bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uterine Sacculation With Entrapped Placenta After Delivery
Authors: Solotke Michael T. , Boyles Glenn , Rood Kara , Hinchcliff Emily , Horowitz Jeanne M. , Yee Lynn M. 
Published: February 2024

BACKGROUND:

Uterine sacculation refers to a temporary pouch or sac within the uterus that may contain the placenta or fetal parts and that may be diagnosed antepartum or after delivery. There is very limited published information about this rare condition and its management.

CASES:
We report two cases of uterine sacculation with entrapped placenta diagnosed immediately postpartum, managed with two different approaches. In one case, the patient underwent immediate laparotomy and placental extraction. In the second case, the patient was managed conservatively but ultimately developed signs of infection and underwent laparotomy.

CONCLUSION:
Uterine sacculation with entrapped placenta is a rare condition that is a potential etiology of retained placenta. Obstetric clinicians should be aware of this diagnosis and the management strategies available.
Barriers and Facilitators to Collecting Surgical Outcome Data in Low- and Middle-Income Countries: An International Survey
Authors: Diehl Thomas , Jaraczewski Taylor J. , Ahmed Kaleem Sohail , Khan Muhammad Rizwan , Harrison Ewen M. , Abebe Belay Mellese , Latif Asad , Mughal Nabiha , Khan Sadaf , McQueen K. A. Kelly , Tefera Girma , Zafar Syed Nabeel 
Published: February 2024

Background:
Perioperative data are essential to improve the safety of surgical care. However, surgical outcome research (SOR) from low- and middle-income countries (LMICs) is disproportionately sparse. We aimed to assess practices, barriers, facilitators, and perceptions influencing the collection and use of surgical outcome data (SOD) in LMICs.

Methods:
An internet-based survey was developed and disseminated to stakeholders involved in the care of surgical patients in LMICs. The Performance of Routine Information Systems Management framework was used to explore the frequency and relative importance of organizational, technical, and behavioral barriers. Associations were determined using χ
2 and ANOVA analyses.

Results:
Final analysis included 229 surgeons, anesthesia providers, nurses, and administrators from 36 separate LMICs. A total of 58.1% of individuals reported that their institution had experience with collection of SOD and 73% of these reported a positive impact on patient care. Mentorship and research training was available in <50% of respondent’s institutions; however, those who had these were more likely to publish SOD (P = 0.02). Sixteen barriers met the threshold for significance of which the top 3 were the burden of clinical responsibility, research costs, and accuracy of medical documentation. The most frequently proposed solutions were the availability of an electronic data collection platform (95.3%), dedicated research personnel (93.2%), and access to research training (93.2%).

Conclusions:
There are several barriers and facilitators to collection of SOD that are common across LMICs. Most of these can be addressed through targeted interventions and are highlighted in this study. We provide a path towards advancing SOR in LMICs.
Physical Therapy Utilization After Single-level Posterior Lumbar Fusion
Authors: Gouzoulis Michael J. , Moran Jay , Jeong Seongho , Galivanche Anoop R. , Kammien Alexander J. , Jabbouri Sahir S. , Grauer Jonathan N. 
Published: February 2024

Study Design.Retrospective cohort study.Objective.Characterize physical therapy (PT) utilization following single-level posterior lumbar fusion (PLF).Summary of Background Data.PLF is a common procedure that is increasing in frequency. After such surgeries, PT may be considered to facilitate mobilization and return to activities. However, the usage of such therapy has not been well-characterized in the literature.Materials and Methods.Patients undergoing single-level PLF were identified from the 2010 to 2021 PearlDiver administrative database. These patients were stratified based on usage of therapy, homeversusoutpatient therapy, and timing of therapy within the year after surgery. To determine predictors of therapy, patient characteristics were determined and multivariable regressions were performed.Results.A total of 213,240 patients undergoing single-level PLF were identified, of which therapy was done in the year after surgery for 63,231 (29.0%, of which home therapy accounted for 16.5% of therapy visits). Of those who utilized PT, the average number of visits was 10.6±10.6. Home therapy peaked within the first month after surgery and outpatient therapy peaked at month two. Factors associated with any PT following PLF in decreasing odds ratio (OR) were having commercial insurance (OR: 1.68), being from the Northeast (OR: 1.41), age (OR: 1.13 for 70+ of age) female sex (OR: 1.09), and ECI (OR: 1.04 per point) (P<0.001 for all). Of those who received therapy, factors associated with home PT utilization were being from the Northeast (OR: 2.55), age (OR: 1.91 for 70+ of age), Medicaid insurance (OR: 1.48), female sex (OR: 1.39), and interbody fusion (OR:1.07) (P<0.001 for all).Conclusions.After single-level PLF, the minority of patients received home or outpatient PT. Of those who did, there was significant variation in the number of visits, with nonmedical factors such as insurance plan and geographic region being strongly associated suggesting room for more consistent practice patterns.Level of Evidence:Level 3.
Avelumab in the Treatment of Advanced Merkel Cell Carcinoma: A Systematic Review
Authors: Sharma Ajay N. , Shah Karishma S. , Sharma Aditi A. , Yu Siegrid S. 
Published: February 2024

