bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reverse total shoulder arthroplasty for fractures and posttraumatic sequelae is associated with inferior forward elevation strength: a retrospective cohort study
Authors: Ochsner Mims G. , Brolin Tyler J. , Smith Richard , Azar Frederick M. , Throckmorton Thomas W. 
Published: November 2021

Background:
Studies have reported excellent results with improvement in active range of motion and pain relief after reverse total shoulder arthroplasty (RTSA), but few have specifically compared the strength and range-of-motion outcomes in RTSA done for different pathologies. The purpose of this study was to determine if strength is decreased after reverse total shoulder arthroplasty (RTSA) done for degenerative conditions compared with patients with posttraumatic or acute trauma indications.

Methods:
Records review identified 165 patients with 2 yr of clinical follow-up after RTSA for degenerative conditions (130), posttraumatic sequelae (19), or acute proximal humeral fractures (PHF) (16). Strength in forward elevation and internal and external rotation strength were measured at final follow-up. Secondary outcomes included active range of motion, visual analog scale (VAS) pain scores, American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numerical Evaluation (SANE) score, and complication rate.

Results:
Forward elevation strength was 4.8 in the degenerative group, 4.25 in posttraumatic patients, and 4.33 in the acute PHF group (P=0.036). Internal rotation strength was 4.95, 4.63, and 4.73 in the degenerative, posttraumatic, and acute PHF groups, respectively (P=0.053). External rotation strength was 4.8, 4.50, and 4.67 in the degenerative, posttraumatic, and acute traumatic groups, respectively. There were no significant differences in range of motion, ASES scores, VAS scores, or complication rates.

Conclusions:
RTSA for acute PHF and posttraumatic conditions results in significantly less forward elevation strength than RTSA done for degenerative conditions.

Level of Evidence:
Level III.
Combination of Full-Field and Fractional Erbium: YAG Laser for Nonhealing Wounds
Authors: Caliskan Ercan , Botsali Aysenur 
Published: November 2021

BACKGROUND
To evaluate the outcomes of a heterogeneous group of patients with chronic ulcer receiving a combination regimen of full-field and fractional erbium-doped yttrium aluminum garnet (erbium: YAG) laser applications.

METHODS
Enrolled in this study were patients with chronic ulcer who had received at least 2 erbium: YAG laser sessions. Fractional applications followed the initial full-field application for debridement. The therapeutic outcomes were evaluated by serial photographs. The primary outcome measure was the proportion of patients achieving complete re-epithelialization at the first year.

RESULTS
Forty-three treatment regions from 23 patients between 40 and 90 years (F: M = 11:12; age: 60.3 ± 15.5 years, mean ± SD) were eligible. The ulcers' median duration was 24 months (min–max: 2–240 months). The median number of laser sessions was 5 (min–max: 2–12). Of arterial (n = 13), immunologic (n = 9), venous (n = 8), diabetic (n = 8), and mechanical ulcers (n = 5), the primary outcome measure was achieved in 69%, 77.7%, 75%, 88.8%, and 100% of the groups, respectively.

CONCLUSION
Full-field erbium: YAG laser applications preserve the vascular architecture and enable delicate debridement. Ongoing maintenance fractional laser sessions promote wound healing. Similar to the previous reports of erbium: YAG laser in venous and diabetic ulcers, arterial ulcers, and ulcers of immunologic origin demonstrated an objective treatment response along with different adjuvant approaches.
The analgesic efficacy of intravenous dexamethasone for post-caesarean pain
Authors: Singh Narinder Pal , Makkar Jeetinder Kaur , Yadav Neha , Goudra Basavana Gouda , Singh Preet Mohinder 
Published: November 2021

BACKGROUND
Analgesic efficacy of intravenous dexamethasone has not been well defined after caesarean delivery. We performed a systematic review and meta-analysis to evaluate the impact of peri-operative dexamethasone administration on postoperative pain after caesarean delivery.

OBJECTIVES
We investigated the impact of perioperative intravenous dexamethasone on postoperative pain after caesarean delivery. The two primary outcomes of interest were early (4 to 6 h) resting pain scores and time to first rescue analgesia.

DESIGN
A systematic review and meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES
PubMed, EMBASE, Scopus and the Cochrane central registers of controlled trials were searched to identify RCTs from inception to April 2021.

