bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathogenic Detection by Metagenomic next-generation Sequencing in Spinal Infections
Authors: Yin Chuqiang , Cong Yanan , Wang Huafeng , Wang Dechun , Yang Xizhong , Wang Xuesong , Wang Ting 
Published: September 2024

Study Design.
Retrospective, observational study.

Objective.
To evaluate the ability and value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from spinal infections.

Background.
The pathogenic diagnosis of primary spinal infection is challenging. The widespread application of mNGs in clinical practice makes it particularly useful in detecting rare, emerging, and atypical complex infectious diseases.

Methods.
From January 2019 to December 2023, a retrospective collection of 120 samples was obtained from patients suspected of spinal infections and undergoing treatment. Pairwise comparisons between traditional laboratory tests and mNGS were conducted for all cases.

Results.
Among the 120 cases, 95 were diagnosed as spinal infections, while 25 were classified as non-infectious. Microbiological evidence was found in 59 cases, while 36 cases were clinically diagnosed as spinal infection without definitive microbiological evidence. Rare microorganisms such as Aspergillus fumigatus, Taifanglania major, and Coxiella burnetii were detected by mNGS. The positive rate of mNGS was significantly higher at 88.42% compared to microbiological culture (43.16%), P<0.001. At the genus level, mNGS exhibited a consistency rate of 86.44% (51/59) with confirmed microorganisms. MNGS demonstrated very good agreement with clinically confirmed microorganisms at the genus level (kappa=0.833). The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 86.44%, 92.00%, 96.23%, and 74.19%, respectively.

Conclusions.
The mNGS test exhibits rapidity, efficiency, and accuracy, rendering it of immense diagnostic and therapeutic value in the realm of spinal infection diseases.
How Do Functional Comorbidities Affect PROMIS-PF Scores Following Lumbar Fusion Surgery?
Authors: Mizels Joshua , Connelly Jake , Martin Brook , Karamian Brian , Spiker W. Ryan , Lawrence Brandon D. , Brodke Darrel S. , Spina Nicholas T. 
Published: September 2024

Study Design.
A retrospective review.

Objective.
The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery and to investigate how the presence of functional comorbidities affects PROMIS PF scores. In addition, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and PROMIS Pain Interference (PI) scores.

Summary of Background Data.
National Institute of Health’s (NIH) Patient-reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) domain has been validated in spine surgery. However, little is known about how PROMIS-PF scores are affected by functional comorbidities and how these scores change in patients recovering from lumbar fusion surgery over time. In this study, we hypothesize that functional comorbidities negatively affect recovery.

Materials and Methods.
We retrospectively identified 1893 patients who underwent thoracolumbar, lumbar, or lumbosacral fusion for degenerative conditions between January 2, 2014, and January 7, 2022. We summarized PF at three-month intervals for 2 years following surgery between those with and without functional comorbidity, defined as the presence of congestive heart failure (HF), chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), or paraplegia. Mixed effects multivariable regressions were used to model between group trends in PF through 2 years postoperatively controlling for age, gender, indication, and surgical invasiveness. The minimally clinically important difference (MCID) was defined as 5+ point improvement from baseline in PF.

Results.
The cohort includes 1224 (65%) patients without functional comorbidity and 669 (35%) with functional comorbidity. The mean age was 65.0, and the Charlson index was 1.0 in the cohort without functional comorbidity compared with 65.4 and 3.8 in the cohort with functional comorbidity (P=0.552 and <0.001, respectively). The groups were otherwise similar with respect to surgical invasiveness index, vertebral levels, and spine diagnosis (all P>0.05). At 24 months postoperatively, the functional comorbidity group had a 2.5-point lower absolute PF score and a 1.3-point less improvement from baseline (P=0.012 and 0.190, respectively). 19.3% of patients in the functional comorbidity group achieved the MCID compared with 80.9% in patients without functional comorbidity (P<0.001).

Conclusions.
Based on PROMIS PF scores, patients with functional comorbidities do not recover to the same extent and are less likely to achieve an MCID compared with patients without baseline functional comorbidities. PROMIS-PF can help benchmark patients along their recovery, and other metrics may be needed to better understand the recovery of patients with functional comorbidities.
Tranexamic Acid in Mohs Micrographic Surgery: A Systematic Review
Authors: Kumar Eenika A. , Morris Lisa M. , Michalski-McNeely Basia M. 
Published: September 2024

BACKGROUND
Tranexamic acid (TXA) is an antifibrinolytic that has historically been used to treat menorrhagia and bleeding disorders. Exploration of its use in procedures has grown, and it has shown promise in its ability to achieve hemostasis with low risk to patients. Analysis of its use in Mohs micrographic surgery (MMS) is warranted due to its potential superiority to traditional methods of achieving hemostasis (direct pressure, electrocoagulation, and sutures).

