bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of the Pathogen Distribution and Antimicrobial Resistance after Plastic Surgery of the Urogenital System
Authors: Jiang Fengli , Chen Qi , Wu Yuanyuan , Lin Jinhao , Su Xueshang , Zhuang Jun , Zhan Sien 
Published: September 2024

Background:
We aimed to summarize the distribution of pathogenic bacteria for postoperative infection of different genitourinary plastic surgery and the antimicrobial resistance of the major pathogens.

Methods:
Between January 2011 and December 2021, following plastic surgery of the urogenital system, microbial strains from infected patients were collected, identified, and counted. The antibiotic sensitivity and distribution characteristics of common pathogens in relation with the surgical procedures were studied by WHONET 5.6, along with the main bacteria accounting for early infection.

Results:
A total of 76 cases were included in the study. Among these, 53 Gram-negative bacteria were detected, with Escherichia coli (18 of 53) and Pseudomonas aeruginosa (nine of 53) accounting for the majority. There were also 23 Gram-positive bacteria, among which Staphylococcus aureus (six of 23) and Coagulase-negative Staphylococcus (five of 23) were the most common. In terms of antimicrobial resistance, E. coli was highly sensitive to amikacin, piperacillin/tazobactam, cefoxitin, and imipenem, whereas P. aeruginosa was highly sensitive to gentamicin, amikacin, cefepime, piperacillin/tazobactam, imipenem, ceftazidime, and ciprofloxacin. Procedures for urethral repair, urethral reconstruction, and lump resection were most commonly associated with infection. Among these, urethral repair was responsible for the majority of infections. The pathogenic bacteria involved in postoperative infections varied overall, but the most prevalent was E. coli.

Conclusions:
Gram-negative bacteria are the major cause of infection following genitourinary plastic surgery. The specific bacterial strains, degrees of antimicrobial resistance, and length of infection varied among the various procedures. The results of this study may provide references for clinical medication and the prevention and control of such infections.
Incidence and type of adverse events in patients with cirrhosis receiving terlipressin: A systematic review and meta-analysis
Authors: Shang Yiyang , Wang Cai’e , Lu Huiyuan , Chai Lu , Xu Wentao , Bernardi Mauro , Qi Xingshun 
Published: September 2024

Background:
Terlipressin has been widely used for various cirrhosis-related complications, but its safety profile remains controversial. Herein, this issue was systematically evaluated.

Methods:
All studies reporting adverse events (AEs) of terlipressin in cirrhosis were screened. Incidences were pooled using a random-effects model. Subgroup analyses were performed according to the patient’s characteristics and treatment regimens. Interaction among subgroups was evaluated.

Results:
Seventy-eight studies with 7257 patients with cirrhosis were included. The pooled incidences of any AEs, treatment-related AEs, any serious AEs (SAEs), treatment-related SAEs, treatment withdrawal due to AEs, and treatment withdrawal due to treatment-related AEs were 31%, 22%, 5%, 5%, 4%, and 4% in patients with cirrhosis receiving terlipressin, respectively. Patients with hepatorenal syndrome had higher incidences of any SAEs (29% vs. 0% vs. 0%, p
interaction = 0.01) and treatment-related SAEs (8% vs. 1% vs. 7%, p
interaction = 0.02) than those with variceal bleeding or ascites. Patients who received terlipressin with human albumin had higher incidences of any SAEs (18% vs. 1%, p
interaction = 0.04) and treatment-related SAEs (7% vs. 0%, p
interaction = 0.09) than those without albumin. Patients with total bilirubin level >4.3 mg/dL had higher incidences of any AEs (69% vs. 24%, p
interaction = 0.02), any SAEs (64% vs. 0%, p
interaction < 0.01), and treatment-related SAEs (8% vs. 1%, p
interaction = 0.04) than those ≤4.3 mg/dL.

