Compared with accepted scores, NLR showed moderate accuracy in predicting 28-day mortality and high accuracy in predicting 90-day mortality. Three levels of mortality risk were graded on the basis of NLR values (<3.10, 3.10–4.79 and >4.79), and NLR >4.79 was associated with 53.2–60.0% 28-day and 75.0–80.0% 90-day mortality in these cohorts. Multivariate analyses indicated that NLR retained statistical significance independently of CLIF consortium organ failure score (CLIF-C OFs). NLR-based CLIF-C ACLF score was primarily developed and showed excellent performance in predicting 28/90-day mortality.

Conclusions
NLR is a dependable biomarker for bacterial infection assessment and short-term mortality prediction in ACLF patients and can be used jointly with CLIF-C OFs to improve the accuracy of mortality prediction in patients with the disease. NLR-based CLIF-C ACLF model needs further validation.
Simplified 6-month prediction scores for primary biliary cholangitis patients treated with ursodeoxycholic acid
Authors: Pinyopornpanish Kanokwan , Chadalavada Pravallika , Talal Sarmini Muhammad , Khoudari George , Alomari Mohammad , Padbidri Vinay , Romero-Marrero Carlos 
Published: June 2021

Objectives
To develop a prognostic score evaluating treatment response at 6 months after ursodeoxycholic acid (UDCA) initiation in primary biliary cholangitis (PBC) patients.

Methods
Adult PBC patients who were newly prescribed UDCA at our institution (n = 292) were included. Significant determinants of liver-related adverse events in the multivariable Cox model were used for score development, weighted by β-coefficients. Discrimination ability was assessed using Harrell’s C-statistic. The performance of our model was compared to the previous models.

Results
Our model included the following variables evaluated at 6 months: (1) alkaline phosphatase decline of less than 50% from baseline and >upper limit normal (ULN) (2 points); (2) bilirubin >ULN (2 points); (3) albumin <lower limit normal (1 point). The score ranged from 0 to 5 points. C-statistic estimates were 0.87 (overall cohort), 0.87 (no cirrhosis) and 0.77 (cirrhosis), indicating good discrimination of treatment response. Patients with scores ≥3 points had significant shorter transplant-free survival (TFS) than scores <3 points (P < 0.001). The TFS rates for patients with score ≥3 points at 5, 10 and 15 years were 52, 26 and 7%, and for patients with scores <3 points were 96, 92 and 82%, respectively. There was no significant difference between the performance of our 6-month model and the previous models (Paris I, Paris II, Barcelona, Rotterdam and GLOBE scores evaluated at 12 months) in predicting liver-related outcomes (all P = NS).

Conclusion
This novel 6-month prognostic model showed good prognostic performance. Utilization of this score would identify patients with suboptimal responses to UDCA earlier.
Mean platelet volume and platelet to lymphocyte count ratio are associated with hepatitis B-related liver fibrosis
Authors: Kosekli Mehmet Ali 
Published: June 2021

Aim
Chronic hepatitis B is associated with important morbidity and mortality. Inflammation has a pivotal role in hepatic fibrosis of this population. Hemogram-derived inflammatory predictors, such as mean platelet volume (MPV) and platelet to lymphocyte ratio (PLR), are supposed as inflammatory markers in various diseases. We aimed to compare MPV and PLR of the patients with chronic hepatitis B to those of healthy controls and to observe possible correlation between these markers and fibrosis.

Methods
Chronic hepatitis B patients that visited our outpatient gastroenterology clinics were enrolled in the study. Healthy volunteers were enrolled as controls. MPV, PLR and other parameters of the study groups were compared.

Results
Median MPV of the mild fibrosis, advanced fibrosis control groups were 8.1 (6.6–13) fL, 8.2 (6.3–14.5) fL and 7.2 (4.6–8.9) fL, respectively (P < 0.001). Median PLR of the mild fibrosis, advanced fibrosis control groups were 99.5 (36–259) %, 119 (61–1547) % and 122 (64–197) %, respectively (P = 0.02). PLR was correlated with the ISHAK score (r = 0.32, P = 0.002). A MPV value greater than 7.52 fL have 80% sensitivity and 56% specificity in determining advanced fibrosis (AUC: 0.68, P = 0.002, 95% confidence interval, 0.58–0.77).