OBJECTIVE
To perform a systematic review of studies which evaluate the efficacy and safety profile of topical application or subcutaneous injection of TXA and analyze as it applies to MMS.

MATERIALS AND METHODS
A comprehensive literature search was conducted using the PubMed database to identify relevant studies using the search terms: “tranexamic acid” OR “TXA.” The search was performed up to December 1, 2023.

RESULTS
Tranexamic acid has a strong safety profile, and its effectiveness in achieving hemostasis is well-demonstrated. Tranexamic acid has reduced risk of bleeding complications compared with traditional methods of achieving hemostasis.

CONCLUSION
An extensive review of the literature has yielded positive results, suggesting the potential of TXA in improving patient outcomes, reducing surgical time, decreasing intraoperative and postoperative bleeding, and increasing overall patient satisfaction.
ChatGPT-4 Surpasses Residents: A Study of Artificial Intelligence Competency in Plastic Surgery In-service Examinations and Its Advancements from ChatGPT-3.5
Authors: Hubany Shannon S. , Scala Fernanda D. , Hashemi Kiana , Kapoor Saumya , Fedorova Julia R. , Vaccaro Matthew J. , Ridout Rees P. , Hedman Casey C. , Kellogg Brian C. , Leto Barone Angelo A. 
Published: September 2024

Background:
ChatGPT, launched in 2022 and updated to Generative Pre-trained Transformer 4 (GPT-4) in 2023, is a large language model trained on extensive data, including medical information. This study compares ChatGPT’s performance on Plastic Surgery In-Service Examinations with medical residents nationally as well as its earlier version, ChatGPT-3.5.

Methods:
This study reviewed 1500 questions from the Plastic Surgery In-service Examinations from 2018 to 2023. After excluding image-based, unscored, and inconclusive questions, 1292 were analyzed. The question stem and each multiple-choice answer was inputted verbatim into ChatGPT-4.

Results:
ChatGPT-4 correctly answered 961 (74.4%) of the included questions. Best performance by section was in core surgical principles (79.1% correct) and lowest in craniomaxillofacial (69.1%). ChatGPT-4 ranked between the 61st and 97th percentiles compared with all residents. Comparatively, ChatGPT-4 significantly outperformed ChatGPT-3.5 in 2018–2022 examinations (P < 0.001). Although ChatGPT-3.5 averaged 55.5% correctness, ChatGPT-4 averaged 74%, a mean difference of 18.54%. In 2021, ChatGPT-3.5 ranked in the 23rd percentile of all residents, whereas ChatGPT-4 ranked in the 97th percentile. ChatGPT-4 outperformed 80.7% of residents on average and scored above the 97th percentile among first-year residents. Its performance was comparable with sixth-year integrated residents, ranking in the 55.7th percentile, on average. These results show significant improvements in ChatGPT-4’s application of medical knowledge within six months of ChatGPT-3.5’s release.

Conclusion:
This study reveals ChatGPT-4’s rapid developments, advancing from a first-year medical resident’s level to surpassing independent residents and matching a sixth-year resident’s proficiency.
Spherical Aberration Changes in Patients With Early Presbyopia Wearing Aspheric Multifocal Soft Contact Lenses in South Korea
Authors: Jang Hyo-Seung , Lee Koon-Ja 
Published: September 2024

Objectives:
The aim of this study was to evaluate the impact of wearing center-near (CN) and center-distance (CD) multifocal contact lenses (MFCLs) on spherical aberrations and visual acuity in patients with early presbyopia.

Methods:
Fifty participants with early presbyopia wore CN-MFCLs and CD-MFCLs for 1 week. The average corrected refractive power was −2.65±1.67 D. Spherical aberration was measured using an auto-refractor after 1 week of lens use.

Results:
No significant difference in overall visual acuity was observed when using either lens. Participants favored CD-MFCLs for distance vision and CN-MFCLs for near vision. This study highlighted variations in aberration and satisfaction based on age, refractive errors, and individual responses. Patients with positive spherical aberrations tended to benefit from CN-MFCLs, which improved both distance and near vision, although additional correction was required for clear distance vision. Patients with early presbyopia generally preferred CN-MFCLs when positive aberration was prevalent, whereas those with negative aberration reported greater satisfaction with distance vision when wearing CD-MFCLs.

