bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic value of the neutrophil-to-lymphocyte ratio in critically ill cirrhotic patients
Authors: Giabicani Mikhael , Weiss Emmanuel , Chanques Gerald , Lemaitre Caroline , De Jong Audrey , Grangé Steven , Moreau Richard , Piton Gaël , Paugam-Burtz Catherine , Jaber Samir , Tamion Fabienne 
Published: January 2021

Background
Hospital death rates following ICU admission of cirrhotic patients remain high. Identifying patients at high risk of mortality after few days of aggressive management is imperative for providing adequate interventions. Herein, we aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with usual organ failure scores in the outcome prediction of cirrhotic patients hospitalized more than 3 days in ICU.

Methods
We conducted a retrospective bicentric study in two cohorts of cirrhotic patients hospitalized more than 3 days in French university hospital ICUs. At admission and day 3, we calculated several clinico-biological scores grading liver disease and organ failure severity and calculated the NLR. The primary outcome was 28-day mortality.

Results
The test cohort included 116 patients. At day 28, 43 (37.1%) patients had died. Variations of MELD score (ΔMELD), SOFA score (ΔSOFA), CLIF-SOFA score (ΔCLIF-SOFA) and NLR (ΔNRL) between admission and day 3 were significantly associated with 28-day mortality in univariate analysis. When included in bivariate analysis ΔNLR remained a significant predictor of 28-day mortality independently of these severity scores. Kaplan–Meier curves and statistics using reclassification methods showed a better 28-day mortality risk prediction using ΔNRL in association with ΔSOFA in comparison to ΔSOFA alone. These results were confirmed in an external validation cohort, including 101 critically ill cirrhotic patients.

Conclusions
ΔNLR is an independent predictor of mortality in the critically ill cirrhotic patients’ population who requires intensive care supportive treatment and should be used in association with ΔSOFA as a prognostic biomarker.
Association between Schatzki ring and eosinophilic esophagitis: a systematic review and meta-analysis
Authors: Sarbinowska Joanna , Wiatrak Benita , Waśko-Czopnik Dorota 
Published: January 2021

Background/objective
The involvement of hydrochloric acid in the etiology of eosinophilic esophagitis and numerous reports on its coexistence and interaction with reflux disease, as well as the rings of the esophageal mucosa formed with the advancement of the disease, suggest a potential association of eosinophilic esophagitis with another disorder of esophageal morphology potentially caused by exposure to acid reflux–Schatzki ring. Therefore, it seems reasonable to check the relationship of eosinophilic esophagitis with the coexistence of the Schatzki ring as a potential effect of advanced esophageal trachealization, which is the subject of this systematic review with a meta-analysis.

Methods
The protocol of this meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A systematic search of the indexed literature in the MEDLINE and Scopus databases from early to December 2019 was performed to identify all original research articles on the association between the occurrence of the Schatzki ring and eosinophilic esophagitis in adults.

Results
Out of 68 searched studies, after the analysis and evaluation of the works, only 4 met the criteria set according to the protocol and were included in the meta-analysis. Based on the performed meta-analysis, no relationship was found between the occurrence of Schatzki ring and eosinophilic esophagitis.

Conclusion
The present study did not show a significant relationship between the occurrence of the Schatzki ring and eosinophilic esophagitis in the adult population, which suggests that these are two independent causes of dysphagia in this patient population.
Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis
Authors: Zeng Weibiao , Qi Kai , Ye Miao , Zheng Li , Liu Xinliang , Hu Sheng , Zhang Wenxiong , Tang Wenjing , Xu Jianjun , Yu Dongliang , Wei Yiping 
Published: January 2021

Objective
Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19.

Methods
We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I
2 statistic.

Results
A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0–51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05–1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3–76.4%) and 2.76 (95% CI: 1.59–4.81), respectively; for nausea, 41.4% (95% CI: 23.2–60.7%) and 0.92 (95% CI: 0.59–1.43), respectively; for vomiting, 51.3% (95% CI: 36.8–65.8%) and 1.68 (95% CI: 0.97–2.92), respectively.

Conclusion
The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.
Association between mean arterial pressure and survival in patients after cardiac arrest with vasopressor support: a retrospective study
Authors: Li Zhimin , Zhou Dawei , Zhang Shaolan , Wu Lei , Shi Guangzhi 
Published: January 2021

Background
Mortality among patients admitted to the ICU after cardiac arrest is high. Hemodynamic management in the phase of postresuscitation care is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range in postcardiac arrest patients with vasopressor support is still unclear.

Objective
The purpose of the article is to investigate the association between the time spent in different MAP categories and ICU mortality in postcardiac arrest patients admitted to the ICU surviving ≥24 h with vasopressor support.