Conclusion
We think that increased MPV and decreased PLR are characteristics of chronic hepatitis B disease. Moreover, increased MPV could predict advanced fibrosis in this population.
Prognostic significance of 18F-FDG PET/CT parameters in IDH-1 wild-type GBM and correlation with molecular markers
Authors: Dev Indraja Devidas , Puranik Ameya D. , Purandare Nilendu C. , Gupta Tejpal , Sridhar Epari , Shetty Prakash , Moiyadi Aliasgar , Agrawal Archi , Shah Sneha , Rangarajan Venkatesh 
Published: June 2021

Aim
To assess the prognostic role of metabolic parameters on 18F-FDG PET/CT & correlation with molecular markers in IDH-1 wild-type GBM.

Methods
A total of 129 patients with brain lesions showing equivocal findings on baseline MRI who were referred for fluoro-deoxy-glucose PET/CT were analyzed. Of these, 50 underwent surgery/biopsy and postoperative histopathological diagnosis of IDH-1 wild-type GBM. SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG) & T/w ratio was calculated. Median metabolic parameters were used for stratification. Overall survival was calculated using Kaplan–Meier method and was compared using log rank test. P value < 0.05 was considered significant. Multivariate analysis was done using Cox proportional hazard model. Correlation between metabolic parameters and molecular markers was done using Mann–Whitney U test.

Results
Median of SUVmax, T/w ratio, MTV, TLG, 18.3, 2.09, 61, 409. Average overall survival (OS) for T/w ratio >2.08 was 5 months, <2.08 was 18 months (P value 0.001). For MTV >61 was 4 months, <61 was 18 months (P value 0.001). Similarly, for TLG >409 was 5 months while for <409 was 19 months (P value 0.001). SUVmax was not significant for OS. In multivariate analysis, age was the statistically significant independent prognostic factor.

Conclusion
Metabolic parameters of fluoro-deoxy-glucose PET/CT help in prognosticating IDH-1 wild-type GBM. Higher MiB-1 index correlates with higher T/w ratio and is associated with poor overall survival.
The solid organ transplant recipient with SARS-CoV-2 infection
Authors: Laracy Justin C. , Miko Benjamin A. , Pereira Marcus R. 
Published: June 2021

Purpose of review
The COVID-19 pandemic is a major challenge to global health, particularly among vulnerable populations. Here, we describe the emerging epidemiology and relevant data on treatment options for COVID-19. We discuss the implications of current knowledge for solid organ transplant (SOT) recipients.

Recent findings
Risk factors and outcomes of COVID-19 among SOT recipients remain uncertain, but recent data suggest similar outcomes to the general population. Case reports of donor-derived SARS-CoV-2 infection are emerging. Few studies on treatment of COVID-19 among SOT recipients are available, and therefore, general recommendations are similar to the general population. Vaccine efficacy in the SOT population is uncertain.

Summary
COVID-19 remains a significant threat to SOT recipients and studies on treatment and prevention specific to this population are urgently needed. Although vaccines represent the greatest hope to control this pandemic, their efficacy in this immunocompromised population is uncertain.
Emerging fungal pathogens in solid organ transplantation
Authors: Mishkin Aaron 
Published: June 2021

Purpose of review
This review examines recent cases and updated literature on emerging or newly resistant fungal infections in solid organ transplantation.

Recent findings

Candida auris, a newly described candida capable of drug resistance and persistence in the environment, is a growing concern with both published cases on donor-derived transmission and a hospital outbreak involving liver transplant recipients. Infections with non-albicans candida species are also increasing in incidence in SOT recipients, leading to increasing antifungal resistance and higher mortality. Aspergillus usti has emerged in immunocompromised patients on antifungal prophylaxis. Cryptococcus species continue to be responsible for a number of infections in SOT recipients. Dimorphic fungi, endemic to geographic areas and responsible for sporadic infections in SOT recipients are noted to have an expanding geographic area. Emergomyces are newly classified groups of five species of dimorphic fungi noted to disseminated disease in immunocompromised patients including SOT recipients.

