bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optic Nerve Head Morphology is Associated with the Initial Location of Structural Progression in Early Open Angle Glaucoma
Authors: Park Young Min , Park Jong Woon , Bae Hyoung Won , Kim Chan Yun , Lee Kwanghyun 
Published: July 2023

Précis:
Glaucoma eyes with a small cup-to-disk ratio (CDR) tend to show retinal nerve fiber layer progression earlier than ganglion cell-inner plexiform layer progression.

Purpose:
To investigate the effects of clinical variables on the temporal relationship between macular ganglion cell-inner plexiform layer (mGCIPL) loss and peripapillary retinal nerve fiber layer (pRNFL) loss in glaucoma.

Methods:
This retrospective observational study used medical records of patients diagnosed with open angle glaucoma. Structural change was determined using guided progression analysis software of Cirrus optical coherence tomography. Based on the time of detection of pRNFL and mGCIPL changes, eyes showing progressive layer loss were categorized into the pRNFL-first and mGCIPL-first groups. The association between sites of layer thinning and clinical variables such as major retinal arterial angles and several optic disk measurements, including disk area, average CDR, and vertical CDR, were analyzed.

Results:
A total of 282 eyes were included in the study, of which 104 showed structural progression either in the mGCIPL or pRNFL. Out of these, 49 eyes showed the first progression in pRNFL, while 37 eyes showed the first progression in mGCIPL. The minimum mGCIPL thickness, pRNFL thickness, average CDR, vertical CDR, and location of progression were significantly different between the 2 groups (P=0.041, P=0.034, P=0.015, P<0.001, and P<0.001, respectively). In multivariate analysis, average CDR and vertical CDR were significantly associated with the progression site (P=0.033 and P=0.006, respectively). The structural changes in the inferoinferior area and the superior vulnerability zone were significantly associated with RNFL-first progression (P<0.001 for both).

Conclusion:
The location of layer loss and CDR are related to the layer where loss is first detected (either pRNFL or mGCIPL) in open angle glaucoma.
The Short-Term Effect of 1% Tropicamide Drop on Pupillary Diameter and Intraocular Pressure Change in Patients With Pseudoexfoliation Material
Authors: Ural Fatihoğlu Özlem , Vural Esra , Çelebi Ali Riza Cenk 
Published: July 2023

Précis:
In this study, in patients with pseudoexfoliation syndrome (PXS) or glaucoma, changes in intraocular pressure (IOP) and pupil size after 1% tropicamide used for pupil dilation, compared with healthy patients were quantitatively demonstrated up to 4 hours after dilation.

Purpose:
The purpose of this study was to evaluate pharmacological dilatation with one drop of 1% tropicamide on pupillary diameter and IOP changes in patients with PXS and glaucoma (PXG).

Materials and Methods:
Eighty-two patients with PXS, 78 Patients with PXG, and 35 healthy subjects were included in the study. PXG and PXS were diagnosed based on IOP assessment, corneal pachymetry, optic disc examination, visual field testing, and peripapillary retinal nerve fiber analysis. IOP and the diameter of pupil size were measured before dilatation and at postdilatation first, second, and fourth hours.

Results:
The mean pupillary diameter values at postdilatation second and fourth hours were statistically significantly different between the patients with PXS and PXG (P<0.001, for each). Also, there were significant differences between the PXS group and the control group in terms of the mean pupillary diameter values at predilatation and postdilatation at the first hour and postdilatation second hour (P=0.007, <0.001, respectively). The mean pupillary diameter at all times was statistically significantly different between PXG and control groups (P<0.001 for each). Significant IOP increases were observed in all groups after dilatation. The mean IOP at predilatation and postdilatation fourth hour was statistically significantly different between PXG and PXS groups (P=0.042, <0.001, respectively). Whereas the mean IOP at predilatation, postdilatation first hour, postdilatation second hour, and postdilatation fourth hour were statistically significantly different between PXG and control group (P<0.001 for each)

