bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Social Determinants of Health on Melanoma Nodal Surveillance in a Multi-institutional Cohort
Authors: Montgomery Kelsey B. , McLeod M. Chandler , DePalo Danielle K. , Dugan Michelle M. , Zager Jonathan S. , Elleson Kelly M. , Sabel Michael S. , Hieken Tina J. , Kottschade Lisa A. , Ollila David W. , Pham Veronica , Archer Dion , Berman Russell S. , Lee Ann Y. , Cintolo-Gonzalez Jessica A. , McDonald Hannah G. , Winchester Sydney , Burke Erin E. , Rhodin Kristen E. , Beasley Georgia M. , Broman Kristy K. 
Published: November 2024

Abstract

Background
Nodal surveillance (NS) has overtaken completion lymphadenectomy as the preferred management for sentinel node-positive (SLN+) melanoma, but requires frequent exams and nodal ultrasound (US). Social determinants of health (SDoH) may affect US adherence in real-world populations, and evaluation of these potential impacts is needed.

Methods
Adults with SLN+ melanoma diagnosed from July 2017 to December 2019 who received NS at nine cancer centers were identified retrospectively. Exposures included insurance status, travel distance, and Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), a validated measure of area-level SDoH, indicated as 0 (low) to 1 (high) vulnerability. The primary outcome was US adherence (≥ 1 study per 6-month follow-up interval). The secondary outcomes were combined-modality adherence [US, computed tomography (CT), or positron emission tomography (PET)] and loss to follow-up (LTFU). Bivariate analyses and mixed-effects multivariable logistic regression were performed.

Results
Most of the 519 patients were male (57%), non-Hispanic white (94.4%), and insured privately (45.3%) or by Medicare (43.5%). The median travel distance was 63.3 miles (interquartile range [IQR], 31.2–111.0 miles), and the median SVI was 0.426 (IQR, 0.253–0.610). The surveillance adherence rates were 41.6% for US and 75.1% for combined modalities. No significant differences in US adherence were observed based on sociodemographic covariates in regression analysis. Medicaid (odds ratio [OR], 3.12; p = 0.02) and uninsured (OR 4.48; p = 0.01) patients had increased likelihood of LTFU.

Conclusions
Less than half of the patients in this multicenter cohort achieved US adherence, although the rates improved with combined modalities. Medicaid or non-insurance were social risk factors for LTFU. Optimizing surveillance practices for socially vulnerable groups will be crucial for the ongoing real-world implementation of NS.
Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report
Authors: Chen Kuan-Hua , Kang Ming-Yuan , Chang Yi-Ting , Huang Sheng-Yang , Wu Yung-Szu 
Published: November 2024

BACKGROUND
Abdominal aortic aneurysm (AAA) repair often involves significant postoperative pain, traditionally managed with systemic opioids, which can cause undesirable side effects. This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.
CASE SUMMARY
A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA, which had grown from 3.4 cm to 4.3 cm over 14 months. A rectus sheath block was initiated surgically for postoperative pain control. The patient reported low pain scores and did not require systemic intravenous opioids, enabling early ambulation and discharge on postoperative day seven without complications. By preventing complications of systemic opioids, the method indicating a promising direction for postoperative pain management in major vascular surgeries.
CONCLUSION
Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
Anlotinib-induced sick sinus syndrome: Two case reports
Authors: Fu Cheng-Feng , Yang Li-Fen , Tian Lei , Deng Song , Zhang Qi , Yao Biao 
Published: November 2024

BACKGROUND
This manuscript describes the first known cases of sick sinus syndrome (SSS) associated with the use of anlotinib in non-small cell lung cancer patients, highlighting the need for increased vigilance and cardiac monitoring.
CASE SUMMARY
Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment, respectively, presenting with syncope and palpitations. Electrocardiogram confirmed SSS, and different treatment approaches were taken for each patient. One patient received a dual-chamber permanent pacemaker, while the other discontinued the medication and experienced symptom resolution.
CONCLUSION
Anlotinib can induce SSS, suggesting that cardiac monitoring is crucial during anlotinib treatment. Individualized management strategies are necessary for affected individuals.
Saccharomyces boulardii as a single trigger of food protein-induced enterocolitis syndrome: Seven case reports
Authors: Hwang Jin-Bok , Jang Hyo-Jeong 
Published: November 2024