Design, settings and participants
This retrospective observational study analysis on the basis of the multicenter ICU database (eICU database, eicu-crd.mit.edu) with high granularity data for 200 859 admissions admitted between 2014 and 2015 to one of 335 units at 208 hospitals located across the USA. Postcardiac arrest patients surviving ≥24 h with vasopressor support during the first 24 h were included.

Exposure
The main exposure was time spent in different MAP categories during the first 24 h after ICU admission.

Outcome measures and analysis
The primary outcome was ICU mortality. Associations between time spent in different MAP categories and ICU mortality were evaluated using 10 MAP thresholds: ≤100, ≤95, ≤90, ≤85, ≤80, ≤75, ≤70, ≤65, ≤60 and ≤55 mmHg. Multivariable logistic regression analyses were used to test the association between time spent in different MAP categories and ICU mortality.

Main results
The study included 1018 eligible subjects in ICUs from 156 hospitals. The ICU mortality rate was 44.5%. After adjusting for confounders, MAP thresholds of ≤60 mmHg (OR, 1.13; 95% CI, 1.02–1.24; P = 0.014) and ≤55 mmHg (OR, 1.25; 95% CI, 1.09–1.45; P = 0.002) were significantly associated with increased ICU mortality. MAP thresholds of 65 mmHg or above were not associated with ICU mortality.

Conclusions
This study suggests that maintaining a mean arterial pressure of equal or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure targets in this patient population.
Outcomes of thulium fibre laser for treatment of urinary tract stones: results of a systematic review
Authors: Kronenberg Peter , Hameed BM Zeeshan , Somani Bhaskar 
Published: January 2021

Purpose of review
Lasers have become a fundamental aspect of stone treatment. Although Holmium:Yttrium-Aluminum-garnet (Ho:YAG) laser is the current gold-standard in endoscopic laser lithotripsy, there is a lot of buzz around the new thulium fibre laser (TFL). We decided to evaluate the latest data to help create an objective and evidence-based opinion about this new technology and associated clinical outcomes.

Recent findings
Sixty full-text articles and peer-reviewed abstract presentations were included in the qualitative synthesis of this systematic review performed over the last 2 years. Current super pulsed TFL machines are capable of achieving peak powers of 500W and emit very small pulse energies of 0.025 Joules going up to 6 Joules, and capable of frequency over 2000 Hz. This makes the TFL ablate twice as fast for fragmentation, 4 times as fast for dusting, more stone dust of finer size and less retropulsion compared to the Ho:YAG laser. Because of the smaller laser fibres with the TFL, future miniaturization of instruments is also possible.

Summary
Based on the review, the TFL is a potential game-changer for kidney stone disease and has a promising role in the future. However larger multicentric prospective clinical studies with long-term follow-up are needed to establish the safety and efficacy of the TFL in endourology.
Health and Financial Burdens Associated With Venous Thrombosis in Hospitalized Children With Inflammatory Bowel Disease
Authors: Chien Kimberley A. , Cooley Victoria , Prishtina Fisnik , Grinspan Zachary M. , Gerber Linda M. , Kucine Nicole 
Published: January 2021

ABSTRACT
Venous thromboembolism (VTE) is a known complication in children with inflammatory bowel disease (IBD). Despite awareness of the increased thrombosis risk in this population, prophylaxis is not standardly used and there is limited published guidance for thrombosis prevention. To better appreciate the impact of thrombosis in this population, we compared children with IBD who did or did not have a VTE, using the Pediatric Health Information System inpatient database from 2009 to 2017. In hospitalized children with IBD, VTE was associated with longer median hospital stays (11 vs 5 days), need for intensive care unit admission (30.2% vs 4.8%), higher median adjusted costs ($32.8k vs $12.3k) and hospital charges ($96.6k vs $36k), and in-hospital death (1.5% vs 0.2%) (P
< 0.001 in all comparisons). These findings highlight the need to determine and implement appropriate strategies to reduce VTE rates in children with IBD, given its association with high morbidity, mortality, and cost.
Uterine Dehiscence and Subsequent Pregnancy Management: A Review of the Literature
Authors: Whittington Julie R. , Slaton Kala B. , Rhomberg Mary E. , Ghahremani Taylor , Thomas Shelia L. , Magann Everett F. 
Published: January 2021

Importance
Uterine dehiscence is a separation of the uterine musculature with intact uterine serosa. Uterine dehiscence can be encountered at the time of cesarean delivery, be suspected on obstetric ultrasound, or be diagnosed in between pregnancies. Management is a conundrum for obstetricians, regardless of timing of onset.

Evidence Acquisition
A literature search was undertaken by our research librarian using the search engines PubMed, CINAHL, and Web of Science. The search term used was “uterine dehiscence.” The search was limited to the English language, and there was no limit on the years searched.