Conclusions:
Significant IOP increases have been observed in our study with 1% tropicamide in the PXG and PXS groups, with the peak effect at the second hour in the postdilatation period. Furthermore, the mean pupil diameter was found to be significantly lower in PXG patients compared with the control group.
Efficacy and Safety of Antiviral Therapy for Immune-tolerant Hepatitis B Viral Infection in Children: A Systematic Review and Meta-analysis
Authors: Zheng Fengli , Tan Zhijun , Liang Zhou , Xiang Wenyao 
Published: July 2023

Background:
Chronic hepatitis B virus (HBV) infection burden in children remains a pressing public health concern. Whether antiviral therapy should be administered to children with HBV in the immune-tolerant phase remains controversial. We performed a meta-analysis to evaluate antiviral therapy efficacy and safety in children with immune-tolerant hepatitis B (ITHB).

Methods:
A search was conducted in multiple databases (PubMed, Embase, Cochrane, Web of Science, CBM, CNKI and Wanfang Data) to identify clinical trials examining antiviral therapy efficacy and safety in children (1–18 years) with ITHB viral infection from inception to February 2023. Outcomes were calculated separately for controlled and single-arm studies.

Results:
Nine trials (442 patients), including 2 randomized controlled trials (RCTs), 3 non-RCTs and 4 single-arm studies, were included in this meta-analysis. In the RCTs, antiviral therapy group exhibited greater rates of HBsAg loss [risk ratio (RR) = 6.11, 95% confidence interval (CI): 1.67–22.31, PZ-test = 0.006], HBsAg serologic response (RR = 5.29, 95% CI: 1.47–19.07, PZ-test = 0.011) and HBeAg loss (RR = 3.00, 95% CI: 1.35–6.66, PZ-test = 0.007) compared with the control group at the end of follow-up. In single-arm studies, the pooled incidences of HBsAg loss, HBeAg loss and HBsAg seroconversion were 24% (95% CI: −0.1% to 48%), 24% (95% CI: −0.1% to 48%) and 24% (95% CI: −5% to 52%), respectively.

Conclusion:
Current evidence suggests the effectiveness of antiviral therapy in children with HBV infection in the immune-tolerant stage, with few serious adverse events. Due to the limited quality and number of included studies, more high-quality studies are required to validate our findings.
Endoscopic therapy for gastroesophageal reflux disease: where are we, where are we going?
Authors: Haseeb Muhammad , Thompson Christopher C. 
Published: July 2023

Purpose of review
Gastroesophageal reflux disease (GERD) is the most common chronic condition with increasing prevalence in the Western world. Despite medical therapy, a considerable proportion of patients continue to experience symptoms, thus fueling the demand for minimally invasive GERD treatment options. This review will assess the currently available endoscopic approaches by analyzing their outcomes data, indication for use and limitations.

Recent findings
With increasing evidence of the safety and efficacy of endoscopic therapies, recent guidelines and consensus society documents have updated their recommendations for the endoscopic treatment of GERD. In this review, we have comprehensively assessed the current landscape of endoscopic approaches for the treatment of GERD and provided insight into future directions.

Summary
Endoscopic therapies for GERD show promise as new treatments emerge and existing therapies evolve into safer and more reproducible options. They are well positioned to cater to a large subset of the population suffering from chronic condition of GERD.
Recent advances in immunomodulators for atopic dermatitis
Authors: Yim Hyun J. , Jean Tiffany , Ong Peck Y. 
Published: July 2023

Purpose of review
Conventional treatments of atopic dermatitis have been inadequate, especially in patients with moderate-to-severe disease.

Recent findings
In the past 5 years, four immunomodulators have been approved for the treatment of atopic dermatitis in children. These include dupilumab, ruxolitinib, upadacitinib, and abrocitinib. The review summarizes the pivotal phase 3 trials of these medications.