Summary
Emerging fungal species and the development of resistance in well entrenched fungal pathogens impacts SOT recipients and those caring for them. Knowledge of these trends aids in the successful identification and optimal treatment of these challenging conditions.
Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments
Authors: Finkelstein Yaron , Maguire Bryan , Zemek Roger , Osmanlliu Esli , Kam April J. , Dixon Andrew , Desai Neil , Sawyer Scott , Emsley Jason , Lynch Tim , Mater Ahmed , Schuh Suzanne , Rumantir Maggie , Freedman Stephen B. ,   on behalf of Pediatric Emergency Research Canada (PERC)
Published: June 2021

ObjectivesThe aim of this study was to quantify the effect of the COVID-19 pandemic on pediatric emergency department (ED) utilization and outcomes.MethodsThis study is an interrupted-time-series observational study of children presenting to 11 Canadian tertiary-care pediatric EDs. Data were grouped into weeks in 3 study periods: prepandemic (January 1, 2018–January 27, 2020), peripandemic (January 28, 2020–March 10, 2020), and early pandemic (March 11, 2020–April 30, 2020). These periods were compared with the same time intervals in the 2 preceding calendar years. Primary outcomes were number of ED visits per week. The secondary outcomes were triage acuity, hospitalization, intensive care unit (ICU) admission, mortality, length of hospital stay, ED revisits, and visits for trauma and mental health concerns.ResultsThere were 577,807 ED visits (median age, 4.5 years; 52.9% male). Relative to the prepandemic period, there was a reduction [−58%; 95% confidence interval (CI), −63% to −51%] in the number of ED visits during the early-pandemic period, with concomitant higher acuity. There was a concurrent increase in the proportion of ward [odds ratio (OR), 1.39; 95% CI, 1.32–1.45] and intensive care unit (OR, 1.20; 95% CI, 1.01–1.42) admissions, and trauma-related ED visits among children less than 10 years (OR, 1.51; 95% CI, 1.45–1.56). Mental health–related visits in children declined in the early-pandemic period (in <10 years, −60%; 95% CI, −67% to −51%; in children ≥10 years: −56%; 95% CI, −63% to −47%) relative to the pre–COVID-19 period. There were no differences in mortality or length of stay; however, ED revisits within 72 hours were reduced during the early-pandemic period (percent change: −55%; 95% CI, −61% to −49%;P< 0.001).ConclusionsAfter the declaration of the COVID-19 pandemic, dramatic reductions in pediatric ED visits occurred across Canada. Children seeking ED care were sicker, and there was an increase in trauma-related visits among children more than 10 years of age, whereas mental health visits declined during the early-pandemic period. When faced with a future pandemic, public health officials must consider the impact of the illness and the measures implemented on children's health and acute care needs.
Determining the Independent Risk Factors for Worse SCAR-Q Scores and Future Scar Revision Surgery
Authors: Ziolkowski Natalia I. , Behman Ramy , Klassen Anne F. , Fish Joel S. , Mundy Lily R. , She Richard Wong , Forrest Christopher R. , Hollenbeck Scott , Arriagada Cristian , Greenhalgh David , Pusic Andrea L. 
Published: June 2021

Background:
Scar revisions have been increasing in number. Patient-reported outcome measures are one tool to aid scar modulation decision-making. The aims of this study were to determine patient, scar, and clinical risk factors for (1) low SCAR-Q Appearance, Symptom, and Psychosocial Impact scores and how this differs for children; and (2) the potential need for future scar revision surgery to better identify such patients in a clinical setting.

Methods:
A multicenter international cross-sectional cohort study based on survey data of participants with traumatic, surgical, and burn scars attending plastic, hand, and burn clinics in four countries was conducted following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Univariate analysis to identify risk factors and multivariable logistic analysis to select risk factors were completed. Collinearity for nonindependent factors and C statistic for model discrimination were also calculated.

Results:
Seven hundred thirty-one participants completed the study booklet, and 546 participants (74.7 percent) had full data. Independent risk factors were determined to be a bothersome scar and perception of scarring badly for all three scales. Risk factors for self-reporting the need for future surgery included a health condition, scarring badly, scar diagnosis, prior scar revision, and low Psychosocial Impact scores. We did not identify evidence of multicollinearity. C statistics were high (0.81 to 0.84).

