bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adjudication of Codes for Identifying Sepsis in Hospital Administrative Data by Expert Consensus*
Authors: Garland Allan , Li Na , Sligl Wendy , Lane Alana , Thavorn Kednapa , Wilcox M. Elizabeth , Rochwerg Bram , Keenan Sean , Marrie Thomas J. , Kumar Anand , Curley Emily , Ziegler Jennifer , Dodek Peter , Loubani Osama , Gervais Alain , Murthy Srinivas , Neto Gina , Prescott Hallie C. ,   for the Sepsis Canada Network
Published: October 2024

OBJECTIVES:
Refine the administrative data definition of sepsis in hospitalized patients, including less severe cases.

Design and Setting:
For each of 1928 infection and 108 organ dysfunction codes used in Canadian hospital abstracts, experts reached consensus on the likelihood that it could relate to sepsis. We developed a new algorithm, called AlgorithmL, that requires at least one infection and one organ dysfunction code adjudicated as likely or very likely to be related to sepsis. AlgorithmL was compared with four previously described algorithms, regarding included codes, population-based incidence, and hospital mortality rates—separately for ICU and non-ICU cohorts in a large Canadian city. We also compared sepsis identification from these code-based algorithms with the Centers for Disease Control’s Adult Sepsis Event (ASE) definition.

SUBJECTS:
Among Calgary’s adult population of 1.033 million there were 61,632 eligible hospitalizations.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
AlgorithmL includes 720 infection codes and 50 organ dysfunction codes. Comparison algorithms varied from 42–941 infection codes to 2–36 organ codes. There was substantial nonoverlap of codes in AlgorithmL vs. the comparators. Annual sepsis incidence rates (per 100,000 population) based on AlgorithmL were 91 in the ICU and 291 in the non-ICU cohort. Incidences based on comparators ranged from 28–77 for ICU to 11–266 for non-ICU cohorts. Hospital sepsis mortality rates based on AlgorithmL were 24% in ICU and 17% in non-ICU cohorts; based on comparators, they ranged 27–38% in the ICU cohort and 18–47% for the non-ICU cohort. Of AlgorithmL-identified cases, 41% met the ASE criteria, compared with 42–82% for the comparator algorithms.

CONCLUSIONS:
Compared with other code-based algorithms, AlgorithmL includes more infection and organ dysfunction codes. AlgorithmL incidence rates are higher; hospital mortality rates are lower. AlgorithmL may more fully encompass the full range of sepsis severity.
Increased Risk of Postoperative Complications in Organ Transplant Recipients Undergoing Mohs Micrographic Surgery
Authors: O'Donnell-Cappelli Megan , Mandel Jenna , Elder Alexandra , Banner Lauren , Nikbakht Neda 
Published: October 2024

BACKGROUND
Solid organ transplant recipients (SOTRs) are at increased risk of developing nonmelanoma skin cancers (NMSC), which may require treatment by Mohs micrographic surgery (MMS). Previous small-scale studies yielded conflicting findings on post-MMS complications in immunosuppressed individuals, and large-scale population-based analyses for SOTRs undergoing MMS are lacking.

OBJECTIVE
The authors investigate postoperative complications after MMS in SOTRs using the TriNetX database of over 106 million patients in the US Collaborative Network.

MATERIALS AND METHODS
Among MMS recipients in this database, a cohort of organ transplant recipients and a cohort of immunocompetent patients were generated. Immunosuppressive medications other than antirejection medications for the SOTR cohort were excluded from both groups. The outcomes for common postoperative complications including infection, wound disruption, graft failure, bleeding, rash, disturbance of skin sensation, and hypertrophic scarring were assessed during a 60-day postoperative window.

RESULTS
SOTRs exhibit a twofold increased risk of postoperative infection, 2.5-fold increased risk of surgical wound disruption, and over threefold increased likelihood of swelling within 60 days post-MMS compared with immunocompetent patients. There was no significant difference in bleeding between the cohorts.

CONCLUSION
Given these findings, it may be worth assessing the role of antibiotics and close monitoring for the SOTR population in larger prospective studies to inform future surgical guidelines.
The management of new-onset atrial fibrillation in critical illness: an update on current therapeutic options
Authors: Wang Zhe , Li Jiang , Sun Yihong 
Published: October 2024

Purpose of review
New-onset atrial fibrillation (NOAF) is the most prevalent arrhythmia among critically ill patients, correlating with heightened morbidity and mortality rates. Current evidence for managing NOAF in this patient population is limited.

