bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Report: Vision Loss in a Child Caused by Streptococcus constellatus
Authors: Xiaoyan Liu , Wenjuan Luo , Wanna Ren 
Published: August 2023

ABSTRACT

Purpose
We present a rare case of Streptococcus constellatus-induced odontogenic orbital cellulitis.

Methods
An 8-year-old boy presented to an outpatient clinic with complaints of right-sided toothache, right eye swelling, and decreased visual acuity. He was referred to a pediatric critical care department for further management. Comprehensive diagnostic assessments, such as ophthalmic examination, blood tests, computed tomography (CT), and magnetic resonance imaging, were performed.

Results
On presentation, the best-corrected visual acuities were 20/250 and 20/20 in the right and left eyes, respectively. Examination revealed grade 2+ eyelid edema and erythema and grade 4+ chemosis and exophthalmos in the right eye. The patient displayed restricted eye movements in all directions. Blood tests revealed a total white cell count of 12,100 cells/μL. Axial and coronal CT revealed right-sided maxillary sinus, ethmoidal sinus, and orbital abscesses. Therefore, the patient was diagnosed with septicemia, orbital cellulitis, and orbital apex syndrome in the right eye. Intravenous antibiotics were administered; paracentesis of the orbital abscess was performed under local anesthesia. However, the patient’s condition worsened, resulting in a complete loss of light perception in the right eye. Accordingly, surgery was performed under general anesthesia within 24 h of admission; the surgery involved drainage of the orbital abscess through an inferior intraorbital incision, as well as drainage of the ethmoid sinus and maxillary sinus abscesses via nasal endoscopy. A culture obtained from the orbital abscess yielded S. constellatus. The infection was managed by a combination of surgical intervention, antibiotics, steroids, and hyperbaric oxygen therapy. However, because of optic nerve injury, vision in the affected eye partially recovered to 20/200.

Conclusions

S. constellatus-induced pediatric orbital cellulitis can result in significant morbidity. The significant improvement in vision, from no light perception to 20/200, emphasizes the importance of timely diagnosis and treatment in patients who present with acute orbital cellulitis and vision loss symptoms.
Intereye Differences in the Clinical Assessment of Intraocular Pressure and Ocular Biomechanics
Authors: Yuhas Phillip T. , McHugh-Morrison Cora , Canavan Joshua , Jeyandran Joshua , Mahmoud Ashraf M. , Roberts Cynthia J. 
Published: August 2023

SIGNIFICANCE
Clinicians and researchers will have evidence whether intereye differences confound clinical measurements of intraocular pressure or of ocular biomechanical parameters.

PURPOSE
The purpose of this study was to determine whether intraocular pressure and biomechanical parameters, as measured by the Ocular Response Analyzer (ORA) and by Cornea Visualization with Scheimpflug Technology (CorVis ST), are different between the first and second eye measured.

METHODS
Intraocular pressure and biomechanical parameters were collected from both eyes of healthy participants (N = 139). The ORA measured corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, and corneal hysteresis. The CorVis ST measured biomechanically corrected intraocular pressure, stiffness parameter at first applanation, and stiffness parameter at highest concavity. For each measurement, a paired t test compared the value of the first eye measured against that of the second eye measured.

RESULTS
For the ORA, Goldmann-correlated intraocular pressure was significantly higher (P = .001) in the first eye (14.8 [3.45] mmHg) than in the second eye (14.3 [3.63] mmHg). For the CorVis ST, biomechanically corrected intraocular pressure was significantly higher (P < .001) in the second eye (14.7 [2.14] mmHg) than in the first eye (14.3 [2.11] mmHg). Stiffness parameter at first applanation (intereye difference, 6.85 [9.54] mmHg/mm) was significantly (P < .001) higher in the first eye than in the second eye. Stiffness parameter at highest concavity was significantly higher (P = .01) in the second eye (14.3 [3.18] mmHg/mm) than in the first eye (14.0 [3.13] mmHg/mm).

