bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients
Authors: Palka Sydney V. , Gonillo-Davis Jenna A. , George Benjamin P. , McHugh Daryl C. 
Published: March 2024

OBJECTIVES:
To determine the association between spontaneous hypothermia (SH), defined as initial post-resuscitation core body temperature less than 34°C, and diffuse anoxic brain injury (DABI) on initial CT scan of the head (CTH) in post-cardiac arrest patients.

DESIGN, SETTING, AND PARTICIPANTS:
This was a retrospective, observational cohort study. This study was performed at the University of Rochester Medical Center Strong Memorial Hospital. All in-hospital and out-of-hospital cardiac arrest patients with return of spontaneous circulation admitted between January 1, 2022, and October 31, 2022, were included.

MAIN OUTCOMES AND MEASURES:
The primary outcomes were the odds of DABI on initial CTH for patients with SH compared with patients without SH post-cardiac arrest using a multivariable logistic regression controlling for patient covariates including basic demographics and arrest features. DABI on initial CTH was measured qualitatively and quantitatively using neuroradiologist interpretation and calculated gray-white matter ratio of the basal ganglia, respectively. Secondary outcome measures included length of stay (LOS), inpatient mortality, and those who underwent withdrawal of life-sustaining therapy (WOLST) or progression to brain death.

RESULTS:
Out of the observed 150 cases of cardiac arrest, 31 patients (21%) had SH. Of the 128 patients who had an initial CTH performed, 27 (21%) had DABI. The adjusted odds ratio of DABI on initial CTH associated with SH was 3.55 (95% CI, 1.08–11.64; p = 0.036) and 2.18 (95% CI, 0.69–6.91; p = 0.182) when DABI was measured qualitatively and quantitatively, respectively, after controlling for multiple covariates. There was a difference observed in LOS between the groups (3 vs. 10 d; p = 0.0005) and this was driven by early WOLST.

CONCLUSIONS AND REVELANCE:
Patients presenting with SH after cardiac arrest may be at greater risk of early DABI on initial CTH compared with those with higher body temperatures in the post-arrest period. Recognition of early SH may help to risk stratify post-cardiac arrest patients at highest risk of DABI.
Modified percutaneous nephropexy for nephroptosis: Technical description and short-term results
Authors: Liu Honglei , Gao Wenzhi , Zhang Zheng , Yang Kunlin , Meng Chang , Wang Bing , Han Yangjun , Diao Mingxin , Zuo Chao , Zhang Minghua , Diao Yingzhi , Li Zhihua , Li Xinfei , Wang Gang , Wang Chunji , Gao Zihui , Gu Yaming , Li Xuesong 
Published: March 2024

Abstract

Objectives
Percutaneous nephropexy (PCN) has been demonstrated as a feasible method for treating nephroptosis. This study describes an improved technique for PCN that better addresses the issue of nephroptosis.

Materials and methods
We reviewed 4 patients who underwent the improved PCN procedure between January 2021 and January 2023. These patients were diagnosed with nephroptosis, with 1 case having both a narrow ureteropelvic junction and nephroptosis due to a kidney stone, and 3 cases having simple nephroptosis. Patient characteristics, perioperative data, and follow-up results were collected. Surgical success was determined by symptom relief (subjective success) and the absence of kidney descent by intravenous pyelography (objective success).

Results
Preoperative computed tomography urography showed that all patients had hydronephrosis, with severe hydronephrosis in 75% (3/4) and moderate hydronephrosis in 25% (1/4) of cases. The mean operative time was 63.8 minutes (range, 45–95 minutes), and the mean blood loss was 5 mL (range, 5–50 mL). The mean length of hospital stay was 4.5 days (range, 3–6 days). The mean time to removal of the nephrostomy tube was 2 months (range, 1–4 months). No serious complications (Clavien-Dindo grade ≥3) occurred during or after the procedure. The mean postoperative serum creatinine level was 54.75 μmoI/L (range, 43–65 μmoI/L). The mean follow-up time was 6.25 months (range, 4–8 months). The objective and subjective success rates were both 100%.