BACKGROUND
Avelumab, a programmed death ligand-1 inhibitor, has shown success in providing durable responses for difficult-to-treat Merkel cell carcinomas (MCCs).

OBJECTIVE
Evaluate the efficacy and safety of avelumab in the treatment of advanced MCC.

METHODS
Studies reporting the use of avelumab as a monotherapy or in combination with other agents in the treatment of stage III or IV (advanced) MCC were included. The primary outcomes were overall response rate, overall survival (OS), and treatment-related adverse events.

RESULTS
A total of 48 studies were included, involving 1,565 patients with advanced MCC. Most patients were male (1,051, 67.3%) with stage IV MCC (517, 97.0%). The overall response rate was 46.1% (partial response—25.4% and complete response—20.7%) after a mean follow-up period of 9.5 months. Kaplan–Meier survival curves for the pooled stage III and IV group demonstrated OS rates of 58% at 1 year, 47% at 2 years, and 28% at 5 years after completion of treatment with avelumab (median OS: 23.1 months). The most common treatment-related adverse events consisted of constitutional (44%), gastrointestinal (19%), and dermatologic (12%) symptoms.

CONCLUSION
Avelumab monotherapy and combination therapy have shown success in the overall response rate and survival for patients with advanced MCC.
Dexamethasone Mesotherapy: An Alternative for Keloid Treatment in Hispanic Skin
Authors: Carvajal Jenny , Carvajal Melissa 
Published: February 2024

Summary:The incidence of keloids in individuals with skin of color is as high as 16%. Intralesional steroid injection is recommended as a first-line treatment, even though the outcomes are often suboptimal. Histologically, the keloid epidermal layer is thicker than in normal skin, and the vascular density is higher in the marginal area at subepidermal level due to the elevated expression of vascular endothelial growth factor. Dexamethasone significantly suppresses this proangiogenic cytokine compared with Triamcinolone. We report the case of a 32-year-old phototype VI man with a 6-month-history of a keloid on the dorsum of his right hand that caused functional and cosmetic morbidity. We performed an intralesional injection of dexamethasone using a mesotherapy technique, that led to significant shrinking and complete recovery of range of motion after two sessions, with no regrowth at the 1-year follow-up. Mesotherapy is a safe and easy technique used in cosmetic medicine, which allows for a slower diffusion of dexamethasone and prolongs its pharmacological action, reducing the risk of local side effects. This technique has the potential to be standardized, but its main drawback is the need for proper sedation. Randomized clinical trials are required to further evaluate the clinical efficacy of dexamethasone mesotherapy.
Use of In Vivo Corneal Confocal Microscopy to Guide Excimer Laser With Adjunctive Mitomycin C for Treatment of Recalcitrant Acanthamoeba Keratitis
Authors: Kaiser Klemens Paul , Wissiak Elfriede , Daas Loay , Walochnik Julia , Ardjomand Navid 
Published: February 2024

Purpose:
The aim of this study was to describe 3 cases of recalcitrant Acanthamoeba keratitis (AK) that were successfully treated using in vivo corneal confocal microscopy (IVCM) to guide excimer laser ablation depth with adjunctive mitomycin C 0.02%.

Methods:
Three patients diagnosed with AK did not respond to several weeks of intensive topical therapy with antiamoebic agents. The patient underwent phototherapeutic keratectomy with topical mitomycin C 0.02% application. The maximum stromal depth of cysts measured by IVCM was 80 μm, 100 μm, and 240 μm, and the stromal ablation depths were 80 μm, 100 μm, and 100 μm, respectively.

Results:
In all 3 eyes, AK resolved after a single excimer laser application, and topical treatment was gradually discontinued within 6 weeks afterward. In 1 eye, penetrating corneal transplantation was performed 6 weeks after phototherapeutic keratectomy because of ongoing severe corneal pain. IVCM and histology of the corneal transplant did not reveal any Acanthamoeba cysts within the excised corneal button. No recurrence was observed during the follow-up period of 19 to 34 months.

