bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Physical Therapy After Lumbar Fusion Surgery
Authors: Heard Jeremy C. , Lee Yunsoo A. , Lambrechts Mark , Brush Parker , Issa Tariq Z. , Kanhere Arun , Bodner John , Purtill Caroline , Reddy Yashas C. , Patil Sanath , Somers Sydney , D’Antonio Nicholas D. , Mangan John J. , Canseco Jose A. , Woods Barrett R. , Kaye Ian D. , Rihn Jeff A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D. 
Published: July 2023

Study Design:
Retrospective Cohort.

Objective:
To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery.

Summary of Background Data:
The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines.

Methods:
We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively.

Results:
The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P=0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1 min, P=0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P=0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up.

Conclusion:
Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery.

Level of Evidence:
Level—Ⅲ
Fatal Severe Cytokine Release Syndrome Post-haploidentical Stem Cell Transplant With Post-transplant Cyclophosphamide in an Infant With Severe Combined Immunodeficiency and Disseminated Bacille Calmette-Guérin Infection
Authors: Arora Sunisha , Upasana K. , Thakkar Dhwanee , Yadav Anjali , Rastogi Neha , Yadav Satya P. 
Published: July 2023

Introduction:
Severe Combined Immunodeficiency (SCID) is a primary immunodeficiency disorder characterized by absent or dysfunctional T lymphocytes, leading to defective cellular and humoral immunity requiring urgent hematopoietic stem cell transplantation (HSCT). We report a case of SCID with disseminated Bacille Calmette-Guérin (BCG) infection who developed cytokine release syndrome (CRS) and possible Immune reconstitution inflammatory syndrome (IRIS) after Haploidentical HSCT with post-transplant cyclophosphamide.

Methods:
Data were retrospectively retrieved from electronic medical records.

Result:
A 5-month-old male infant was referred with fever, cough, and generalized maculopapular rash for 15 days, and had pallor without hepatosplenomegaly or lymphadenopathy. He had a history of previous male sibling death at 6 months of age due to pneumonia. Investigations: hemoglobin: 4.7 g/dL, TLC-6.37×103/uL, absolute lymphocytes: 0.98×103/uL, platelets: 319×103/uL, bilateral patchy opacities in both lung fields, and low immunoglobulin levels. Lymphocyte subset analysis revealed T−, B+, NK− SCID. Genetic analysis showed a hemizygous mutation in IL2RG (c.314A>G). The child received intravenous (IV) antibiotics, antifungal, antitubercular drugs, irradiated blood products, and IV immunoglobulins. Urgent haploidentical HSCT from the mother was planned. Conditioning was Fludarabine-40 mg/m2/d for 4 days, cyclophosphamide: 14.5 mg/kg/d for 2 days. He received peripheral blood hematopoietic stem cells with CD34− 15×106 cells/kg and CD3− 805×106 cells/kg. Within 2 hours of stem cell infusion, he developed respiratory distress, fever, shock, and flaring of rash. Methylprednisolone was started in view of CRS. On day+2, he had sudden desaturation and bradycardia needing mechanical ventilation and inotropes. His inflammatory markers were elevated (Ferritin: 3640 ng/mL, IL-6:5000 pg/mL, CRP:255 mg/L). In view of high-grade CRS, he received an injection of tocilizumab 8 mg/kg on day +2 and day +4. He received post-transplant cyclophosphamide 5 mg/kg on day +3. The endotracheal secretion GeneXpert was positive for Mycobacterium supporting the diagnosis of disseminated tuberculosis. Our patient had disseminated BCG infection which could also be contributory in the initiation of IRIS as the mother was immunized with the BCG vaccine in childhood so she must be having cytotoxic T cells specific for BCG, which were transferred to the infant with peripheral blood stem cell product. He succumbed to severe acute respiratory distress syndrome and multiorgan dysfunction on day +5 post-transplant.

