bluuebunny/crossref_metadata_2025_split huggingface dataset:
A High Immediate Postoperative Systemic Immune-inflammation Index Is Associated With Postoperative Symptomatic Cerebral Infarction in Moyamoya Patients Undergoing Combined Revascularization Surgery
Authors: Kim Na young , Shin Kyung Won , Jo Woo-young , Oh Hyongmin , Lee Sung Ho , Cho Won-Sang , Kim Jeong Eun , Park Hee-Pyoung 
Published: May 2024

Background:
Inflammation plays a role in the pathogenesis of cerebral infarction. Postoperative symptomatic cerebral infarction (SCI) is a complication after revascularization surgery in patients with moyamoya disease (MMD). We investigated the association between the systemic-immune-inflammation index (SII) and postoperative SCI during hospital stay in such patients.

Methods:
Perioperative data were retrospectively obtained from 681 MMD patients who underwent revascularization surgery. SII cutoff values were identified as those where the sum of sensitivity and specificity associated with SCI were highest. Patients were divided into 4 subgroups according to the preoperative and immediate postoperative cutoff SII: HH (preoperative and postoperative SII high, n=22), LH (low preoperative and high postoperative SII, n=68), HL (high preoperative and low postoperative SII, n=125), and LL (preoperative and postoperative SII low, n=466).

Results:
Postoperative SCI occurred in 54 (7.6%) patients. The cutoff values for preoperative and immediate postoperative SII were 641.3 and 1925.4, respectively. Postoperative SCI during hospital stay was more frequent in the high postoperative SII group than in the low postoperative SII group (25.6% vs. 4.9%; P<0.001). Multivariate analysis revealed that a high immediate postoperative SII was a predictor of postoperative SCI (odds ratio, 11.61; 95% CI: 5.20-26.00; P<0.001). Postoperative SCI was lower in group LL than in group LH (3.6% vs. 23.5%, P<0.008) and was lower in group HL than in groups HH and LH (9.6% vs. 31.8% and 23.5%, both P<0.05).

Conclusions:
A high immediate postoperative SII was associated with postoperative SCI during hospital stay in MMD patients who underwent revascularization surgery.
Clinical Outcome of Lumbar Hybrid Surgery in a Consecutive Series of Patients With Long-term Follow-up
Authors: Shellock Jessica L. , Zigler Jack E. , Blumenthal Scott L. , Guyer Richard D. , Ohnmeiss Donna D. 
Published: May 2024

Study Design.
This was a retrospective study combined with attempted prospective patient contact to collect current data.

Objective.
The purpose of this study was to investigate the long-term clinical outcomes of patients undergoing lumbar hybrid surgery (total disk replacement (TDR) at one level and fusion at an adjacent level.

Summary of Background Data.
Many patients with symptomatic lumbar disk degeneration are affected at more than one level. Lumbar TDR was introduced as a fusion alternative; however, some disk levels are not amenable to TDR, and fusion is preferable at such levels. Hybrid surgery was introduced as an option to fusing multiple levels.

Methods.
A consecutive series of 305 patients undergoing lumbar hybrid surgery was identified, beginning with the first case experience in 2005. Operative and clinical outcome data, including visual analog scales (VAS) assessing back and leg pain, Oswestry Disability Index (ODI), and reoperations, were collected. The mean follow-up duration was 67.1 months.

Results.
There were statistically significant improvements (P<0.01) in the mean values of all three clinical outcome measures: VAS back pain scores improved from 6.7 to 3.3; leg pain improved from 4.3 to 2.0; and ODI scores improved from 45.5 to 24.6. There were no significant differences in pain and function scores for patients with a minimum 10-year follow-up versus those with a shorter follow-up duration. Re-operation occurred in 16.1% of patients, many of which involved removal of posterior instrumentation at the fusion level (6.2% of the study group, 38.8% of re-operations). Reoperation involving the TDR level occurred in 9 patients (2.9%), only 3 of which (1.0%) involved TDR removal/revision.

Conclusion.
This study supports that for many patients with multilevel symptomatic disk degeneration, hybrid surgery is a viable surgical option. Significant improvements were demonstrated in pain and function scores, with no diminished improvement in scores among patients with more than 10-year follow-up.

Level of Evidence.
Level IV
Does Paraspinal Muscle Mass Predict Lumbar Lordosis Before and After Decompression for Degenerative Spinal Stenosis?
Authors: Narayanan Rajkishen , Ezeonu Teeto , Kellish Alec , Somers Sydney , Lee Yunsoo , Khanna Akshay , Labarbiera Anthony , Fras Sebastian , Canseco Jose A. , Kurd Mark F. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher , Schroeder Gregory D. 
Published: May 2024

Study Design.
Retrospective cohort study.