Conclusions:
AEs are common in patients with cirrhosis receiving terlipressin and influenced by clinical scenarios, combination with albumin, and bilirubin levels.
Effect of maneuvers, diuresis, and fluid administration on ultrasound-measured liver stiffness after Fontan
Authors: Debnath Pradipta , Morin Cara E. , Bonn Julie , Thapaliya Samjhana , Smith Clayton A. , Dillman Jonathan R. , Trout Andrew T. 
Published: September 2024

Background:
To determine the effect of stress maneuvers/interventions on ultrasound liver stiffness measurements (LSMs) in patients with Fontan circulation and healthy controls.

Methods:
In this prospective, IRB-approved study of 10 patients after Fontan palliation and 10 healthy controls, ultrasound 2D shear-wave elastography LSMs were acquired at baseline and after maximum inspiration, expiration, standing, handgrip, aerobic exercise, i.v. fluid (500 mL normal saline) administration, and i.v. furosemide (20 mg) administration. Absolute and percent change in LSM were compared between baseline and each maneuver, and then from fluid infusion to after diuresis.

Results:
Median ages were 25.5 and 26 years in the post-Fontan and control groups (p = 0.796). LSMs after Fontan were higher at baseline (2.6 vs. 1.3 m/s) and with all maneuvers compared to controls (all p < 0.001). Changes in LSM with maneuvers, exercise, fluid, or diuresis were not significant when compared to baseline in post-Fontan patients. LSM in controls increased with inspiration (+0.02 m/s, 1.6%, p = 0.03), standing (+0.07 m/s, 5.5%, p = 0.03), and fluid administration (+0.10 m/s, 7.8%, p = 0.002), and decreased 60 minutes after diuretic administration (−0.05 m/s, −3.9%, p = 0.01) compared to baseline. LSM after diuretic administration significantly decreased when compared to after i.v. fluid administration at 30 minutes (−0.79 m/s, −26.5%, p = 0.004) and 60 minutes (−0.78 m/s, −26.2%, p = 0.017) for patients after Fontan and controls at 15 minutes (−0.12 m/s, −8.70%, p = 0.002), 30 minutes (−0.15 m/s, −10.9%, p = 0.003), and 60 minutes (−0.1 m/s, −10.9%, p = 0.005).

Conclusions:
LSM after Fontan is higher with more variability compared to controls. Diuresis is associated with significantly decreased liver stiffness in both patients after Fontan and controls, with the suggestion of a greater effect in Fontan patients.
Prevalence of subclinical hypothyroidism and longitudinal thyroid-stimulating hormone changes in youth with metabolic dysfunction–associated steatotic liver disease: An observational study
Authors: Untalan Matthew , A. Crimmins Nancy , Yates Katherine P. , A. Mencin Ali , A. Xanthakos Stavra , Thaker Vidhu V. 
Published: September 2024

Background:
Studies on adults have shown an association between overt or subclinical hypothyroidism and metabolic dysfunction–associated steatotic liver disease (MASLD). The goal of this study was to assess the relationship between thyroid-stimulating hormone (TSH) levels and the histological characteristics of MASLD in youth.

Methods:
This observational study used prospectively collected liver biopsy and clinical data from youth enrolled in 2 pediatric clinical trials in the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Thyroid assays were compared between youth with MASLD and population-based controls aged ≤18 years from the National Health and Nutrition Examination Survey. Individuals with overt hypothyroidism, abnormal antithyroid antibodies, or thyroid-related medications were excluded. Subclinical hypothyroidism was defined as TSH between 4.5 and 10.0 uIU/L. Multinomial logistic regression was used to test the association between TSH and MASLD histological changes at baseline, adjusting for age, sex, race/ethnicity, and body mass index. Mixed-effect models, including treatment and time, were used for the longitudinal analysis.

Results:
Mean TSH, total thyroxine (T4), total triiodothyronine (T3), and free T4 levels were higher (p < 0.001) in the NASH CRN cohort (n = 218; 421 observations) than in the National Health and Nutrition Examination Survey cohort (n = 2198). TSH levels were positively associated with increased steatosis over time (p = 0.03). Subclinical hypothyroidism was associated with borderline or definite metabolic-associated steatohepatitis on histology at baseline (p = 0.03) and with changes in fibrosis over time (p = 0.01).