ELIGIBILITY CRITERIA
Prospective RCTs comparing the role of intravenous dexamethasone with non-active control were eligible for inclusion. Exclusion criteria included trials comparing various doses of dexamethasone without any control treatment arm, dexamethasone with other active drugs and trials comparing different routes of dexamethasone, for example, wound infiltration.

RESULTS
Thirteen RCTs constituting of 988 parturients undergoing caesarean delivery were included. Patients receiving dexamethasone had lower pain scores at rest at 4 to 6 h after surgery, mean difference –1.29 [95% confidence interval (CI), −1.85 to −0.73], P < 0.0001, with low quality of evidence (I
2 = 94%). Moderate quality of evidence (I
2 = 17%) suggested that the time to first rescue analgesia in the dexamethasone group was significantly longer, mean difference 2.64 h (95% CI, 1.85 to 3.42), P
< 0.0001. Trial sequential analysis for pain scores suggested the benefit of dexamethasone; however, the requisite information size (RIS) could not be reached, whereas RIS was adequate for time to rescue analgesia. Significant reduction in pain scores at all times and opioid consumption at 24 h with dexamethasone were observed with sparse reporting on adverse effects.

CONCLUSION
Peri-operative intravenous dexamethasone was associated with a significant decrease in postoperative pain scores at rest and a longer time to first rescue analgesia, along with a small but statistically significantly reduced opioid consumption after caesarean delivery compared with nonactive control.
Therapeutic Drug Monitoring of Antibiotic Drugs in Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis: A Critical Review
Authors: Matusik Elodie , Boidin Clément , Friggeri Arnaud , Richard Jean-Christophe , Bitker Laurent , Roberts Jason A. , Goutelle Sylvain 
Published: November 2021

Purpose:
Antibiotics are frequently used in patients receiving intermittent or continuous renal replacement therapy (RRT). Continuous renal replacement may alter the pharmacokinetics (PK) and the ability to achieve PK/pharmacodynamic (PD) targets. Therapeutic drug monitoring (TDM) could help evaluate drug exposure and guide antibiotic dosage adjustment. The present review describes recent TDM data on antibiotic exposure and PK/PD target attainment (TA) in patients receiving intermittent or continuous RRT, proposing practical guidelines for performing TDM.

Methods:
Studies on antibiotic TDM performed in patients receiving intermittent or continuous RRT published between 2000 and 2020 were searched and assessed. The authors focused on studies that reported data on PK/PD TA. TDM recommendations were based on clinically relevant PK/PD relationships and previously published guidelines.

Results:
In total, 2383 reports were retrieved. After excluding nonrelevant publications, 139 articles were selected. Overall, 107 studies reported PK/PD TA for 24 agents. Data were available for various intermittent and continuous RRT techniques. The study design, TDM practice, and definition of PK/PD targets were inconsistent across studies. Drug exposure and TA rates were highly variable. TDM seems to be necessary to control drug exposure in patients receiving intermittent and continuous RRT techniques, especially for antibiotics with narrow therapeutic margins and in critically ill patients. Practical recommendations can provide insights on relevant PK/PD targets, sampling, and timing of TDM for various antibiotic classes.

Conclusions:
Highly variable antibiotic exposure and TA have been reported in patients receiving intermittent or continuous RRT. TDM for aminoglycosides, beta-lactams, glycopeptides, linezolid, and colistin is recommended in patients receiving RRT and suggested for daptomycin, fluoroquinolones, and tigecycline in critically ill patients on RRT.
Therapeutic Drug Monitoring of Antibiotics in Critically Ill Patients: Current Practice and Future Perspectives With a Focus on Clinical Outcome
Authors: Koch Birgit C. P. , Muller Anouk E. , Hunfeld Nicole G. M. , de Winter Brenda C.M. , Ewoldt Tim M. J. , Abdulla Alan , Endeman Henrik 
Published: November 2021

Purpose:
Early initiation of antibiotics is essential for ameliorating infections in critically ill patients. The correct dosage of antibiotics is imperative to ensure their adequate exposure. Critically ill patients have altered pharmacokinetic parameters and are often infected by less susceptible microorganisms. Differences in drug disposition are not considered with standard doses of antibiotics. This can lead to suboptimal antibiotic exposure in critically ill patients. To overcome this problem of suboptimal dosing, therapeutic drug monitoring (TDM) is a strategy commonly used to support individualized dosing of antibiotics. It is routinely used for vancomycin and aminoglycosides in clinical practice. In recent years, it has become apparent that TDM may also be used in other antibiotics.