Conclusions
The improved PCN procedure that was used in this study is feasible and provides a good option for treating nephroptosis.
Prevalence and influencing factors of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer
Authors: Fang Xiao , Ren Kong , Li Yan , Meng Qiao , Li Mingyue , Miao Miao , Zhan Jing , Wang Xia , Wu Fei , Zhang Meixia 
Published: March 2024

AbstractObjectivesThis study aims to not only investigate the prevalence of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer but also identify the contributing factors.Materials and methodsA total of 245 elderly patients diagnosed with prostate cancer and undergoing radical prostatectomy at a tertiary care general hospital in Jinan were included in this study. To assess the patients, several questionnaires were used. These included the General Situation Questionnaire, General Alienation Scale, Social Impact Scale, Modified Memorial Anxiety Scale for Prostate Cancer, and Perceived Social Support Scale. Pearson correlation analysis was conducted to examine the relationships between variables, whereas multiple linear regression was used to identify the factors influencing social alienation among patients who underwent radical prostatectomy.ResultsPatients who underwent radical prostatectomy had a mean total score of 44.13 ± 7.24 on the Social Alienation Scale. The results of the Pearson correlation analysis indicated that social alienation showed an inverse association with social support (r= −0.627,p< 0.05) and positive associations with age, disease stigma, and anxiety (r= 0.325, 0.575, 0.421, allp’s < 0.01) among patients who underwent radical prostatectomy. The findings from multiple linear regression analysis demonstrated that educational level, age, urinary incontinence, disease stigma, anxiety, and social support significantly influenced social alienation among elderly patients who underwent radical prostatectomy (p< 0.05).ConclusionsElderly patients who undergo radical prostatectomy often experience social alienation. This study found that social alienation was associated with factors such as educational level, age, urinary incontinence, social support, anxiety, and disease stigma. Consequently, healthcare providers should actively monitor the degree of social alienation in elderly patients after radical prostatectomy and provide suitable psychological care to facilitate positive social reintegration and alleviate their feelings of social alienation.
ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN DIABETIC MACULAR EDEMA
Authors: Zur Dinah , Hod Keren , Trivizki Omer , Rabinovitch David , Schwartz Shulamit , Shulman Shiri 
Published: March 2024

Purpose:
To explore visual acuity (VA) outcomes of anti–vascular endothelial growth factor (VEGF) intravitreal injections in treatment-naive eyes with diabetic macular edema (DME), with bevacizumab as first-line treatment.

Methods:
Retrospective single-center cohort study over a three-year follow-up. Overall, 1765 eyes from 1179 patients treated with intravitreal injections were evaluated. The cohort was divided according to the treatment given: (1) bevacizumab monotherapy, (2) eyes switched to a second-line agent, and (3) eyes switched to a third-line agent.

Results:
In total, 644 eyes of 444 patients met inclusion criteria. The mean age at presentation was 64.0 ± 11.1 years. The mean follow-up period was 24.6 ± 12.4 months. Furthermore, 67.1% of eyes were treated with bevacizumab monotherapy, 25.45% switched to a second-line agent, and 7.45% were switched to a third-line agent. The mean number of injections decreased significantly during each treatment year in the total cohort and within each treatment group (P < 0.001). Mean VA for the total cohort and within each treatment group improved significantly throughout follow-up (P < 0.001). No significant difference in VA was found between the groups (P = 0.373).

Conclusion:
This real-world study demonstrates robust and consistent VA gains over long-term follow-up in eyes with DME treated with either bevacizumab monotherapy or switching to alternative anti-VEGF agents in cases of suboptimal response.
CONCENTRIC MACULAR RINGS SIGN IN COMBINED HAMARTOMA OF RETINA AND RETINAL PIGMENT EPITHELIUM
Authors: da Silva Conci Lívia , Maia Renata Martins , Cavalcanti Lira Rodrigo Pessoa , Zacharias Leandro Cabral , Cunha de Souza Eduardo , Gianotti Pimentel Sergio Luis , Shields Carol 
Published: March 2024

Purpose:
To describe two cases of concentric macular rings (CMR) sign in patients with combined hamartoma of retina and retinal pigment epithelium (CHRRPE).