Conclusions:
This study is the first multicenter international study to examine independent risk factors for low patient-reported outcome measure scores and the potential need for future scar revision surgery. Patients that perceive themselves as scarring badly and having a bothersome scar were at a higher risk of scar appearance concern, an increased symptom burden, and poorer psychosocial impact scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Secondary Rhinoplasty for Unilateral Cleft Nasal Deformity
Authors: Rohrich Rod J. , Benkler Michal , Avashia Yash J. , Savetsky Ira L. 
Published: June 2021

Background:
Secondary cleft rhinoplasty presents some of the most challenging cases of both cosmetic and functional nasal deformities. Understanding the anatomy and growth abnormality seen with the cleft nasal deformity helps to tailor surgical management. This article seeks to expand on the application of current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity.

Methods:
The authors review nasal analysis in the cleft rhinoplasty patient and provide the surgical management for each aspect in the secondary cleft rhinoplasty.

Results:
The secondary rhinoplasty was divided into seven areas: piriform hypoplasia, septal reconstruction, dorsal reshaping, tip reshaping, tip projection, alar reshaping, and alar repositioning. Surgical management for each is provided.

Conclusion:
Secondary cleft rhinoplasty requires an understanding of the structural dysmorphology, and the use of cosmetic, functional, and secondary rhinoplasty techniques for its successful management.
Soluble biomarkers associated with chronic lung disease in older children and adolescents with perinatal HIV infection
Authors: Hameiri-Bowen Dan , Sovershaeva Evgeniya , Flaegstad Trond , Gutteberg Tore Jarl , Ngwira Lucky Gift , Simms Victoria , Rehman Andrea M. , Mchugh Grace , Bandason Tsitsi , Ferrand Rashida Abbas , Rowland-Jones Sarah , Yindom Louis-Marie 
Published: June 2021

Objective:
HIV-associated chronic lung disease (HCLD) is a common comorbidity in children and adolescents in sub-Saharan Africa (SSA). The pathogenesis of HCLD is unclear and may be driven by underlying dysregulated systemic immune activation and inflammation. We investigated the association between 26 plasma soluble biomarkers and HCLD.

Design:
Case--control analysis of baseline biomarker data from 336 children and adolescents (6–19 years old) with perinatal HIV infection (PHIV) and HCLD (cases) and 74 age-matched and sex-matched controls with PHIV but no CLD. HCLD was defined as having a forced expiratory volume in one second (FEV1) z score less than −1 with no reversibility.

Methods:
Cryopreserved plasma collected at recruitment was used in a multiplex bead assay (Luminex) to measure baseline levels of soluble biomarkers. Logistic regression alongside data-reduction and techniques quantifying the interconnectedness of biomarkers were used to identify biomarkers associated with odds of HCLD.

Results:
Biomarkers of general immune activation and inflammation (β2M, CRP, sCCL5, GCSF, IFN-γ, IP-10), T-cell activation (sCD25, sCD27), platelet activation (sCD40-L), monocyte activation (sCD14), coagulation (D-Dimer), cellular adhesion (E-selectin), and extracellular matrix degradation (MMP-1, MMP-7, MMP-10) were associated with increased odds of HCLD. Exploratory PCA and assessment of biomarker interconnectedness identified T-cell and platelet activation as centrally important to this association.

Conclusion:
HCLD was associated with a large number of soluble biomarkers representing a range of different pathways. Our findings suggest a prominent role for T-cell and platelet activation in HCLD.
Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse
Authors: Bradley Catherine S. , Brown Heidi W. , Shippey Stuart S. , Gutman Robert E. , Andy Uduak U. , Yurteri-Kaplan Ladin A. , Kudish Bela , Mehr Allen , O’Boyle Amy , Foster Raymond T. , Anger Jennifer T. , Ten Eyck Patrick , Moalli Pamela A. 
Published: June 2021

Objective
Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors.

Methods
This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores.

Results
Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P’s ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.5], P = 0.56). Global Health scores correlated with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire scores (all P’s < 0.0001). In multivariable models, menopause was associated with better physical QOL, and constipation, coronary artery disease, pelvic pain, and increased body mass index with worse physical QOL. Age was associated with better mental QOL, and constipation, fecal incontinence, pelvic pain, and coronary artery disease with worse mental QOL.

Conclusions
Women choosing POP surgery versus pessary had similar physical and mental generic QOL.