Conclusions:
IVCM-guided phototherapeutic keratectomy with mitomycin C 0.02% seems to be a safe and successful approach for the treatment of AK, especially in cases of resistance to topical treatment. Corneal IVCM should be performed before laser application to measure cyst depth, determine ablation depth, and assess postoperative treatment success.
The Incidence of Strabismus After Upper and Lower Blepharoplasty in the United States
Authors: Oke Isdin , Elze Tobias , Miller Joan W. , Lorch Alice C. , Hunter David G. , Freitag Suzanne K. , Dagi Linda R. ,   on behalf of the IRIS® Registry Analytic Center Consortium
Published: February 2024

Purpose:
To compare the incidence of strabismus after upper and lower blepharoplasty in the United States.

Methods:
Retrospective cohort study of adults (age ≥18 years) in the IRIS Registry (Intelligent Research in Sight) who underwent blepharoplasty between January 1, 2013 and December 31, 2020. The primary outcome was the Kaplan–Meier estimated cumulative incidence of strabismus diagnosis and surgery within 3 years of blepharoplasty. Multivariable Cox regression was used to determine the association of blepharoplasty type with strabismus diagnosis and surgery, adjusting for patient age, sex, and geographic region.

Results:
Blepharoplasty was performed in 368,623 patients (median [interquartile range] age, 69 [63–75] years, and 69% female). Compared with those undergoing upper eyelid blepharoplasty, patients treated with lower eyelid blepharoplasty were slightly younger (median age, 66 vs. 69 years; p < 0.001) and more likely to be female (71% vs. 69%; p < 0.001). There was a greater 3-year incidence of strabismus diagnosis (2.0% vs. 1.5%; p < 0.001) and a greater 3-year incidence of strabismus surgery (0.15% vs. 0.06%; p = 0.003) for individuals undergoing lower vs. upper blepharoplasty. After adjusting for age, sex, and geographic region, lower blepharoplasty was associated with a higher 3-year risk of strabismus diagnosis (HR, 1.49; 95% CI, 1.23–1.81; p < 0.001) and surgery (HR, 2.53; 95% CI, 1.27–5.03; p = 0.008).

Conclusions:
This registry-based analysis found that individuals undergoing lower eyelid blepharoplasty were at higher risk of strabismus compared with those undergoing upper eyelid blepharoplasty. Using large databases to understand the incidence of complications of frequently performed procedures may improve ophthalmologists’ ability to provide data-driven counseling on surgical risks prior to intervention.
Blepharotomy Versus Levator Recession With Adjustable Sutures for Correction of Upper Eyelid Retraction in Thyroid Eye Disease
Authors: Ueland Hans Olav , Halsøy Kathrine , Rødahl Eyvind 
Published: February 2024

Purpose:
To compare outcome, complications and surgical time of blepharotomy versus levator recession with adjustable sutures (LRWAS) for correction of upper eyelid retraction in thyroid eye disease.

Methods:
In the period 2019–2023, we performed a prospective randomized comparative study between blepharotomy and LRWAS. We examined patients, recorded time consumption, and obtained photographs preoperatively, 1 day, 1 week, 3 months, and 6 months after surgery. Outcome was categorized according to Mourits and Sasim`s classification from 1999 (perfect–acceptable–unacceptable).

Results:
A total of 30 patients (25 women) with a median (range) age of 51.5 (34–74) years at surgery were included. A significant different (p < 0.01) median operation time was found between blepharotomy (41.5 (17–105) minutes) and LRWAS (68 (35–101) minutes). Median time from operation to last examination was 6 (6–18) months. Fifteen patients (24 eyelids) were operated with blepharotomy and 15 patients (25 eyelids) with LRWAS. Preoperative median margin reflex distance 1 was 6.5 (5–8) mm, and at final visit, median margin reflex distance 1 was 3.5 (3–4) mm after blepharotomy and 3.5 (2–5.5) mm after LRWAS. Reoperation was performed in 11 eyelids, 10 due to overcorrection and 1 because of a residual retraction. Significantly more eyelids needed reoperation after LRWAS (n = 9) compared with blepharotomy (n = 2). At final examination, a perfect or acceptable result was found in 14 (93%) patients after both procedures. Significantly shorter total duration of all visits was observed after treatment with blepharotomy (50 (35–70) minutes) compared with LRWAS (65 (40–115) minutes). Wound dehiscence occurred in 1 patient after blepharotomy, and 1 postoperative infection was observed after LRWAS.