Methods:
History and clinical examination, spectral-domain optical coherence tomography (SD-OCT), and optic coherence tomography angiography (OCTA)

Results:
The first patient was a 26-year-old woman with clinical diagnosis of Neurofibromatosis type 2. The Best-Corrected Visual Acuity (BCVA) was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). She presented a subtle grayish lesion in the macular region of OD. On macular SD-OCT, there was a thickened and disorganized retina, suggestive of CHRRPE. In addition, at the parafoveal region, there was a dentate pattern in the outer plexiform layer (OPL) and Henle fiber layer (HFL) on cross-sectional SD-OCT. OCTA showed no foveal avascular zone (FAZ) in OD and Optos ultra-wide-field revealed CMR sign in this eye. The second patient was a 14-year-old boy, with diabetes mellitus type 1. His BCVA was 20/25 in OD and 20/20 in OS. He had a subtle whitish lesion in the macular region of OD, with SD-OCT findings suggestive of CHRRPE. Similar to the first case, there was a dentate pattern in the OPL and HFL, on SD-OCT. In OD, blue reflectance images exhibited the CMR sign, and OCTA showed absent FAZ.

Conclusion:
CHRRPE may be related to changes in the OPL and HFL interface and may present the CMR sign.
Double-Bubble Technique Assisted by Holding Forceps: A Modified Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes With Scleral Fixated Intraocular Lens
Authors: Igarashi Ami , Yokogawa Hideaki , Shimizu Toshiki , Kobayashi Akira , Yamagami Satoru , Hayashi Takahiko 
Published: March 2024

Purpose:
Several techniques have been developed for graft unfolding approaches in Descemet membrane endothelial keratoplasty (DMEK). However, despite these techniques, graft deployment and configuration in eyes with deep anterior chambers remain challenging in some cases. Therefore, in this study, we described a modified technique for DMEK, known as the “double-bubble technique assisted by holding forceps.”

Methods:
This was a retrospective interventional case series. Patients who underwent DMEK between August 2022 and July 2023, including cases with a history of vitrectomy and scleral fixation of intraocular lens, were enrolled in this study. Two experienced surgeons performed DMEK. In brief, after graft insertion into the anterior chamber, the first bubble with a small volume of air was injected above the graft to open the tight roll, and the graft edge was held using a 25-gauge graft manipulator. The second bubble was injected underneath the graft for fixation, while the graft edge was grasped using forceps during gas injection. The graft was released from the forceps. Best spectacle corrected visual acuity, central corneal thickness, endothelial cell density, and incidence of postoperative complications were measured before and after DMEK.

Results:
Eleven eyes of 11 patients were included in this study (mean follow-up period, 4.5 ± 4.4 months). Best spectacle corrected visual acuity and central corneal thickness significantly improved postoperatively (P < 0.001). Rebubbling was required in 2 eyes; no other postoperative complications or primary graft failure were observed.

Conclusions:
The present technique enables safe and feasible DMEK surgery in vitrectomized eyes with scleral fixated IOLs and in those with a deep anterior chamber.
Traumatic flap dehiscence 15 years after LASIK: case report and review of the literature
Authors: Slavinsky Victoria , Mahan Marielle , Donovan Kelsey , Turlapati Namratha , Lustbader Jay 
Published: March 2024

Introduction:
Corneal flap trauma rarely occurs years after laser in situ keratomileusis (LASIK), and management is not standardized. The authors report a case of LASIK flap dehiscence 15 years postoperatively with a review of the literature describing clinical characteristics, management, and outcomes of similar cases occurring at least 6 years postoperatively.