Conclusions:
This study confirmed that wearing MFCLs leads to changes in spherical aberration and visual acuity in patients with early presbyopia, particularly when positive aberration prevails. Future research should investigate these effects across different stages of presbyopia.
Outcomes of Photorefractive Keratectomy After Corneal Graft: Brief Review
Authors: Khan Muhammad Saim , Gonzales Alexander L. , Kofi Mostafa , Alio Jorge L. 
Published: September 2024

Purpose:
The purpose of this brief review is to analyze the outcomes of customized photorefractive keratectomy in the correction of refractive errors and irregular astigmatism after corneal graft surgery.

Methods:
Two reviewers (M.S.K. and J.L.A.) independently performed a literature search in the MEDLINE/PubMed database, Google Scholar, and ResearchGate from January 2001 to October 2023. To analyze the efficacy, safety, and predictability of the procedure, primary outcomes such as mean change in uncorrected distance visual acuity, corrected distance visual acuity, and root mean square value (RMS) of higher order aberrations were studied. The complications and adverse reactions were analyzed to predict the safety of this procedure.

Results:
We identified those studies where customized (topography guided/wavefront guided) photograph refractive keratectomy was performed in patients with postkeratoplasty. Significant change in uncorrected distance visual acuity, corrected distance visual acuity, RMS of higher order aberrations, refractive cylinder, and mean spherical equivalent were observed. Corneal haze was the most common complication documented; however, this was more commonly documented by authors who have not used Mitomycin C in their patients.

Conclusions:
We found out that customized photograph refractive keratectomy is a safe, effective, and predictable method of treatment for refractive error and irregular astigmatism after keratoplasty.
Increased Risk of Glaucoma in Fuchs Endothelial Corneal Dystrophy Is Independent of TCF4 Trinucleotide Repeat Expansion
Authors: Xing Chao , Schultis Sara , Bondar Vladyslav , Gong Xin , Whitson Jess T. , Mootha V. Vinod 
Published: September 2024

Purpose:
The purpose of this study was to determine the prevalence of glaucoma and/or ocular hypertension (G/OHTN) in patients with Fuchs endothelial corneal dystrophy (FECD) and correlate with FECD severity and TCF4 cytosine-thymine-guanine18.1 (CTG18.1) trinucleotide repeat expansion genotype.

Methods:
We included 167 FECD probands and 110 controls from the University of Texas Southwestern Medical Center FECD Genetics Study to estimate the association between FECD and G/OHTN. Participants underwent slit-lamp microscopy for the assessment of Krachmer grade disease severity of FECD. The diagnosis of G/OHTN was ascertained using a patient-reported history of G/OHTN, previous glaucoma surgery and/or glaucoma laser procedure, and use of glaucoma drops. Genomic DNA from blood of participants was used to genotype the CTG18.1 repeat polymorphism by fragment analysis using short tandem repeat and triplet repeat primed polymerase chain reaction assays.

Results:
We observed a 19.2% prevalence of G/OHTN in the FECD probands compared with that of 7.3% in controls. The odds ratio of developing G/OHTN in FECD cases compared with controls was estimated to be 3.34 with a 95% confidence interval of 1.42–7.79 adjusting for age and sex. Among FECD cases, the likelihood of developing G/OHTN correlated positively with Krachmer grade (P = 0.043) and age (P = 0.026). There was no statistical difference of the proportions of patients developing G/OHTN between FECD cases with and without TCF4 CTG18.1 repeat expansion (16 out of 94 and 15 out of 72, respectively, P > 0.05).

Conclusions:
Patients with clinically significant FECD should be routinely monitored for the development of glaucoma regardless of their TCF4 repeat expansion genotype.
Characterization of Gaze Metrics and Visual Search Pattern Among Glaucoma Patients While Viewing Real-World Images
Authors: Nagarajan Sangeetha , Meethal Najiya Sundu K. , Pel Johan J.M. , Asokan Rashima , Negiloni Kalpa , George Ronnie 
Published: September 2024

Précis:
We quantified and compared the gaze metrics during target-oriented visual search tasks between glaucoma and healthy controls. On the basis of a mathematical concept we showed that due to glaucoma, focal search becomes prominent over global search.

