bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative advanced haemodynamic monitoring of patients undergoing multivisceral debulking surgery: an observational pilot study
Authors: Middel Charlotte , Stetzuhn Matthias , Sander Nadine , Kalkbrenner Björn , Tigges Timo , Pielmus Alexandru-Gabriel , Spies Claudia , Pietzner Klaus , Klum Michael , von Haefen Clarissa , Hunsicker Oliver , Sehouli Jalid , Konietschke Frank , Feldheiser Aarne 
Published: September 2023

Abstract
Background
Patients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry.

Methods
In a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien–Dindo classification were used as a grouping criterion.

Results
The relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median – 19 [25-quartile − 26%; 75-quartile − 10%]%, p < 0.0001), stroke volume index (SVI, − 9.5 [− 15.3; 3.2]%, p = 0.0038), cardiac index (CI, − 24.5 [− 32; − 13]%, p < 0.0001) and index of contractility (− 17.5 [− 35.3; − 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery.

Conclusions
Substantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.
Mapping the knowledge structure of a gluten-free diet: a global perspective
Authors: Zyoud Sa ’ed H. , Shakhshir Muna , Abushanab Amani S. , Koni Amer , Hamdallah Moath , Al-Jabi Samah W. 
Published: September 2023

Abstract
Background
A gluten-free diet (GFD) has become one of the most popular eating plans and is essential for managing gluten-related medical conditions, signs, and symptoms. Therefore, we performed a bibliometric analysis of the scientific literature on the GFD to describe the research landscape.

Methods
The Scopus database was searched for publications on the GFD from 1952 to 2021. A bibliometric analysis of the data was performed. VOSviewer software was used to perform visualization analysis, co-occurrence analysis, and publication trends in GFD.

Results
A total of 3,258 publications were retrieved. In terms of publications, Italy (n = 468, 14.36%) led in the number of publications, followed by the USA (n = 398, 12.22%) and Spain (n = 274, 8.41%). The retrieved documents earned an average of 22.89 citations per document, for a total of 74,560 citations. Since 2001, there has been a gradual growth in the number of articles published, going from 23 to more than 370 in 2021. Using the mapping terms in the title/abstract a minimum of 50 times, 291 terms were divided into two main clusters: ‘adherence to a gluten-free diet in celiac disease’ and ‘improvement of the nutritional and sensory quality of gluten-free products.’

Conclusions
Over the past six decades, there has been a growing need for gluten-free bakery products and a noticeable increase in related publications. This study indicates that the “improvement of the nutritional and sensory quality of gluten-free products” will remain a hotspot in this research field for upcoming years.
Fragmented QRS complex, highly sensitive CRP, and fibrinogen in early detection of asymptomatic cardiac involvement in systemic lupus erythematosus
Authors: Kamal Doaa E. , Fahmi Dalia S. , Abdelsalam Noha A. , Elsayed Doaa M. , Seddik Eman H. , Kotb Lobna I. 
Published: September 2023

Abstract
Background
Patients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular illnesses. Asymptomatic affection might exist, so early diagnosis can improve the outcome.

Aim
The purpose of this study was to determine the importance of highly sensitive C-reactive protein, fragmented QRS, and fibrinogen levels in identifying subclinical cardiac involvement in SLE patients, as well as how these variables relate to disease activity.

Results
Regarding hs-CRP and fibrinogen, there were significant differences between the SLE and control group, with a higher frequency of fQRS in the lupus group. The lupus group was divided into 2 subgroups: 44 patients with fragmented QRS in ECG (83%) and 9 patients with normal QRS (17%) with a higher mean value of hs-CRP and fibrinogen level (58.76 ± 70.15, 18.54 ± 26.79) and low HDL (53.37 ± 10.37) in those with fQRS ( +). The sensitivity and specificity of hs-CRP at a cut of level (3.5 mg/L) for fQRS in SLE patients were 75.5%, and 71.7%, respectively. Regression analysis showed hs-CRP and were significant predictors for fQRS changes in SLE patients.