BACKGROUND
Food protein-induced enterocolitis syndrome (FPIES) is the most serious type of non-immunoglobulin E (IgE)-mediated food allergic reaction manifesting as sepsis-like symptom, which can lead to shock. Saccharomyces boulardii (S. boulardii ), a probiotic prescribed frequently in clinical settings, has been reported to trigger FPIES in an infant with soy-triggered FPIES. In this report, we describe a new clinical FPIES in which S. boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.
CASE SUMMARY
Seven FPIES cases triggered by only S. boulardii were gathered from 2011 to the present. None of the patients had previously experienced any allergic reaction to cow’s milk, soy, or complementary food. The age of the patients was 4-10-months old, and the symptoms of FPIES developed after ingestion of S. boulardii , which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea. All patients experienced severe repetitive vomiting 1-3 hours after S. boulardii ingestion. Extreme lethargy, marked pallor, and cyanosis were also observed. No IgE-mediated hypersensitivity developed in any patient. Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S. boulardii ingestion, and only one case showed bloody, purulent, and foul-smelling diarrhea. The patients stabilized quickly, mostly within 6 hours. Symptoms got all improved within 24 hours after discontinuation of S. boulardii .
CONCLUSION
S. boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.
ANTIMICROBIAL BIOACTIVE GLASS FOR TREATMENT OF TRAUMATIC OR PATHOLOGICAL BONE DEFECTS
Authors: Samuel Bolaji John , Horbert Victoria , Jin Zhaorui , Brauer Delia S. , Matziolis Georg 
Published: November 2024

AimBiomaterial-associated infections (BAI) present a formidable clinical challenge. Bioactive glasses (BG) have proven highly successful in diverse clinical applications, especially in dentistry and orthopaedics. In this study, we aimed to determine the effect of three commonly used BG composition and particle sizes on cell and bacterial attachment and growth. Our focus is on understanding the changes in pH and osmotic pressure in the surrounding environment during glass degradation.MethodFirst, three different melt-derived glasses were characterized by analyzing particle size and glass network structure using Raman and NMR. The different glasses were then tested in vitro by seeding 4x 104 cells/well (SaOS Cell line) in a 48 well plate. After a pre-incubation period of 72 hours, the different BGs and particle sizes were added to the cells and the pH value, ion release and live/dead staining was measured every hour. The effect of BG against bacteria (S. epidermidis) was analyzed after 24 and 72 hours of treatment by using XTT viability assay and CFU counting by plating out the treated aliquot agar to estimate the viable bacteria cells.ResultsAll three BG compositions tested showed a significant increase in pH, which was highest in BG composition 45S5 with a value of 11 compared to the other BG compositions 10 and 9 in S53P4 and 13-93 respectively. This strong increase in the pH in all BG samples tested results in a strongly reduced cell viability rate of more than 75% compared to the untreated control and 6-fold reduction in bacterial viability compared to the untreated control. The live/ dead assay also showed an increased cell viability with increasing glass particle size (i. e smallest glass particle < 25% viable cell and largest glass particle> 65% viable cell). The ion release concentration over 50 h showed an increase in sodium ions to 0.25 mol/L, calcium to 0.003 mol/L and a decrease in phosphorus.ConclusionsThese results show that the composition of the bioactive glass and the choice of particle size have a major influence on subsequent applications. In addition to the different compositions of the BG, particle size and additional medium change also influence the pH and ion release, and therefore also on cells or bacteria viability. The sizes of the bioactive glass particle are inversely proportional to it. Further tests are necessary to develop custom design BG compositions, which simultaneously stimulate osteoblasts proliferation and prevent microbial adhesion.
THE MANAGEMENT OF UNHEALED FRACTURE-RELATED INFECTIONS WITH A SINGLE-STAGE PROTOCOL AND WITHOUT BONE GRAFT
Authors: Frank Florian , Hotchen Andrew , Valand Poonam , Stubbs David , Ferguson Jamie , McNally Martin 
Published: November 2024