Results
The search identified 152 articles, 32 of which are the basis for this review. Risk factors, treatment, and management in subsequent pregnancies are discussed. The number of prior cesarean deliveries is the greatest risk factor for uterine dehiscence. Unrepaired uterine dehiscence can cause symptoms outside of pregnancies and may require repair for alleviation of these symptoms. Dehiscence should also be repaired prior to subsequent pregnancies.

Conclusion and Relevance
Planned delivery prior to the onset of labor with careful monitoring of maternal symptoms is the preferred management strategy of women with prior uterine dehiscence. Careful attention should be paid to the lower uterine segment thickness when ultrasonography is performed in women with prior cesarean delivery.

Relevance Statement
An evidence-based review of uterine dehiscence in pregnancy and how to manage subsequent pregnancies following uterine dehiscence.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to identify the risks of pregnancy following uterine dehiscence; explain treatment of uterine dehiscence; and describe symptoms of unrepaired uterine dehiscence.
Post-Ablation Cavity Evaluation: A Prospective Multicenter Observational Clinical Study to Evaluate Hysteroscopic Access to the Uterine Cavity 4 Years After Water Vapor Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding
Authors: Johns D. Alan , Garza-Leal Jose G. , Diamond Michael P. , Harris Micah 
Published: January 2021

(Abstracted from J Minim Invasive Gynecol 2020;27:1273–1280)
A minimally invasive treatment for heavy menstrual bleeding (HMB) due to benign causes in women who have completed childbearing is endometrial ablation (EA). Intracavity scarring following EA may result in recurrent heavy bleeding, cyclic pelvic pain with or without bleeding, and postmenopausal bleeding, often manifesting many years after the original treatment.
Immunotherapy in Triple-Negative Breast Cancer
Authors: Emens Leisha A. 
Published: January 2021

Abstract
Triple-negative breast cancer (TNBC) is an aggressive subtype of mammary carcinoma. A subset of TNBC is immune activated, suggesting that immunotherapy may be a viable treatment strategy. Phase III clinical trials have shown that atezolizumab or pembrolizumab is well-tolerated in combination with chemotherapy, with progression-free survival benefit in metastatic programmed death ligand-1 (PD-L1)–positive TNBC patients treated first line. Based on IMpassion130, the combination of atezolizumab and nab-paclitaxel is now considered a standard of care for the treatment of PD-L1–positive advanced TNBC. In early TNBC, pembrolizumab and atezolizumab have been tested in combination with standard neoadjuvant chemotherapy, resulting in a higher complete pathologic response rate than standard neoadjuvant chemotherapy alone, regardless of disease PD-L1 status. These findings establish proof of principle for immunotherapy in both early and advanced TNBC. High priorities for the field include developing more active immunotherapy combination regimens and more refined biomarkers that optimally identify patients most likely to benefit from immunotherapy.
Pneumonia in older adults
Authors: Furman Christian Davis , Leinenbach Angela , Usher Ronnita , Elikkottil Jaseena , Arnold Forest W. 
Published: January 2021

Purpose of review
The purpose of this review is to address the relevant issues surrounding older adults with community-acquired pneumonia (CAP) today.

Recent findings
Approximately 1 million people >65 years have CAP in the US per year, which is more than previously reported (or realized). Older adults are vulnerable to the increasing prevalence of viral CAP, as the SARS-CoV-2 pandemic emphasizes, but pneumococcus is still the most common pathogen to cause CAP. Racial disparities continue to need to be addressed in order to improve early and late outcomes of older adults with CAP.

Summary
The epidemiology of CAP, specifically for older adults is changing. More recent pathogen incidence studies have included culture, as well as newer microbiological methods to determine etiology. Current disparities among disadvantaged populations, including African-Americans, result in more comorbidities which predisposes to more severe CAP. However, outcomes in the hospital between races tend to be similar, and outcomes between age groups tends to be worse for older compared to younger adults. Finally, the cost of CAP is significant compared to diabetes mellitus, myocardial infarction and stroke.
Comparison of Radiomics Analyses Based on Different Magnetic Resonance Imaging Sequences in Grading and Molecular Genomic Typing of Glioma
Authors: Huang Wei-yuan , Wen Ling-hua , Wu Gang , Hu Ming-zheng , Zhang Chao-cai , Chen Feng , Zhao Jian-nong 
Published: January 2021

Objective
To investigate the value of radiomics analyses based on different magnetic resonance (MR) sequences in the noninvasive evaluation of glioma characteristics for the differentiation of low-grade glioma versus high-grade glioma, isocitrate dehydrogenase (IDH)1 mutation versus IDH1 wild-type, and mutation status and 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation (+) versus MGMT promoter methylation (−) glioma.