Conclusions:
The association between TSH and steatosis severity in individuals with normal thyroid hormone concentrations suggests an independent role of TSH in MASLD.
Neighborhood Deprivation and Recovery Following Traumatic Brain Injury Among Older Adults
Authors: Albrecht Jennifer S. , Kirk Jennifer , Ryan Kathleen A. , Falvey Jason R. 
Published: September 2024

Objective:
Understanding the extent to which neighborhood impacts recovery following traumatic brain injury (TBI) among older adults could spur targeting of rehabilitation and other services to those living in more disadvantaged areas. The objective of the present study was to determine the extent to which neighborhood disadvantage influences recovery following TBI among older adults.

Setting and Participants: Community-dwelling Medicare beneficiaries aged ≥65 years hospitalized with TBI 2010-2018.

Design and Main Measures:
In this retrospective cohort study, the Area Deprivation Index (ADI) was used to assess neighborhood deprivation by linking it to 9-digit beneficiary zip codes. We used national-level rankings to divide the cohort into the top 10% (highest neighborhood disadvantage), middle 11-90%, and bottom 10% (lowest neighborhood disadvantage). Recovery was operationalized as days at home, calculated by subtracting days spent in a care environment or deceased from monthly follow-up over the year post-TBI.

Results:
Among 13,747 Medicare beneficiaries with TBI, 1713 (12.7%) were in the lowest decile of ADI rankings and 1030 (7.6%) were in the highest decile of ADI rankings. Following covariate adjustment, beneficiaries in neighborhoods with greatest disadvantage [rate ratio (RtR) 0.96; 95% confidence interval (CI) 0.94, 0.98] and beneficiaries in middle ADI percentiles (RtR 0.98; 95% CI 0.97, 0.99) had fewer days at home per month compared to beneficiaries in neighborhoods with lowest disadvantage.

Conclusion:
This study provides evidence that neighborhood is associated with recovery from TBI among older adults and highlights days at home as a recovery metric that is responsive to differences in neighborhood disadvantage.
Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018–2022
Authors: Nguyen Jennifer L. , Do Duy , Swart Elizabeth C. , Lee Tiffany , Peasah Samuel K. , Patel Urvashi , Good Chester B. 
Published: September 2024

Objective:
This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs

Background:
There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures.

Methods:
A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018–2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values.

Results:
Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45–64 years old compared with those 18–44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group.

Conclusions:
This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.
Predicting invasiveness of ground-glass nodules in lung adenocarcinoma: based on preoperative 18F-fluorodeoxyglucose PET/computed tomography and high-resolution computed tomography
Authors: Wang Ximei , Yang Chunyan , Wang Xuewei , Wang Dalong 
Published: September 2024

Objective
This study was conducted to explore the differential diagnostic value of PET/computed tomography (PET/CT) combined with high-resolution computed tomography (HRCT) in predicting the invasiveness of ground-glass nodules (GGNs).

Materials and methods
This retrospective analysis included 67 patients (mean age 62.5 ± 8.4, including 45 females and 22 males) with GGNs who underwent preoperative 18F-fluorodeoxyglucose (18F-FDG) PET/CT and HRCT examinations between January 2018 and October 2022. Based on the postoperative pathological results of lung adenocarcinoma, the patients were classified into two groups: invasive adenocarcinoma (IAC) and non-IAC. Besides, the clinical and imaging information of these patients was collected. HRCT signs include the existence of air bronchial signals, vascular convergence, pleural indentation, lobulation, and spiculation. Moreover, the diameter of solid components (DSolid), diameter of ground-glass nodules (DGGN), and computed tomography values of ground-glass nodules (CTGGN) were measured concurrently. Furthermore, the mean standardized uptake value, maximal standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were assessed during PET/CT. Associations between invasiveness and these factors were evaluated using univariate and multivariate analyses.

