bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-life therapeutic effects of beclomethasone dipropionate/formoterol fumarate/glycopyrronium combined triple therapy in patients with chronic obstructive pulmonary disease
Authors: Pelaia Corrado , Procopio Giada , Rotundo Fioramante Lello , Deodato Maria Rosaria , Ferrante Bannera Anna , Tropea Francesco Giuseppe , Cancelliere Anna , Vatrella Alessandro , Pelaia Girolamo 
Published: February 2023

Background: The small airway disease has been recognized as a central feature of chronic obstructive pulmonary disease (COPD). Triple fixed combination beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G) is provided as a pressurized single-dose inhaler based on an extra-fine formulation, which has been approved for patients with COPD experiencing frequent disease exacerbations. Methods: The aim of our real-life single-center observational study was to investigate, in 22 patients with COPD, the effects of BDP/FF/G on lung function, respiratory symptoms, health status, and exacerbation rate. Several clinical and lung functional parameters were evaluated at baseline and after 12 months of treatment with combined inhaled triple therapy. Results: With respect to baseline, after 12 months of treatment with BDP/FF/G, significant changes were recorded with regard to forced expiratory flow at 75% of forced vital capacity (FVC) ( p < 0.01), forced expiratory flow at 50% of FVC ( p < 0.01), forced expiratory flow at 25% of FVC ( p < 0.05), and forced mid-expiratory flow between 25% and 75% of FVC ( p < 0.01). Moreover, we observed reductions of total resistance ( p < 0.01), effective resistance ( p < 0.01), and effective specific resistance ( p < 0.01). In the same period, residual volume diminished ( p < 0.01) and forced expiratory volume in 1 s increased ( p < 0.01). Moreover, in a subgroup of 16 patients, an enhancement of diffusion lung capacity ( p < 0.01) was also detected. These functional results were paralleled by concomitant clinical effects, as evidenced by the improvements of modified British Medical Research Council (mMRC) dyspnea scale ( p < 0.001), COPD Assessment Test (CAT) score ( p < 0.0001), and COPD exacerbations ( p < 0.0001). Conclusion: In conclusion, the valuable findings of our observational study consist in the corroboration in a real-life context of the therapeutic effects evidenced by randomized controlled trials with regard to the use of the triple inhaled BDP/FF/G therapy in patients with COPD.
Academic performance in children with pectus excavatum: a real-world research with propensity score matching
Authors: Li Hongbo , Fan Shulei , Kong Xiangpan , Pan Zhengxia , Wu Chun , Li Yonggang , Wang Gang , Dai Jiangtao , He Dawei , Wang Quan 
Published: February 2023

Background: The optimal timing of surgery for pectus excavatum (PE) is controversial. A large proportion of children will not undergo surgery before puberty. However, untimely surgery may lead to a decline in the children’s social adaptation and competitiveness because the children have already developed psychological and physiological impairments due to PE at an early age. The study retrospectively compared the academic performance in PE children undergoing the Nuss procedure versus nonsurgical observation. Methods: This retrospective real-world research study included 480 PE patients with definite surgical indications, in whom it was first recommended that they undergo surgery between the ages of 6 and 12 years old. Academic performance was collected at baseline and 6 years later. A generalized linear regression was calculated to screen the factors affecting the performance. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding factors between surgical and nonsurgical PE patients. Results: Haller index (HI) and pulmonary function were recognized as factors affecting baseline performance according to the generalized linear regression. For PE children with surgical indications, their academic performance significantly declined after 6 years of nonsurgical observation (52.1% ± 17.1% versus 58.3% ± 16.7%, p = 0.042). The academic performance in the surgery group was better than that in the nonsurgery group 6 years after PSM (60.7% ± 17.7% versus 52.1% ± 17.1%, p = 0.008). Conclusions: The severity of PE will affect the academic performance of children. For PE children with definite surgical indications between the ages of 6 and 12 years old, surgical intervention rather than nonsurgical observation is more conducive to the development of children’s academic performance.
A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis
Authors: Machida Masayoshi , Rocos Brett , Zeller Reinhard , Lebel David E 
Published: February 2023

