bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Preoperative Growth Differentiation Factor-15 Concentrations and Postoperative Cardiovascular Events after Major Noncardiac Surgery
Authors: Duceppe Emmanuelle , Borges Flavia K. , Conen David , Tiboni Maria , Chan Matthew T. V. , Patel Ameen , Sessler Daniel I. , Kavsak Peter A. , Ofori Sandra , Srinathan Sadeesh , Pearse Rupert , Jaffe Allan S. , Heels-Ansdell Diane , Garg Amit X. , Pettit Shirley , Sapsford Robert , Devereaux P. J. 
Published: April 2023

Background
The association between growth differentiation factor-15 concentrations and cardiovascular disease has been well described. The study hypothesis was that growth differentiation factor-15 may help cardiac risk stratification in noncardiac surgical patients, in addition to clinical evaluation.

Methods
The objective of the study was to determine whether preoperative serum growth differentiation factor-15 is associated with the composite primary outcome of myocardial injury after noncardiac surgery and vascular death at 30 days and can improve cardiac risk prediction in noncardiac surgery. This is a prospective cohort study of patients 45 yr or older having major noncardiac surgery. The association between preoperative growth differentiation factor-15 and the primary outcome was determined after adjusting for the Revised Cardiac Risk Index. Preoperative N-terminal-pro hormone brain natriuretic peptide was also added to compare predictive performance with growth differentiation factor-15.

Results
Between October 27, 2008, and October 30, 2013, a total of 5,238 patients were included who had preoperative growth differentiation factor-15 measured (median, 1,325; interquartile range, 880 to 2,132 pg/ml). The risk of myocardial injury after noncardiac surgery and vascular death was 99 of 1,705 (5.8%) for growth differentiation factor-15 less than 1,000 pg/ml, 161 of 1,332 (12.1%) for growth differentiation factor-15 1,000 to less than 1,500 pg/ml, 302 of 1476 (20.5%) for growth differentiation factor-15 1,500 to less than 3,000 pg/ml, and 247 of 725 (34.1%) for growth differentiation factor-15 concentrations 3,000 pg/ml or greater. Compared to patients who had growth differentiation factor-15 concentrations less than 1,000 pg/ml, the corresponding adjusted hazard ratio for each growth differentiation factor-15 category was 1.93 (95% CI, 1.50 to 2.48), 3.04 (95% CI, 2.41 to 3.84), and 4.8 (95% CI, 3.76 to 6.14), respectively. The addition of growth differentiation factor-15 improved cardiac risk classification by 30.1% (301 per 1,000 patients) compared to Revised Cardiac Risk Index alone. It also provided additional risk classification beyond the combination of preoperative N-terminal-pro hormone brain natriuretic peptide and Revised Cardiac Risk Index (16.1%; 161 per 1,000 patients).

Conclusions
Growth differentiation factor-15 is strongly associated with 30-day risk of major cardiovascular events and significantly improved cardiac risk prediction in patients undergoing noncardiac surgery.

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External fixator as a safe method in the treatment of distal tibial fractures in children
Authors: Wen Yuwei , Zhu Danjiang , Wang Qiang , Song Baojian , Feng Wei 
Published: April 2023

Objective
The objective of this study is to evaluate the functional and radiological results of external fixator application in the treatment of distal tibial metaphyseal diaphyseal junction (MDJ) fractures in children and to analyze differences between stable and unstable fractures.

Methods
Medical records of children with distal tibial MDJ fracture confirmed by imaging from January 2015 to November 2021 were retrospectively analyzed. Patients were divided into stable and unstable groups and parameters, including clinical and imaging data and Tornetta ankle score were compared.

Results
Twenty-five children, comprising 13 with stable and 12 with unstable fractures, were included in our study. The mean age was 7 years (range, 2–13.1 years), and there were 17 males and 8 females. All children had closed reduction, and the basic clinical data of the two groups were comparable. Stable fractures showed shorter intraoperative fluoroscopy, operation, and fracture healing times than unstable fractures. No significant difference in Tornetta ankle score was observed. Twenty-two patients had excellent ankle score, and three had a good ankle score, for a combined incidence of 100%. Two patients in the stable fracture group and one in the unstable fracture group developed a pin site infection, and one patient with unstable fracture showed a length discrepancy (discrepancy<1 cm).