Results
The results of logistic regression analysis demonstrated that DGGN, DSolid, consolidation tumor ratio (CTR), CTGGN, and SUVmax were independent predictors in the IAC group. The combined diagnosis based on these five predictors revealed that area under the curve was 0.825.

Conclusion
The DGGN, DSolid, CTR, CTGGN, and SUVmax in GGNs were independent predictors of IAC, and combining 18F-FDG PET/CT metabolic parameters with HRCT may improve the predictive value of pathological classification in lung adenocarcinoma.
Feasibility of self-management for amputee rehabilitation using technology and peer support for improving walking and confidence in individuals with lower limb loss
Authors: Esfandiari Elham , Miller William C. , Mortenson W. Ben , King Sheena , Underwood Heather , Ashe Maureen C. 
Published: September 2024

Background:
Individuals with lower limb loss (LLL) require self-management education for amputation adaptation. eHealth technologies, like online platforms, widen access to educational resources. We developed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART).

Objective:
To assess the feasibility of SMART for improving walking capacity and confidence for adults with recent LLL.

Study Design:
A single-group pre-post intervention design.

Methods:
We recruited community-dwelling adults, with unilateral, transtibial, or transfemoral amputation. Self-management for amputee rehabilitation using technology included 6 weekly online educational modules, for example, pain management, diet, and sock management, and 6 weekly online meetings with a peer mentor to discuss goal setting and action planning. Outcomes were assessed at baseline (before SMART) and after 6 weeks using SMART. Feasibility indicators included process (retention rate), resource (duration of training sessions), management (participant processing), and treatment issues (effect size). The primary clinical outcome was walking capacity measured using Timed Up and Go, and secondary outcome was walking confidence measured using the Ambulatory Self-Confidence Questionnaire.

Results:
Twelve participants were recruited. The median (range) age was 56.0 (26–79) years. The retention rate was 100%. All participants were trained in less than 15 min. Four participants had an enrollment delay of more than 10 days. Two participants reported noninjurious falls because of amputation comorbidities and increased activity. The effect sizes for walking capacity and confidence were 0.51 and 0.86, respectively.

Conclusions:
Only small intervention and protocol refinements are required to SMART. These will be incorporated for a future multisite randomized controlled trial. SMART is an eHealth education program for people with LLL. Self-management for amputee rehabilitation using technology with peer support is a feasible intervention. However, adjustments to the study protocol and intervention safety are necessary before proceeding with the evaluation of SMART in a larger study.
Hypertension control and risk of age-associated dementia in people with HIV infection
Authors: Lam Jennifer O. , Hou Craig E. , Lee Catherine , Samiezade-Yazd Zahra , Levine Tory , Horberg Michael A. , Satre Derek D. , Silverberg Michael J. 
Published: September 2024

Objective:
Hypertension is a major risk factor for dementia, but sustained blood pressure control is difficult to achieve. We evaluated whether inadequately controlled hypertension may contribute to excess dementia risk among people with HIV.

Design:
A retrospective cohort study.

Methods:
We studied demographically matched people with and without HIV between July 1, 2013, and December 31, 2021, who were at least 50 years old and had a hypertension diagnosis but no dementia diagnosis. Hypertension control was calculated using a disease management index (DMI), which captured degree and duration above the hypertension treatment goals of SBP less than 140 mmHg and DBP less than 90 mmHg. DMI values ranged from 0 to 100% (perfect control); hypertension was considered ‘inadequately controlled’ if DMI was less than 80% (i.e., in control for <80% of the time). Annual, time-updated DMI was calculated for SBP and DBP. Associations of SPB and DPB control with incident dementia were evaluated using extended Cox regression models.

Results:
The study included 3099 hypertensive people with HIV (mean age: 58.3 years, 90.2% men) and 66 016 people without HIV. Each year of inadequate SBP control was associated with greater dementia risk in both people with HIV (adjusted hazard ratio [aHR] = 1.26, 0.92–1.64) and people without HIV (aHR = 1.27 (1.21–1.33); P-interaction = 0.85). Similarly, inadequate DBP control was associated with greater dementia risk in both people with HIV (aHR = 1.43, 0.90–1.95) and people without HIV (aHR = 1.71, 1.50–1.93; P-interaction = 0.57).