Recent findings
Numerous meta-analyses have been conducted to assess the efficacy of atrial fibrillation treatments in acute settings, including rate or rhythm control strategies, anticoagulation, and intensive care interventions. The employment of β-blockers for rate control appears to confer greater benefits in critically ill patients. However, the advantage of anticoagulation remains ambiguous because of bleeding risks, which is partly attributed to the scarcity of evidence in the complex context of critical illness. Approximately one-third of patients with transient atrial fibrillation face recurrence within a year. Therefore, vigilant posthospitalization follow-up and monitoring should be considered for high-risk patients to detect atrial fibrillation recurrence. Long-term anticoagulation strategies should be tailored to individual patient profiles, weighing the risks of thromboembolism.

Summary
Factors predicting atrial fibrillation recurrence include age, the burden of atrial fibrillation, and atrial size. There are significant knowledge gaps concerning NOAF in critically ill patients, highlighting the need for further research, particularly randomized clinical trials.
The Effect of a Mindfulness-Based Stress Reduction Program on Depression and Quality of Life in Cancer Patients
Authors: Özmaya Esma , Uzun Sevda , Aytaç Tufan 
Published: October 2024

Mindfulness-based interventions have been receiving growing attention in cancer care. This study was performed to determine the effect of a mindfulness-based stress reduction program on depression and quality of life in cancer patients. The screenings in the study were performed in January to May 2023 through the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, Science Direct, and YÖK Thesis Center databases. After the reviews, 14 studies were included in the study. This meta-analysis showed that mindfulness-based stress reduction programs were effective on depression (SMD: −0.363; 95% CI: −0.711 to 0.015; Z = −2.042; P = .041; I2 = 85.229%) and quality of life (SMD: 0.363; 95 CI%: 0.111-0.615; Z = 2.822; P = .005; I2 = 75.222%). The type of cancer (SMD: 0.385; CI: between 0.005 and 0.528; P = .000); duration of therapy (SMD: 0.243; CI: between 0.093 and 0.393; P = .002); the person providing therapy (SMD: 0.335; CI: between 0.133 and 0.507; P = .001); scale used (SMD: 0.290; CI: between 0.148 and 0.432; P = .000); and the origin of the study (SMD: 0.298; CI: between 0.158 and 0.438; P = .000) moderators were found to play a role in the effectiveness of a mindfulness-based stress reduction program on the quality of life of cancer patients. The mindfulness-based stress reduction program yields positive outcomes by reducing depression, enhancing the quality of life in cancer patients, and promoting overall mental well-being in individuals.
EYE SHAPE DEFORMITY PREDICTS MYOPIC MACULOPATHY PROGRESSION AMONG HIGHLY MYOPIC INDIVIDUALS
Authors: Li Cong , Wu Huawang , Xiao Ou , Xiong Ruilin , Guo Xinxing , Chen Yanxian , Yin Qiuxia , He Mingguang , Li Zhixi 
Published: October 2024

Purpose:
To determine the impact of eye shape using three-dimensional magnetic resonance imaging on myopic maculopathy (MM) progression.

Methods:
At baseline, 67 participants with high myopia were selected. Eye shape was classified into spheroidal, ellipsoidal, temporally distorted, nasally distorted, conical, and barrel-shape identified from three-dimensional magnetic resonance imaging. Spheroidal and ellipsoidal shapes were defined as nondeformity; others were defined as eye deformity. Myopic maculopathy progression was determined through color fundus photography.

Results:
Within a 4-year follow-up, 17.1% (7/41) of patients with nondeformed eye shape had MM progression, whereas 69.2% (18/26) of patients with eye shape deformity had MM progression. In multivariable analysis, eye shape deformity (odds ratio, 4.35; 95% confidence interval, 1.10–17.29; P = 0.036) and axial length of ≥28 mm (odds ratio, 12.75; 95% confidence interval, 2.27–71.48; P = 0.004) significantly correlated with MM progression. The predictive discrimination of eye shape alone for MM progression did not differ from axial length (area under the curve: 0.765 vs. 0.750, P = 0.486). By incorporating age, sex, axial length, and eye shape, the prediction model achieved an area under the curve of 0.862 for discriminating MM progression.

Conclusion:
Eye shape deformity assessed by three-dimensional magnetic resonance imaging is a novel predictor for MM progression in high myopia.
IMPACTS OF POSTERIOR STAPHYLOMA ON PARAPAPILLARY MICROVASCULATURE AND ATROPHY IN HIGH MYOPIC EYES
Authors: Chen Yanhui , Hui Yan-Nian , Xing Xiaoli , Rong Hua , Bai Yang , Li Haoru , Mi Baoyue , Guo Xingyi , Wei Ruihua 
Published: October 2024

Purpose:
To evaluate the impacts of the different types of posterior staphyloma (PS) in high myopia on parapapillary microvasculature and parapapillary atrophy (PPA, i.e., γ-zone and δ-zone) with optical coherence tomography angiography.