Objective.
The purpose of this study was to determine whether muscle mass and quality of the lumbar paraspinal muscles was associated with improvements in lumbar lordosis and other sagittal parameters after isolated posterior lumbar decompression surgery for lumbar spinal stenosis.

Summary of Background Data.
Individuals may develop sagittal imbalance over time, either due to degenerative changes or other spinal conditions. In patients with lumbar spinal stenosis, sagittal imbalance can further exacerbate symptoms of pain and radiculopathy. Sarcopenia of paraspinal muscles has been implicated in previous spine research as a variable with influence on surgical outcomes.

Methods.
Sagittal parameters were measured on preoperative and postoperative lateral lumbar radiographs and included lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Preoperative MRI images were evaluated at the base of the L4 vertebral body to assess muscles mass of the psoas muscle and paravertebral muscles (PVM) and the Goutallier grade of the PVM. Patients were divided into three muscle size groups based on PVM normalized for body size (PVM/BMI): Group A (smallest), Group B, and Group C (largest).

Results.
Patients in group C had greater LL preoperatively (51.5° vs. 47.9° vs. 43.2, P=0.005) and postoperatively (52.2° vs. 48.9° vs. 45.7°, P=0.043). There was no significant difference in the ∆LL values between groups (P>0.05). Patients in group C had larger SS preoperatively (35.2° vs. 32.1° vs. 30.0°, P=0.010) and postoperatively (36.1° vs. 33.0° vs. 31.7°, P=0.030). Regression analysis showed that PVM/BMI was a significant predictor of LL preoperatively (P=0.039) and postoperatively (P=0.031), as well as SS preoperatively (P=0.001) and postoperatively (P<0.001).

Conclusions.
Muscle mass of the paravertebral muscles significantly impacts lumbar lordosis and sacral slope in patients with lumbar spinal stenosis before and after posterior lumbar decompression. These findings highlight the need to address risk factors for poor muscle quality in patients with sagittal imbalance.

Level of Evidence.
Level III.
Significance of metastatic lymph nodes ratio in overall survival for patients with resected nonsmall cell lung cancer: a retrospective cohort study
Authors: Lin Xiaoping , Yao Jianfeng , Huang Baoshan , Chen Tebin , Xie Liutian , Huang Rongfu 
Published: May 2024

Objective
The tumor, node and metastasis stage is widely applied to classify lung cancer and is the foundation of clinical decisions. However, increasing studies have pointed out that this staging system is not precise enough for the N status. In this study, we aim to build a convenient survival prediction model that incorporates the current items of lymph node status.

Methods
We performed a retrospective cohort study and collected the data from resectable nonsmall cell lung cancer (NSCLC) (IA-IIIB) patients from the Surveillance, Epidemiology, and End Results database (2006–2015). The x-tile program was applied to calculate the optimal threshold of metastatic lymph node ratio (MLNR). Then, independent prognostic factors were determined by multivariable Cox regression analysis and enrolled to build a nomogram model. The calibration curve as well as the Concordance Index (C-index) were selected to evaluate the nomogram. Finally, patients were grouped based on their specified risk points and divided into three risk levels. The prognostic value of MLNR and examined lymph node numbers (ELNs) were presented in subgroups.

Results Totally,
40853 NSCLC patients after surgery were finally enrolled and analyzed. Age, metastatic lymph node ratio, histology type, adjuvant treatment and American Joint Committee on Cancer 8th T stage were deemed as independent prognostic parameters after multivariable Cox regression analysis. A nomogram was built using those variables, and its efficiency in predicting patients’ survival was better than the conventional American Joint Committee on Cancer stage system after evaluation. Our new model has a significantly higher concordance Index (C-index) (training set, 0.683 v 0.641, respectively; P < 0.01; testing set, 0.676 v 0.638, respectively; P < 0.05). Similarly, the calibration curve shows the nomogram was in better accordance with the actual observations in both cohorts. Then, after risk stratification, we found that MLNR is more reliable than ELNs in predicting overall survival.

Conclusion
We developed a nomogram model for NSCLC patients after surgery. This novel and useful tool outperforms the widely used tumor, node and metastasis staging system and could benefit clinicians in treatment options and cancer control.
Wide Local Excision Before Sentinel Lymph Node Biopsy in Melanoma
Authors: Tassavor Michael , Bland Madalyn , Goldenberg Olivia , Tassavor Bryan , Coldiron Brett 
Published: May 2024

BACKGROUND
Current guidelines suggest that wide local excision of thick melanomas be delayed until sentinel lymph node biopsies can be performed.

OBJECTIVE
To examine the literature and determine if there is a scientific basis for delaying wide local excision of thick melanomas.

MATERIALS AND METHODS
A narrative review of the literature was undertaken to examine all available studies on the subject.