Methods:
This review summarizes the evidence for TDM of antibiotics in critically ill patients, focuses on clinical outcomes, and summarizes possibilities for optimized TDM in the future.

Results and Conclusion:
After reviewing the literature, we can conclude that general TDM implementation is advised for glycopeptides and aminoglycosides, as evidence of the relationship between TDM and clinical outcome is present. For antibiotics, such as beta-lactams, fluoroquinolones, and linezolid, it seems rational to perform TDM in specific patient cases. TDM involving other antibiotics is supported by individual cases, specifically to decrease toxicity. When focusing on future possibilities to improve TDM of antibiotics in critically ill patients, implementation of model-informed precision dosing should be investigated because it can potentially streamline the TDM process. The logistics of TDM, such as turnaround time and available equipment, are challenging but may be overcome by rapid bioanalytical techniques or real-time monitoring of drug concentrations through biosensors in the future. Education, clinical information on targets, and clinical outcome studies are other important factors that facilitate TDM implementation.
Minimally invasive glaucoma surgery in childhood glaucoma
Authors: Go Michelle S. , Freedman Sharon F. 
Published: November 2021

Purpose of review
Minimally invasive glaucoma surgery (MIGS) has been shown to be safe and effective in treatment of mild to moderate glaucoma in adults, but reports in childhood glaucoma are limited. We review the available data concerning MIGS and discuss its potential role in childhood glaucoma management.

Recent findings
Ab interno counterparts to circumferential ab externo trabeculotomy such as gonioscopy-assisted transluminal trabeculotomy (GATT) and Trab360 show promise in treatment of primary glaucomas as reported in a few retrospective case series. Kahook Dual Blade (KDB) and Trabectome have demonstrated mixed results in few published case reports in children. Small case series and reports suggest that the Xen gel stent can be a safer alternative to traditional filtration surgery, though data on long-term implant and bleb stability are unavailable. Newer devices are being investigated and early results are encouraging.

Summary
GATT and Trab360 seem to be safe, effective methods of achieving circumferential trabeculotomy in childhood glaucoma. KDB, Trabectome, and Xen gel stent have shown some success in selected cases with short-term follow-up. Surgeons must determine the risks and benefits of MIGS over more established methods of intraocular pressure reduction for each individual child. Further research is needed to validate initial findings regarding MIGS in childhood glaucoma.
Detection of Plasmid-Mediated Tigecycline Resistance Gene tet(X4) in a Salmonella enterica Serovar Llandoff Isolate
Authors: Wang Yanan , Liu Fei , Xu Xuebin , Huang Hua , Lyu Na , Ma Sufang , Chen Luping , Mao Mengyu , Hu Yongfei , Song Xiaofeng , Li Jing , Pan Yuanlong , Wang Aiping , Zhang Gaiping , Zhu Baoli , Gao George F. 
Published: November 2021

Abstract
The emergence and spread of plasmid-mediated tigecycline resistance genes have attracted extensive attention worldwide. We investigated the distribution of mobile tigecycline resistance genes in Salmonella genomes generated by both our laboratory and public bacterial genomes downloaded from the NCBI GenBank. The tet(X4)-positive strains were subjected to susceptibility testing and conjugation assays. The genetic features of the tet(X4)-bearing plasmid sequence were analyzed. Here, we report the identification of the plasmid-mediated tigecycline resistance gene tet(X4) in a conjugative plasmid of the Salmonella enterica serovar Llandoff strain SH16G3606, isolated from a man in China in 2016, the first reported serovar Llandoff in China as a novel sequence type ST8300. The tet(X4)-mediated resistance phenotype was successfully transferred from the Salmonella Llandoff strain into Escherichia coli J53, resulting in a 32-fold increase in the minimal inhibitory concentration of tigecycline. The tet(X4) gene was located between two copies of ISCR2 in the plasmid pSal21GXH-tetX4. To our knowledge, this is the first report of the plasmid-mediated tigecycline resistance gene tet(X4) in a Salmonella Llandoff strain isolated from a human stool sample in China. In addition, our findings demonstrated that a total of 171 isolates are carrying tet(X)-like genes distributed in 21 countries or areas across 6 continents, posing a serious threat to humans and public health. Overall, our timely discovery of the recent emergence of the tet(X4) gene in Salmonella isolates and other Enterobacteriaceae bacteria species supports the need for rapid surveillance to prevent the tet(X)-like gene from spreading.
Incidence, Reinfection, and Discrepancy Between Sexual Practice and Anatomic Site Positivity of Sexually Transmitted Infections in Youth With HIV
Authors: Loerinc Leah , Scheel Amy , Jordan-Thompson Sierra , Gillespie Scott , Camacho-Gonzalez Andres 
Published: November 2021