Conclusions:
In haploidentical HSCT of SCID, post-transplant course can be complicated by CRS and IRIS as these patients are inefficient in mounting any response to infused donor lymphocytes resulting in their unregulated growth.
Capecitabine-induced Gastrointestinal Injury Shows a Graft-Versus-Host Disease (GVHD)-like Pattern
Authors: Ojukwu Kenechukwu , Cox Brian K. , Larson Brent K. , Guindi Maha , Waters Kevin M. , Hutchings Danielle A. 
Published: July 2023

Capecitabine is a commonly used oral chemotherapeutic agent. Gastrointestinal (GI) side effects are clinically well-known, however, the histopathologic changes have not been comprehensively studied. This study describes the largest case series (8 patients) characterizing the histopathology of capecitabine-induced GI injury. All patients were adults (median age: 64.5 y, range: 61 to 76 y) and there was gender parity. Patients were receiving treatment for malignancies of the colorectum (n=5), breast (n=1), pancreas (n=1), and appendix (n=1). All had GI symptoms, including 7 with diarrhea and abdominal pain and 1 with melena. Five of 8 (63%) showed graft-versus-host disease (GVHD)-like histologic changes in small intestinal and/or colonic biopsies characterized by crypt disarray and dropout, crypt atrophy, dilated crypts lined by attenuated epithelium, and increased crypt apoptosis. Neuroendocrine cell aggregates were present in 4 of 5 cases. Four of 5 showed patchy prominence in lamina propria eosinophils. One patient receiving concomitant radiation therapy had a small intestinal biopsy showing regenerative changes. Two patients had histologically unremarkable biopsies. On follow-up, capecitabine was discontinued or dose-reduced in all patients. Three of 5 patients with a GVHD-like pattern had clinical improvement, whereas 2 died shortly after biopsy. One with regenerative changes also had radiation dose reduction and improved clinically. Two with unremarkable biopsies improved symptomatically. In summary, capecitabine-related GI injury shows a GVHD-like pattern. Knowledge of this is important to confirm the diagnosis as patients typically improve with dose reduction or discontinuation of the drug.
Variation in Early Pediatric Intensive Care Management Strategies and Duration of Invasive Mechanical Ventilation for Acute Viral Bronchiolitis in the United Kingdom: A Retrospective Multicenter Cohort Study*
Authors: Miranda Mariana , Ray Samiran , Boot Elizabeth , Inwald David , Meena Daleep , Kumar Ramesh , Davies Patrick , Rivero-Bosch Maria , Sturgess Philippa , Weeks Charlotte , Holliday Kathryn , Cuevas-Asturias Sofia , Donnelly Peter , Elsaoudi Ahmed , Lillie Jon , Nadel Simon , Tibby Shane , Mitting Rebecca 
Published: July 2023

OBJECTIVES:
Management of mechanically ventilated patients with bronchiolitis is not standardized and duration of mechanical ventilation has been shown to vary widely between centers. The aim of this study was to examine practice in a large number of U.K. PICUs with a view to identify if early management choices relating to fluid prescription, sedative agent use, and endotracheal tube (ETT) placement were associated with differences in duration of invasive mechanical ventilation (IMV).

DESIGN:
Retrospective multicenter cohort study. Primary outcome was duration of IMV. A hierarchical gamma generalized linear model was used to test for associations between practice variables (sedative and neuromuscular blocking agents, route of endotracheal intubation at 24 hr and fluid balance at 48 hr) and duration of IMV after adjustment for known confounders.

SETTING:
Thirteen U.K. PICUs. Duration of 2 months between November and December 2019.

PATIENTS:
Three hundred fifty infants receiving IMV for bronchiolitis. Excluded were patients receiving long-term ventilation, extracorporeal life support, or who died before separation from IMV.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
After adjustment for confounders, several variables were associated with an increase in the geometric mean duration of IMV (expressed as a percentage) including: nasal ETT use, 16% (95% CI, 1–32%); neuromuscular blockade use, 39% (95% CI, 21–61%); and fluid balance at 48 hr, 13% per 100 mL/kg positive fluid balance (95% CI, –1% to 28%). The association of sedative use varied with class of agent. The use of an alpha-2 agonist alone was associated with a reduction in duration of IMV by 19% in relation to no sedative agent (95% CI, –31 to –5%), whereas benzodiazepine uses alone or with alpha-2 agonist in combination were similar to using neither agent.

