bluuebunny/crossref_metadata_2025_split huggingface dataset:
Resource Utilization Following Anterior Versus Posterior Cervical Decompression and Fusion for Acute Central Cord Syndrome
Authors: Du Jerry Y. , Shafi Karim , Blackburn Collin W. , Chapman Jens R. , Ahn Nicholas U. , Marcus Randall E. , Albert Todd J. 
Published: March 2024

Study Design:
Retrospective cohort study.

Objective:
The purpose of this study is to compare the impact of anterior cervical decompression and fusion (ACDF) versus posterior cervical decompression and fusion (PCDF) for the treatment of acute traumatic central cord syndrome (CCS) on hospital episodes of care in terms of (1) cost, (2) length of hospital stay, and (3) discharge destination.

Summary of Background Data:
Acute traumatic CCS is the most common form of spinal cord injury in the United States. CCS is commonly treated with surgical decompression and fusion. Hospital resource utilization based on surgical approach remains unclear.

Methods:
Patients undergoing ACDF and PCDF for acute traumatic CCS were identified using the 2019 Medicare Provider Analysis and Review Limited Data Set and Centers for Medicare and Medicaid Services 2019 Impact File. Multivariate models for hospital cost of care, length of stay, and discharge destination were performed, controlling for confounders. Subanalysis of accommodation and revenue center cost drivers was performed.

Results:
There were 1474 cases that met inclusion criteria: 673 ACDF (45.7%) and 801 PCDF (54.3%). ACDF was independently associated with a decreased cost of $9802 (P<0.001) and a 59.2% decreased risk of discharge to nonhome destinations (adjusted odds ratio: 0.408, P<0.001). The difference in length of stay was not statistically significant. On subanalysis of cost drivers, ACDF was associated with decreased charges ($55,736, P<0.001) compared with PCDF, the largest drivers being the intensive care unit ($15,873, 28% of total charges, P<0.001) and medical/surgical supply charges ($19,651, 35% of total charges, P<0.001).

Conclusions:
For treatment of acute traumatic CCS, ACDF was associated with almost $10,000 less expensive cost of care and a 60% decreased risk of discharge to nonhome destination compared with PCDF. The largest cost drivers appear to be ICU and medical/surgical-related. These findings may inform value-based decisions regarding the treatment of acute traumatic CCS. However, injury and patient clinical factors should always be prioritized in surgical decision-making, and increased granularity in reimbursement policies is needed to prevent financial disincentives in the treatment of patients with CCS better addressed with posterior approach-surgery.
Somatic CDKN2A copy number variations are associated with the prognosis of esophageal squamous cell dysplasia
Authors: Fan Zhiyuan , Zhou Jing , Tian Yuan , Qin Yu , Liu Zhaojun , Gu Liankun , Dawsey Sanford M. , Wei Wenqiang , Deng Dajun 
Published: March 2024

Abstract

Background:
Somatic copy number variations (SCNVs) in the CDKN2A gene are among the most frequent events in the dysplasia-carcinoma sequence of esophageal squamous cell carcinoma. However, whether CDKN2A SCNVs are useful biomarkers for the risk stratification and management of patients with esophageal squamous cell dysplasia (ESCdys) is unknown. This study aimed to investigate the characteristics and prognostic value of CDKN2A SCNVs in patients with mild or moderate (m/M) ESCdys.

Methods:
This study conducted a prospective multicenter study of 205 patients with a baseline diagnosis of m/M ESCdys in five high-risk regions of China (Ci County, Hebei Province; Yanting, Sichuan Province; Linzhou, Henan Province; Yangzhong, Jiangsu Province; and Feicheng, Shandong Province) from 2005 to 2019. Genomic DNA was extracted from paraffin biopsy samples and paired peripheral white blood cells from patients, and a quantitative polymerase chain reaction assay, P16-Light, was used to detect CDKN2A copy number. The cumulative regression and progression rates of ESCdys were evaluated using competing risk models.