Methods:
This cross-sectional study included 152 high myopic eyes (152 participants) with γ-zone. After matching, high myopic eyes were stratified into PS (n = 33) and non-PS (n = 33) groups. Posterior staphyloma types, parapapillary microvasculature characteristics, the prevalence of nonjuxtapapillary microvasculature dropout, the longest radial width from the optic disk edge to retinal pigment epithelial atrophy edge (PPA width), γ-zone, and δ-zone with changes in visual field, and best-corrected visual acuity were evaluated and analyzed.

Results:
According to Curtin classification, we identified five types of PS included: primary Types I, II, III, and compound Types VII, and IX. Eyes with Type II showed a higher optic disk tilted ratio and larger PPA width compared with other primary PS. Subjects with Type IX were the oldest. Eyes with Types VII and IX had wider γ-zone and δ-zone, worse visual field outcomes, poorer best-corrected visual acuity, and a higher incidence of non-juxtapapillary microvasculature dropout compared with primary PS. Choroidal and intrascleral vessels were associated with nonjuxtapapillary microvasculature dropout and were located near or connected to the circle of Zinn-Haller.

Conclusion:
Eyes with high myopia and PS show wider PPA, affecting the γ-zone and δ-zone, and are at a higher risk of developing nonjuxtapapillary microvasculature dropout. Specifically, eyes with PS Types VII and IX are more susceptible to visual field damage and decreased best-corrected visual acuity. These results highlight the importance of the impact of PS on parapapillary microvasculature and PPA in high myopia.
Numerical Aberrations of the Extraocular Muscles and the Levator Palpebrae Superioris: An Anatomical and Clinical Insight
Authors: Tawfik Hatem A. , El Houssieny Omar Amro , Dutton Jonathan J. 
Published: October 2024

Purpose:
To comprehensively review the literature about numerical aberrations of the orbital muscles of ocular motility (here referred to as extraocular muscles [EOMs]) and the levator palpebrae superioris (LPS).

Methods:
The authors summarize the embryologic bases and the possible etiopathogenetic causes of numerical aberrations of the EOMs and the LPS and organize these lesions into several broad categories. The clinical and radiologic diagnostic challenges are discussed.

Results:
Numerical aberrations of the EOMs include: 1) the complete absence of EOMs, 2) duplication of an entire EOM, 3) the presence of muscle bands that connect 2 EOMs, and 4) minor morphological variations such as bifid muscles (partial splitting of the muscle). Some cases may defy categorization into any of the above or may resemble atavistic remnants of the retractor bulbi muscle. Broadly speaking, numerical aberrations of the LPS generally fall into the same categories although the LPS has several peculiar numerical anomalies of its own.

Conclusions:
Although numerical EOM and LPS variations are relatively rare and of little clinical significance, raising awareness about their presence is a fundamental clinical keystone not just for the strabismus surgeon but for the orbital surgeon as well. During orbital surgery, this may spare the surgeon from pursuing an orbital witch hunt for these benign innocuous accessory orbital structures that were accidentally discovered by the radiologist and misinterpreted as sinister etiologies. For the strabismus surgeon, the failure to identify them may result in an unfavorable surgical outcome if these structures are missed because of a lack of awareness despite being responsible for generating complex strabismus patterns or having a restrictive potential of their own.
Evaluation of a Self-collected Device for Human Papillomavirus Screening to Increase Cervical Cancer Screening
Authors: Crane LaShonda , Fitzpatrick Megan B. , Sutton Elizabeth , Conageski Christine , Favreau Jessica , Conway Kristin , Young Steve , Young Jesse , Jennings Ashley 
Published: October 2024

Objective
The authors compared the performance of a novel self-collect device with clinician-collected samples for detection of high-risk human papillomavirus (hrHPV).

Materials and Methods
Eighty-two (82) participants were recruited from 5 clinical sites in the United States. Each participant performed self-collect sampling using the self-collect device followed by a standard of care clinician-collected sample. Both samples were evaluated for hrHPV using polymerase chain reaction (PCR)-based HPV assays. A subset of HPV-positive samples underwent dual staining (p16/Ki-67), and concordance was evaluated. Biopsy results collected per standard of care were recorded.