Purpose:
Visual search (VS) which is essential for target identification and navigation is significantly impacted by glaucoma. VS metrics can be influenced by differences in cultural exposure or coping strategies, leading to varying VS patterns. This study aimed to explore and label the pattern of VS based on gaze metrics quantified using eye-tracking technology.

Methods:
Twenty-seven glaucoma subjects and 30 healthy controls [median age 51 (14) and 54 (19) y, respectively] underwent a VS experiment during which they had to identify specific targets from real-world images. Eye movements were recorded using a remote eye-tracker and gaze metrics—fixation count (FC), fixation duration (FD), saccade amplitude (SA), and VS time (VST) were computed and compared between the study groups. A Z-score-based coefficient “K” was derived to label the search patterns as global (K≤-0.1: short FD with long SA), focal (K≥+0.1: long FD with short SA), or a combination (K between ±0.1)

Results:
Similar to other ethnicities, Indian glaucoma subjects also exhibited statistically significantly increased FC, FD, and VST (P=0.01). Healthy controls presented a comparable proportion of focal (47%) and global (42%) search patterns while glaucoma subjects exhibited predominantly focal (56%) than global search patterns (26%, P=0.008).

Conclusions:
This study suggests that glaucoma subjects perform more focal searches during active gaze scanning. This change in viewing behavior reflects underlying compensatory strategies adapted for coping with their visual impairments. These search patterns can be influenced by factors such as saliency which requires further investigation.
Rotational stability and visual performance of aberration-free, hydrophobic acrylic monofocal toric intraocular lens with enhanced material
Authors: Wiley William F. , Epitropoulos Alice T. , Whitman Jeffrey , Liang Eva , Sadri Ehsan , Lau George 
Published: September 2024

Purpose:
To evaluate the rotational stability and visual performance of the enVista toric intraocular lens (IOL) (MX60ET) in cataract patients with preexisting astigmatism.

Setting:
6 U.S. sites.

Design:
Prospective, multicenter.

Methods:
Cataract patients 18 years and older with preexisting astigmatism (0.77 to 4.53 diopters [D]) underwent phacoemulsification and implantation of enVista toric IOL (MX60ET). Outcome measures were the proportion of patients with absolute IOL axis rotation of ≤5 degrees, uncorrected and corrected distance visual acuities (UDVA and CDVA) at 4 m, uncorrected intermediate visual acuity (UIVA) at 66 cm, manifest refraction, and adverse events. The patients were followed up on days 1 to 2, 7 to 14, 30 to 60, and 120 to 180.

Results:
Mean astigmatism of 101 eyes (101 patients) reduced from 1.47 ± 0.64 D preoperatively to 0.38 ± 0.38 D at days 120 to 180 (P < .001), with 88.1% (N = 89/101) of eyes achieving astigmatism within 0.75 D. Mean postoperative UDVA and UIVA were 0.10 ± 0.16 and 0.25 ± 0.15 logMAR, respectively. While 79.2% (N = 80/101) of patients had postoperative UDVA of 20/32 or better, 63.9% (N = 62/97) had UIVA of 20/40 or better. The mean toric IOL rotation from the operative visit to days 30 to 60 was 1.97 ± 2.06 degrees, with 97.4% (N = 74/76) of eyes showing toric IOL rotation of 5 degrees or less.

Conclusions:
The enhanced enVista toric IOL (MX60ET) demonstrated excellent rotational stability and astigmatic outcomes indicating good efficacy of the IOL for the correction of astigmatism during cataract surgery.
Association Between Urinary Rare Earth Element Levels and Metabolic Syndrome
Authors: Xu Xuemei , Lu Peini , Luo Xingxi , Wei Gangjie , Huang Xuanqian , Lv Fangfang , Mo Caimei , Lei Lidi , Huang Dongping , Su Li , Zeng Xiaoyun , Qiu Xiaoqiang , Liu Shun 
Published: September 2024

Objective
This study aimed to investigate the association between rare earth elements (REEs) and metabolic syndrome (MetS).

Methods
We used a cross-sectional design based on the baseline data of the Prospective Cohort Study of Chronic Diseases in Ethnic Minority Natural Population in Guangxi in China. Logistic regression and BKMR models were employed to evaluate the association between REEs and risk of MetS.

Results
Although REEs were not significantly associated with MetS, certain elements such as La, Pr, and Nd were negatively associated with abdominal obesity, whereas Ce, Pr, Nd, and Dy were positively associated with hypertension. BKMR models suggested a U-shaped relationship between mixed REEs and MetS, with varying effects on abdominal obesity and high blood pressure.

