bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients
Authors: Emara Ahmed K. , Oyem Precious C. , Ferre Alexandra , Churchill Jessica , Grits Daniel , Ng Mitchell , Pan Xuankang , Nagy Matthew , Obiri-Yeboah Derrick , Molloy Robert M. , Piuzzi Nicolas S. 
Published: February 2023

Objective:
We aimed to characterize the association between BMI as a continuous variable and 30-day postoperative outcomes following hip fracture surgery through (1) 30-day readmission and reoperation; (2) local wound-related; and (3) systemic complications.

Methods:
The National Surgical Quality Improvement Program database (January 2016–December 2019) was queried for patients undergoing hip fracture open reduction and internal fixation. Baseline patient demographics, comorbidities, and patient outcomes were recorded. Multivariable regression models accounted for baseline demographics, comorbidities, and fracture patterns. Significant associations were analyzed using spline regression models to evaluate the continuous association between BMI and the aforementioned outcomes.

Results:
Spline models demonstrated a U-shaped curve for the odds of 30-day readmission and 30-day reoperation with nadirs at the BMI of 27.5 and 22.0 kg/m2. The odd ratios of superficial infection, deep infection, any wound complication, and inability to weight bear on POD 1 rose progressively starting at a BMI of 25.6, 35.5, 25.6, and 32.7 kg/m2 respectively. Odds of 30-day mortality, transfusion, pneumonia, and delirium were greatest at the lowest recorded BMI (11.9 kg/m2).

Conclusion:
BMI has a U-shaped association with 30-day readmission and reoperation. Conversely, the highest risk of mortality and systemic complications (transfusion, pneumonia, and delirium) were within the lower BMI range, with diminishing risk as BMI increased. Local wound complications and systemic sepsis exhibited a third unique pattern with progressive rise in odds as BMI increased. The odds of any complications demonstrated a U-shaped pattern with a nadir in the overweight to obese I categories, suggesting that patients may be at lowest risk within this range.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Deep Learning–Based Recurrent Delirium Prediction in Critically Ill Patients
Authors: Lucini Filipe R. , Stelfox Henry T. , Lee Joon 
Published: February 2023

OBJECTIVES:
To predict impending delirium in ICU patients using recurrent deep learning.

DESIGN:
Retrospective cohort study.

SETTING:
Fifteen medical-surgical ICUs across Alberta, Canada, between January 1, 2014, and January 24, 2020.

PATIENTS:
Forty-three thousand five hundred ten ICU admissions from 38,426 patients.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We used ICU and administrative health data to train deep learning models to predict delirium episodes in the next two 12-hour periods (0–12 and 12–24 hr), starting at 24 hours after ICU admission, and to generate new predictions every 12 hours. We used a comprehensive set of 3,643 features, capturing patient history, early ICU admission information (first 24 hr), and the temporal dynamics of various clinical variables throughout the ICU admission. Our deep learning architecture consisted of a feature embedding, a recurrent, and a prediction module. Our best model based on gated recurrent units yielded a sensitivity of 0.810, a specificity of 0.848, a precision (positive predictive value) of 0.704, and an area under the receiver operating characteristic curve (AUROC) of 0.909 in the hold-out test set for the 0–12-hour prediction horizon. For the 12–24-hour prediction horizon, the same model achieved a sensitivity of 0.791, a specificity of 0.807, a precision of 0.637, and an AUROC of 0.895 in the test set.

CONCLUSIONS:
Our delirium prediction model achieved strong performance by applying deep learning to a dataset that is at least one order of magnitude larger than those used in previous studies. Another novel aspect of our study is the temporal nature of our features and predictions. Our model enables accurate prediction of impending delirium in the ICU, which can potentially lead to early intervention, more efficient allocation of ICU resources, and improved patient outcomes.
Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the ICU: An Observational Study From the OUTCOMEREA Database, 1997–2018
Authors: Galerneau Louis-Marie , Bailly Sébastien , Terzi Nicolas , Ruckly Stéphane , Garrouste-Orgeas Maité , Cohen Yves , Hong Tuan Ha Vivien , Gainnier Marc , Siami Shidasp , Dupuis Claire , Darmon Michael , Forel Jean-Marie , Rigault Guillaume , Adrie Christophe , Goldgran-Toledano Dany , Laurent Virginie , de Montmollin Etienne , Argaud Laurent , Reignier Jean , Pepin Jean-Louis , Timsit Jean-François ,   on behalf of the OUTCOMEREA Network
Published: February 2023

OBJECTIVES:
Our aim was to describe changes in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) by ICUs and patient outcomes.