AimThis retrospective study evaluated the outcome of treatment for unhealed fracture-related infections (FRI).MethodsWe identified a consecutive, single-centre cohort of patients having treatment for an FRI Consensus confirmed FRI. All fractures were unhealed at the time of treatment. Patients were followed up for at least one year. Successful outcome was a healed fracture without recurrent infection. Lack of union, persistent infection and/or unplanned reoperation defined failure.ResultsDemographics: 183 patients (184 FRIs) with mean age 52.1 years (range 17-96) were treated and followed up for a mean of 2.8 years (range 1-9.4). Mean duration of FRI was 1.1 years with 65 (35.5 %) presenting within 6 months of injury. 118 patients had established infected non-union. FRI was most frequent in the tibia (74), femur (48) and humerus (24). 171 patients were BACH Complex.75.5% of FRIs were culture positive, with Staph. aureus being the most frequent organism. Polymicrobial infection and Gram negative cultures were common (25.5% and 33.6%).Treatment: 98.3% of surgeries were performed in one stage with just 3 planned 2-stage procedures (2 endoprosthetic replacements and 1 free fibular flap). No bone graft was used in any surgery and all wounds were closed at first operation. 48 cases (26%) required flap coverage (29 free flaps and 19 local flaps). Local antibiotics were used in 124 cases (67.4%) of primary surgeries.All patients had sampling, debridement, systemic antibiotics and wound closure. 40 (21.7%) had DAIR, 31 (16.8%) had new internal fixation and 105 (57.1%) had external fixation (including 79 Ilizarov fixators).Outcomes: After primary surgery, 84.6% of all patients were infection-free and 77.2% had united. After further surgery, 98.8% were infection-free and 98.1% had united. External fixation techniques achieved infection eradication in 89.1% compared to 71.7% with any internal fixation (p=0.005). Primary internal fixation achieved union in 81.7% compared to 74.3% with external fixation (p=0.27). Secondary surgery after external fixation was mainly docking site fixation.ConclusionUnhealed FRIs present a difficult challenge for treatment. This large series demonstrated that single-stage treatment, without bone grafting, gave acceptable results with few reoperations. Primary external fixation gave more certainty of infection eradication but required more reoperations to secure union. However, this difference in reoperation was not statistically significant. We strongly advocate managing these patients with a multidisciplinary team which can treat all aspects of the condition.
A CLINICAL EVALUATION OF THE SAFETY AND TOLERABILITY OF A NOVEL ANTIMICROBIAL PEPTIDE IN PERIPROSTHETIC JOINT INFECTION OF THE KNEE TREATED BY DEBRIDEMENT, ANTIMICROBIALS AND IMPLANT RETENTION (DAIR)
Authors: McNally Martin , Dietz Matthew , Piuzzi Nicolas , Chen Antonia , Parvizi Javad , Stolarski Edward , Pelt Christopher , Rodriguez-Quintana David , Trautner Barbara , Dobbins Despina 
Published: November 2024

AimAntimicrobial peptides occur naturally in our intrinsic immune system. PLG0206 is a novel, engineered, 24-amino acid peptide which has broad-spectrum antimicrobial activity, including in biofilm and against multi-drug resistant pathogens (1,2). This is the first clinical study to evaluate the safety and tolerability of PLG0206 when administered via an irrigation solution in patients with periprosthetic joint infections (PJI) following total knee arthroplasty (TKA) during debridement, antibiotics, and implant retention (DAIR). Secondary objectives were to evaluate pharmacokinetics (PK), biomarkers and initial clinical efficacy at one year post-DAIR procedure.MethodThis prospective, multicenter, open-label, interventional study assessed two dose levels of PLG0206. Fourteen patients underwent revision for PJI after TKA. At the end of debridement, they received a single intra-articular irrigation of PLG0206 into the wound cavity lasting 15 minutes at concentrations of 3 mg/mL (n=7) or 10 mg/mL (n=7). Patients received post-operative care and intravenous/oral antimicrobial therapy as per their institutional guidelines. Patients were monitored for safety and signs of relapse or persistent infection for 12 months post study drug administration and PK and blood biomarkers were assessed.ResultsAll patients completed their final study assessment at Day 365. Over the 1-year follow-up, only one recurrence (7%) was noted at Day 169 in the low-dose cohort. Following dosing, nine patients (64.3%) had limited systemic exposure; maximum plasma concentration occurred 1-hour post-administration and declined rapidly to undetectable levels by 24 hours following treatment in all patients. The incidence of drug related treatment-emergent adverse events (TEAEs) was low. Two patients, both in the higher dose cohort, experienced a transient drug related TEAE; one of hypertransaminasaemia and one of neuralgia. Both events were moderate in severity and resolved within two weeks of onset.ConclusionsA single 15-minute irrigation of PLG0206 into the wound cavity of patients undergoing a DAIR procedure for PJI following TKA, is safe and well tolerated by patients. This new antimicrobial peptide offers a promising therapeutic option in musculoskeletal infection. The initial clinical efficacy is encouraging but now needs to be investigated in a much larger clinical trial.
IS THE PRESENCE OF A POSITIVE BLOOD CULTURE A RISK FACTOR FOR DAIR FAILURE IN HAEMATOGENOUS TOTAL KNEE ARTHROPLASTY INFECTION?
Authors: Pedemonte Gloria , Reynaga Esteban , López Vicente , de los Rios Javier Diez , Molinos Sònia , Larraza Ainhoa Vivero , Hermoso Jose Antonio Hernandez 
Published: November 2024

