bluuebunny/crossref_metadata_2025_split huggingface dataset:
New molecules for atopic dermatitis treatment beyond biological therapy
Authors: Freitas Egídio , Torres Tiago 
Published: April 2023

Purpose of review
This review aims to provide a summary of current knowledge on new topical and oral non-biological therapies recently approved for Atopic Dermatitis (AD) treatment.

Recent findings
The immense research carried out in the last decade has focused on understanding the molecular basis underlying AD and has allowed the development of new targeted drugs. Despite several biologic therapies are approved or in development, other non-biologic targeted therapies (small molecules) have emerged, such as the Janus kinase (JAK) inhibitors baricitinib, upadacitinib and abrocitinib, expanding the range of therapeutic options. Based on recent available data from head-to-head comparisons and meta-analysis studies, JAK inhibitors showed a faster onset of action and slightly higher efficacy at 16 weeks compared with biologic agents. Concerning topical treatment, presently, corticosteroids and calcineurin inhibitors are the main therapeutic options, but are not recommended for long-term management due to potential safety issues. Currently, two topical JAK inhibitors (ruxolitinib and delgocitinib) and one phosphodiesterase 4 (PDE4) inhibitor (difamilast) are approved and have shown good efficacy results and a favorable safety profile.

Summary
These new drugs (systemic and topical) are needed to increase the success of AD treatment, particularly for patients who do not or no longer respond to treatment.
Effectiveness of an Oral Gastrografin Regimen for Complete Distal Intestinal Obstruction Syndrome
Authors: Giddings Hugh L. , McNeill Jared , Rahman Bayzidur , Meagher Alan P. , Gett Rohan , Lord Reginald V. 
Published: April 2023

Objectives:
To assess the effectiveness of oral Gastrografin treatment and outcomes in adult patients with complete distal intestinal obstruction syndrome (cDIOS).

Background:
DIOS is an important gastrointestinal complication of cystic fibrosis (CF). Conservative treatment options for cDIOS are largely empirical, and the optimal management remains unclear. Surgery should be reserved for patients who have failed nonoperative treatment or have immediate indications for surgery.

Methods:
A retrospective single-institution cohort study was undertaken of adults with CF who had undergone lung transplantation and were admitted with an episode of cDIOS between 2004 and 2020. The outcomes of treatment in a high-volume CF transplant center with routine oral Gastrografin-based therapy were assessed.

Results:
Forty-seven episodes of cDIOS were recorded in 29 (23.3%) of 124 patients who had undergone lung transplantation for CF, and mean age at cDIOS was 30.3 years (SD ±11.2). Mean follow-up post cDIOS was 75.6 months (SD ±45.5). Twelve patients had >1 cDIOS episode. One episode occurred during recovery after transplantation, and 5 patients were readmitted within 30 days posttransplant with cDIOS. A history of previous abdominal surgery was associated with the development of cDIOS (P < 0.001). Oral Gastrografin therapy was used in 95.7% of the episodes, at varying doses. Three patients (7.0%) were resistant to oral Gastrografin treatment, requiring laparotomy. There were no deaths due to DIOS.

Conclusions:
Oral Gastrografin is effective and safe for the treatment of cDIOS, with low treatment failure rates. It should be considered as a first-line treatment option for patients with CF presenting with complete distal intestinal obstruction.
Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials
Authors: He Kun , Gao Lin , Yang Zihan , Zhang Yuelun , Hua Tianrui , Hu Wenmo , Wu Dong , Ke Lu 
Published: April 2023

Abstract

Background:
Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.

Methods:
The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.

Results:
A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95–3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32–2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53–6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission (P = 0.02) and the length of hospital stay (P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.

Conclusion:
For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.

Registration:
PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD 42022363945.
Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery
Authors: Schwartz Jean-Claude D. 
Published: April 2023

Summary:
Oncoplastic breast conservation is classically divided into two approaches: volume displacement and volume replacement (VR). These approaches are important to use when more than 20% of the breast is removed to avoid deformity. Smaller, nonptotic breasts require VR strategies from flaps based off of local chest wall perforators. When larger volumes are required, a flap based off the thoracodorsal artery can be used. Although this flap can replace larger volumes, it usually requires a position change with increased operative time, patient morbidity, and longer recovery while also exhausting a major reconstructive modality. In an effort to avoid this increased operative complexity, we have found that combining a local chest wall perforator flap and bioabsorbable implant, which has been previously shown to be safe and effective in reconstructing partial mastectomy defects, allows for a simpler VR strategy in patients who might otherwise require a more extensive thoracodorsal artery-based flap surgery or a mastectomy. Here, we present 10 cases where we combined flaps based off the lateral, anterior or medial intercostal artery perforators or lateral thoracic artery perforator with a bioabsorbable implant to successfully perform oncoplastic breast conservation in patients who might otherwise be marginal candidates for VR using a local chest wall perforator flap.
Outcomes of Phacoemulsification With Toric Intraocular Lenses in Addressing Postkeratoplasty Astigmatism
Authors: Moreno-Martínez Almudena , Martín-Melero Oscar , Andrés-Pretel Fernando , Gómez-Cortés Alfonso , Granados-Centeno José M. 
Published: April 2023

Purpose:
The aim of this study was to assess the short-term and long-term effectiveness of toric intraocular lenses (IOLs) as a treatment for significant postkeratoplasty astigmatism.

Methods:
This was a retrospective case review study that analyzes postkeratoplasty eyes after phacoemulsification with toric IOL implantation.