Results
On the Roche cobas assay, the preliminary positive percent agreement (PPA) and negative percent agreement (NPA) was 91%. Agreement for hrHPV using the BD OnClarity in PreservCyt was 100% PPA (n = 10), and 100% PPA, 93% NPA in SurePath. Dual-stain concordance was 93% (n = 16) overall, and 100% for HPV other genotypes. Seventy-one participants (n = 71; 89%) indicated they would feel confident using the self-collect device for screening if they knew they could get equal results, and 86% (n = 69) indicated that they would be more likely to get screened with this option.

Conclusions
The self-collect device shows high (>92%) positive and negative agreement for detection of HPV when compared with reference clinician-collected samples, with very high acceptability and preference. Furthermore, the self-samples collected with the self-collect device showed highly concordant results by dual stain, which is a novel and emerging application for a self-collected sampling device, thus enabling potential triage from 1 sample.
The Distribution of Cervical Transformation Zone and Its Impact on Colposcopic Diagnosis: A Multicenter Study in China
Authors: Ye Zichen , Cui Xiaoli , Wang Huike , Chen Mingyang , Lu Qu , Jiang Yu , Xue Peng , Qiao Youlin 
Published: October 2024

Objective
The value of the transformation zone (TZ) is often overlooked in clinical settings. This study aims to assess TZ distribution, associated factors, and its impact on colposcopic diagnosis.

Methods
χ2 tests were used to analyze demographics, clinical history, and tissue samples to examine the differences in TZ distribution. Factors affecting the TZ were explored using logistic regression, and diagnostic indicators were calculated.

Results
A total of 5,302 individual datasets were finally included. TZ1, TZ2, and TZ3 accounted for 31.6%, 38.5%, and 30.0%, respectively. Age is the most important factor that influences the location of the TZ. The proportion of TZ3 steadily increased with age, comprising over 55% in women over 50. The colposcopic diagnostic performance shows that high-grade squamous intraepithelial lesion or worse (HSIL+) sensitivity of TZ3 (58.1%, 95% confidence interval [CI] = 52.9–63.4) is significantly lower than that of TZ1 (69.8%, 95% CI = 65.5–74.1) and TZ2 (73.2%, 95% CI = 69.7–76.8). The HSIL+ specificity of TZ3 (96.3, 95% CI = 95.3–97.4) was higher than that of TZ1 (96.3, 95% CI = 95.2–97.3) and TZ2 (92.5, 95% CI = 91.1–93.9). The HSIL+ positive predictive value (81.3%, 95% CI = 76.4–86.2) and negative predictive value (89.3%, 95% CI = 87.6–90.9) for TZ3 are high, with no significant differences when compared with TZ1 and TZ2.

Conclusions
Age predominantly influences TZ location, with TZ3 being most frequently found in women over 50. While TZ3 poses a higher risk of missed diagnosis during colposcopy, it remains clinically valuable in identifying diseased and nondiseased status. Increasing colposcopists' awareness of TZ importance is needed in clinical practice.
Association between loneliness, social isolation, and frailty: A two-sample Mendelian randomization
Authors: Huang Huanhuan , Jiang Siqi , Wang Chunni , Yu Xinyu , Chen Zhiyu , Huang Qi , Yang Xuesen , Zhao Qinghua 
Published: October 2024

Abstract

Objective:
This study aimed to examine the causal relationship between loneliness, social isolation, and frailty using Mendelian Randomization (MR) analysis.

Methods:
Data were obtained from a large-scale genome-wide association study (GWAS) of a European-descent population. Variables included frailty index (FI), 2 loneliness variables (Feeling lonely, able to confide), and 3 social isolation variables (frequency of friend/family visits, number in household, no leisure/social activities). The inverse variance weighting (IVW) method was set as the primary MR analysis, with MR-Egger and weighted median methods employed as complementary approaches. Cochran Q test, the MR-Egger intercept test, and MR-PRESSO methods were used to evaluate the robustness of MR results. Bonferroni corrected P-values <0.01 were considered statistically significant.

Results:
Genetic predisposition to feeling lonely [IVW: odds ratio (OR)=1.47; 95% CI: 1.34–1.60; P<0.001] and no leisure or social activities (IVW: OR=1.78; 95% CI: 1.50–2.11; P<0.001) were significantly associated with increased FI. In addition, the genetically predicted ability to confide was positively associated with decreased FI (IVW: OR=0.91; 95% CI: 0.87–0.95; P<0.001). There was no statistically significant causal association between the number in the household, frequency of friend/family visits, and the risk of frailty.