CONCLUSIONS:
Early management strategies for bronchiolitis were associated with the duration of IMV across U.K. centers after adjustment for confounders. Future work should prospectively assess the impact of fluid restriction, route of endotracheal intubation, and alpha-2 agonist use on duration of IMV in infants with bronchiolitis, with the aim of reducing seasonal bed pressure.
A Multiclass Radiomics Method–Based WHO Severity Scale for Improving COVID-19 Patient Assessment and Disease Characterization From CT Scans
Authors: Henao John Anderson Garcia , Depotter Arno , Bower Danielle V. , Bajercius Herkus , Todorova Plamena Teodosieva , Saint-James Hugo , de Mortanges Aurélie Pahud , Barroso Maria Cecilia , He Jianchun , Yang Junlin , You Chenyu , Staib Lawrence H. , Gange Christopher , Ledda Roberta Eufrasia , Caminiti Caterina , Silva Mario , Cortopassi Isabel Oliva , Dela Cruz Charles S. , Hautz Wolf , Bonel Harald M. , Sverzellati Nicola , Duncan James S. , Reyes Mauricio , Poellinger Alexander 
Published: July 2023

Objectives
The aim of this study was to evaluate the severity of COVID-19 patients' disease by comparing a multiclass lung lesion model to a single-class lung lesion model and radiologists' assessments in chest computed tomography scans.

Materials and Methods
The proposed method, AssessNet-19, was developed in 2 stages in this retrospective study. Four COVID-19–induced tissue lesions were manually segmented to train a 2D-U-Net network for a multiclass segmentation task followed by extensive extraction of radiomic features from the lung lesions. LASSO regression was used to reduce the feature set, and the XGBoost algorithm was trained to classify disease severity based on the World Health Organization Clinical Progression Scale. The model was evaluated using 2 multicenter cohorts: a development cohort of 145 COVID-19–positive patients from 3 centers to train and test the severity prediction model using manually segmented lung lesions. In addition, an evaluation set of 90 COVID-19–positive patients was collected from 2 centers to evaluate AssessNet-19 in a fully automated fashion.

Results
AssessNet-19 achieved an F1-score of 0.76 ± 0.02 for severity classification in the evaluation set, which was superior to the 3 expert thoracic radiologists (F1 = 0.63 ± 0.02) and the single-class lesion segmentation model (F1 = 0.64 ± 0.02). In addition, AssessNet-19 automated multiclass lesion segmentation obtained a mean Dice score of 0.70 for ground-glass opacity, 0.68 for consolidation, 0.65 for pleural effusion, and 0.30 for band-like structures compared with ground truth. Moreover, it achieved a high agreement with radiologists for quantifying disease extent with Cohen κ of 0.94, 0.92, and 0.95.

Conclusions
A novel artificial intelligence multiclass radiomics model including 4 lung lesions to assess disease severity based on the World Health Organization Clinical Progression Scale more accurately determines the severity of COVID-19 patients than a single-class model and radiologists' assessment.
Highly Sensitive 3-Tesla Real Inversion Recovery MRI Detects Leptomeningeal Contrast Enhancement in Chronic Active Multiple Sclerosis
Authors: Okar Serhat Vahip , Dieckhaus Henry , Beck Erin S. , Gaitán María I. , Norato Gina , Pham Dzung L. , Absinta Martina , Cortese Irene CM , Fletcher Anita , Jacobson Steven , Nair Govind , Reich Daniel S. 
Published: July 2023

Background
Leptomeningeal contrast enhancement (LME) on T2-weighted Fluid-Attenuated Inversion Recovery (T2-FLAIR) MRI is a reported marker of leptomeningeal inflammation, which is known to be associated with progression of multiple sclerosis (MS). However, this MRI approach, as typically implemented on clinical 3-tesla (T) systems, detects only a few enhancing foci in ~25% of patients and has thus been criticized as poorly sensitive.

Purpose
To compare an optimized 3D real-reconstruction inversion recovery (Real-IR) MRI sequence on a clinical 3 T scanner to T2-FLAIR for prevalence, characteristics, and clinical/radiological correlations of LME.

Materials and Methods
We obtained 3D T2-FLAIR and Real-IR scans before and after administration of standard-dose gadobutrol in 177 scans of 154 participants (98 women, 64%; mean ± SD age: 49 ± 12 years), including 124 with an MS-spectrum diagnosis, 21 with other neurological and/or inflammatory disorders, and 9 without neurological history. We calculated contrast-to-noise ratios (CNR) in 20 representative LME foci and determined association of LME with cortical lesions identified at 7 T (n = 19), paramagnetic rim lesions (PRL) at 3 T (n = 105), and clinical/demographic data.