Results:
A total of 205 patients with baseline m/M ESCdys were enrolled. The proportion of ESCdys regression was significantly lower in the CDKN2A deletion cohort than in the diploid and amplification cohorts (18.8% [13/69] vs. 35.0% [28/80] vs. 51.8% [29/56], P <0.001). In the univariable competing risk analysis, the cumulative regression rate was statistically significantly lower (P = 0.008), while the cumulative progression rate was higher (P = 0.017) in ESCdys patients with CDKN2A deletion than in those without CDKN2A deletion. CDKN2A deletion was also an independent predictor of prognosis in ESCdys (P = 0.004) in the multivariable analysis.

Conclusion:
The results indicated that CDKN2A SCNVs are associated with the prognosis of ESCdys and may serve as potential biomarkers for risk stratification.
Single-incision laparoscopic surgery transabdominal preperitoneal approach for hernia in elderly: A cross-sectional study
Authors: Pham Van Thuong , Vu Ngoc Son , Do Minh-Tung 
Published: March 2024

Abstract

Background
Only a few studies on single-incision laparoscopic surgery for transabdominal preperitoneal (SILS-TAPP) inguinal hernia (IH) repair have been conducted. Thus, we aimed to verify whether SILS-TAPP IH repair in elderly patients (≥65 years old) is safe and effective for nonelderly patients (<65 years old).

Materials and Methods
A retrospective study of 91 patients who underwent SILS-TAPP for IH between November 2011 and April 2014 and were followed up until June 2018 was conducted. The inclusion criterion was SILS-TAPP for unilateral IH, regardless of primary or recurrent. The main variables of interest were age, body mass index, comorbidities, IH classification, operation time, perioperative and postoperative complications, postoperative visual analog scale pain score, long-term complications, and recurrence.

Results
Elderly patients had a higher prevalence of comorbidities and higher American Society of Anesthesiologists physical status scores than nonelderly patients. Intraoperative characteristics, including IH classification and size of the internal hernia ring, were similar. Operation time did not differ between the 2 groups (44.1 ± 14.7 minutes in the elderly versus 49.8 ± 19.7 minutes in the nonelderly). The postoperative pain score, short- and long-term complications, and recurrence rates were similar between the groups.

Conclusions
SILS-TAPP is safe, feasible, and an alternative treatment for IH in the elderly.
Bisphosphonate-related osteonecrosis of the jaw: Is the medication duration related to advanced disease stage?
Authors: Su Yu-Pin , Liu Wen-Chung , Lin Cheng-Ta , Chien Hsin-I , Yang Kuo-Chung 
Published: March 2024

Abstract

Background
Osteonecrosis of the jaw (ONJ) is a serious adverse effect of therapy with bisphosphonates (BP) and other antiresorptive agents. The aim of the study was to report 13 patient cases of bisphosphonates-related osteonecrosis of the jaw (BRONJ) at Kaohsiung Veterans General Hospital (VGHKS), Taiwan, and their medical history and disease outcomes.

Materials and Methods
Thirteen symptomatic patients with BRONJ were reviewed between 1985 and 2021 at VGHKS. We included symptomatic patients who were in advanced BRONJ stages 2 and 3: 4 multiple myeloma, 3 bone metastatic breast cancer, and 6 advanced osteoporosis patients.

Results
Seven patients were American Association of Oral and Maxillofacial Surgeons’ medication-related osteonecrosis of the jaw stage 3, and 6 were stage 2. The average antiresorptive medication duration was 25.83 ± 31.45 months in BRONJ stage 2 patients and 53.71 ± 31.25 months in BRONJ stage 3 patients, respectively. No correlation was found between the antiresorptive agent duration and BRONJ stage (P = 0.098; Mann-Whitney U test) among cancer (P = 0.157; Mann-Whitney U test) and osteoporosis patients (P = 0.184; Mann-Whitney U test).

Conclusions
Most of them died of terminal stage cancer disease or complications of being bedridden. The correlation between the duration of antiresorptive agents and BRONJ stage needs larger patient data to confirm the result.
Implementation of a standardized management protocol improved the survival of patients with necrotizing fasciitis
Authors: Tsai Shih-Chen , Cheng Yin , Fang Chi-Tai , Tai Hao-Chih , Cheng Nai-Chen 
Published: March 2024

Abstract

Background
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent interventions. This study aimed to investigate the effect of implementation of a standardized management protocol on the outcome of NF patients admitted to the intensive care unit.