Conclusions
A more thorough evaluation of SLE patients with fQRS complexes with hs-CRP and fibrinogen is important with close follow-up for the detection of subclinical cardiac involvement in SLE. Also, SLE activity is linked to fQRS and fibrinogen. Therefore, we advise using them for additional medical care for lupus.
The Rate and Predictors of 30-Day Readmission in Patients Treated for Unruptured Cerebral Aneurysms: A Large Single-Center Study
Authors: El Naamani Kareem , Hunt Adam , Jain Paarth , Lawall Charles L. , Yudkoff Clifford J. , El Fadel Omar , Ghanem Marc , Mastorakos Panagiotis , Momin Arbaz A. , Alhussein Abdulaziz , Alhussein Reyoof , Atallah Elias , Abbas Rawad , Zakar Rida , Tjoumakaris Stavropoula I. , Gooch M. Reid , Herial Nabeel A. , Zarzour Hekmat , Schmidt Richard F. , Rosenwasser Robert H. , Jabbour Pascal M. 
Published: September 2023

BACKGROUND AND OBJECTIVES:
Numerous studies of various populations and diseases have shown that unplanned 30-day readmission rates are positively correlated with increased morbidity and all-cause mortality. In this study, we aim to provide the rate and predictors of 30-day readmission in patients undergoing treatment for unruptured intracranial aneurysms.

METHODS:
This is a retrospective study of 525 patients presenting for aneurysm treatment between 2017 and 2022. All patients who were admitted and underwent a successful treatment of their unruptured intracerebral aneurysms were included in the study. The primary outcome was the rate and predictors of 30-day readmission.

RESULTS:
The rate of 30-day readmission was 6.3%, and the mean duration to readmission was 7.8 days ± 6.9. On univariate analysis, factors associated with 30-day readmission were antiplatelet use on admission (odds ratio [OR]: 0.4, P = .009), hemorrhagic rupture (OR: 15.8, P = .007), surgical treatment of aneurysms (OR: 2.2, P = .035), disposition to rehabilitation (OR: 9.5, P < .001), and increasing length of stay (OR: 1.1, P = .0008). On multivariate analysis, antiplatelet use on admission was inversely correlated with readmission (OR: 0.4, P = .045), whereas hemorrhagic rupture (OR: 9.5, P = .04) and discharge to rehabilitation (OR: 4.5, P = .029) were independent predictors of 30-day readmission.

CONCLUSION:
In our study, risk factors for 30-day readmission were aneurysm rupture during the hospital stay and disposition to rehabilitation, whereas the use of antiplatelet on admission was inversely correlated with 30-day readmission. Although aneurysm rupture is a nonmodifiable risk factor, more studies are encouraged to focus on the correlation of antiplatelet use and rehabilitation disposition with 30-day readmission rates.
Efficacy of preoperative Tranexamic Acid in patients undergoing intertrochanteric hip fracture surgery: A randomized placebo controlled trial
Authors: Shah Faaiz Ali , Naeemullah  , Mian Amjad Ali  , Mian Javed Iqbal  
Published: September 2023

Objective: To determine the efficacy of preoperative Tranexamic Acid (TXA) in reducing perioperative allogenic blood transfusion frequency in patients with intertrochanteric fractures treated with Dynamic Hip Screw (DHS).
Methods: We conducted this placebo controlled double-blinded randomized trial in Orthopaedics & Traumatolgy Division Lady Reading Hospital, Peshawar from 1st January 2020 to 25th December 2022. All patients with intertrochanteric hip fractures fulfilling the inclusion criteria were treated with Dynamic Hip Screw (DHS) and were randomly divided into two equal groups. One group was administered single dose IV Tranexamic Acid (TXA) in a dose of 15mg/kg body weight in 100ml of saline while the other group (Placebo) was given 100 ml normal saline preoperatively. Post-operative Hemoglobin was measured on first, second and third day. The frequency of allogenic blood transfusions in the perioperative period was determined in both groups based upon the transfusion trigger (Hemoglobin 9g/dl). Categorical variables were compared with Chi-square test and mean with Independent sample t-test. P value of <0.05 was considered significant.
Results: The total number of patients in our trial were 200 which were equally but randomly allocated into TXA group and Placebo group each containing 100 patients. The mean age of the patients in TXA group was 48.16±1.75 years and the age of patients in the Placebo group was 48.35±1.60. The baseline demographic and clinical variables of both groups were identical (p< 0.05). The average preoperative hemoglobin was 11.5±4.2 g/dl in TXA group and 11.3±2.4g/dl in the Placebo group (p>0.05). The frequency of allogenic blood transfusion was significantly lower (p<0.05) in TXA group (13%, n=13) than in the Placebo group (41%, n=41).
Conclusion: Tranexamic acid (TXA) significantly reduces the frequency of peri operative allogenic blood transfusion in patients undergoing Dynamic Hip Screw (DHS) for intertrochanteric fractures.
doi: https://doi.org/10.12669/pjms.39.6.7667
How to cite this: Shah FA, Naeemullah, Ali MA, Iqbal MJ. Efficacy of preoperative Tranexamic Acid in patients undergoing intertrochanteric hip fracture surgery: A randomized placebo controlled trial. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7667
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Clinical effectiveness of suture anchor repair combined with open reduction and internal fixation in the treatment of deltoid ligament rupture in ankle fracture
Authors: Zhang Le , Kong Xiaochuan , Hong Gang , Zheng Yinfeng , Zang Lei 
Published: September 2023