Summary
The newer immunomodulators have transformed the treatment of atopic dermatitis, particularly in patients with moderate-to-severe disease. Dupilumab targets IL-4 and IL-13, which are the main causes of allergic inflammation, resulting in great efficacy and few side effects. Upadacitinib and abrocitinib are alternative systemic medications for adolescents who have failed or are unable to tolerate dupilumab. Ruxolitinib cream is the latest addition to the current topical therapy. It is indicated for children 12 years and older with mild-to-moderate atopic dermatitis. Further studies are needed to confirm its safety and efficacy for younger children and for patients with more severe disease.
Identifying Liver Metastasis-Related Genes Through a Coexpression Network to Construct a 5-Gene Model for Predicting Pancreatic Ductal Adenocarcinoma Patient Prognosis
Authors: Liu Tao , Chen Jian , Liu An-an , Chen Long , Liang Xing , Peng Jun-Feng , Zheng Ming-Hui , Li Ju-Dong , Cao Yong-Bing , Shao Cheng-Hao 
Published: July 2023

Objectives
This study aimed to develop a liver metastasis-related gene prognostic index (LMPI) for pancreatic ductal adenocarcinoma prognosis and therapy.

Methods
The Cancer Genome Atlas data set was used to identify liver metastasis-related hub genes via weighted gene coexpression network analysis. The core genes were identified to construct an LMPI by using the Cox regression method. An immune cell abundance identifier was applied to determine the immune cell abundance.

Results
A total of 78 hub liver metastasis-related genes in the black module were significantly enriched in complement and coagulation cascades, fat digestion and absorption, and the PPAR signaling pathway. Then, an LMPI was constructed on the basis of the 5 prognostic genes (MOGAT3, ASGR1, TRPM8, SGSM1, and LOC101927851). Patients with higher LMPI scores had poor overall survival, more co-occurring or mutually exclusive pairs of driver gene mutations, and less benefit from immunotherapy than patients with lower LMPI scores. In addition, a high correlation was also found between LMPI scores and immune infiltration, such as CD4 naive, CD8 T, cytotoxic T, T helper 2, follicular helper T, and natural killer cells.

Conclusions
The core genes of the LMPI developed may be independent factors for predicting prognosis, immune characteristics, and immunotherapy efficacy in pancreatic ductal adenocarcinoma.
Pediatric Acute Respiratory Distress Syndrome in South African PICUs: A Multisite Point-Prevalence Study
Authors: Morrow Brenda M. , Lozano Ray Eleonora , McCulloch Mignon , Salie Shamiel , Salloo Asma , Appel Ilse N. , Du Plooy Elri , Cawood Shannon , Moshesh Porai , Keeling Kathryn H. , Solomon Lincoln J. , Hlophe Sbekezelo , Demopoulos Despina , Parker Noor , Khan Ayesha Bibi , Naidoo Kuban D. , Argent Andrew C. 
Published: July 2023