Purpose: Managing severe scoliosis is challenging and risky with a significant complication rate regardless of treatment strategy. In this retrospective comparative study, we report our results using a three-rod compared to two-rod construct in the surgical treatment of severe spine deformities to investigate which technique is safer, and which provides superior radiological outcomes. Methods: Forty-six consecutive patients undergoing posterior spine fusion for scoliosis between 2006 and 2017 were identified in our institutional records. Inclusion criteria were minimum coronal deformity of 90°, age < 18 years at the time of surgery and a minimum 2 years of follow-up. Radiographic and clinical parameters, as well as post-operative complications were compared between the two groups. Results: There were 21 patients in the three-rod group and 25 in the two-rod group. The mean preoperative major coronal deformity was 100°± 9 and 102°± 10 in the three-rod and two-rod, respectively ( p = 0.6). The average major curve correction was 51% and 59% in three-rod and two-rod groups, respectively ( p = 0.03). The post-operative thoracic kyphosis was 30°± 11 and 21°± 12 in the three-rod and the two-rod groups, respectively ( p = 0.01). The surgical time was 476 ± 52 and 387 ± 84 min in three-rod and two-rod, respectively ( p < 0.01). One patient in the two-rod cohort showed permanent post-operative sensory deficit. There were three unplanned returns to operating theater in the two-rod group. Conclusions: Coronal correction was better with two-rod, whereas sagittal balance was superior with three-rod. Both techniques achieved balanced spine treating severe scoliosis. The two-rod technique was associated with a higher likelihood of requiring revision surgery. Level of evidence: level 3.
State of the Art Medical Management of Nasal Polyps
Authors: Staricha Kelly L. , Ali Hawa M. , Stokken Janalee K. 
Published: February 2023

Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) is an inflammatory disease with a treatment goal of controlling symptoms and limiting disease burden. While endoscopic sinus surgery is effective for removing polyps and aerating sinuses, proper medical management remains necessary for reducing inflammation and limiting polyp recurrence. Objective This article aims to summarize the literature regarding medical treatment of chronic rhinosinusitis with nasal polyposis, with a specific focus on developments in the past 5 years. Methodology We conducted a literature review using PubMed to identify studies assessing medical treatment strategies for patients with CRSwNP. Articles focusing on chronic rhinosinusitis without nasal polyposis were excluded unless specifically stated. Surgical treatment and biologic therapies for CRSwNP will be covered in subsequent chapters and are therefore not included. Results Intranasal saline irrigations and topical steroids are mainstays of CRSwNP treatment in the pre-surgical, post-surgical, and maintenance phases of the disease. Alternative steroid delivery methods and adjunctive treatments with antibiotics, anti-leukotrienes, and other topical therapies have been investigated and may benefit certain patient populations, but convincing evidence does not exist to warrant addition of these treatments to the standard of care for CRSwNP. Conclusions Topical steroid therapy is clearly effective for CRSwNP, and recent studies demonstrate the safety and efficacy of high-dose nasal steroid rinses. Alternate delivery methods for local steroids may be useful for patients who are not responding to or who are noncompliant with conventional intranasal corticosteroid sprays and rinses. Future studies are needed to clarify if oral or topical antibiotics, oral anti-leukotrienes, or other novel therapies are significantly effective in decreasing symptoms and improving the quality of life in patients with CRSwNP.
Current Understanding of the Role of Eosinophils in CRSwNP and Implications for Treatment with Mepolizumab and Benralizumab
Authors: Carney A. Simon , Smith Peter K. 
Published: February 2023

Background International consensus statements now subdivide chronic rhinosinusitis (CRS) into several phenotypes and endotypes, including the presence of polyps (CRSwNP) and eosinophilia (eCRSwNP). Biological treatments aimed at blocking eosinophilic inflammation in CRSwNP via interleukin 5 (IL5) or the interleukin 5 receptor (IL5R) have demonstrated limited efficacy thus far. Objective To review the pathophysiology of eCRSwNP, the evidence for mepolizumab (anti-IL5) and benralizumab (anti-IL5R) in CRSwNP, and to highlight areas for future research and therapeutic intervention. Methods Primary and secondary literature search. Results Clinical trials on mepolizumab and benralizumab in CRSwNP are limited and restricted by trial design which prevents direct comparison with other interventions, including surgery. Both agents would appear to provide some benefit in reducing nasal polyp size but limited clinical patient benefit. Molecular biological research highlights that eCRSwNP can occur in the absence of IL5 and that other cells/cytokines play an important part in the disease’s pathophysiology. Conclusion Blockade of IL5/IL5R alone would appear to provide limited “real life” clinical benefit in patients with CRSwNP due to the complexities of the pathophysiology of the condition. Therapy aimed at several simultaneous cytokine targets has logic but well-designed trials are unlikely to be forthcoming in the short term due to the financial cost and commercial conflicts of interest.
Understanding the CRSwNP Patient as Whole
Authors: Bandi Sindhura , Stephen Ellen , Bansal Keerthi , Mahdavinia Mahboobeh 
Published: February 2023