Materials and Methods
We initiated a management protocol for NF patients in 2012 at our institution. The protocol consisted of early surgical intervention, initial board-spectrum antibiotic regimen, daily wound inspection, repeated debridement, and interprofessional collaboration. Herein, we reviewed the NF cases admitted between 2005 and 2018 and compared their clinical features and outcome before and after the protocol implementation. All of the NF cases were confirmed by intraoperative findings.

Results
We included 134 NF patients before (2005 to 2011, n = 62) and after (2013 to 2018, n = 72) the protocol implementation. The baseline patient profile from these 2 periods was largely similar, except that after protocol implementation, more patients presented with erythema (64.5% vs 84.7%) and a higher C-reactive protein level (65.5% vs 85.5%) on admission. Notably, the day 28–censored mortality was significantly lower after protocol implementation (40.3% vs 13.9%). By analyzing the 28-day mortality with univariate and multivariate model, initial presentation with neutropenia was identified as a risk factor [hazard ratio (HR) = 8.45, 95% confidence interval (CI) = 1.76–40.6], while protocol implementation (HR = 0.27, 95% CI = 0.11–0.71) was a protective factor.

Conclusions
A multidisciplinary bundle care protocol for NF including board-spectrum empirical antibiotic regimen and interprofessional collaboration was feasible, which was associated with improved overall and 28-day survival.
Genotype correlates with clinical course and outcome of children with tight junction protein 2 (TJP2) deficiency–related cholestasis
Authors: Lal Bikrant Bihari , Alam Seema , Sibal Anupam , Kumar Karunesh , Hosaagrahara Ramakrishna Somashekara , Shah Vaibhav , Dheivamani Nirmala , Bavdekar Ashish , Nagral Aabha , Wadhwa Nishant , Maria Arjun , Shah Aashay , Shah Ira , Nalwalla Zahabiya , Snehavardhan Pandey , Srikanth K.P. , Gupta Subhash , Sivaramakrishnan Viswanathan M. , Waikar Yogesh , Suchismita Arya , Ashritha A. , Sood Vikrant , Khanna Rajeev ,   Indian PFIC Registry
Published: March 2024

Background and Aims:
The study aimed to describe the clinical course and outcomes, and analyze the genotype-phenotype correlation in patients with tight junction protein 2 (TJP2) deficiency.

Approach and Results:
Data from all children with chronic cholestasis and either homozygous or compound heterozygous mutations in TJP2 were extracted and analyzed. The patients were categorized into 3 genotypes: TJP2-A (missense mutations on both alleles), TJP2-B (missense mutation on one allele and a predicted protein-truncating mutation [PPTM] on the other), and TJP2-C (PPTMs on both alleles). A total of 278 cases of genetic intrahepatic cholestasis were studied, with TJP2 deficiency accounting for 44 cases (15.8%). Of these, 29 were homozygous and 15 were compound heterozygous variants of TJP2. TJP2-A genotype was identified in 21 (47.7%), TJP2-B in 7 cases (15.9%), and TJP2-C in 16 cases (36.4%), respectively. Patients with the TJP2-C genotype were more likely to experience early infantile cholestasis (87.5% vs. 53.5%, p=0.033), less likely to clear jaundice (12.5% vs. 52.2%, p=0.037), more likely to develop ascites, and had higher serum bile acids. Patients with the TJP2-C genotype were more likely to die or require liver transplantation (native liver survival: 12.5% vs. 78.6%, p<0.001), with a median age at death/liver transplantation of 2.5 years. Cox regression analysis revealed that TJP2-C mutations (p=0.003) and failure to resolve jaundice (p=0.049) were independent predictors of poor outcomes.

Conclusions:
Patients with the TJP2-C genotype carrying PPTMs in both alleles had a rapidly progressive course, leading to early decompensation and death if they did not receive timely liver transplantation.
Suprachoroidal Space Injection Technique: Expert Panel Guidance
Authors: Wykoff Charles C. , Avery Robert L. , Barakat Mark R. , Boyer David S. , Brown David M. , Brucker Alexander J. , Cunningham Emmett T. , Heier Jeffrey S. , Holekamp Nancy M. , Kaiser Peter K. , Khanani Arshad M. , Kim Judy E. , Demirci Hakan , Regillo Carl D. , Yiu Glenn , Ciulla Thomas A. 
Published: March 2024

Purpose:
To develop professional guidelines for best practices for suprachoroidal space (SCS) injection, an innovative technique for retinal therapeutic delivery, based on current published evidence and clinical experience.