Patient and Clinical Findings:
A 55-year-old man with a history of LASIK surgery 15 years prior presented with flap dehiscence after trauma with a tree branch. His right eye uncorrected distance visual acuity (UDVA) at presentation was counting fingers. On slitlamp examination, the medial flap edge was folded underneath the temporal aspect.

Diagnosis, Intervention, and Outcomes:
The flap was unfolded, irrigated, repositioned, and instilled with topical antibiotics. The patient was started on prednisolone acetate 1% and moxifloxacin. On postoperative day 1, his UDVA improved to 20/50 and the flap remained centered and clear. His vision stabilized at 20/30 after 7 months. Peripheral epithelial ingrowth was noted without visual axis obscuration.

Conclusions:
This case, along with 20 reported instances of late traumatic flap dehiscence, highlights that early recognition with prompt intervention can optimize visual outcomes. Comparison of injury mechanisms, treatments, and complications may guide surgeons in patient counseling and care.
Suicide by Gunshot Wound to the Posterior Head and Neck: A Retrospective Case Series and Review of the Literature
Authors: Bovio Nicholas R. , Brooks Jared K. , Prahlow Joseph A. 
Published: March 2024

Abstract
Suicide by firearm is a significant public health concern in specific regions of the world. Depending on firearm availability, any type of firearm may be used, including handguns, shotguns, and long rifles. Common entrance wound sites in suicidal gunshot wounds include the head, with classic gunshot wound locations including the temple, the forehead, the submental aspect of the chin, and inside the mouth. Occasionally, suicidal gunshot wounds occur in atypical body locations such as the back of the head and neck. Given their relative rarity, suicidal gunshot wounds in these regions may be mistaken for homicides. In this report, we present 5 cases of suicidal gunshot wounds to the back of the head and/or neck. In our series, we focus on differentiating each case from homicides involving gunshot wounds in similar areas of the head and neck.
Patient Safety Indicators During the Initial COVID-19 Pandemic Surge in the United States
Authors: Rodriguez Jorge A. , Samal Lipika , Ganesan Sandya , Yuan Nina H. , Wien Matthew , Ng Kenney , Huang Hu , Park Yoonyoung , Rajmane Amol , Jackson Gretchen Purcell , Lipsitz Stuart R. , Bates David W. , Levine David M. 
Published: March 2024

Objective
The COVID-19 pandemic presented a challenge to inpatient safety. It is unknown whether there were spillover effects due to COVID-19 into non–COVID-19 care and safety. We sought to evaluate the changes in inpatient Agency for Healthcare Research and Quality patient safety indicators (PSIs) in the United States before and during the first surge of the pandemic among patients admitted without COVID-19.

Methods
We analyzed trends in PSIs from January 2019 to June 2020 in patients without COVID-19 using data from IBM MarketScan Commercial Database. We included members of employer-sponsored or Medicare supplemental health plans with inpatient, non–COVID-19 admissions. The primary outcomes were risk-adjusted composite and individual PSIs.

Results
We analyzed 1,869,430 patients admitted without COVID-19. Among patients without COVID-19, the composite PSI score was not significantly different when comparing the first surge (Q2 2020) to the prepandemic period (e.g., Q2 2020 score of 2.46 [95% confidence interval {CI}, 2.34–2.58] versus Q1 2020 score of 2.37 [95% CI, 2.27–2.46]; P = 0.22). Individual PSIs for these patients during Q2 2020 were also not significantly different, except in-hospital fall with hip fracture (e.g., Q2 2020 was 3.42 [95% CI, 3.34–3.49] versus Q4 2019 was 2.45 [95% CI, 2.40–2.50]; P = 0.01).