RESULTS
There is no evidence that prior excision compromises sentinel lymph node identification. There are multiple unsubstantiated suggestions that large rotation flaps may lead to false negatives.

CONCLUSION
There is no basis for delaying wide local excision of thick melanomas until a sentinel lymph node biopsy can be performed.
Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study
Authors: Al Aamri Rajaa , Al Yazidi Laila , Al Hashami Hilal , Al Jabri Amal , AL Haddabi Rahma , Al Adawi Badriya 
Published: May 2024

Background:
Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes.

Methods:
We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018.

Results:
Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4–0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5–0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), (P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%.

Conclusions:
The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.
HIV and Undetectable = Untransmittable (U=U)
Authors: Bush Larry M. , Nguyen Cynthia , Maska Edlira 
Published: May 2024

Abstract
Advances in development of antiretroviral therapy and increased utilization of pre-exposure prophylaxis agents have effectively decreased the incidence of HIV sexual transmission. Conversely, at the same moment, there is an epidemic of other sexually transmitted infections in similar high-risk populations that is increasing at an alarming rate. This review aims to provide a summary of the origins and benefits of the Undetectable = Untransmittable (U=U) HIV campaign and the positive impact it has had on HIV prevention, while addressing the concomitant need for implementation of effective strategies to prevent further rise in sexually transmitted infections.
Paget-Schroetter Syndrome in a Patient With Posterior Shoulder Subluxation: A Case Report
Authors: Röthlisberger David , Rashid Mustafa S. , Ruijs Peter , Zumstein Matthias A. 
Published: May 2024

Abstract:
Paget-Schroetter syndrome describes a primary thrombosis of the subclavian vein induced by effort. In most cases, the clinical presentation includes painful swelling, discoloration, and visible collateral circulation in the arm. Paget-Schroetter syndrome is treated with anticoagulation, rest, and physical therapy. In certain cases, invasive treatment such as thrombolysis and decompression surgery (first rib resection) may be necessary. We present the case of a 28-year-old healthy male patient with effort-induced deep vein thrombosis of the upper extremity after posterior shoulder subluxation. Anticoagulation, rest, and physical therapy were used to treat the patient, who became asymptomatic and was able to resume normal activities without restriction. To our knowledge, this is the first case of effort-induced upper extremity deep vein thrombosis after posterior shoulder subluxation. Paget-Schroetter syndrome is rare diagnosis that requires vigilance during musculoskeletal assessment for shoulder pain and swelling. The early detection, radiological confirmation, and prompt initiation of treatment are essential to successful management of Paget-Schroetter syndrome. The impact of associated posterior shoulder subluxation remains unclear.
Failure in HiRes Ultra Series Recall Devices Does Not Necessarily Lead to Decrement in Performance
Authors: Harvey Erin , Khokhar Muhammad , Harris Michael S. , Adams Jazzmyne , Friedland David R. 
Published: May 2024

Objective
To understand the impact on speech perception for patients experiencing Advanced Bionics V1 series Ultra and Ultra 3D cochlear implant failure.

Study Design
Retrospective cohort study.

Setting
Tertiary academic center.

Patients
Adult patients implanted with V1 series devices.

Interventions
Device integrity and speech perception testing.

Main Outcome Measures
consonant–nucleus–consonant and AzBio in quiet speech recognition scores.

Results
At our institution, 116 V1 series cochlear implants were placed in 114 patients. Thirteen devices in prelingual patients were excluded, leaving 103 (89%) for final analysis. Forty-eight (46.6%) devices were considered as failed using the company provided EFI analysis tool. There were 36 (65.5%) of the remaining 55 devices that consistently tested within normal range; the remainder lost to follow-up with unknown status. Among the 48 device failures, 29 were revised and 19 patients were not revised. Among those not revised, 11 self-opted for observation (57.9%). Observed patients, despite impedance changes meeting failure criteria, had no subjective or objective changes in speech perception. Sentence testing scores for failure patients who elected observation (82.9 ± 11.4%) were significantly higher at failure compared with those opting for revision (55 ± 22.8%, p = 0.006). For those undergoing revision surgery, significant improvement in post-activation scores was noted as compared with time of failure with a mean improvement of 12.9% (p = 0.002, n = 24) for consonant–nucleus–consonant word scores and 17.2% (p = 0.001, n = 19) for AzBio in quiet scores.