Conclusion
External fixator is safe and effective for the treatment of distal tibial MDJ fractures, whether the fracture is stable or not. It has the advantages of minimally invasive, excellent ankle function score, few major complications, needless auxiliary cast fixation, and early functional exercise and weight bearing.

Level of evidence
Level IV.
Projected Lifetime Cancer Risk Associated with Intraoperative Computed Tomography for Lumbar Spine Surgery
Authors: Crawford Alexander M. , Striano Brendan M. , Giberson-Chen Carew C. , Xiong Grace X. , Lightsey Harry M. , Schoenfeld Andrew J. , Simpson Andrew K. 
Published: April 2023

Study Design.
Retrospective cross-sectional study.

Objective.
(1) To determine the incremental increase in intraoperative ionizing radiation conferred by CT as compared to conventional radiography; and (2) To model different lifetime cancer risks contextualized by the intersection between age, sex, and intraoperative imaging modality.

Summary of Background Data.
Emerging technologies in spine surgery like navigation, automation, and augmented reality commonly utilize intraoperative CT. While much has been written about the benefits of such imaging modalities, the inherent risk profile of increasing intraoperative CT has not been well evaluated.

Methods.
Effective doses of intraoperative ionizing radiation were extracted from 610 adult patients who underwent single-level instrumented fusion for lumbar degenerative or isthmic spondylolisthesis from January 2015 through January 2022. Patients were divided into those who received intraoperative CT (n=138) and those who underwent conventional intraoperative radiography (n=472). Generalized linear modeling was utilized with intraoperative CT use as a primary predictor and patient demographics, disease characteristics, and preference-sensitive intraoperative considerations (e.g. surgical approach, surgical invasiveness) as covariates. The adjusted risk difference in radiation dose calculated from our regression analysis was used to prognosticate the associated cancer risk across age and sex strata.

Results.
(1) After adjusting for covariates, intraoperative CT was associated with 7.6 mSv (IQR 6.8–8.4 mSv; P<0.001) more radiation than conventional radiography. (2) For the median patient in our population (a 62-year-old female), intraoperative CT use increased lifetime cancer risk by 2.3 incidents (IQR 2.1–2.6) per 10,000. Similar projections for other age and sex strata were also appreciated.

Conclusion.
Intraoperative CT use significantly increased cancer risk compared to conventional intraoperative radiography for patients undergoing lumbar spinal fusions. As emerging technologies in spine surgery continue to proliferate and leverage intraoperative CT for cross-sectional imaging data, strategies must be developed by surgeons, institutions, and medical technology companies to mitigate long-term cancer risks.
The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks
Authors: Nguyen Alexandre , Grape Sina , Gobbetti Mattia , Albrecht Eric 
Published: April 2023

BACKGROUND
Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively.

OBJECTIVES
To compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks.

DESIGN
A systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES
MEDLINE, Embase and Web of Science, among others, up to June 2022.

ELIGIBILITY CRITERIA
We retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24 h. Secondary endpoints included rest pain score at 48 and 72 h, and morphine consumption at 24, 48 and 72 h.

RESULTS
Twenty-seven trials including 2122 patients were identified. Rest pain scores at 24 h were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I
2 = 87%, P < 0.001. This reduction in pain scores persisted at 48 h and 72 h with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I
2 = 82%, P = 0.001 and -0.7 (-1.1 to -0.3), I
2 = 80%, P < 0.001, respectively. There were no differences in interval morphine consumption at 24 h (P = 0.15), 48 h (P = 0.15) and 72 h (P = 0.07). The quality of evidence was moderate.

CONCLUSIONS
There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.
Diagnosis, causes, and treatment of dyspareunia in postmenopausal women
Authors: Streicher Lauren F. 
Published: April 2023

Abstract

Importance and Objectives
Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women.