Methods:
A panel of expert ophthalmologists reviewed current published evidence and clinical experience during a live working group meeting to define points of consensus and key clinical considerations to inform the development of guidelines for in-office SCS injection.

Results:
Core consensus guidelines for in-office SCS injection were reached and reported by the expert panel. Current clinical evidence and physician experience supported SCS injection as a safe and effective method for delivering retinal and choroidal therapeutics. The panel established consensus on the rationale for SCS injection, including potential benefits relative to other intraocular delivery methods, and current best practices in patient preparation, pre- and peri-injection management, SCS-specific injection techniques, and post-injection management and follow-up.

Conclusion:
These expert panel guidelines may support and promote standardization of SCS injection technique, with the goal of optimizing patient safety and outcomes. Some aspects of the procedure may reasonably be modified based on clinical setting and physician judgement, as well as areas requiring additional study.
Predischarge oxygen uptake efficiency slope has short and long-term value in the prognosis of patients after acute myocardial infarction
Authors: Tuan Sheng-Hui , Chung Jin-Hui , Tsai Yi-Ju , Huang Wei-Chun , Chen Guan-Bo , Tsai Yun-Jeng , Lin Ko-Long 
Published: March 2024

Background:
Patients who survive an acute myocardial infarction (AMI) have a higher risk of having a major cardiovascular event (MACE). Cardiopulmonary exercise testing (CPET) could develop prognostic stratification and prescribing exercise prescription. Patients after AMI frequently terminate CPET early with submaximal testing results. We aimed to look at the characteristics of patients’ predischarge CPET variables after AMI intervention and find potential CPET variables with prognostic value.

Methods:
Between July 2012 and August 2017, we recruited patients who survived first AMI after primary percutaneous coronary intervention and received predischarge CPET retrospectively in a tertiary medical center of Taiwan. Patients were followed-up on a MACE or administrative censoring occurred (up to 5 years). To identify significant predictors of a MACE, a Cox regression model was used.

Results:
One hundred thirteen patients (103 men and 10 women) were studied, with an average age of 58.32 ± 12.49. MACE over 3 months, 2-years, and 5-years was 17.70%, 53.10%, and 62.83%, respectively. The oxygen uptake efficiency slope during the whole during of CPET (OUES 100) divided by body surface area (OUES 100/BSA) was found to be a significant event predictor for MACE at 3-month, 2- and 5-years. Cox regression analysis revealed that those with OUES 100/BSA <0.722 (p = 0.004), OUES 100/BSA <0.859 (p = 0.002), and OUES 100/BSA <0.829 (p = 0.002) had a 7.14-fold, 3.47-fold, and 2.72-fold increased risk of 3-month, 2-year, and 5-year MACE, respectively.

Conclusion:
It is critical to identify a submaximal predictor during CPET for patients who survive AMI. Our findings suggested that OUES could be a significant prognostic indicator in patients after first AMI in both the short and long term.
Disparities in 30-Day Readmission Between Medicare/Medicaid and Private Insurance Among Patients With Heart Failure Screened for Cognitive Impairment
Authors: Dzikowicz Dillon J. , Keady Karen G. , Carey Mary G. 
Published: March 2024

Background
Racial disparities exist among patients with heart failure (HF). HF is often comorbid with cognitive impairment. Appropriate self-care can prevent HF hospital readmissions but requires access to resources through insurance. Racial differences exist between insurance types, and this may influence the disparity between races and patients with HF and cognitive impairment.

Objective
The objectives of this study were to examine the relationships between insurance type and self-care stratified by race and to assess for differences in time-to-30-day readmission among patients with HF with cognitive impairment.

Methods
This is a secondary analysis of data collected among hospitalized patients with HF with cognitive impairment. Patients completed surveys on self-care (Self-Care of Heart Failure Index), HF knowledge (Dutch Heart Failure Knowledge Scale), depression (Geriatric Depression Scale), and social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory). Socioeconomic data were collected. Linear models were created to examine the relationships between insurance type and self-care by race. Kaplan-Meier curves and Cox regression were used to assess readmission.