CONCLUSIONS
Although there were statistically significant intereye differences in intraocular pressure and in biomechanical parameters for both devices, the variations were small and thus unlikely to affect clinical outcomes.
User perspectives of digital manufacturing for lower-limb prosthetic sockets
Authors: Phillips Clara , Li Lynn , Miguel Marian , Eshraghi Arezoo , Heim Winfried , Dilkas Steven , Devlin Michael , Wasilewski Marina , Verweel Lee , MacKay Crystal 
Published: August 2023

Background:
There is growing interest to use digital technology (DT) for manufacturing lower-limb prosthetic sockets to improve efficiency and clinical outcomes. However, little is known about how lower-limb prosthesis users perceive DTs, such as 3D scanning and 3D printing.

Objectives:
This study aimed to provide an understanding of perceptions and experiences with DT for prosthetic socket manufacturing from the perspective of prosthesis users.

Study design:
A qualitative descriptive research study.

Methods:
Nine lower-limb prosthesis users (mean age 56; 5 female; 4 male) participated in one-on-one semistructured telephone interviews. Inductive thematic analysis was performed to identify a codebook and emerging themes from the interview transcripts.

Results:
Two major themes were identified: (1) expectations and prioritization of 3D printed socket usability and (2) facilitators and barriers to uptake of DT among patients.

Conclusion:
DT methods were found to be acceptable and feasible from a patient perspective, although technological advancements are still required, and real-time communication about the process may be vital for ensuring patient engagement. Consideration of these findings may improve patient satisfaction to emerging prosthesis treatment plans and ultimately support widespread adoption of DT as an additional tool for fabricating prosthetic sockets.
Lateral Osteotomy for the Surgical Treatment of the Asian Wide Nose
Authors: Zhang Jinsong , Chen Aihong , Liu Ye , Herrler Tanja , Yu Baofu , Fang Linsen , Zhu Fei , Li Xiaojing , Dai Chuanchang , Wei Jiao 
Published: August 2023

Objective:
Narrowing of the nasal dorsum allows for a more pleasing moderate width. We here introduce a lateral osteotomy technique that is less traumatic and easier to perform than commonly used procedures in Asian and share our experiences in the application.

Methods:
After a blunt dissection of the periosteum at the mucosal side of the nasal bone, all patients who underwent treatment using nasal osteotomy at the level of the maxillary nasal process were retrospectively analyzed. The bony nasal width, height, and the nasal lateral wall slope of bone before and after surgery were measured. The postoperative outcomes, complications, and patient satisfaction were analyzed and evaluated.

Results:
From January 2008 to January 2018, nasal dorsum narrowing was implemented in 106 patients. On average, nasal width was significantly decreased and no change in nose height after the nasal osteotomy. The nasal width was significantly reduced by 8.51 ± 2.16 mm compared with before surgery. The slope of the nasal lateral wall was reduced from the mean of 155.0 ± 7.63-degree preoperation to the mean of 135.25 ± 7.50-degree postoperation. The follow-up period ranged from 6 months to 4 years, with an average of 10.3 months.

Conclusions:
This type of nasal bone base osteotomy is a simple and feasible method for the treatment of wide Asian noses with a high patient acceptance and stable postoperative results.

Level of Evidence:
Level IV.
Tracheostomy, the Not So Definitive Airway?: Tracheostomy Morbidity in Pediatric Craniofacial Patients
Authors: La-Anyane Okensama M. , Whitney Natalia B. , Harmon Kelly A. , Karas Anatoli F. , Jeffe Jill S. , Tragos Christina 
Published: August 2023

Background:
Tracheostomy is the definitive treatment for airway management in severe cases of craniofacial-associated upper airway obstruction, like the Pierre-Robin sequence, but is associated with significant morbidity. The purpose of this study was to examine tracheostomy-associated morbidities and mortalities in craniofacial patients to identify opportunities to improve clinical care and patient prognosis.

Methods:
The study was a retrospective review of pediatric craniofacial patients who were tracheostomized between 2016 and 2022. Data regarding their demographics, craniofacial diagnoses, endoscopic airway anomalies, intubation grade of view classification, tracheostomy-related complications, and causes of mortality were analyzed.

Results:
Sixteen of the 17 tracheostomized pediatric patients had the Pierre-Robin sequence, with 5 of those patients having an additional syndromic craniofacial diagnosis. Additional airway anomalies were found in 82.4% of the patients. The mean length of hospital stay after tracheostomy was 4.08 months. Infection was the most common complication, observed in 94.1% of patients, followed by stomal granulation in 76.5% of patients. Two mortalities were observed: one following the compassionate removal of ventilator support and the other following the accidental dislodgment of the tracheostomy tube.