Background:
This study aimed to determine the overall incidence and reinfection rates of sexually transmitted infections (STIs) and the discrepancy between self-reported exposure history and anatomic site positivity of STIs among adolescents and young adults (AYAs) with HIV in Atlanta, GA.

Methods:
Retrospective chart review was conducted on all patients 13–24 years of age at the Grady Ponce and Family Youth Clinic from January 1, 2009 to December 31, 2018. Data were collected on patient demographics, self-reported sexual history and STI events. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time.

Results:
A total of 626 sexually active AYAs with HIV were included in analysis. The mean age at first observation was 18.9 (SD: ±2.8) years; 72% were male, 92% were Black and 80% were horizontally infected. The cumulative first STI incidence rate was 45.49 cases per 100 person-years, and the recurrent STI incidence rate was 119.86 cases per 100 person-years. Among all Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) cases, the most common site of infection was the rectum (48.6% and 49.6%, respectively). Disagreement between exposure history and presence of GC or CT infection was statistically significant for nearly all anatomic sites and types of intercourse.

Conclusions:
AYAs with HIV in Atlanta have disproportionately high first and recurrent incidence rates of STIs, with many patients not reporting exposure at their site of infection. There is considerable need to increase screening for STIs, including routine extragenital testing for GC and CT, among AYAs with HIV regardless of self-reported exposure history.
Clinical Testing of Head Impulse Paradigm and Suppression Head Impulse Paradigm Using a Diagnostic Headband: Combined Clinical Sign for Improved Performance
Authors: D’Albora Ricardo , Noboa Rodrigo , Road José Cuervo , Gutman Marcos Cvizonas , Fuentes Susana Fernández , Palazón Carlos Vicente Alcayaga , Silveira Ligia , Moreno Carlos Agustín Fau , Monaco Maria Julia , Zalazar Guillermo Javier , Carmona Sergio 
Published: November 2021

Objective:
We developed a clinical sign that improves the sensitivity, specificity, and predictive values of the Head Impulse Paradigm (HIMP) Test by adding the Suppression Head Impulse Paradigm (SHIMP) Test using a diagnostic headband.

Methods:
Prospective and descriptive study analyzing the function of 1,255 horizontal semicircular canals of subjects with differing vestibulo-ocular reflex (VOR) gains who showed-up with symptoms related to neurotology (Montevideo, Uruguay, March 2017 to March 2019). The clinical HIMP and SHIMP tests were assessed and the amplitudes of overt saccades were compared to each other. Clinical findings were contrasted against vHIT gains.

Conclusion:
The HIMP and SHIMP combined test using the H/S headband has high specificity and low sensibility. This test association can identify healthy individuals among individuals typically misdiagnosed as ill by the conventional HIT or HIMP maneuver of the HIMP test, as originally described by Halmagyi and Curthoys. Therefore, we recommend using the headband assisted HIMP/SHIMP test, instead of exclusively relying on positive HIMP results.
Use of IOOG Classification to Categorize Middle Ear Surgery in Children: Evaluation After 5 Months of Use in 119 Consecutive Pediatric Middle Ear Surgeries
Authors: Alvin Fiona , Simon François , Denoyelle Françoise 
Published: November 2021

Introduction:
SAMEO-ATO classification is an international consensual tool published in 2018. In order to evaluate the ease of use and reliability of this classification in pediatric otologic surgery, a retrospective study was conducted in our tertiary referral center.

Method:
We began to use IOOG classification in September 2018, after a 15-day testing period. In this monocentric retrospective study, we reviewed the classification and the operative charts of all the pediatric middle ear surgeries after the first 5 months of use. Each classification was carefully re-checked by a junior and senior surgeon. In parallel, all the surgeons involved received a questionnaire to evaluate the ease of use, with a score from 1 (very difficult) to 5 (very easy).