Methods
This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia.

Findings
Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.

Conclusions
Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.
Interactions between genetic variants and environmental risk factors are associated with the severity of pelvic organ prolapse
Authors: Li Lei , Zhao Guangyi , Wu Jie , Pang Haiyu , Zhang Tianli , Chen Juan , Zhang Kunlin , Zhu Lan 
Published: April 2023

Abstract

Objective
Both environmental and genetic risk factors contribute to pelvic organ prolapse (POP). No genome-wide study has investigated the gene-environment (G × E) interactions. In this study, we aim to identify single nucleotide polymorphisms (SNPs) that may interact with the potential environmental factors, maximum birth weight, and age in Chinese women.

Methods
We recruited 576 women for phase 1 and 264 women for phase 2 with stages III and IV prolapse from six geographic regions of China. Genomic DNAs from blood samples were genotyped using Affymetrix Axiom Genome-Wide CHB1 Array of 640,674 SNPs for phase 1 and Illumina Infinium Asian Screening Array of 743,722 SNPs for phase 2. Meta-analysis was used to combine the two results. Interactions of genetic variants with maximum birth weight and age on POP severity were identified.

Results
In phase 1, 502,283 SNPs in 523 women passed quality control and 450 women had complete POP-quantification measurements. In phase 2, 463,351 SNPs in 257 women passed quality control with complete POP-quantification measurements. Three SNPs rs76662748 (WDR59, P
meta = 2.146 × 10−8), rs149541061 (3p26.1, P
meta = 9.273 × 10−9), and rs34503674 (DOCK9, P
meta = 1.778 × 10−9) respectively interacted with maximum birth weight, and two SNPs rs74065743 (LINC01343, P
meta = 4.386 × 10−8) and rs322376 (NEURL1B-DUSP1, P
meta = 2.263 × 10−8), respectively, interacted with age. The magnitude of disease severity associated with maximum birth weight and age differed according to genetic variants.

Conclusions
This study provided preliminary evidence that interactions between genetic variants and environmental risk factors are associated with POP severity, suggesting the potential use of combining epidemiologic exposure data with selected genotyping for risk assessment and patient stratification.
Ocular Manifestations of Peters Plus-Like Syndrome in 8q21.11 Microdeletion Syndrome
Authors: Shigeyasu Chika , Yamada Masakazu , Miyata Yohane , Uchiyama Yuri , Matsumoto Naomichi , Kusumi Yumi , Shiraishi Atsushi 
Published: April 2023

Purpose:
The aim of this study was to report a case of Peters plus-like syndrome, which revealed to have an 8q21.11 microdeletion by copy number variation analysis using exome data.

Methods:
A 6-month-old Japanese boy presented with bilateral corneal opacity since birth. The right eye maintained central corneal transparency with slightly inferior nasal and superior peripheral corneal opacities. The entire cornea was opacified in the left eye, particularly in the superior quadrants with vascularization, suggesting Peters anomaly. Identification of intraocular structures in the left eye was difficult; however, hypoplasia of the circumferential anterior iris stroma appeared bilaterally present, and no abnormalities were present in the posterior segment on funduscopic examination of the right eye and ultrasonography in the left eye. He had several facial malformations in addition to corneal opacity, but no other external abnormalities. General examination, including biochemical tests of blood and urine, physiological and imaging tests including abdominal echo, auditory brain stem response, brain computed tomography, and magnetic resonance imaging, showed no abnormalities. However, the patient showed intellectual disability and delayed motor development.

Results:
Although his karyotype was normal, copy number variation analysis using exome data and subsequent quantitative polymerase chain reaction identified a de novo 4.6-Mb deletion at 8q21.11q21.13; thus, the patient was diagnosed with 8q21.11 microdeletion syndrome.