Objective: To explore the clinical effectiveness of suture anchor (SA) repair combined with open reduction and internal fixation (ORIF) in the treatment of deltoid ligament rupture (DLR) in ankle fractures.
Methods: This is a retrospective analysis of 210 patients with DLR in ankle fracture who were treated in Beijing Chaoyang Hospital from January 2020 to June 2022. According to the surgical records, 125 patients received SA repair combined with ORIF (Repair group) and 85 patients received ORIF only (Non-repair group). The curative effect, recovery of ankle joint function, pain, and bone metabolism of the two groups were observed.
Results: The clinical effectiveness (overall good) was higher in the Repair group (P<0.05). The American Orthopedic Foot and Ankle Society (AOFAS) score was higher three and six months post-operation in the Repair group, and the Visual Analogue Scale (VAS) score was lower than that of the Non-repair group (P<0.05). The Repair group had higher levels of bone-specific alkaline phosphatase (BALP) and bone gla protein (BGP) than the Non-repair group six months post-operation (P<0.05).
Conclusions: SA combined with ORIF has a good effect in the treatment of DLR in ankle fracture patients, which can promote the recovery of ankle function, relieve postoperative pain and improve bone metabolism.
doi: https://doi.org/10.12669/pjms.39.6.8070
How to cite this: Zhang L, Kong X, Hong G, Zheng Y, Zang L. Clinical effectiveness of suture anchor repair combined with open reduction and internal fixation in the treatment of deltoid ligament rupture in ankle fracture. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.8070
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Opening new vista for rapid detection of antimicrobial resistant genes via film array multiplex PCR
Authors: Zafar Humaira , Mirza Irfan Ali 
Published: September 2023

doi: https://doi.org/10.12669/pjms.39.6.8635
How to cite this: Zafar H, Mirza IA. Opening new vista for rapid detection of antimicrobial resistant genes via film array multiplex PCR. Pak J Med Sci. 2023;39(6):1555-1556. doi: https://doi.org/10.12669/pjms.39.6.8635
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Monte Carlo Methods for Economic Capital
Authors: Li Yajuan , Kaplan Zachary T. , Nakayama Marvin K. 
Published: September 2023

Economic capital (EC) is a risk measure used by financial firms to specify capital levels to protect (with high probability) against large unforeseen losses. Defined as the difference between an (extreme) quantile and the mean of the loss distribution, the EC is often estimated via Monte Carlo methods. Although simple random sampling (SRS) may be effective in estimating the mean, it can be inefficient for the extreme quantile in the EC. Applying importance sampling (IS) may lead to an efficient quantile estimator but can do poorly for the mean. Measure-specific IS (MSIS) instead uses IS to estimate only the quantile, and the mean is independently handled via SRS. We analyze large-sample properties of EC estimators obtained via SRS only, IS only, MSIS, IS using a defensive mixture, and a double estimator using both SRS and IS to estimate both the quantile and the mean, establishing Bahadur-type representations for the EC estimators and proving they obey central limit theorems. We provide asymptotic theory comparing the estimators when the loss is the sum of a large number of independent and identically distributed random variables. Numerical and simulation results, including for a large portfolio credit risk model with dependent obligors, complement the theory.History: Accepted by Bruno Tuffin, Area Editor for Simulation.Funding: This work was supported by the National Science Foundation [Grant CMMI-1537322].Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2021.0261 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2021.0261 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .
Maternal, fetal, and perinatal outcomes among pregnant women admitted to an Ebola treatment center in the Democratic Republic of Congo, 2018–2020
Authors: Philpott David , Rupani Neil , Gainey Monique , Mbong Eta N. , Musimwa Prince Imani , Perera Shiromi M. , Laghari Razia , Ververs Mija , Levine Adam C. 
Published: September 2023

Objective
This study aims to investigate maternal, fetal, and perinatal outcomes during the 2018–2020 Ebola outbreak in Democratic Republic of Congo (DRC).