Results:
From September 2018 to February 2019, the tool was used for 119 pediatric surgeries, involving 13 surgeons. The indications for surgery were tympanic membrane perforations (28/119, 23.5%), retraction pockets (36/119, 30.3%), cholesteatoma first procedures (13/119, 10.9%), cholesteatoma revision procedures (41/119, 34.5%) and temporal bone fracture (1/119, 0.8%). All surgical procedures performed could be classified with the ATO-SAMEO classification. We found misclassification in 29/119 cases (24%), 79% of which concerning ATO items. Of the 8 SAMEO-ATO categories in 119 surgeries, the error rate was 4.5% (49/952). Surgeons reported a mean score of use of 4 (quite easy).

Conclusion:
The easy-to-use SAMEO-ATO classification is well suited for pediatric otology and to the categorization of surgical procedures. However, in a multi-user context, misclassifications were observed in up to a quarter of cases during the first months of use. Carefully anticipated explanations and guidelines given to surgeons should ensure an optimal quality of rating.
Molecular intricacies of upper tract urothelial carcinoma and their relevance for therapy considerations
Authors: Berndl Florian , Hassler Melanie R. 
Published: November 2021

Purpose of review
The aim of this study was to give an overview of molecular alterations in upper tract urothelial carcinomas (UTUCs) and to discuss them in the context of current and prospective systemic therapies.

Recent findings
UTUCs not only share a similar molecular landscape with urothelial carcinoma of the bladder (UCB), but also have distinct molecular features that can have an impact on therapy selection. FGFR3 alterations occur with a significant higher frequency in UTUC, with up to 40% of tumours harbouring FGFR3 driver mutations compared with 20% in UCB. In addition, a substantial number of high-grade UTUC show an immune-depleted phenotype and a luminal papillary expression subtype, thus predisposing them for FGFR inhibitor treatment. Approximately 20% of UTUC tumours have acquired mutations in TP53 and demonstrate a significant degree of genomic instability, which makes them candidates for systemic chemotherapy or immunotherapy. Whereas microsatellite instability (MSI) is rare in sporadic UTUC, 5–10% of UTUC patients have germline mutations in DNA mismatch repair genes, which leads to high MSI with enriched neoantigen load and presumably better response rates to immunotherapy.

Summary
Treatment decisions in UTUC should take molecular tumour characteristics into account. The currently most therapy-relevant molecular alterations in UTUC comprise FGFR3 mutational status and mutations in DNA mismatch repair genes with concomitant microsatellite instability.
Characteristics of Pediatric Frequent Users of Emergency Departments in Alberta and Ontario
Authors: Rosychuk Rhonda J. , Chen Anqi , McRae Andrew , McLane Patrick , Ospina Maria B. , Stang Antonia S. 
Published: November 2021

Objectives
Emergency department (ED) volumes have drawn attention to frequent users but less attention has been paid to children. This study examined sociodemographic and ED presentation characteristics of pediatric high-system ED users (HSUs) in 2 provinces in Canada.

Methods
Cohorts of HSUs were created from the National Ambulatory Care Reporting System in 2015/2016 for children with the top 10% of ED presentations. Controls were random samples of non-HSU patients. Factors were explored in multivariable logistic regression models.

Results
There were 151,497 HSUs (51.7% girls, average age, 6.4 years) and 591,545 controls (53.1% girls; average age, 7.4 years). High-system ED users were more likely to be younger (adjusted odds ratio [aOR], 0.89 per 5 years; 95% confidence interval [CI], 0.88–0.89), live in less populated areas (aOR, 1.85; 95% CI, 1.82–1.88), and from lowest income neighborhoods (aOR, 1.51; 95% CI, 1.48–1.54) than controls. High-system ED users had higher proportions of presentations for pediatric complex chronic (aOR, 1.25 per 0.25 increase; 95% CI, 1.21–1.29), respiratory (aOR, 1.14 per 0.25; 95% CI, 1.12–1.15), and mental health (aOR, 1.14 per 0.25; 95% CI, 1.13–1.16) conditions than controls.

Conclusions
Complex factors underlie pediatric health care utilization decisions. Findings identified conditions to target in interventions to improve health care access and utilization. Future work should engage children and families to design interventions.