Conclusions:
We identified a de novo 4.6-Mb deletion at 8q21.11q21.13 in a patient with ophthalmic anterior segment dysgenesis and systemic complications, clinically diagnosed as Peters plus-like syndrome. Clinically, the 8q21.11 microdeletion syndrome shows a phenotype similar to that of Peters plus syndrome, and a genetic diagnosis is required.
Clinical Pharmacist Transition of Care Model Improves Hospital System Practice by Reducing Readmissions
Authors: Ngo Nha Uyen Tuong , Tangpraphaphorn Soodtida , Kahaku Deborah , Canamar Catherine P. , Young Andrew 
Published: April 2023

ABSTRACT

Purpose:
A primary cause of hospital readmission is medication-related problems (MRPs). Polypharmacy patients taking multiple medications concurrently experience an increased likelihood of MRPs and high occurrence of readmissions to the hospital within 30 days. This study assessed the ability of a pharmacist-led transition of care program to decrease readmissions in polypharmacy patients by evaluating and rectifying MRPs.

Methods:
Over 16 months, patients admitted onto the medicine ward service with ≥10 home medications (n = 536) received medication management interventions from a clinical pharmacist including admission interview, medication reconciliation and consultation, and postdischarge phone follow-up. Admitted patients taking fewer than 10 home medications during the same time served as the control group and received routine standard of care (n = 2317).

Results:
The polypharmacy group who received the pharmacist-led intervention had a statistically significantly lower 30-day readmission rate (8.8%) compared with patients in the control group (12.4%; X2 = 5.63, p = .01). Patients receiving pharmacist intervention were 33% less likely to be readmitted within 30 days of discharge compared with the control group (odds ratio = 0.67, 95% CI = 0.49–0.94). All patients had at least one medication-related discrepancy.

Conclusion:
This pharmacy-led transition of care program can effectively reduce readmission rates through resolution of medication-related problems.
In-hospital waiting time to surgery and functional outcomes in geriatric hip fractures: a directed acyclic graph-based preplanned analysis from a prospective multicenter cohort study
Authors: Cai Qianying , Fu Kai , Jia Weitao , Li Xiaolin , He Haiyan , Yao Zhenjun , Chen Xiaodong , Dong Yuqi , Wang Qiugen , Kang Bin , Qian Biyun , Chen Shengbao , Zhang Changqing 
Published: April 2023

Background:The early recovery of hip function after hip fracture surgery values more attention, especially for patients with delayed surgery of longer than 48 h. We aim to evaluate the associations of in-hospital surgical waiting time with the functional outcomes [Harris Hip Score (HHS), Parker Mobility Score (PMS), and EuroQol 5 dimensions VAS (visual analogue scale) score (EQ-5D VAS)] in elderly patients who sustained hip fractures.Materials and methods:Data on sociodemographic and clinical factors were prospectively collected using a multicenter hip fracture registry system. Participants in the cohort underwent a 12-month follow-up investigation. After adjusting potential confounders identified by the directed acyclic graphs, the associations between surgical waiting time longer than 48 h and functional outcomes were estimated by log-binomial regression and multivariable linear regression models with generalized estimating equations.Results:Of 863 survival participants with available functional data at 12 months after surgery, an increased risk was obtained from receiving surgery after 48 h and the poor functional outcomes (HHS<80: relative risk (RR)=1.56, 95% CI: 1.00–2.51; PMS<7: RR=1.49, 95% CI: 1.13–2.01; EQ-5D VAS<80: RR=1.97, 95% CI: 1.57–2.47). In-hospital waiting time greater than 48 h were time-invariantly associated with lower PMS during recovery (−0.44 units 95% CI: −0.70 to −0.18). In addition, delayed surgery was time-varying associated with HHS and EQ-5D VAS.Conclusions:The associations between in-hospital waiting time and postoperative functional score suggest that delayed surgery can lead to poor functional outcomes, especially in patients waiting longer than 72 h from injury. Delayed surgery mainly impacted hip function and mobility recovery with a slower speed in early recovery of the first 3 months. More attention should be paid to mechanisms behind the associations between delayed surgery on general healthy status.
The role of laparoscopic adrenalectomy in the treatment of large pheochromocytomas (>6 cm): a meta-analysis and systematic review
Authors: Gan Lijian , Peng Lei , Meng Chunyang , Zheng Lei , Zeng Zhiqiang , Ge Si , Wang Zuoping , Li Kangsen , Li Yunxiang 
Published: April 2023

Background:
The effectiveness and safety of laparoscopic adrenalectomy (LA) under different routes for the treatment of large pheochromocytomas (PCCs) is unknown.