DESIGN:
We extracted data from the OutcomeRea database concerning patients admitted for AECOPD between 1997 and 2018. We analyzed trends in the use of ventilatory support, corticosteroid therapy, antibiotic therapy, and patient survival.

SETTING:
ICUs at 32 French sites.

PATIENTS:
One thousand eight hundred sixteen patients in the database had a diagnosis of AECOPD.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Over time, there was a reduction in the prescription of corticosteroids and antibiotics. In a time-series analysis, these changes in practice were not linked with ICU mortality. The proportion of patients treated with invasive mechanical ventilation (IMV) also gradually declined (from 51% between 1997 and 2002 to 35% between 2013 and 2018) with an association between decrease in IMV use and reduction in ICU mortality in a time series analysis. Rates of noninvasive ventilation (NIV) failure decreased with an increase in NIV use to support weaning from IMV. There was a reduction in the median ICU length of stay (from 8 d in 1997–2002 to 4 d in 2013–2018) and in the median total duration of hospitalization (from 23 d in 1997–2002 to 14 d in 2013–2018). We observed an improvement in prognosis, with decreases in overall hospital mortality (from 24% between 1997 and 2002 to 15% between 2013 and 2018), ICU mortality (from 14% between 1997 and 2002 to 10% between 2013 and 2018), and 90-day mortality (from 41% between 1997 and 2002 to 22% between 2013 and 2018).

CONCLUSIONS:
The length of stay and mortality of patients with AECOPD admitted to ICUs has decreased over the last 20 years, with a wider use of NIV and a reduction in antibiotic and corticosteroid prescriptions.
A new era: Comparing wired to wireless endoscopy
Authors: Niu Di , Yang Cheng , Liang Chaozhao 
Published: February 2023

Abstract
Minimally invasive operations represented by laparoscopy have generated a revolution in the field of surgery over recent decades. There are various wired connections of standard endoscopic systems that have some drawbacks to the operators and operative room such as reducing mobility and occupying much space. Emerging technologies are directing endoscopy toward an ultra-high definition, wireless design, with a small volume, and improved ergonomics. This narrative review discusses the application of mobile technology and ordinary cameras in endoscopy and some wireless designs. However, further technical tests and large-scale clinical validation are required for these wireless endoscopes.
A rare triple concurrence of ureteric calculus and renal cell carcinoma in a horseshoe kidney
Authors: Munien Kale , Winston Joshua , Davies Nicholas 
Published: February 2023

Abstract
Horseshoe kidney is a rare anatomical variant with low clinical morbidity. However, the characteristic shape of horseshoe kidney causes significant anomalies within the vascular and collecting systems. This complicates the diagnosis and management of coexisting pathologies within the kidneys. Here, we report a rare case of concurrent diagnoses of ipsilateral ureteric calculus and renal cell carcinoma within a horseshoe kidney and describe the subsequent management rationale based on the current literature.
Management of urolithiasis in pregnancy
Authors: Chan Kimberley , Shakir Taner , El-Taji Omar , Patel Amit , Bycroft John , Lim Chou Phay , Vasdev Nikhil 
Published: February 2023

Abstract
Urolithiasis is the most common cause of nonobstetric abdominal pain, resulting in 1.7 admissions per 1000 deliveries. Urolithiasis most commonly occurs in the second and third trimesters, with an incidence between 1:125 and 1:2000. Acute urinary system obstructions are challenging to manage in obstetric patients because they contribute to physiological and anatomical changes that result in pathological outcomes. The restricted use of computed tomography in diagnosing and managing urolithiasis is particularly challenging. In addition, a prompt diagnosis is required because the presence of renal calculi during pregnancy increases the risk of fulminating sepsis and preterm delivery. Affected pregnancies are conservatively managed; however, 1 in 4 requires surgical intervention. Indications for surgical interventions are complex and range from nephrostomy insertion to empirical stent placement or ureteroscopy. Therefore, a multidisciplinary approach is required to optimize patient care.
The diagnosis and management of urolithiasis in pregnancy are complex. We reviewed the role, safety, advantages and disadvantages of diagnostic tests and treatment used to manage acute urinary obstructions in pregnancy.
Optimizing Anticoagulation Management in Atrial Fibrillation: Beyond the Guidelines. How and for Whom?
Authors: Papakonstantinou Panteleimon E. , Tsioufis Konstantinos 
Published: February 2023