OBJECTIVES:To describe the prevalence of pediatric acute respiratory distress syndrome (pARDS) and the characteristics of children with pARDS in South African PICUs.DESIGN:Observational multicenter, cross-sectional point-prevalence study.SETTING:Eight PICUs in four South African provinces.PATIENTS:All children beyond the neonatal period and under 18 years of age admitted to participating PICUs.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Clinical and demographic data were prospectively collected on a single day of each month, from February to July 2022, using a centralized database. Cases with or at risk of pARDS were identified using the 2015 Pediatric Acute Lung Injury Consensus Conference criteria. Prevalence was calculated as the number of children meeting pARDS criteria/the total number of children admitted to PICU at the same time points. Three hundred ten patients were present in the PICU on study days: 166 (53.5%) male, median (interquartile range [IQR]) age 9.8 (3.1–32.9) months, and 195 (62.9%) invasively mechanically ventilated. Seventy-one (22.9%) patients were classified as being “at risk” of pARDS and 95 patients (prevalence 30.6%; 95% CI, 24.7–37.5%) fulfilled pARDS case criteria, with severity classified as mild (58.2%), moderate (25.3%), and severe (17.6%). Median (IQR) admission Pediatric Index of Mortality 3 risk of mortality in patients with and without pARDS was 5.6 (3.4–12.1) % versus 3.9 (1.0–8.2) % (p= 0.002). Diagnostic categories differed between pARDS and non-pARDS groups (p= 0.002), with no difference in age, sex, or presence of comorbidities. On multivariable logistic regression, increasing admission risk of mortality (adjusted odds ratio [aOR] 1.02; 95% CI, 1.00–1.04;p= 0.04) and being admitted with a respiratory condition (aOR 2.64; 95% CI, 1.27–5.48;p= 0.01) were independently associated with an increased likelihood of having pARDS.CONCLUSIONS:The 30.6% prevalence of pARDS in South Africa is substantially higher than reports from other sociogeographical regions, highlighting the need for further research in this setting.
Diagnosis and Management of Pediatric Gastroesophageal Reflux in the Emergency Department
Authors: Akhouri Rohan , Imdad Aamer , Patel Lina 
Published: July 2023

Abstract
Gastroesophageal reflux (GER) is a common physiologic occurrence in infants, children, and adolescents and can develop into a pathological process (GERD) with associated complications. Gastroesophageal reflux is reported in approximately 30% of healthy infants, with a peak age of 3 to 4 months and is a common concern from families presenting to the emergency department. Evaluation and diagnosis of GER/GERD is primarily clinical and requires a detailed history, a complete physical examination, and exclusion of more severe extraesophageal pathologies. A high index of suspicion for GERD should be considered in patients with recurrent respiratory symptoms, difficulty with weight gain, and children with medically complex conditions who would be at higher risk for these complications. This review will briefly discuss diagnostic studies for the evaluation of GER/GERD; however, these are not helpful in the acute care setting and should be reserved for evaluation by a subspecialist. Management of GER/GERD includes nonmedication management with reflux precautions and dietary/lifestyle modifications; medication management with proton-pump inhibitors, H2 blockers, antacids, or prokinetics, as well as surgical management for refractory or high-risk cases.
Are Craniofacial Asymmetries Related to Trunk Asymmetries?
Authors: Turhan Begumhan , Alcin Fatma Nur , Dogan Hilal , Cetisli-Korkmaz Nilufer 
Published: July 2023

Objective:
The aim of this study was to investigate whether craniofacial asymmetries could be a predictor of spine asymmetries or not.

Methods:
Female individuals aged between 18 and 25 years participated in this cross-sectional descriptive-analytic study. The angle of trunk rotation was measured by a scoliometer in conjunction with the Adams forward-bending test. Individuals in the control group (n = 57) had spinal curvature of 0 to 3 degrees, and individuals in the study group (n = 53) had spinal curvature of between 4 and 6 degrees. Facial anthropometric measurements of individuals were evaluated by referencing anatomical landmarks determined on the face with 2-dimensional photogrammetry using ImageJ (Version 1.53q) program.

Results:
Both groups were similar in terms of facial measurements (P > 0.05). Axial trunk rotation values of the mid-thoracic and thoraco-lumbar regions were significantly higher on both sides of the asymmetry group (P < 0.05). The distances between facial landmarks are not associated with asymmetries of spine regions (P > 0.05).

Conclusion:
Although the sensitivity and predictive value of facial asymmetries in determining trunk asymmetries and sagittal spinal posture were low, it was concluded that comparative studies are needed, especially in individuals with asymmetry at the level of scoliosis, as the asymmetries of the individuals in our study were not at the level of scoliosis.
Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis
Authors: Huo Jinlong , Ou Dong , Guo Youming , Chen Chen , Qu Rui , Zhao Lijin 
Published: July 2023

Objective:
To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases.

Materials and Methods:
Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications.

Results:
A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001).