Conclusion:
We demonstrate equally high success rates after blepharotomy and LRWAS for correcting upper eyelid retraction in thyroid eye disease, but blepharotomy is less time-consuming and implies fewer reoperations.
Lens capsule pathological characteristics in cases of intraocular lens dislocation with atopic dermatitis
Authors: Komatsu Koji , Masuda Yoichiro , Iwauchi Ai , Kubota Hoshiho , Iida Masanobu , Ichihara Kosuke , Iwamoto Masami , Kawai Kenji , Yamamoto Naoki , Shimoda Masayuki , Nakano Tadashi 
Published: February 2024

Purpose:
To explore lens capsule pathological characteristics in intraocular lens (IOL) dislocation after cataract surgery in patients with atopic dermatitis (AD).

Setting:
University hospital department of ophthalmology.

Design:
Case series with clinicopathological correlations.

Methods:
Lens capsules and surrounding tissues excised during surgery from eyes with AD (AD group) and eyes without AD (non-AD group) with IOL dislocation were histologically evaluated. Hematoxylin and eosin staining was used to assess abnormal changes in lens epithelial cells (LECs). Masson trichrome staining distinguished the fibrous metaplasia around the lens capsule into high-density and low-density fibrosis. Capsular splitting (thinning) was identified in both stained preparations.

Results:
The IOL dislocation morphology in the AD group (10 eyes of 10 patients) included 7 cases of capsular bag dislocation (CBD) and 3 cases of dead bag syndrome (DBS), with an average duration to IOL dislocation of 11.5 ± 5.6 years. All patients in the non-AD group (12 eyes of 12 patients) had CBD, averaging 10.2 ± 5.7 years to dislocation. Abnormal LECs, low-density fibrosis, and capsular splitting were observed in 9 (90), 9 (90), and 6 (60) of the patients in the AD group compared with 6 (50), 3 (25), and 2 (18), respectively, in the non-AD group (total n [%]).

Conclusions:
Compared with the non-AD group, the AD group exhibited higher frequencies of morphological changes in LECs, low-density fibrosis around the lens capsule, and capsular splitting characteristics of DBS. These results suggest LEC degeneration and increased lens capsule fragility occurred in patients with AD.
Mesopic pupil indices as potential risk factors for glare disability after intraocular implantable collamer lens implantation: prospective study
Authors: Xiong Jian , Xu Jingjing , Zhou Mengyun , Liu Jie , Wang Qing , Yin Xiaolong , Deng Yan , Luo Xiao , Wang Nanye , Gui Fu , Yu Kang , Liu Jueling , Zhu Zeyu , Cheng Chiwen , Yu Yifeng 
Published: February 2024

Purpose:
To explore the influence of preoperative factors, including varying pupil sizes and refractive attributes, on postoperative glare disability in patients undergoing implantable collamer lens (ICL) implantation.

Setting:
Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China.

Design:
Prospective observational study.

Methods:
The preoperative ocular characteristics and 6-month postoperative glare status in eligible patients who underwent EVO-Visian ICL V4c (VICMO) implantation were analyzed. The glare disability criteria encompassed a glare symptom score >6 and glare sensitivity exceeding 1:2.7. Logistic regression analysis was used to explore the relationship between the preoperative ocular parameters and post-ICL glare.

Results:
The study included 95 patients (mean age, 26.04 ± 6.29 years), comprising 30 men (58 eyes) and 65 women (129 eyes). Multivariate analysis revealed a significant correlation between postoperative glare disability and increased spherical power in preoperative mesopic pupils (β = −0.124, P = .039), as well as elevated cylinder power in preoperative mesopic (β = −0.412, P = .009) and photopic pupils (β = −0.430, P = .007). Moreover, a larger preoperative mesopic pupil diameter (β = 0.561, P = .005) demonstrated a significant correlation with glare disability.

Conclusions:
Preoperative mesopic pupil dimensions and associated refractive parameters, such as sphere and cylinder, were correlated with glare disability, including the cylinder aspect in photopic pupils, which can assist clinicians in optimizing preoperative selection for ICL implantation, aiding in the anticipation of potential glare disability risks.
Evaluation of transrectal ultrasound-guided tru-cut biopsy as a complementary method for predicting pathological complete response in rectal cancer after neoadjuvant treatment: a phase II prospective and diagnostic trial
Authors: Huang Yaoyi , Xie Yumo , Wang Puning , Chen Yao , Qin Si , Li Fangqian , Wu Yuanhui , Huang Mingzhe , Hou Zehui , Cai Yonghua , He Xiaosheng , Lin Hongcheng , Hu Bang , Qin Qiyuan , Ma Tenghui , Tan Shuyun , Liao Yi , Ke Jia , Zhang Di , Lai Sicong , Jiang ZhiPeng , Wang Huaiming , Xiang Jun , Cai Zerong , Wang Hui , He Xiaowen , Yang Zuli , Ren Donglin , Wu Xiaojian , Hong Yisong , Huang Meijin , Luo Yanxin , Liu Guangjian , Lin Jinxin 
Published: February 2024

Importance:
Patients with pathological complete response (pCR) of rectal cancer following neoadjuvant treatment had better oncological outcomes. However, reliable methods for accurately predicting pCR remain limited.