Methods
Fifty-nine patients with untreated glioma who underwent a standard 3T-MR tumor protocol were included in the study. A total of 396 radiomics features were extracted from the MR images, with the manually delineated tumor as the volume of interest. Clinical imaging diagnostic features (tumor location, necrosis/cyst change, crossing midline, and the degree of enhancement or peritumoral edema) were analyzed by univariate logistic regression to select independent clinical factors. Radiomics and combined clinical-radiomics models were established for grading and molecular genomic typing of glioma by multiple logistic regression and cross-validation. The performance of the models based on different sequences was evaluated by using receiver operating characteristic curves, nomograms, and decision curves.

Results
The radiomics model based on T1-CE performed better than models based on other sequences in predicting the tumor grade and the IDH1 status of the glioma. The radiomics model based on T2 performed better than models based on other sequences in predicting the MGMT methylation status of glioma. Only the T1 combined clinical-radiomics model showed improved prediction performance in predicting tumor grade and the IDH1 status.

Conclusions
The results demonstrate that state-of-the-art radiomics analysis methods based on multiparametric MR image data and radiomics features can significantly contribute to pretreatment glioma grading and molecular subtype classification.
Risk of Pneumothorax With Internal Mammary Vessel Utilization in Autologous Breast Reconstruction
Authors: Kelling Joseph A. , Meade Anna , Adkins Morgan , Zhang Andrew Y. 
Published: January 2021

Background
Complications associated with autologous breast reconstruction are well reported in the literature. Regardless of the type of free flap harvested, the anastomosis is most commonly performed to the recipient internal mammary vessels. Although pneumothorax is a known possible complication of breast surgery, incidence of pneumothorax in breast reconstruction involving the use of the internal mammary vessels is rarely discussed. The aim of our study was to determine the incidence of pneumothorax in deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods
A single-institution review was performed examining the incidence of pneumothorax in cases of DIEP flap breast reconstruction with anastomosis to the internal mammary vessels over a 4-year period. Intraoperative irrigation was used to visually assess for evidence of pneumothorax during recipient vessel dissection and anastomosis. Anteroposterior chest radiographs were obtained on the first postoperative day to assess for pneumothorax. Additional variables analyzed included type of retractor used during recipient vessel dissection and history of radiation.

Results
A total of 180 patients underwent autologous DIEP breast reconstruction at our institution. The overall incidence of pneumothorax was 1.4 per 100 recipient vessel dissections and 2.2 per 100 patients undergoing breast reconstruction. There was a total of 4 cases of pneumothorax. Three were attributed to unknown causes, and 1 was due to direct injury to the parietal pleura via electrocautery.

Conclusion
The use of the internal mammary artery and vein as recipient vessels continues to be the most common and reliable recipient for autologous breast reconstruction. Based on our data, pneumothorax does not seem to be a common complication of this procedure. If concern for iatrogenic injury to the pleura arises intraoperatively, we suggest the use of a saline bubble test to investigate the possible injury. Routine postoperative radiographs are not indicated unless the patient develops symptoms suggestive of pneumothorax.
Gender-Affirming Health Insurance Reform in the United States
Authors: Ngaage Ledibabari Mildred , Xue Shan , Borrelli Mimi R. , Safa Bauback , Berli Jens U. , Bluebond-Langner Rachel , Rasko Yvonne M. 
Published: January 2021

Introduction
In May 2014, the US Department of Health and Human Services prohibited insurance discrimination of transgender individuals. Despite this, insurance plans often lack explicit guidelines on gender transition-related care and coverage of surgical procedures is extremely varied. We evaluated the evolution of insurance coverage of gender-affirming care following the 2014 legislative change.

Methods
Insurance providers were selected based on company market share. We conducted a Web-based search and telephone interviews to identify the corresponding policies related to gender-affirming health care. We compared policy changes made before and after the 2014 US Department of Health and Human Services decision.

Results
Of the 92 insurers surveyed, 7% did not have a policy, and 315 policy revisions were documented. After the legislation, a significantly higher proportion of policy revisions were related to coverage of services (36% vs 11%, P < 0.0001), removal of existing criteria significantly decreased (23% vs 49%, P = 0.0044), and addition of criteria unrelated to international standards sharply increased (32% vs 2%, P = 0.0002). This resulted in reduced coverage of facial feminization, hair transplantation, laryngochondroplasty, and voice modification surgery. However, nipple reconstruction experienced increased coverage. The percentage of revisions to add preauthorization criteria to meet international standards (49% vs 45%, P = 0.6714) or to change terminology (37% vs 27%, P = 0.1055) were similar before and after the legislation.

Conclusions
After the transformative legislation in 2014, an increasing number of insurance companies established gender transition–related policies. As more patients seek gender-affirming care, insurers deviate from international guidelines and create additional benchmarks that may act as barriers to care.