Conclusions
The first surge of COVID-19 was not associated with worse inpatient safety for patients without COVID-19, highlighting the ability of the healthcare system to respond to the initial surge of the pandemic.
Detection Rate of Small Pancreas Cysts and Intrareader Reliability of the Cysts Size Measurements on Transabdominal Ultrasonography
Authors: Yoon Do Won , Kim Dong Kyu , Kim Taeho , Lee Kyu-Chong 
Published: March 2024

Abstract
This study aimed to assess the detection rate of small (<10 mm) pancreas cyst and intrareader reliability for cyst size measurements on transabdominal ultrasonography (US). From 2020 to 2022, 194 pancreas cysts in 173 patients, incidentally detected on computed tomography or magnetic resonance imaging, were evaluated on US by 1 of 2 radiologists (readers 1 and 2). Intrareader agreements of cyst size measurements on US were assessed by intraclass correlation coefficient (ICC). Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. In this study, readers 1 and 2 evaluated 86 cysts in 76 patients and 108 cysts in 97 patients, respectively. Most of the cysts (191 of 194) were located in the nontail portion of the pancreas. Overall detection rate of pancreas cysts by US was 92.3% (179 of 194). The mean size of measured 179 pancreas cysts was 4.7 ± 1.5 mm. The readers showed excellent intrareader agreements (ICC = 0.925 and 0.960) for cyst size measurements, except for the cysts with size ≤5 mm, where both readers showed good intrareader agreements (ICC = 0.848 and 0.873). The 95% limits of agreement of readers 1 and 2 were 13.8% and 14.9% of the mean, respectively. Therefore, transabdominal US could be a reliable follow-up imaging modality for small (<10 mm) nontail pancreas cysts incidentally detected on computed tomography or magnetic resonance imaging, especially for the cysts with size between 5 and 10 mm. Size changes of the pancreas cysts approximately less than 15% may be within the measurement error.
Provider Experience With the Use of Ketamine for Refractory Status Epilepticus
Authors: Tantillo Gabriela , Davis Nicole , Granstein Justin , Yoo Ji Yeoun , Agarwal Parul , Reilly Kaitlin , Reynolds Alexandra , Kayal Gina , Liang John , Jetté Nathalie 
Published: March 2024

Objective
Refractory status epilepticus (RSE) treated with anesthetic agents can be associated with complications including respiratory depression and hypotension. Ketamine is an emerging RSE treatment, but optimal dosing and timing are unknown. We studied provider attitudes and practices regarding the use of ketamine for RSE.

Methods
A literature review informed the creation of the survey, developed by professionals in epilepsy, pharmacy, and neurocritical care. The survey was distributed to members of the Critical Care EEG Monitoring and Research Consortium, Neurocritical Care Society, American Academy of Neurology Synapse community, American Epilepsy Society, and the Canadian League Against Epilepsy. Descriptive statistics were calculated.

Results
There were 109 respondents. First-line agents for RSE were midazolam (53%), propofol (42%), pentobarbital (2%), and ketamine (1%). Reasons for ketamine use included failure of midazolam/propofol to control seizures (81%) or hypotension on another anesthetic (35%). Perceived contraindications included hypertension (37%), elevated intracranial pressure (24%), and heart failure (18%). Perceived benefits included decreased use of vasopressors (53%) and more rapid RSE control when used adjunctively (49%). Routine ketamine users often treated more than 10 RSE cases per year, worked as intensivists or at academic institutions. Of the respondents, 59% found ketamine useful for RSE and 94% were interested in learning more about its use.

Conclusions
Although most participants found ketamine helpful for RSE, it is mainly used as a second-line agent adjunctively with midazolam or propofol. Perceived ketamine benefits included decreased need for hemodynamic support and more rapid seizure control when used in conjunction with other anesthetics. Perceived contraindications centered on cardiac and intracranial pressure concerns.
Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study
Authors: Ozsurekci Cemile , Satis Neslihan Kayahan , Demircan Sultan Keskin , Naharci Mehmet Ilkin 
Published: March 2024

BackgroundThe purpose of this study was to investigate the relationship between anticholinergic burden (ACB), and cognitive and functional alterations in patients with dementia of Lewy bodies (DLB) during a 1-year follow-up period.MethodsThis cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0.ResultsA total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (allP<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment.ConclusionOur study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.