Materials and methods:
This meta-analysis and systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. Three databases were systematically searched, including Medline, PubMed, and Web of Science. The time frame of the search was set from the creation of the database to October 2022. Perioperative outcomes were divided into two groups according to tumor size: SMALL group (≤6 cm in diameter), LARGE group (>6 cm in diameter).

Results:
Eight studies including 600 patients were included. In the LA group, complications was comparable in both groups (SMALL group and LARGE group), and the LARGE group had longer operative time [OT weighted mean difference (WMD)=32.55; 95% CI: 11.17, 53.92; P<0.01], length of stay (LOS WMD=0.82; 95% CI: 0.19, 1.44; P<0.05), more estimated blood loss (EBL WMD=85.26; 95% CI: 20.71, 149.82; P<0.05), hypertension [odds ratio (OR)=3.99; 95% CI: 1.84, 8.65; P<0.01], hypotension (OR=1.84; 95% CI: 1.11, 3.05; P<0.05), and conversion (OR=5.60; 95% CI: 1.56, 20.13; P<0.01). In the transabdominal LA group, OT, LOS, EBL, complications, hypertension, and hypotension were the same in both groups. In the retroperitoneal LA group, complications and hypotension were the same in both groups, while the LARGE group had longer OT (WMD=52.07; 95% CI: 26.95, 77.20; P<0.01), LOS (WMD=0.51; 95% CI: 0.00, 1.01; P<0.05), more EBL (WMD=92.99; 95% CI: 27.70, 158.28; P<0.01) and higher rates of hypertension (OR=6.03; 95% CI: 1.95, 18.61; P<0.01).

Conclusions:
LA remains a safe and effective approach for large PCC. Transabdominal LA is superior to retroperitoneal LA.
Preoperative α-blockade versus no blockade for pheochromocytoma–paraganglioma patients undergoing surgery: a systematic review and updated meta-analysis
Authors: Wang Jue , Liu Qingyuan , Jiang Shihao , Zhang Jindong , He Jinke , Li Yunfan , Wang Delin 
Published: April 2023

Background:
Surgical resection of pheochromocytomas and paragangliomas (PPGLs) is associated with a significant risk of intraoperative hemodynamic instability and cardiovascular complications. α-blockade remains the routine preoperative medical preparation despite controversies over the lack of evidence. We presented an updated meta-analysis to ulteriorly evaluate the potential efficacy of preoperative α-blockade versus no blockade for PPGL patients undergoing surgery.

Materials and methods:
Randomized and nonrandomized comparative studies assessing preoperative α-blockade for PPGL surgery in adults were identified through a systematic literature search via MEDLINE, Embase, Web of Science, and CENTRAL up to November 2022. Outcome data of intraoperative hemodynamic parameters and major postoperative events were extracted. Mean difference and risk ratio were synthesized as appropriate for each outcome to determine the cumulative effect size.

Results:
Fifteen nonrandomized studies involving 3542 patients were finally eligible. Intraoperatively, none of the analyzed hemodynamic parameters differed between patients with or without α-blockade: maximum and minimum systolic blood pressure, hypertensive and hypotensive hemodynamic instability episodes, and peak heart rate, subgroup analysis of normotensive PPGL patients yielded similar results with the overall effects. Postoperatively, α-blockade was associated with prolonged hypotension and vasopressor usage (risk ratio: 4.21, 95% CI: 1.17–15.18, P=0.03). ICU admission, length of stay, overall cardiovascular morbidity, and mortality were similar between the two groups.

Conclusions:
Preoperative α-blockade ensured neither more stable intraoperative hemodynamics nor better perioperative outcome over no blockade for PPGL surgery. However, large-volume randomized controlled trials are still warranted to ascertain these findings.