AimHaematogenous prosthetic joint infections account for 20-35% of total prosthetic infections. Debridement, antibiotics and implant retention (DAIR) is a well-accepted treatment for these infections and probably the most desired by surgeons, since it tries to maintain a functional and stable implant. However, the risk of DAIR failure is not negligible and some risk factors have been described, and also, different scores, such as CRIME80.Nonetheless, less is known about the impact of positive blood cultures may have on DAIR treatment. The aim of our study is to analyze whether the presence of a positive culture is a risk factor for DAIR failure.MethodA retrospective cohort study of 50 late acute haematogenous TKA infections was performed from 2015 to 2023. DAIR failure was defined as the need of a subsequent intervention either a new DAIR or a revision surgery. So, patients were divided into two groups depending on the surgical outcome: successful (SG) vs failure (FG).Demographic variables including age, gender, affected side and body mass index were collected. Patient's comorbidities were also collected including chronic obstructive pulmonary disease (COPD), diabetes, rheumatoid arthritis (RA), cirrhosis and chronic renal failure, etc. Other variables, such as ones included in CRIME80 (C-reactive protein (CRP) >150mg/dl and polyethylene exchange), were also collected.Results30 patients had a successful DAIR outcome (60%). Age and sex do not act as risk factors [OR 0.7 (0.2-2.6) and OR 0.4 (0.1-1.3)]. Neither do COPD [OR 3.3 (0.5-2.0), p=0.2]; RA [OR 0.8 (0.2-3.1), p=0.7]; CRP value [3.2 (0.9-11.2), p=0.06]; and polyethylene exchange [OR 0.4 (0.1-2.5), p= 0.3].Thirty-five blood cultures (70%) were obtained before surgery (20 SG and 15 FG). Nine of the obtained blood cultures were positive (25.7%), being 7 from FG (46.7%) [OR 7.6 (1.3-4.8), p=0.02].A logistic regression was performed where positive blood cultures were the only significant variable to predict DAIR failure (OR 12, 95% CI 1.1−18, p=0.049), after adjusting for all CRIME80 variables.Skin and soft tissue origin was described in 5 of the nine positive blood cultures (55.6%). Cardiovascular system was the second most common spread (22.2%), and then followed by urogenital and digestive tract. The most common microorganism in FG was Staphylococcus aureus (57.1%) [OR 6.4 (0.2-18.0), p=0.2].ConclusionsPositive blood cultures may be another risk factor for DAIR failure. This can be important in diagnosis and it may be taken into account in antibiotic and surgical treatment strategies.
HOW DOES SMOKING AFFECT QUALITY OF LIFE AFTER SURGERY FOR BONE AND JOINT INFECTION?
Authors: Dudareva Maria , Lama Shristi , Scarborough Claire , Miyazaki Keiko , Wijendra Asanka , Tissingh Elizabeth , Kumin Michelle , Scarborough Matthew , McNally Martin 
Published: November 2024