Conclusions:
Tracheostomy-related complications were observed in all craniofacial patients in this group. Compared with the general pediatric population, tracheostomized craniofacial patients may endure longer hospital stays and greater stomal granulation rates. Mandibular distraction osteogenesis may allow for tracheostomy avoidance in these patients, and future research should focus on comparing the long-term complication rates and outcomes between tracheostomy mandibular distraction osteogenesis in this challenging patient population.
Effect of Tissue Pedicle Position on Postoperative Recovery From Severe Auricular Laceration
Authors: Wang Weihao , Wang Wangshu , Zhang Wanqi , Jin Manqiu , Shao Ying 
Published: August 2023

Background:
Postoperative recovery from severe auricular lacerations varies significantly. However, few studies have sought to clarify the risk factors associated with the prognosis of severe auricular lacerations, and little attention has been paid to the intraoperative management of severe auricular lacerations and early postoperative intervention. The purpose of this study was to analyze the risk factors that may affect the prognosis of severe auricular lacerations.

Methods:
Case data and imaging data of patients with severe auricular lacerations treated in our department between January 2018 and September 2022 were collected. A total of 90 patients (90 severe auricular lacerations) were included in the analysis and were divided into good group (68 cases) and poor group (22 cases) according to postoperative recovery, which was defined as poor postoperative recovery when postoperative auricular blood supply disorders required interventional treatment or second stage plastic surgery.

Results:
The percentage of ventral tissue pedicles in the poor recovery group was 77.3% (P<0.001). The proportion of ventral tissue pedicle was significantly higher in the poor postoperative group than in the good postoperative group, and ventral tissue pedicle [odds ratio (OR)=12.22, P=0.002] was an independent risk factor for poor postoperative recovery from severe auricular laceration.

Conclusions:
The prognosis of patients with severe auricular lacerations differs between the different tissue pedicle locations, and prophylactic treatment of patients with ventral tissue pedicles is beneficial. In addition, patients with ventral tissue pedicles should be informed in advance of their increased risk of surgical failure.
Immune checkpoint inhibitors induced side effects of the peripheral nervous system
Authors: Hundsberger Thomas , Schreiner Bettina , Roth Patrick 
Published: August 2023

Purpose of review
This review highlights recent knowledge on the diagnosis and treatment of immune checkpoint inhibitor-induced neurological side effects (irNAE) focussing on the neuromuscular system.

Recent findings
irNAEs mainly resemble sporadic neuromuscular autoimmune diseases and paraneoplastic neurological syndromes. However, neurological symptoms may be unspecific (muscle weakness, fatigue) in the oncological setting and carry the risk of misdiagnosis and delayed therapeutic intervention. The role of disease-specific neuromuscular autoantibodies in the diagnosis is controversial as preexisting autoantibodies may otherwise be present before immune checkpoint inhibitor (ICI) treatment without clinical symptoms and may not develop in case of irNAE manifestation. A new necrotising form of myositis (irMyositis) has been described presenting with facial weakness and ptosis mimicking myasthenia gravis. It comes along with a high rate of severe myocarditis accounting for a triad overlap syndrome (myasthenia/myositis/myocarditis). The role of modern biologicals in the treatment of irNAEs has to be determined.

Summary
irNAEs are rare but carry the risk of permanent morbidity and mortality. Early suspicion and diagnosis are key to prevent neurological sequelae. Beyond interruption of ICI administration, treatment corresponds to sporadic autoimmune diseases. The myasthenia/myositis/myocarditis overlap syndrome deserves special attention as it carries the highest risk of mortality. The role of neurotoxic pretreatment regimens, preexisting subclinical neurological autoimmune diseases and the risk of ICI-re-challenge after irNAEs has to be further investigated.
Frailty is related to serum inflammageing markers: results from the VITAL study
Authors: van Sleen Yannick , Shetty Sudarshan A , van der Heiden Marieke , Venema Milou CA , Gutierrez-Melo Nicolas , Toonen Erik JM , van Beek Josine , Buisman AnneMarie M , van Baarle Debbie , Sauce Delphine 
Published: August 2023