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a distinct inflammatory disease of the upper airways with a significant impact on the health and quality of life of affected patients. Several comorbid conditions such as allergic rhinitis, asthma, sleep disorders, and gastroesophageal reflux disease are commonly reported in patients with CRSwNP. Objective In this article, we intended to review the UpToDate information on how these comorbidities can impact CRSwNP patients’ health and well-being. Methods A PUBMED search was performed to review relevant recent article on the topic. Results While there have been significant advances in the knowledge and management options for CRSwNP in the past few years, additional studies are needed to understand the underlying pathophysiologic mechanisms of these associations. In addition, awareness of the impact of CRSwNP on mental health, quality of life, and cognition is paramount to treating this condition. Conclusion Recognition and addressing CRSwNP comorbidities such as allergic rhinitis, asthma, sleep disorders, gastroesophageal reflux disease, and cognitive function impairment are important to optimally understand and manage the patient with CRSwNP as a whole.
Association Between Venous Homografts and Allosensitization After Norwood Procedure
Authors: Tan Christian H , Cleveland David C , Dabal Robert J , Padilla Luz A , Maxwell Kathryn S , Law Mark A , Carlo Waldemar F , Borasino Santiago , Sorabella Robert A 
Published: February 2023

Background Right ventricle (RV) to pulmonary artery (PA) shunts have become the shunt of choice at many centers for use during the Norwood procedure for single ventricle palliation. Some centers have begun to use cryopreserved femoral or saphenous venous homografts as an alternative to polytetrafluoroethylene (PTFE) for shunt construction. The immunogenicity of these homografts is unknown, and potential allosensitization could have significant implications on transplant candidacy. Methods All patients undergoing Glenn procedure at our center between 2013 and 2020 were screened. Patients who initially underwent Norwood procedure with either PTFE or venous homograft RV-PA shunt and had available pre-Glenn serum were included in the study. The primary outcome of interest was panel reactive antibody (PRA) level at the time of Glenn surgery. Results Thirty-six patients met inclusion criteria (N = 28 PTFE, N = 8 homograft). Patients in the homograft group had significantly higher median PRA levels at the time of Glenn surgery (0% [IQR 0-18] PTFE vs 94% [IQR 74-100] homograft, P = .003). There were no other differences between the two groups. Conclusions Despite potential improvements in PA architecture, the use of venous homografts for RV-PA shunt construction at the time of Norwood procedure is associated with significantly elevated PRA level at the time of Glenn surgery. Centers should carefully consider the use of currently available venous homografts given the high percentage of these patients who may require future transplantation.
Isolated Vascular Rings Are Common Cardiovascular Malformations
Authors: Evans William N. , Acherman Ruben J. , Ciccolo Michael L. , Lehoux Juan , Berthoty Dean , Montes Arthur , Mayman Gary A. , Restrepo Humberto 
Published: February 2023