Results
The sample of 125 patients with HF with cognitive impairment was predominantly Black (68%, n = 85) and male (53%, n = 66). The sample had either Medicare/Medicaid (62%, n = 78) or private insurance (38%, n = 47). Black patients with HF with cognitive impairment and private insurance reported higher self-care confidence compared with Black patients with HF with cognitive impairment and Medicare/Medicaid (P < .05). Medicare/Medicaid was associated with a higher frequency of 30-day readmission and a faster time-to-readmission.

Conclusions
Patients with HF with cognitive impairment and Medicare/Medicaid insurance reported lower self-care confidence and more likely to be readmitted within 30 days.
Qualitative Description of Exercise Perceptions and Experiences Among People With Human Immunodeficiency Virus in the High-Intensity Exercise to Attenuate Limitations and Train Habits Study
Authors: Adhiambo Harriet Fridah , Cook Paul , Erlandson Kristine M. , Jankowski Catherine , Oliveira Vitor H. F. , Do Hoai , Khuu Vincent , Davey Christine Horvat , Webel Allison R. 
Published: March 2024

Background
The benefits of physical activity (PA), specifically exercise, among older adults in general are well known. Yet globally, there is concern regarding limited engagement in PA, increased obesity, and frailty among older people with human immunodeficiency virus related to low levels of PA.

Methods
We conducted in-depth interviews among 30 older, sedentary people with human immunodeficiency virus participating in the ongoing High-Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH study, NCT04550676) between February 2021 and August 2022. A semistructured interview guide, informed by two minds theory, which frames behavior change as an intention-behavior gap between 2 neurocognitive systems, was used to elicit data from participants. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations, and PA goals. Thirty interviews from 33 participants were recorded and transcribed verbatim, and deductive and inductive thematic analysis were used using Dedoose.

Results
Physical activity was defined as maintaining daily living activities and addressing health goals. Previous experiences with PA varied among participants and were influenced by chronic illnesses, including human immunodeficiency virus; motivation; work commitments; interest; and social support. Reported barriers to PA included antiretroviral adverse effects, comorbidities, aging, and the COVID-19 pandemic. Changes in health status, body changes, and relationships were identified as benefits of PA. Conversations with healthcare providers supporting exercise goals were perceived to be important but rarely received by the participants.

Conclusion
Understanding how older people with human immunodeficiency virus perceive PA is crucial to developing tailored strategies and structuring service delivery within the healthcare setting to promote a physically active life.
Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network Meta-analysis
Authors: Li Puhan , Ma Yucheng , Liao Banghua , Jin Xi , Xiang Liyuan , Li Hong , Wang Kunjie 
Published: March 2024

Objectives:
Various new positions for percutaneous nephrolithotomy (PCNL) were proposed to reduce the limitations of the traditional position. This study was aimed to evaluate the efficacy and safety of the different PCNL positions.

Methods:
PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) up to April 18, 2023. We collected five common surgical positions used for PCNL: oblique supine position (OSP), supine position (SP), flank position (FP), split-leg oblique supine/flank position (SLP), and prone position (PP). Paired and network meta-analysis were conducted to compare relevant outcomes, including complications, operative time, stone free rates, hospital stay and hemoglobin loss among these different positions.

Results:
The study included 17 RCTs with a total of 1841 patients. The result demonstrated that SLP significantly outperformed in terms of decreasing operation time (FP vs SLP MD- MD-41.65; OSP vs SLP MD 28.97; PP vs SLP MD 34.94), hospital stay, and hemoglobin loss. Ranking probabilities showed SLP had highest stone-free rate. Prone position was more likely to occur complications than others. Based on SMAA model, the benefit-risk analysis suggested the SLP was the optimal position in PCNL.

Conclusions:
For PCNL, the split-leg, flank, supine, and oblique supine positions are as secure as the prone position. Further RCTs are necessary to confirm the outstanding safety and efficacy of split-leg position. Besides, the position should be selected regard for the patient’s demands, the surgeon’s preference and learning curve.