Methods
Mortality between pregnant and non-pregnant women of reproductive age admitted to DRC’s Mangina Ebola treatment center (ETC) were compared using propensity score matching. Propensity scores were calculated using age, initial Ebola viral load, Ebola vaccination status, and investigational therapeutic. Additionally, fetal and perinatal outcomes of pregnancies were also described.

Results
Twenty-seven pregnant women were admitted to the Mangina ETC during December 2018—January 2020 among 162 women of childbearing age. We found no evidence of increase mortality among pregnant women compared to non-pregnant women (relative risk:1.0, 95%CI: 0.58–1.72). Among surviving mothers, pregnancy outcomes were poor with at least 58% (11/19) experiencing loss of pregnancy while 16% (3/19) were discharged with viable pregnancy. Two mothers with viable pregnancies were vaccinated, and all received investigational therapeutics. Two live births occurred, with one infant surviving after the infant and mother received an investigational post-exposure prophylaxis and Ebola therapeutic respectively.

Conclusions
Pregnancy was not associated with increased mortality among women with EVD in the Mangina ETC. Fetal and perinatal outcomes remained poor in pregnancies complicated by EVD, though novel therapeutics may have potential for improving these outcomes.
Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis
Authors: Melo Renato S. , Cardeira Caroline Stefany Ferreira , Rezende Damaris Scarleth A. , Guimarães-do-Carmo Vinícius J. , Lemos Andrea , de Moura-Filho Alberto Galvão 
Published: September 2023

Background
Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists.

Objective
Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs.

Methods
Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses.

Results
3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence.

Conclusions
Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.
The role of infectious disease consultations in the management of patients with fever in a long-term care facility
Authors: Moon Soo-youn , Lim Kyoung Ree , Son Jun Seong 
Published: September 2023

Background
Infectious disease (ID) clinicians can provide essential services for febrile patients in tertiary hospitals. The aim of this study was to evaluate the role of ID consultations (IDC) in managing hospitalized patients with infections in an oriental medical hospital (OMH), which serves as a long-term care facility. To our knowledge, this is the first study on the role of IDCs in managing patients in an OMH.

Methods
This retrospective study was conducted in an OMH in Seoul, Korea, from June 2006 to June 2013.

Results
Among the 465 cases of hospital-acquired fever, 141 (30.3%) were referred for ID. The most common cause of fever was infection in both groups. The peak body temperature of the patient was higher in IDC group (38.8±0.6°C vs. 38.6±0.5°C, p<0.001). Crude mortality at 30 days (14.6% vs. 7.8%, p = 0.043) and infection-attributable mortality (15.3% vs. 6.7%, p = 0.039) were higher in the No-IDC group. Multivariable analysis showed that infection as the focus of fever (adjusted Odd ratio [aOR] 3.49, 95% confidence interval (CI) 1.64–7.44), underlying cancer (aOR 10.32, 95% CI 4.34–24.51,), and multiorgan dysfunction syndrome (aOR 15.68, 95% CI 2.06–119.08) were associated with increased 30-day mortality. Multivariate analysis showed that in patients with infectious fever, appropriate antibiotic therapy (aOR 0.19, 95% CI 0.05–0.76) was the only factor associated with decreased infection-attributable mortality while underlying cancer (aOR 7.80, 95% CI 2.555–23.807) and severe sepsis or septic shock at the onset of fever (aOR 10.15, 95% CI 1.00–102.85) were associated with increased infection-attributable mortality.

Conclusion
Infection was the most common cause of fever in patients hospitalized for OMH. Infection as the focus of fever, underlying cancer, and MODS was associated with increased 30-day mortality in patients with nosocomial fever. Appropriate antibiotic therapy was associated with decreased infection-attributable mortality in patients with infectious fever.