Objective We investigated the prevalence of isolated vascular rings in the general population of Southern Nevada. Methods We identified those prenatally and postnatally diagnosed with an isolated vascular ring between January 2014 and December 2021. We included only those with vascular or ligamentous structures completely encircling the trachea and esophagus. To investigate the prevalence of isolated vascular rings, we included only those with situs solitus, levocardia, and no significant intracardiac malformations. Results We identified 112 patients. Of the 112, 66 (59%) were female. There were approximately 211,000 total live births in Southern Nevada for the study period, for an overall prevalence of 5.3 isolated vascular rings per 10 000 live births. However, for the years 2014 to 2017, the average prevalence figure was 3.5 per 10 000 live births, and for the years 2018 to 2021, the average prevalence figure was 7.1 (range 6.5-8.0) per 10 000 live births. Simultaneously, the prenatal detection rate rose from 66% to 86%. Conclusions Isolated vascular rings are common cardiovascular malformations. As prenatal detection rates in the Southern Nevada general population approach 90%, the prevalence figures for isolated vascular rings appear to asymptote at about 7 per 10 000 live births.
Influence of Body Mass Index in Donor–Recipient Size Mismatch in Pediatric Heart Transplantation
Authors: Lowrey Laura K , Trivedi Jaimin , Ramakrishnan Karthik , Sinha Pranava , Deshpande Shriprasad R 
Published: February 2023

Background Body weight is the traditional metric for matching donor and recipient size for pediatric heart transplantation (pHT). We hypothesized that mismatch in body mass index (BMI) or body surface area (BSA) rather than weight is better associated with outcomes of transplantation and therefore should be used for donor–recipient size matching. Methods Analysis of the United Network for Organ Sharing database limited to pHT recipients was performed. Donor and recipient mismatch groups were created for weight, BMI, and BSA ratios. Differences in recipient characteristics between each cohort and the impact of mismatch on outcomes were statistically analyzed. Results A total of 4,465 patients were included in the analysis of which 43% had congenital heart disease (CHD). There were significant differences in patient characteristics by matching, independent of the matching parameter. Multivariable regression analysis showed that a low donor–recipient BMI ratio (compared to normal) (CHD OR 1.70; non-CHD 2.78) was a predictor of one-year mortality (all P < .001) in both CHD and non-CHD cohorts. Low BMI ratio was also associated with worse long-term survival in non-CHD groups, but not in the CHD cohort. Weight and BSA ratio did not predict one year or long-term survival. Conclusion The use of low BMI donors compared to recipient may predict poor early and long-term survival and therefore should be avoided in pHT. The use of BMI matching may improve donor–recipient matching in pHT.
Factors Influencing the Initial Constraint Level of the Knee Joint and Its Effect on Clinical Outcomes After ACL Reconstruction With Hamstring Graft
Authors: Chung Kwangho , Choi Chong Hyuk , Jung Min , Choi Jeehoon , Kim Sung-Jae , Kim Sung-Hwan 
Published: February 2023

Background: A force-based tension protocol that uses a certain amount of tension at graft fixation could still give rise to variations in initial constraint levels of the knee joint in terms of side-to-side difference (SSD) in anterior translation. Purpose: To investigate the factors influencing the initial constraint level in anterior cruciate ligament (ACL)–reconstructed knees and compare outcomes according to the level of constraint in terms of anterior translation SSD. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 113 patients who underwent ipsilateral ACL reconstruction using an autologous hamstring graft and had minimum 2-year follow-up outcomes. All grafts were tensioned and fixed at 80 N using a tensioner at the time of graft fixation. The patients were classified into the following 2 groups according to the initial anterior translation SSD, measured using the KT-2000 arthrometer: a physiologic constraint group with restored anterior laxity ≤2 mm (group P; n = 66) and a high-constraint group with restored anterior laxity >2 mm (group H; n = 47). Clinical outcomes were compared between the groups, and preoperative and intraoperative variables were evaluated to identify factors affecting the initial constraint level. Results: Between group P and group H, generalized joint laxity ( P = .005), posterior tibial slope ( P = .022), and anterior translation measured in the contralateral knee ( P < .001) were found to differ significantly. Measured anterior translation in the contralateral knee was the only significant predictor of high initial graft tension ( P = .001). No significant differences were found between the groups regarding clinical outcomes and subsequent surgery. Conclusion: Greater anterior translation measured in the contralateral knee was an independent predictor of a more constrained knee after ACL reconstruction. The short-term clinical outcomes after ACL reconstruction were comparable, regardless of the initial constraint level in terms of anterior translation SSD.
Knowledge, Attitudes, Practices, and Associated Factors Towards Care of Elderly Patients among Nurses
Authors: Mitike Hailye , Yimam Wondwossen , Goshiye Debrnesh , Kumar Kumar Prem 
Published: February 2023