ABSTRACTFrailty describes an age-associated state in individuals with an increased vulnerability and less resilience against adverse outcomes. To score frailty, studies have employed the questionnaires, such as the SF-36 and EQ-5D-3L, or the Frailty Index, a composite score based on deficit accumulation. Furthermore, ageing of the immune system is often accompanied by a state of low-grade inflammation (inflammageing). Here, we aimed to associate 29 circulating markers of inflammageing with frailty measures in a prospective cohort study to understand the mechanisms underlying ageing.Frailty measures and inflammageing markers were assessed in 317 participants aged 25-90. We determined four different measures of frailty: the Frailty Index based on 31 deficits, the EQ-5D-3L and two physical domains of the SF-36. Serum/plasma levels of inflammageing markers and CMV/EBV seropositivity were measured using different techniques: Quanterix, Luminex or ELISA.All four measures of frailty strongly correlated with age and BMI. Nineteen biomarkers correlated with age, some in a linear fashion (IL-6, YKL-40), some only in the oldest age brackets (CRP), and some increased at younger ages and then plateaued (CCL2, sIL-6R). After correcting for age, biomarkers, such as IL-6, CRP, IL-1RA, YKL-40 and elastase, were associated with frailty. When corrected for BMI, the number of associations reduced further.In conclusion, inflammageing markers, particularly markers reflecting innate immune activation, are related to frailty. These findings indicate that health decline and the accumulation of deficits with age is accompanied with a low-grade inflammation which can be detected by specific inflammatory markers.
Evaluation of a Large Language Model to Identify Confidential Content in Adolescent Encounter Notes
Authors: Rabbani Naveed , Brown Conner , Bedgood Michael , Goldstein Rachel L. , Carlson Jennifer L. , Pageler Natalie M. , Morse Keith E. 
Published: August 2023

AbstractIntroductionIn adolescent care, information sharing through patient portals can lead to unintentional disclosures to patients’ guardians around protected health topics such as mental health, sexual health, and substance use. A persistent challenge facing pediatric health systems is configuring systems to withhold confidential information recorded as free text in encounter notes. This study evaluates the accuracy of a proprietary large language model (LLM) in identifying content relating to adolescent confidentiality in such notes.MethodsA random sample of 300 notes were selected from outpatient adolescent encounters performed at an academic pediatric health system. The notes were manually reviewed by a group of pediatricians to identify confidential content. A proprietary LLM, GPT-3.5 (OpenAI, San Francisco, CA), was prompted using a “few-shot learning” method to identify the confidential content within these notes. Two primary outcomes were considered: (1) the ability of the LLM to determine whether a progress note contains confidential content and (2) its ability to identify the specific confidential content within the note.ResultsOf the 300 sampled notes, 91 (30%) contained confidential content. The LLM was able to classify whether an adolescent progress note contained confidential content with a sensitivity of 97% (88/91), specificity of 18% (37/209), and positive predictive value of 34% (88/260). Only 40 of the 306 manually reviewed excerpts (13%) were accurately derived from the original note (ie. contained no hallucinations), 22 (7%) of which represented the note’s actual confidential content.DiscussionA proprietary LLM achieved a high sensitivity in classifying whether adolescent encounter notes contain confidential content. However, its low specificity and poor positive predictive value limit its usefulness. Furthermore, an alarmingly high fraction of confidential note excerpts proposed by the model contained hallucinations. In its current form, GPT-3.5 cannot reliably identify confidential content in free-text adolescent progress notes.
Immature platelet dynamics are associated with clinical outcomes after major trauma
Authors: Schofield Henry , Rossetto Andrea , Armstrong Paul C , Allan Harriet E , Warner Timothy D , Brohi Karim , Vulliamy Paul 
Published: August 2023