Abstract:
Anticoagulation therapy (AT) is the cornerstone of atrial fibrillation (AF) treatment for thromboembolic event prevention. The AF burden, however, is of predictive relevance and may be used as a foundation for therapeutic decisions in individuals with paroxysmal or persistent AF. Remote rhythm monitoring devices can provide early detection of the arrhythmia, long-term rhythm monitoring, and the development of anticoagulation strategies based on AF recurrence profile and the total burden of the arrhythmia. Although the exact thromboembolic cut-off value for the AF burden has not yet been established, targeted anticoagulation treatments in the new oral anticoagulants era have shown encouraging outcomes. The combined evaluation of AF burden and patient thromboembolic risk reported in some studies supports the concept of tailored anticoagulation management, at least in a subset of patients with low AF burden and intermediate thromboembolic risk, for whom the guidelines recommend that AT should be individualized based on net clinical benefit and patient values and preferences. Although it is still premature to derive firm conclusions or algorithms diverging from the current guidelines, the combination of a patient's AF burden, thromboembolic risk, and bleeding risk can lead in the future to an individualized management of patients with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65–74 years sex category (female) (CHA2DS2-VASc) score of 1 (2 for female patients), in whom the guidelines do not strictly recommend long-term AT. In this study, we provide an algorithm regarding the individualized implementation of anticoagulation strategies in AF in different patients' thromboembolic risk profiles, based on the available data on the so far tailored anticoagulation strategies in AF.
Measuring Serum Vedolizumab and Vedolizumab Antibodies: Comparison of Commercial Assays with the Vedolizumab Clinical Development Assay
Authors: Vande Casteele Niels , Yang Lili , Dobler Iwona , Agboton Christian , McRorie Osborn Teresa , Suri Ajit , Lindner Dirk , Smithson Glennda M. 
Published: February 2023

Background:
Vedolizumab (VDZ) is an anti-α4β7 integrin monoclonal antibody approved for inflammatory bowel disease treatment. VDZ serum and antidrug antibody (ADA) concentrations may be used for treatment optimization. In this article, the results of 5 commercial assays (Grifols, Immundiagnostik, Progenika, Sanquin, and Theradiag) measuring VDZ concentration and ADA were compared with those of the reference assays used in VDZ clinical studies. Our findings will assist clinicians in interpreting commercial assay results in the context of VDZ clinical trial data.

Methods:
VDZ-treated patient samples were used to evaluate the agreement between commercial assays and the reference VDZ serum concentration assay, based on linear regression, Bland–Altman, and qualitative agreement analyses. VDZ ADAs were detected using qualitative assays. Specificity, selectivity, accuracy, and precision were assessed using serum samples from healthy donors or patients with IBD (VDZ serum concentration <0.5 mcg/mL) spiked with VDZ, with/without other biologics (identical sample sets per assay).

Results:
All assays were specific and selective for VDZ. Overall, the commercial assay results for VDZ-spiked samples correlated well with those of the reference serum concentration assay (R2 ≥ 0.98). Compared with the Immundiagnostik and Theradiag assays, the Grifols, Sanquin, and Progenika assays had the best reference assay agreement (based on regression analysis, Bland–Altman plots, and qualitative agreement [Cohen's kappa ≥0.92]). All immunogenicity assays detected VDZ ADAs; only the reference assay detected VDZ ADAs in the presence of 15 mcg/mL VDZ, advising caution with commercial ADA assays if VDZ is present.