Background Ethiopia's elderly care service is relatively young and little is known about the practices or readiness of nurses to provide care. Nurses need to have good knowledge, a positive attitude, and experience when it comes to caring for the elderly or patients who are chronically providing quality care. This study aimed to assess the knowledge, attitudes, and practices towards care for elderly patients and associated factors among nurses working in adult care units of public hospitals in Harar, 2021. Methods An institutional-based descriptive cross-sectional study was conducted from February 12 to July 10, 2021. A simple random sampling technique was used to select 478 study participants. Data were collected by trained data collectors using a pretested self-administered questionnaire. From the pretest, Cronbach's alpha for all items was above 0.7 for all items. Data were entered into Epi Data v.4.6 and exported to the Statistical Package for Social Science Version 26 for binary logistic regression analysis. A P-value of 0.05 was used to declare a significant association between variables. Results The study revealed that 311 (69%) had inadequate knowledge. Having a first degree and an unfavorable attitude towards nurses showed a statistically significant association with nurses’ inadequate knowledge. A total of 275 (61.0%) nurses were found to have an unfavorable attitude and were significantly associated with having a diploma and first degree, learning in a private organization, 6 to 10 years of experience, lack of training, and inadequate knowledge of nurses. A total of 297 (65.9%) study units had inadequate practice towards the care of elderly patients. Nurses’ practices showed a significant association with the type of hospital, work experience, and adherence to guidelines with a response rate of 94.4%. Conclusion The majority of nurses had inadequate knowledge, an unfavorable attitude, and inadequate practice towards the care of elderly patients. Having a first-degree and an unfavorable attitude with inadequate knowledge, lack of training and inadequate knowledge, unfavorable attitudes and less than 11 years of experience, working in non-academic hospitals, and unavailability of guidelines with inadequate practices were significantly associated.
Mutational Bias and Natural Selection Driving the Synonymous Codon Usage of Single-Exon Genes in Rice (Oryza sativa L.)
Authors: Hu Huan , Dong Boran , Fan Xiaoji , Wang Meixia , Wang Tingzhang , Liu Qingpo 
Published: February 2023

AbstractThe relative abundance of single-exon genes (SEGs) in higher plants is perplexing. Uncovering the synonymous codon usage pattern of SEGs will benefit for further understanding their underlying evolutionary mechanism in plants. Using internal correspondence analysis (ICA), we reveal a significant difference in synonymous codon usage between SEGs and multiple-exon genes (MEGs) in rice. But the effect is weak, accounting for only 2.61% of the total codon usage variability. SEGs and MEGs contain remarkably different base compositions, and are under clearly differential selective constraints, with the former having higher GC content, and evolving relatively faster during evolution. In the group of SEGs, the variability in synonymous codon usage among genes is partially due to the variations in GC content, gene function, and gene expression level, which accounts for 22.03%, 5.99%, and 3.32% of the total codon usage variability, respectively. Therefore, mutational bias and natural selection should work on affecting the synonymous codon usage of SEGs in rice. These findings may deepen our knowledge for the mechanisms of origination, differentiation and regulation of SEGs in plants.
Total exudative retinal detachment in a child with pars planitis- a challenging case with optimistic results
Authors: Navarrete Ana , Jaouni Tareq , Amer Radgonde 
Published: February 2023

AbstractWe describe a case report of pediatric pars planitis complicated with massive exudative retinal detachment (ERD). A 7-year-old presented with visual acuity (VA) in the right eye (RE) of 6/9 and in the left eye (LE) 6/15. Fundoscopy revealed BE inferior retinoschisis, vitritis and snowballs. He was treated with systemic immunosuppressants. RE retinoschisis resolved within 2 months. Three years later presented with LE VA 6/60 and total ERD. Systemic and intravitreal steroids were administered. Due to refractoriness, he underwent 360° scleral buckle and drainage of subretinal fluid. No retinal breaks or traction were detected. Five months postoperatively LE VA was 6/7.5. Long-term stable outcome was maintained. We report a challenging total ERD as a complication of pars planitis. Although extensive and non-responsive to medical therapy, complete resolution and improvement in vision was achieved with surgical intervention and systemic immunosuppression. We speculate that uncontrolled chronic vasculitic process culminated in diffuse ERD.