Conclusions
This study suggests that exposure to REEs may be associated with a reduced risk of abdominal obesity and an increased risk of high blood pressure.
Human umbilical cord mesenchymal stem cells-derived extracellular vesicles ameliorate kidney ischemia-reperfusion injury by suppression of senescent tubular epithelial cells: experimental study
Authors: Ma Ming , Zeng Jun , Zhu Mengli , Li Hui , Lin Tao , Yang Hao , Wei Xin , Song Turun 
Published: September 2024

Background:
Human umbilical cord mesenchymal stem cells-derived extracellular vesicles (HUMSC-EVs) have drawn much interest in kidney transplantation, mainly because of their renoprotection by alleviating cell injury and stimulating tissue repair. Cellular senescence has been proven to play a dual regulatory role in kidney ischemia-reperfusion injury (IRI), and the regulation of HUMSC-EVs on tubular epithelial cell senescence may be a potential therapeutic target.

Materials and methods:

In vitro, the hypoxia-reoxygenation of human kidney-2 cells was used to simulate kidney IRI, and the regulation of HUMSC-EVs on human kidney-2 cells was detected. Transcriptome sequencing of human kidney-2 cells was used to explore the potential regulatory mechanism. In vivo, adult male mice were divided into five groups: control group, IRI group, HUMSC-EVs treatment group, senolytics treatment group (dasatinib + quercetin), and combined treatments group (HUMSC-EVs and senolytics). Kidney function, senescent features of tubular epithelial cells, acute kidney injury, and chronic interstitial fibrosis in mice were detected to explore the renoprotection effects of HUMSC-EVs.

Results:
Kidney IRI significantly up-regulated expressions of LaminB1, p53, p21, p16, senescence-associated beta-galactosidase, and apoptosis of tubular epithelial cells. In the mouse kidney IRI model, kidney subcapsular injection of HUMSC-EVs significantly improved kidney function, reducing the senescent features of tubular epithelial cells and alleviating acute kidney injury and chronic interstitial fibrosis. HUMSC-EVs mainly achieved renoprotection by regulating Bax/Bcl-2-dependent apoptosis during acute kidney injury and mostly reduced tubular atrophy and kidney interstitial fibrosis by regulating Ras-pERK-Ets1-p53 pathway-dependent cell senescence. Oral administration of senolytics also alleviated kidney injury induced by IRI, while the combined treatments of HUMSC-EVs and senolytics had better renoprotection effects.

Conclusions:
The combination of HUMSC-EVs and senolytics alleviated acute kidney injury and chronic interstitial fibrosis by dynamic regulation of cell senescence and apoptosis, which provides a therapeutic potential strategy for organ preservation and tissue repair in kidney transplantation.
Daytime Somnolence and Sleep Apnea Are Associated With Dizziness in the Elderly
Authors: Szeto Betsy , Kesser Bradley 
Published: September 2024

Objective
Dizziness is a debilitating multifactorial disorder commonly affecting the elderly. Daytime somnolence and sleep apnea have been linked to dizziness, but previous studies were limited by small sample sizes. The purpose of this study was to examine the relationship between dizziness and daytime somnolence and sleep-disordered breathing, in a nationally representative sample of elderly adults, while adjusting for possible confounders and mediators.

Study Design
Data from the National Health and Nutrition Examination Study (NHANES; 2017–2020 prepandemic data) were analyzed in a cross-sectional manner using survey methods.

Setting
Community-based setting in the United States.

Participants
A total of 1,490 nationally representative participants aged ≥70 years.

Main Outcomes
Multivariable logistic regression was used to examine the relationship between dizziness and daytime somnolence, snoring, and apnea, while adjusting for covariates (gender, age, body mass index, and various medical conditions that may confound this relationship).

Results
Frequent daytime somnolence five or more times monthly (odds ratio, 2.13; 95% confidence interval, 1.49–3.06) and presence of apnea (odds ratio, 1.65; 95% confidence interval, 1.20–2.27) were found to be associated with greater odds of dizziness when adjusting for medical comorbidities. A significant association was not found between snoring and dizziness.

Conclusions and Relevance
In the elderly, daytime somnolence and apnea were independently associated with increased odds of dizziness, even after adjusting for medical comorbidities. Daytime somnolence and sleep apnea should be added to the differential diagnosis in this patient population. Optimizing sleep may help reduce symptoms of dizziness in this population, but prospective studies would be required to confirm these findings.

Level of evidence: 4