Results
We observed focal LME in 73% of participants on Real-IR (70% in established MS, 33% in healthy volunteers, P < 0.0001), compared to 33% on T2-FLAIR (34% vs. 11%, P = 0.0002). Real-IR showed 3.7-fold more LME foci than T2-FLAIR (P = 0.001), including all T2-FLAIR foci. LME CNR was 2.5-fold higher by Real-IR (P < 0.0001). The major determinant of LME status was age. Although LME was not associated with cortical lesions, the number of PRL was associated with the number of LME foci on both T2-FLAIR (P = 0.003) and Real-IR (P = 0.0003) after adjusting for age, sex, and white matter lesion volume.

Conclusions
Real-IR a promising tool to detect, characterize, and understand the significance of LME in MS. The association between PRL and LME highlights a possible role of the leptomeninges in sustaining chronic inflammation.
Pathways Associated with Positive Sepsis Survival Outcomes in African American/Black and Non-Hispanic White UTI Patients
Authors: Kapp Kathryn L. , Choi Min Ji , Bai Kun , Du Liping , Yende Sachin , Kellum John A. , Angus Derek C. , Peck-Palmer Octavia M. , Robinson Renã A. S. 
Published: July 2023

ABSTRACT
Urinary tract infections (UTIs) are a common cause of sepsis worldwide. Annually, over 60,000 US deaths can be attributed to sepsis secondary to UTIs, and African American/Black adults have higher incidence and case-fatality rates more so than Non-Hispanic White adults. Molecular-level factors that may help partially explain differences in sepsis survival outcomes between African American/Black and Non-Hispanic White adults are not clear. In this study, patient samples (N = 166) from the Protocolized Care for Early Septic Shock (ProCESS) cohort were analyzed using discovery-based plasma proteomics. Patients had sepsis secondary to UTIs and were stratified according to self-identified racial background and sepsis survival outcomes. Proteomics results suggest patient heterogeneity across mechanisms driving survival from sepsis secondary to UTIs. Differentially-expressed proteins (N = 122, FDR-adjusted p < 0.05) in Non-Hispanic White sepsis survivors were primarily in immune system pathways, while differentially-expressed proteins (N = 47, FDR-adjusted p < 0.05) in African American/Black patients were mostly in metabolic pathways. However, in all patients, regardless of racial background, there were 16 differentially-expressed proteins in sepsis survivors involved in translation initiation and shutdown pathways. These pathways are potential targets for prognostic intervention. Overall, this study provides information about molecular factors that may help explain disparities in sepsis survival outcomes among African American/Black and Non-Hispanic White patients with primary UTIs.
Exosomal circVMA21 derived from adipose-derived stem cells alleviates sepsis-induced acute kidney injury by targeting miR-16-5p
Authors: He Yuexian , Li Xiaoyue , Huang Bolun , Yang Yiyu , Luo Nandu , Song Wenxiu , Huang Bo 
Published: July 2023

Abstract

Background
Exosome from adipose-derived stem cells (ADSCs-Exo) has been shown to inhibit the progression of human diseases, including sepsis-related acute kidney injury (AKI). CircVMA21 is considered to be an important regulator for sepsis-related AKI. However, whether ADSCs-Exo affected sepsis-induced AKI by delivering circVMA21 is not clear.

Methods
ADSCs was identified by alizarin red staining, oil red O staining, and flow cytometry. ADSCs-Exo was authenticated by transmission electron microscopy, nanoparticle tracking analysis, western blot analysis, and immunofluorescence assay. Cell apoptosis was assessed by flow cytometry, and inflammation cytokine levels were determined by ELISA. Lactate production was assessed using Lactate Acid Content Assay Kit. The expression levels of aerobic glycolysis-related markers, circVMA21 and miR-16-5p were evaluated by qRT-PCR. Dual-luciferase reporter assay and RIP assay were employed to detect RNA interaction. Animal experiments were used to evaluate the role of ADSCs-Exo on renal function and cell injury in LPS-induced AKI mice model.