AimPeople awaiting surgery for bone and joint infection may be recommended to stop smoking to improve anaesthetic and surgical outcomes. However, restricting curative surgical treatment to non-smokers on the basis of potentially worse surgical outcomes is not validated for functional outcomes or quality of life differences between patients who do and do not smoke.This study used secondary analysis of trial data to ask: do peri-operative non-smokers have a greater improvement in their quality of life 12 months after surgery for bone and joint infection, compared with non-smokers?MethodParticipants in the SOLARIO and OVIVA clinical trials who had complete baseline and 12 month EQ-5D-5L or EQ-5D-3L scores were included. Smoking status was ascertained at baseline study enrolment from participant self-report. Normalised quality of life scores were calculated for participants at baseline and 12 months, based on contemporaneous health state scores for England. Baseline and 12 month scores were compared to calculate a post-operative increment in quality of life.ResultsMean quality of life increment over 12 months was +0.17 for people who reported smoking peri-operatively (95% confidence interval −0.55 to +0.89), compared to +0.23 for people who did not report smoking peri-operatively (95% confidence interval −0.48 to +0.94). Linear regression analysis found no significant difference between the improvement in quality of life for smokers and non-smokers (p>0.1). Mean increments for both groups were greater than estimates of Minimal Clinically Important Difference in quality of life in musculoskeletal conditions. [1,2]ConclusionsPeople who smoke peri-operatively still experience an improvement in quality of life after surgery for orthopaedic infections, commensurate with the improvement experienced by non-smokers. Surgery should not be denied to people on the basis of reported smoking status alone.
WHAT IS THE BEST SURGICAL OPTION FOR PERIPROSTHETIC JOINT INFECTION (PJI) DUE TO CANDIDA SPECIES?
Authors: McNally Martin , Lora-Tamayo Jaime , Oustau Cecile Ronde , Salles Mauro , Morata Laura , Mancheño-Losa Mikel , Giordano Gerard , Frank Bernhard J.H. , Hofstaetter Jochen , Dinh Aurélien 
Published: November 2024

AimCandida species are uncommon pathogens causing prosthetic joint infection (PJI). This study evaluated the surgical management and outcome of Candida PJI.MethodsPatients with EBJIS Definition confirmed PJI, due to Candida species, from 19 medical centres were assessed. Demographic, diagnostic, medical and surgical treatment and outcome data were collected.Results269 patients were recruited with follow-up for at least one year. Mean age was 70.2 years (+/- 12.4) with 10.8% being immunocompromised. The most common fungal species were C. albicans (55.8%), C. parapsilosis (29.4%), C. glabrata (7.8%) and C. tropicalis (5.6%). Co-infection with bacteria occurred in 138 (51.3%) cases.DAIR was performed in 96 (36.2%) cases, with 169 (63.8%) having implant exchange or removal (76 one-stage, 78 two-stage, 11 removal/Girdlestone arthroplasty, 2 amputation). Patient demographics and antifungal therapy were similar in all surgical groups.Overall, treatment was successful in 156 (58%) cases. Failure was more likely in older patients (>70 years; p=0.008) and those who had DAIR (OR 1.945; 1.156-3.279; p=0.004). Failure was less likely with C. parapsilosis infection compared to C. albicans (31.6% vs 48%; p=0.037).DAIR patients had more co-infection with bacteria (63.5% vs 47.4%; p=0.013) and more previous surgeries (median 4 vs 3; p=0.007), but multivariate analysis showed that these were not independent risk factors for failure. There was no difference in mortality between DAIR patients and those with other surgery (13.5% vs 17.7%; p=0.372).DAIR was successful in 45/96 (46.9%) cases compared to 110/169 (65.1%) cases with other surgery (p<0.004). Early DAIR (surgery performed <I month from implantation/infection onset) was not more effective than late DAIR (surgery performed after 1 month)(early DAIR 44.4% cure vs 63.9% cure in late DAIR; p=0.004).Two-stage revision was successful in 54/78 (69.2%), which was significantly better than DAIR (p=0.003). One-stage revision was successful in 51/76 (67.1%) patients; also significantly better than DAIR (p=0.002), but equivalent to two-stage revision (p=0.777).ConclusionDAIR was successful in less than half of patients with Candida PJI. We could not identify any subgroup which might have better outcomes with this surgical option. Interestingly, almost 90% of our patients with Candida PJI had no immunocompromise. One or two-stage revision offer a better option, if possible, and do not increase mortality.