Conclusion:
Findings suggest the association of inadequate hypertension control with greater dementia risk is similar by HIV status. Stronger associations of DBP control with dementia merit further investigation.
Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries
Authors: Fox Justin P. , Latham Kerry P. , Darmon Sarah , Eaglehouse Yvonne L. , Bytnar Julie A. , Shriver Craig D. , Zhu Kangmin 
Published: September 2024

Background
In the Military Health System (MHS), women with breast cancer may undergo surgical treatment in military hospitals (direct care) or in the civilian setting via the insurance benefit (private sector care). We conducted this study to determine immediate breast reconstruction rates among women undergoing mastectomy for cancer in the MHS by setting of care.

Methods
Using the linked Department of Defense's Central Cancer Registry and MHS Data Repository, the Department of Defense's medical claims database, we identified adult women who underwent mastectomy for breast cancer from 1998 to 2014. Patients were then subgrouped by setting of care (direct vs private sector care). The primary outcome was the rate and type of immediate breast reconstruction. Regression models were constructed to determine factors associated with receipt of immediate breast reconstruction.

Results
The final sample included 3251 women who underwent mastectomy for cancer in the direct (67.0%) or private sector care (32.6%) settings. The overall rate of immediate breast reconstruction was 29.9% with an upward trend noted throughout the study (P < 0.001). Overall, implant-based reconstruction (81.4%) was more common than tissue-based reconstruction (18.6%). Compared with direct care, the immediate breast reconstruction rate was significantly higher in the private sector care setting (49.3% vs 20.5%, P < 0.001) despite accounting for differences in clinical characteristics (adjusted odds ratio = 4.51, 95% confidence interval [3.72–5.46]).

Conclusions
Immediate breast reconstruction in the direct care setting lags that in the civilian community during the study time period. Further research is needed to ascertain current immediate reconstruction rates and understand factors contributing to any differences in rates between care settings.
Classification of Microtia With Unusable Remnant Ear and Techniques in the First Stage of Two-Stage Auricular Reconstruction
Authors: He Bei , Wang Bingqing , Zhang Qingguo 
Published: September 2024

Background
The remnant ear is a very important material in auricular reconstruction surgery; its dimension, position, and shape determine how it is used. However, the local conditions of microtia patients are complex and variable. Situations may be encountered where a series of abnormal remnant ears cannot be utilized in clinical practice. Currently, there are no literature that elaborates on this type of microtia and provides systematic treatment methods. The purpose of this article is to systematically classify them and optimize the two-stage method auricular reconstruction, to provide an effective surgical method for these patients.

Methods
Based on the size, shape, and relative position of the residual ears, the unusable remnant ears were classified into three types: tiny size, abnormal shape, and relative position anomaly (over 1-cm higher than the contralateral earlobe). Fifty-three microtia patients with unusable remnant ear (54 ears) who underwent two-stage auricular reconstruction from August 2020 to August 2023 were reviewed. All patients had experienced earlobe reconstruction by using autologous rib cartilage during the first stage of surgery. Aesthetic assessments were evaluated from the naturalness of the earlobe reconstructed with autologous rib cartilage and the connection with the overall framework. The data on any complications that occurred during the follow-up period and patient satisfaction were collected.

Results
Among all patients, 31 had tiny size, 14 had abnormal shape, and 8 had excessively high positions. Patients were followed up for an average period of 9.2 months (6 to 12 months). No complex complications such as infection, skin necrosis, or cartilage exposure occurred. Fifty patients (94.3%) achieved excellent or good aesthetic outcomes. Fifty-one patients (96.2%) were satisfied with the reconstruction outcomes.

Conclusions
An accurate assessment of the residual ear preoperatively is essential. Reconstructing and splicing the earlobe with autologous rib cartilage in cases where the residual ear cannot be utilized compensate for the defect that the soft tissue cannot provide the earlobe flap. This is an effective surgical method for the ear reconstruction in such patients.