Results
ADSCs-Exo inhibited LPS-induced HK-2 cell apoptosis, inflammation and aerobic glycolysis. Knockdown of exosomal circVMA21 derived from ADSCs enhanced HK-2 cell injury induced by LPS. In terms of mechanism, circVMA21 could serve as sponge for miR-16-5p. Besides, miR-16-5p inhibitor reversed the promotion effect of Exo-sh-circVMA21 on LPS-induced cell injury. In addition, ADSCs-Exo protected LPS-induced AKI in mice by increasing circVMA21 expression and decreasing miR-16-5p expression.

Conclusion
Exosomal circVMA21 derived by ADSCs relieved LPS-induced AKI through targeting miR-16-5p, which provided a potential molecular target for treating sepsis-related AKI.
Mild therapeutic hypothermia reduces ischemia-reperfusion injury following Zone 1 REBOA in a swine hemorrhagic shock model
Authors: Yang Zhao , Jianxin Gao , Chengcheng Li , Guogeng Song , Yi Shan 
Published: July 2023

ABSTRACT

Background
Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular hemostasis method used for the management of traumatic abdominal and pelvic hemorrhages. However, REBOA-associated ischemia-reperfusion injury (IRI) complication limits its blocking time. We hypothesized that mild therapeutic hypothermia (TH) would relieve IRI caused by prolonged zone 1 REBOA.

Methods
Ten pigs were anesthetized, intubated, and subsequently struck with the experimental sliding-chamber ballistic gun to inflict liver damage. Animals were randomized to hypothermia (60 min of Zone 1 REBOA with external cooling for 180 min, n = 5) or control (60 min of Zone 1 REBOA with no external cooling, n = 5). Physiological and laboratory parameters were monitored and assessed. Distal organs were obtained for histologic analysis.

Results
At 180 min, compared with the control, the hypothermia animals exhibited significantly increased pH and significantly reduced lactate (Lac), hemoglobin (Hb) and hematocrit (Hct) (all p < 0.05). The change of Lac from 0 to 180 min in hypothermia animals was less than that in the control (p = 0.02). The total bleeding in the control group was significantly less than the hypothermia (p < 0.01). In the hypothermia group, PT at 120 and 180 min was significantly longer than that at baseline (all p < 0.05). Compared with the control, animals in hypothermia group showed slighter pathological injury of the distal organs and significantly lower overall injury score (all p < 0.05).

Conclusions
Mild TH during prolonged Zone 1 REBOA offered extraordinary distal organ preservation, and decreased metabolic acidosis.
Anatomic Criterion for Clinically Relevant Apical Prolapse in Urogynecology Populations
Authors: Oh Sumin , Shin E. Kyung , Lee So Yeon , Kim Min Ju , Lee Youjoung , Jeon Myung Jae 
Published: July 2023

Importance
Despite recognition of the critical role of the apex in vaginal support, there is no consensus on the anatomic criteria for clinically relevant apical prolapse.

Objective
The aim of this study was to define an optimal anatomic criterion for clinically relevant apical prolapse.

Study Design
This retrospective cohort study included 3,690 patients who had visited a tertiary hospital for ambulatory urogynecologic care. Vaginal bulge symptom was defined as a response of “somewhat,” “moderately,” or “quite a bit” to Question 3 on the Pelvic Floor Distress Inventory-20. Receiver operating characteristic curves were generated for a vaginal bulge symptom and apical support (Pelvic Organ Prolapse Quantification point C and C/total vaginal length [TVL]).

Results
Both point C and the C-to-TVL ratio (C/TVL) had excellent performance for predicting vaginal bulge symptoms (area under the curve, 0.917 and 0.927, respectively). The optimal cutoffs were −3.0 for C and −0.50 for C/TVL. When we analyzed the data set according to the TVL, there was a significant difference in the cutoffs for C, whereas those for C/TVL had little difference. There was no difference in the cutoffs of C and C/TVL according to hysterectomy status.

Conclusions
The C/TVL is more appropriate than point C as a measure to define an anatomic criterion for clinically relevant apical prolapse. Descent of the vaginal apex beyond the halfway point of the vagina could be considered as an anatomic threshold for clinically relevant apical prolapse. This finding needs to be validated in nonurogynecology populations.