Conclusions:
This MR study provides evidence of the causal relationship between loneliness, social isolation, and frailty from a genetic perspective and highlights the importance of decreasing social isolation in the development of frailty prevention and intervention programs.
Prominent Bone Marrow Infiltration in the Appendicular Skeleton in a B-cell Acute Lymphoblastic Leukemia Patient Demonstrated by FDG PET-MRI
Authors: Zheng Mengmeng , Grant Frederick D , Zhuang Hongming 
Published: October 2024

Abstract
Leukemia spread in the bone marrow typically is greater in the axial skeleton than in the appendicular skeleton. We report an unusual pattern of FDG-avid bone marrow infiltration that is more prominent in the appendicular skeleton than the axial skeleton in a pediatric patient with B-cell acute lymphoblastic leukemia.
To Perform, or Not to Perform Interim PET
Authors: Wetz Christoph , Ruhwedel Tristan , Rogasch Julian M.M. , Steinhagen Peter R. , Bolduan Felix , Amthauer Holger , Schatka Imke 
Published: October 2024

Purpose
This study aimed to analyze the impact of interim evaluation on the continuation of 177Lu-based peptide receptor radionuclide therapy (PRRT) in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and to survey its usage across German university hospitals.

Patients and Methods
In 119 GEP-NET patients who underwent PRRT, we retrospectively assessed the results and therapeutic impact of restaging performed after 2 cycles using MRI/CT/somatostatin receptor imaging. Therapeutic decisions based on interim PET results were made in multidisciplinary tumor board meetings. Additionally, an online survey was conducted among 37 German university hospitals regarding their interim evaluation practices, focusing on the change in management.

Results
Of 119 patients, 83 completed 4 PRRT cycles; 36 stopped after 2: 27 showed PD, 3 had PR leading to surgery, 5 experienced toxicity, and 1 died. Those completing 4 cycles showed a median PFS of 38.0 months (95% confidence interval, 32.2–43.8). Seventeen of 37 surveyed hospitals routinely used interim evaluation. In a survey among 37 German university hospitals, 62% reported offering PRRT for GEP-NET patients, with 74% of these performing a routinely interim evaluation after 2 cycles of PRRT, primarily using PET/CT imaging techniques.

Conclusions
Interim PET after 2 PRRT cycles helps to identify early progression in GEP-NET patients. Standardizing interim evaluation practices could enhance the comparability of clinical outcomes and optimize patient management.
18F-FDG PET/CT in Pediatric INI1-Negative Soft Tissue Myoepithelial Carcinoma
Authors: Singh Karan B. , Rossleigh Monica A. , Wegner Eva A. 
Published: October 2024

Abstract
A 12-year-old girl with no previous comorbidities presented with a left gluteal swelling. 18F-FDG PET/CT demonstrated heterogenous, moderate hypermetabolism localizing to a very large pelvic soft tissue mass with extension through the left greater sciatic notch into the left deep gluteal space. Core biopsy of the mass revealed INI1-negative myoepithelial carcinoma. Here we report the molecular imaging findings in an extremely rare pediatric case of INI1-negative, soft tissue myoepithelial carcinoma.
Focal Pancreatitis Mimicking Neuroendocrine Tumor on DOTATATE PET/CT With Radiology-Pathology Correlation
Authors: Daggumati Lasya , Ballentine Samuel J. , Fraum Tyler J. 
Published: October 2024

Abstract
A 54-year-old man presented with left lower quadrant pain. CT showed no cause for his pain but identified an incidental 2.0-cm enhancing lesion in the pancreatic tail. On MRI, this lesion was hyperenhancing and diffusion-restricting, suspicious for a neuroendocrine tumor. However, EUS-guided biopsy yielded only benign pancreatic tissue. Due to this discordance, 64Cu-DOTATATE PET/CT was performed. The pancreatic tail lesion was tracer-avid, suggesting a well-differentiated neuroendocrine tumor. Based on the PET findings, the patient underwent distal pancreatectomy. Surgical pathology revealed only focal chronic pancreatitis with islet aggregation, a previously undescribed mimic of neuroendocrine tumor on DOTATATE PET/CT.
Heterogeneous Uptake of Al18F-NOTA-FAPI and 18F-FDG in Apical Aneurysm in Apical Hypertrophic Cardiomyopathy
Authors: Xu Yang , Guo Yue-Hong , Yang Min-Fu 
Published: October 2024

Abstract
Apical aneurysm in apical hypertrophic cardiomyopathy (HCM) is a very rare condition in clinical practice. Some studies have reported abnormal uptake of 18F-FDG and 18F-FAPI in HCM, respectively. We presented a case of FAPI and FDG imaging in a patient with apical aneurysm in apical HCM, and further analyzed the discrepancy of spatial distribution pattern of these 2 radiotracers.