Conclusions
Proactive monitoring using EFI identifies a higher rate of Ultra Series V1 device failure than previously reported. However, about 20% of these patients may not have subjective change in hearing or objective decline in test scores and could be observed. Should performance worsen, reimplantation provides significant improvement in speech recognition.
Rituximab as a treatment for refractory immune thrombocytopenia during pregnancy
Authors: Sousa Maria I. , Braga António C. , Buchner Graça C. , Braga Jorge S. 
Published: May 2024

Immune thrombocytopenia (ITP) is most common in women during their reproductive years. When a low platelet count occurs for the first time during pregnancy, the differential diagnosis includes pregnancy-specific conditions. Although ITP is the most common cause of thrombocytopenia early in pregnancy, pregnancy-related thrombocytopenia develops mainly in late gestation. As maternal and neonatal outcomes are usually favourable, ITP per se is not a contraindication for pregnancy.
We report the case with a literature review of patient with ITP, whose diagnosis was established in early pregnancy. This condition was refractory to first-line treatments, such as high-dose steroids and intravenous immunoglobulin and other splenectomy-sparing approaches, as rituximab, having the control been reached on the third trimester after splenectomy. Although not effective in this case, we still believe that rituximab should be considered before surgery during pregnancy.
Psychiatric Comorbidities of Incarceration in a Patient With Gender Dysphoria
Authors: Gill Gurtej , Segal Yarden , Srinivas Sushma , Laul Anish , Yadav Garima , McMahon Zachary , Korenis Panagiota 
Published: May 2024

Abstract

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines gender identity disorder (GID) as a strong and persistent identification with the opposite sex and the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. The onset of GID commonly begins early in childhood. Gender dysphoria has a higher prevalence of other comorbid psychiatric illnesses, such as mood, anxiety, and adjustment disorders, with increased suicide incidence and self-harming behaviors than the general population. Studies show that some temperamental, environmental, genetic, and psychological factors play a role in developing GID. Approximately 16% of transgender people and 21% of transgender women get incarcerated compared with the general US population. During incarceration, they face many issues, such as victimization, severe verbal harassment, purposeful humiliation, unwanted sexual advances, physical assault, forcible sex, and unwanted strip searches. There is a need for a better understanding of the issues and needs of this population to promote positive outcomes.
Well-Being Therapy for Fibromyalgia
Authors: Olivero Alberto , Cuniberti Francesco , Leombruni Paolo 
Published: May 2024

Abstract
Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, fatigue, anxiety, depression, and sleep disturbances, significantly impairing quality of life and psychological well-being. Well-being therapy (WBT) is a brief psychotherapeutic intervention aimed at increasing well-being and optimizing functioning, which has proven effective in treating various conditions involving pain and psychological or psychiatric symptoms. We describe a case study of a 22-year-old university student experiencing FMS, highlighting the far-reaching effects of the condition on her quality of life. After eight sessions of WBT, there was a marked improvement in subjective well-being and euthymia, as well as a decrease in pain perception, improved ability to manage stress, reduced allostatic overload despite the presence of stressors, improved social relationships, and increased self-efficacy. The positive effects of WBT continued at 3-month follow-up, suggesting that WBT may represent a short-term effective intervention for patients with FMS.
Predictors of real-world response in adults treated with botulinumtoxin-A for upper limb spasticity
Authors: Fheodoroff Klemens , Jacinto Jorge , Ashford Stephen , Danchenko Natalya , Grandoulier Anne-Sophie , Pietri Guilhem , Bourhis Yann , Spurden Dean , Turner-Stokes Lynne 
Published: May 2024

Background:
To explore predictors of treatment response in adults receiving botulinumtoxin-A (BoNT-A) for upper limb spasticity (ULS) and to describe the association between response and concomitant medication, professional physical therapy, and quality of life (QoL).

Methods:
This was a secondary analysis of the longitudinal Upper Limb International Spasticity study (ULIS-III) data set. Eligible patients were adults receiving/initiating BoNT-A treatment for ULS in clinical practice. The treatment response was a goal attainment scaling (GAS) T score change of ≥10 points from baseline to follow-up for each cycle. Concomitant medication was recorded. Time spent on professional physical therapy and self-management was recorded using the Upper Limb Focal Spasticity Therapy Recording (ULSTR) schedule. QoL was assessed using the EQ-5D-5L questionnaire. Baseline patient and clinical characteristics were described. Factors predictive of treatment response were explored using stepwise multivariable regression modeling (linear or logistic as appropriate for the outcome) and backward elimination (α=0.1).

Results:
Overall, 828/981 patients had response data; 71.9% responded to BoNT-A therapy. Potential predictors of response identified were the use of injection guidance techniques (P=0.001), female sex (P=0.031), and abobotulinumtoxin-A therapy (vs. onabotulinumtoxin-A; P<0.001). Compared with nonresponders, responders had marginally lower use of concomitant medication, received marginally more professional physical therapy and (subgroup only) had improved QoL. Age, duration/distribution, severity of impairment, and previous BoNT-A had no predictive value.

Conclusions:
Future analyses of ULIS-III data will aim to validate these findings and further explore determinants of treatment response and the interplay between care modalities.