Conclusions:
All 5 commercial assays are suitable for VDZ therapeutic monitoring and ADA testing. However, the absolute values from the reference assays and the different commercial assays were not comparable, indicating that the same assay must be used for repeated monitoring of VDZ serum concentrations.
Elbasvir/grazoprevir in children aged 3–18 years with chronic HCV genotype 1 or 4 infection: a pharmacokinetic modeling study
Authors: Gonzalez-Peralta Regino P. , Wirth Stefan , Squires Robert H. , Mutschler Frauke , Lang Thomas , Pawlowska Malgorzata , Sluzewski Wojciech , Majda-Stanislawska Ewa , Fischler Bjorn , Balistreri William F. , Jonas Maureen M. , Blondet Niviann , Rosenthal Philip , Alkhouri Naim , Romero Rene , Grandhi Anjana , Castronuovo Patricia , Caro Luzelena , Du Lihong , Rosenbloom Daniel I.S. , Haber Barbara A. 
Published: February 2023

Background:
Approximately 3.5 million children and adolescents worldwide are chronically infected with HCV. This study uses pharmacokinetic modeling to identify pediatric doses of elbasvir/grazoprevir (EBR/GZR) that achieve plasma concentrations similar to those seen in adults receiving the approved fixed-dose combination regimen of EBR/GZR.

Patients and Methods:
We conducted a nonrandomized, single-arm, multicenter, open-label phase 2b trial in children and adolescents aged 3 to <18 years with chronic HCV genotype 1 or 4 infection (NCT03379506). Pharmacokinetic data were used to bridge efficacy and safety data from adults to children in a stepwise (oldest to youngest) manner. A total of 57 participants were enrolled: cohort 1 (aged 12 to <18 y), n=22; cohort 2 (aged 7 to <12 y), n=17; and cohort 3 (aged 3 to <7 y), n=18.

Results:
Steady-state plasma exposures were achieved by week 4 for EBR and GZR in all cohorts and daily dosing achieved geometric mean steady-state area under the concentration-time curve at 0–24 hours that fell within comparability bounds established for adults. All participants achieved sustained virologic response 12 weeks after completing treatment (ie, undetectable HCV RNA 12 wk following completion of treatment). Headache (n=4), fatigue (n=4), and nausea (n=2) were the most common treatment-related adverse events (all mild or moderate); no participant discontinued because of an adverse event.

Conclusions:
Pediatric EBR/GZR pharmacokinetic models were successfully developed based on complex adult population pharmacokinetic models. At appropriate age-related doses, EBR/GZR is safe and effective in pediatric and adolescent participants with HCV infection.
Genetics of aortic valve disease
Authors: Ackah Ruth L. , Yasuhara Jun , Garg Vidu 
Published: February 2023

Purpose of review
Aortic valve disease is a leading global cause of morbidity and mortality, posing an increasing burden on society. Advances in next-generation technologies and disease models over the last decade have further delineated the genetic and molecular factors that might be exploited in development of therapeutics for affected patients. This review describes several advances in the molecular and genetic understanding of AVD, focusing on bicuspid aortic valve (BAV) and calcific aortic valve disease (CAVD).

Recent findings
Genomic studies have identified a myriad of genes implicated in the development of BAV, including NOTCH1, SMAD6 and ADAMTS19, along with members of the GATA and ROBO gene families. Similarly, several genes associated with the initiation and progression of CAVD, including NOTCH1, LPA, PALMD, IL6 and FADS1/2, serve as the launching point for emerging clinical trials.

Summary
These new insights into the genetic contributors of AVD have offered new avenues for translational disease investigation, bridging molecular discoveries to emergent pharmacotherapeutic options. Future studies aimed at uncovering new genetic associations and further defining implicated molecular pathways are fuelling the new wave of drug discovery.
Genetics of atrial fibrillation
Authors: Lee David S.M. , Damrauer Scott M. , Levin Michael G. 
Published: February 2023

Purpose of review
Atrial fibrillation is the most common cardiac arrhythmia worldwide. There is considerable interest in better understanding the molecular genetics and biology of atrial fibrillation to inform the development of new therapies and improve clinical management. This review summarizes recent advances in our understanding of the genetic basis of atrial fibrillation and new efforts to utilize genetics to inform clinical management.

Recent findings
Genome-wide association studies in diverse populations have increased the number of genetic loci associated with atrial fibrillation and its specific subtypes. Large-scale biobanks with deep phenotyping have provided invaluable data to study the impact of both common and rare variants on atrial fibrillation, susceptibility, and prognosis. Polygenic risk scores help improve individual atrial fibrillation risk stratification and prognostication.