Conclusion:
For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.
Real-life Indications and Outcome of Electrocautery-enhanced Lumen-apposing Metal Stents in a Tertiary Center
Authors: Gantschnigg Antonia , Singhartinger Franz , von Rahden Burkhard , Mühlbacher Iris , Koch Oliver Owen , Emmanuel Klaus , Holzinger Josef 
Published: July 2023

Purpose:Electrocautery-enhanced lumen-apposing stents (EC-LAMS) were originally designed for the drainage of the gallbladder, bile duct, and pancreas pseudocysts. Throughout the years, several off-label indications were established. This study aims to evaluate the indication, safety, efficacy, and outcome of all LAMS implanted in a single tertiary referral center.Methods:From April 2016 to April 2022, all patients undergoing LAMS placement in a single tertiary center were included. We present a detailed analysis of indications, success rates, and complications based on a retrospective analysis of our prospectively maintained database.Results:A total of 86 stents were placed in 77 patients between April 2016 and April 2022. Indications were walled-off pancreatic necrosis (25.6%), bile duct obstructions (16.3%), acute cholecystitis (15.1%), pancreas pseudocysts (15.1%), postoperative collections (10.5%), postoperative pancreatic fistulas (9.3%), and gastro-gastrostomy/jejunostomy (8.1%) to enable to perform an endoscopic retrograde cholangiopancreatography in patients with gastric bypass. Technical success was 97.7% (84 out of 86). A total of 10 (11.7%) adverse events were observed. In 3 patients (3.5%), severe complications occurred, which required acute surgery; one displacement was closed through clips. In 7 patients (8.2%), bleedings occurred during necrosectomy or from mucosal erosions at the stent side, respectively, that were treated with endoclips.Conclusions:EC-LAMS are safe and show a high technical success rate in all indications. In everyday clinical practice, the main indications are hepato-pancreato-biliary, and therefore an hepato-pancreato-biliary-surgical department should have EC-LAMS in their armamentarium.
Risk of Bleeding After Percutaneous Endoscopic Gastrostomy in Patients Using Antithrombotic Drugs
Authors: Parlar Yavuz Emre , Mustafayev Fuad , Vahabov Cavanşir , Şahin Tevhide , İsrafilov Sabir , Keskin Onur , Balaban Hatice Yasemin , Kav Taylan , Parlak Erkan , Şimşek Halis , Sivri Bülent 
Published: July 2023

Background:
The rate of using antithrombotic (AT) drugs is frequently high in patients who require percutaneous endoscopic gastrostomy (PEG). The aim of this study was to determine whether the risk of bleeding after PEG increases in patients whose AT drugs were discontinued according to the European Society Gastrointestinal Endoscopy guidelines (warfarin for 5 d, low molecular weight heparin for 24 h, DOAC for 3 d, and clopidogrel for 7 d).

Patients and Methods:
Data from 243 patients, who underwent PEG tube placement and received AT drugs and 206 patients who did not between 2018 and 2021 in our hospital, were evaluated retrospectively. Bleeding was defined as requiring blood transfusion, hematemesis and/or melena, decreased hemoglobin, or bleeding from PEG.

Results:
A total of 243 (54.1%) patients (121 (49.7%), women, mean age (75.7 y) who underwent PEG and received AT drugs, and 206 (45.9%) patients who did not (92 (44.6%), women, mean age (63.15 y). The medications and bleeding rates of the patients are given in Table 1. The rate of bleeding in patients using AT medication was significantly higher than that in patients not using medication (Table 2) (P = 0.007). When the AT drugs were compared among themselves, the bleeding risk did not differ. Bleeding was detected in 10 patients with bleeding from the PEG tube in 4 with melena. Bleeding detected in 14 patients was controlled with adrenaline injections. None of the patients required transfusion or repeat endoscopies. No bleeding-related deaths were reported.

Conclusion:
Even if patients receiving AT drugs are treated as recommended by international guidelines, it should be kept in mind that bleeding may occur after PEG, and the patients should be followed accordingly.