ABSTRACTBackgroundMajor trauma results in dramatic changes in platelet behavior. Newly-formed platelets are more reactive than older platelets, but their contributions to hemostasis and thrombosis after severe injury have not been previously evaluated.ObjectivesTo determine the relationship between immature platelet metrics and circulating drivers of platelet production with clinical outcomes after major injury.MethodsProspective observational cohort study of adult trauma patients. Platelet counts and the immature platelet fraction (IPF) were measured at admission, 24 hours, 72 hours and 7 days post-injury. Plasma proteins involved in thrombopoiesis were quantified at admission. The primary outcome was in-hospital mortality; secondary outcomes were venous thromboembolic events (VTE) and organ failure.ResultsAt two hours post-injury, immature platelet counts (IPC) were significantly lower in non-survivors (n=40) compared to survivors (n=236; 7.3x109/L vs 10.6x109/L, p=0.009). Similarly, impaired platelet function on thromboelastometry was associated with a lower admission IPC (9.1x109/L vs 11.9x109/L, p<0.001). However, at later timepoints we observed a significantly higher IPF and IPC in patients who developed VTE (21.0x109/L vs 11.1x109/L, p=0.02) and prolonged organ dysfunction (20.9 x109/L vs 11x109/L, p=0.003) compared to those who did not develop complications. Plasma levels of thrombopoietin at admission were significantly lower in in non-survivors (p<0.001), in patients with organ failure (p<0.001) and in those who developed VTE (p=0.04).ConclusionsImmature platelet depletion in the acute phase after major injury is associated with increased morality, whereas excessive immature platelet release at later timepoints may predispose to thrombosis and organ dysfunction.ESSENTIALS-Newly-formed platelets are highly active, but their role in outcomes after major trauma is unknown-Immature platelets were quantified in a cohort of 276 severely injured patients-Early depletion of immature platelets is associated with increased mortality and coagulopathy-Raised immature platelet at later timepoints increases the risk of thrombosis and organ failure
Serologic biomarkers and scoring systems for hepatic fibrosis in obese children with nonalcoholic steatohepatitis
Authors: Joo Jung Yeon , Yoo In Hyuk , Yang Hye Ran 
Published: August 2023

AbstractObjectivesThe prevalence of nonalcoholic steatohepatitis (NASH) is increasing with the increasing prevalence of childhood obesity. Although NASH has a high risk of progression to liver fibrosis and cirrhosis, few studies have reported on noninvasive markers for predicting hepatic fibrosis in children. This study aimed to evaluate and compare the diagnostic accuracy of serologic biomarkers and scoring systems for hepatic fibrosis in obese children with NASH.MethodsA total of 99 children were diagnosed with NASH based on liver biopsy findings, and divided into two groups according to the degree of liver fibrosis: mild (stage 0-1) or advanced (stage 2-4). Clinical and laboratory parameters and serum levels of hyaluronic acid and type IV collagen were measured. Moreover, the aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were calculated.ResultsAmong the noninvasive markers, only serum type IV collagen level and FIB-4 revealed significant differences between the two fibrosis groups. The area under the receiver operating curve of each biomarker and scoring system was 0.80 (95% confidence interval [CI]: 0.70-0.90) for type IV collagen at an optimal cutoff of 148 ng/mL (sensitivity 69.8%, specificity 84.6%), followed by 0.69 (95% CI: 0.57-0.83) for APRI, 0.68 (95% CI: 0.56-0.80) for FIB-4, and 0.65 (95% CI: 0.53-0.77) for hyaluronic acid.ConclusionsType IV collagen as a single noninvasive serologic biomarker for hepatic fibrosis and FIB-4 as a hepatic fibrosis score are beneficial in predicting advanced hepatic fibrosis, and in determining proper diagnosis and treatment strategies before fibrosis progresses in obese children with NASH.Why was this study done?With the increase of the obese population of children and adolescents, the prevalence of nonalcoholic fatty liver disease is increasing. Non-alcoholic steatohepatitis has a high risk of developing liver fibrosis and cirrhosis. However, a single non-invasive serological marker that can predict fatty liver fibrosis in children and adolescents has not been clearly presented.What did the researchers do and find?We evaluate diagnostic accuracy of serological biomarkers and scoring systems for hepatic fibrosis in obese children with NASH.What do these findings mean?Type IV collagen is a useful single noninvasive serological biomarker for hepatic fibrosis. Therefore, it is useful in making appropriate diagnosis and treatment decisions before fibrosis progresses in obese children with non-alcoholic steatohepatitis.