Summary
Our understanding of atrial fibrillation genetics is rapidly improving with larger and more diverse genome-wide association studies. Translating genetic discoveries into molecular pathways and new therapeutic targets remains a bottleneck in the development of new therapies for atrial fibrillation. Genetic risk scores have shown early promise in improving atrial fibrillation risk stratification; however, their broader utility for the general population remains unclear.
An Electrocoagulation Fixation Technique for One-Piece Intraocular Lens Scleral Flapless Fixation With Sutures Without Knots
Authors: Si Shancheng , Zhang Jianhui 
Published: February 2023

Purpose:
To present an electrocoagulation fixation technique for one-piece intraocular lens (IOL) scleral flapless fixation with sutures without knots.

Methods:
First of all, after repeated tests and comparisons, we chose 8-0 polypropylene suture as the material for electrocoagulation fixation of one-piece IOL haptics because of its proper elasticity and size. A transscleral tunnel puncture at the pars plana was performed using an arc-shaped needle with 8-0 polypropylene suture. The suture was subsequently guided out of the corneal incision by a 1-mL syringe needle and then guided by the needle into the inferior haptics of the IOL. The suture was cut off and heated into a shape of a probe with a spherical tip using a monopolar coagulation device to prevent slippage from the haptics.

Results:
In the end, 10 eyes underwent our new surgical procedures, and the average operation time was 42.5 ± 12.4 minutes. At the 6-month follow-up, seven of 10 eyes achieved significant vision improvement and nine of 10 kept the implanted one-piece IOL stable in the ciliary sulcus. No serious intraoperative/postoperative complications were observed.

Conclusion:
The electrocoagulation fixation was a safe and effective alternative technique for previously implanted one-piece IOL scleral flapless fixation with sutures without knots.
New simulation software to predict postoperative corneal stiffness before laser vision correction
Authors: Francis Mathew , Shetty Rohit , Padmanabhan Prema , Vinciguerra Riccardo , Vinciguerra Paolo , Lippera Myrta , Matalia Himanshu , Khamar Pooja , Chinnappaiah Nandini , Mukundan Deepa , Nuijts Rudy M.M.A. , Sinha Roy Abhijit 
Published: February 2023

Purpose:
To develop a new virtual surgery simulation platform to predict postoperative corneal stiffness (Kcmean) after laser vision correction (LVC) surgery.

Setting:
Narayana Nethralaya Eye Hospital and Sankara Nethralaya, India; Humanitas Clinical and Research Center, Italy.

Design:
Retrospective observational case series.

Methods:
529 eyes from 529 patients from 3 eye centers and 10 post–small-incision lenticule extraction (SMILE) ectasia eyes were included. The software (called AcuSimX) derived the anisotropic, fibril, and extracellular matrix biomechanical properties (using finite element calculation) of the cornea using the preoperative Corvis-ST, Pentacam measurement, and inverse finite element method assuming published healthy collagen fibril orientations. Then, the software-computed postoperative Kcmean was adjusted with an artificial intelligence (AI) model (Orange AI) for measurement uncertainties. A decision tree was developed to classify ectasia from normal eyes using the software-computed and preoperative parameters.

Results:
In the training cohort (n = 371 eyes from 371 patients), the mean absolute error and intraclass correlation coefficient were 6.24 N/m and 0.84 (95% CI, 0.80-0.87), respectively. Similarly, in the test cohort (n = 158 eyes from 158 patients), these were 6.47 N/m and 0.84 (0.78-0.89), respectively. In the 10 ectasia eyes, the measured in vivo (74.01 [70.01-78.01]) and software-computed (74.1 [69.03-79.17]) Kcmean were not statistically different (P = .96). Although no statistically significant differences in these values were observed between the stable and ectasia groups (P ≥ .14), the decision tree classification had an area under the receiver operating characteristic curve of 1.0.

Conclusions:
The new software provided an easy-to-use virtual surgery simulation platform for post-LVC corneal stiffness prediction by clinicians and was assessed in post-SMILE ectasia eyes. Further assessments with ectasia after surgeries are required.