Objective:
To evaluate whether transrectal ultrasound-guided tru-cut biopsy (TRUS-TCB) adds diagnostic value to conventional modalities for predicting pathological complete response in patients with rectal cancer after neoadjuvant treatment.

Design, setting, and participants:
This study evaluated data of patients with rectal cancer who were treated with neoadjuvant treatment and reassessed using TRUS-TCB and conventional modalities before surgery. This study is registered with ClinicalTrials.gov.

Main outcomes and measures:
The primary outcome was accuracy, along with secondary outcomes including sensitivity, specificity, negative predictive value, and positive predictive value in predicting tumour residues. Final surgical pathology was used as reference standard.

Results:
Between June 2021 and June 2022, a total of 74 patients were enroled, with 63 patients ultimately evaluated. Among them, 17 patients (28%) exhibited a complete pathological response. TRUS-TCB demonstrated an accuracy of 0.71 (95% CI, 0.58–0.82) in predicting tumour residues. The combined use of TRUS-TCB and conventional modalities significantly improved diagnostic accuracy compared to conventional modalities alone (0.75 vs. 0.59, P=0.02). Furthermore, TRUS-TCB correctly reclassified 52% of patients erroneously classified as having a complete clinical response by conventional methods. The occurrence of only one mild adverse event was observed.

Conclusions and relevance:
TRUS-TCB proves to be a safe and accessible tool for reevaluation with minimal complications. The incorporation of TRUS-TCB alongside conventional methods leads to enhanced diagnostic performance.
Metagenomic next-generation sequencing, instead of procalcitonin, could guide antibiotic usage in patients with febrile acute necrotizing pancreatitis: a multicenter, prospective cohort study
Authors: Lin Chiayen , Li Jiarong , Liu Baiqi , Hong Xiaoyue , Luo Tao , Ye Jinsong , Yu Yi , Peng Xinran , Gou Shanmiao , Tang Huayong , Yuan Tongli , Luo Jianguan , Yang Ming , Feng Bin , Zhao Zhijian , Ning Caihong , Sun Zefang , Zhu Shuai , Chen Lu , Shen Dingcheng , Huang Gengwen 
Published: February 2024

Backgrounds:The effectiveness of procalcitonin-based algorithms in guiding antibiotic usage for febrile acute necrotizing pancreatitis (ANP) remains controversial. Metagenomic next-generation sequencing (mNGS) has been applied to diagnose infectious diseases. We aimed to evaluate the effectiveness of blood mNGS in guiding antibiotic stewardship for febrile ANP.Materials and Methods:The prospective multicenter clinical trial was conducted at seven hospitals in China. Blood samples were collected during fever (T ≥38.5°C) from ANP patients. The effectiveness of blood mNGS, procalcitonin, and blood culture in diagnosing pancreatic infection was evaluated and compared. Additionally, the real-world utilization of antibiotics and the potential mNGS-guided antimicrobial strategy in febrile ANP were also analyzed.Results:From May 2023 to October 2023, a total of 78 patients with febrile ANP were enrolled and 30 patients (38.5%) were confirmed infected pancreatic necrosis (IPN). Compared with procalcitonin and blood culture, mNGS showed a significantly higher sensitivity rate (86.7% vs. 56.7% vs. 26.7%,P<0.001). Moreover, mNGS outperformed procalcitonin (89.5% vs. 61.4%,P<0.01) and blood culture (89.5% vs. 69.0%,P<0.01) in terms of negative predictive value. Blood mNGS exhibited the highest accuracy (85.7%) in diagnosing IPN and sterile pancreatic necrosis (SPN), significantly superior to both procalcitonin (65.7%) and blood culture (61.4%). In the multivariate analysis, positive blood mNGS (OR=60.2,P<0.001) and lower fibrinogen level (OR=2.0,P<0.05) were identified as independent predictors associated with IPN, whereas procalcitonin was not associated with IPN, but with increased mortality (OR=11.7,P=0.006). Overall, the rate of correct use of antibiotics in the cohort was only 18.6% (13/70) and would be improved to 81.4% (57/70) if adjusted according to the mNGS results.Conclusion:Blood mNGS represents important progress in the early diagnosis of IPN, with particular importance in guiding antibiotic usage for patients with febrile ANP.