Results:
Seventy-five eyes were included. Previous surgery was penetrating keratoplasty (50.6%), deep anterior lamellar keratoplasty (34.6%), or automated anterior lamellar therapeutic keratoplasty (14.6%). The mean age at phacoemulsification with toric IOL implantation was 55.0 years (SD: ±14.4). The mean follow-up time was 48.2 ± 26.6 months. Preoperative mean topographic astigmatism was 6.34 ± 2.70 D (range 2–13.2 D). The mean IOL cylinder power was 6.00 ± 4.75 D (range 2–12 D). Both mean refractive astigmatism and mean refractive spherical equivalent decreased significantly from −5.30 ± 1.86 D to −1.62 ± 1.94 D (P < 0.001) and from −4.00 ± 4.46 D to −0.25 ± 1.25 D (P < 0.001), respectively. From preoperative to the last visit, there was a significant improvement in mean uncorrected distance visual acuity (UCVA) (from 1.3 ± 1.0 logMAR to 0.4 ± 0.3 logMAR, P < 0.001) and mean corrected distance visual acuity (CDVA) (from 0.7 ± 0.6 logMAR to 0.2 ± 0.3 logMAR, P< 0.001). Postoperative UDVA was 20/40 and 20/30 or better in 34% and 21% of eyes, respectively. Postoperative CDVA was 20/40 and 20/30 or better in 70% and 58% of eyes, respectively.

Conclusions:
Phacoemulsification and toric IOL implantation can effectively reduce moderate to high postkeratoplasty astigmatism, with a corresponding significant visual improvement.
Rates and Reasons for Clozapine Treatment Interruptions
Authors: John Alexander P. , Stanley Susanne , Haywood Darren 
Published: April 2023

Abstract

Background
Differing rates and reasons for interruptions of clozapine treatment have been reported globally. This article evaluated the rates and reasons for clozapine therapy interruptions in Australia and explored the impact of the frequency of hematological monitoring on these parameters.

Methods
Data of the patients who were newly commenced on clozapine at three metropolitan public mental health services in Western Australia over 11 years were retrospectively collated. The rate and reasons for clozapine therapy interruptions and their association with the frequency of hematological monitoring, age, sex, and treatment site were analyzed using parametric, nonparametric, and correlational analyses.

Results
Of the 457 patients whose data were collected, 69.6% had an interruption of treatment with 41.2% of those occurring during the period of mandatory weekly hematological monitoring in the first 18 weeks. Nonadherence (57.4%) and adverse effects (28.8%) were the 2 main reasons for the treatment interruptions. Cardiac issues accounted for the majority of the interruptions (61.8%) due to specified adverse effects, and these occurred significantly more commonly within the first 18 weeks. Location, age, and sex did not predict the possibility of treatment interruptions.

Conclusions
The high rates of clozapine treatment interruption observed during the period of weekly monitoring point toward the need to address the burden of frequent hematological monitoring for patients. Disproportionately higher rates of interruption due to cardiac adverse effects observed in this study compared with research from non-Australian settings raise the possibility of geographical differences in the adverse effects leading to treatment discontinuation.
Midsubstance Vastus Lateralis Tear in the Young Athlete: Case Report and a Review of the Literature
Authors: Miles Rebecca N. , Schroeder Jeremy D. , Creech Julie A. , Hulsopple Chad , Higgins David L. 
Published: April 2023

Abstract:
Vastus lateralis tendon tear is an infrequent cause of lateral knee pain. Previously reported cases have described acute injury in middle-aged men after eccentric quadriceps contraction. This case report discusses 2 adolescent patients with longitudinal midsubstance tears diagnosed with MRI and dynamic ultrasound and treated successfully with operative intervention.
AFP-L3 and DCP are superior to AFP in predicting waitlist dropout in HCC patients: Results of a prospective study
Authors: Mehta Neil , Kotwani Prashant , Norman Joshua , Shui Amy , Li P. Jonathan , Saxena Varun , Chan Wesley , Yao Francis Y. 
Published: April 2023

In patients with HCC awaiting liver transplantation (LT), there is a need to identify biomarkers that are superior to AFP in predicting prognosis. AFP-L3 and des-gamma-carboxyprothrombin (DCP) play a role in HCC detection, but their ability to predict waitlist dropout is unknown. In this prospective single-center study commenced in July 2017, 267 HCC patients had all 3 biomarkers obtained at LT listing. Among them, 96.2% received local-regional therapy, and 18.8% had an initial tumor stage beyond Milan criteria requiring tumor downstaging. At listing, median AFP was 7.0 ng/mL (IQR 3.4–21.5), median AFP-L3 was 7.1% (IQR 0.5–12.5), and median DCP was 1.0 ng/mL (IQR 0.2–3.8). After a median follow-up of 19.3 months, 63 (23.6%) experienced waitlist dropout, while 145 (54.3%) received LT, and 59 (22.1%) were still awaiting LT. Using Cox proportional hazards analysis, AFP-L3≥35% and DCP≥7.5 ng/mL were associated with increased waitlist dropout, whereas AFP at all tested cutoffs, including ≥20,≥ 100, and≥250 ng/mL was not. In a multivariable model, AFP-L3≥35% (HR 2.25, p=0.04) and DCP≥7.5 ng/mL (HR 2.20, p=0.02) remained associated with waitlist dropout as did time from HCC diagnosis to listing ≥ 1 year and increasing MELD-Na score. Kaplan-Meier probability of waitlist dropout within 2 years was 21.8% in those with AFP-L3<35% and DCP<7.5 ng/mL, 59.9% with either AFP-L3 or DCP elevated, and 100% for those with both elevated (p<0.001). In this prospective study, listing AFP-L3% and DCP were superior to AFP in predicting waitlist dropout with the combination of AFP-L3≥35% and DCP≥7.5 ng/mL associated with a 100% risk of waitlist dropout, thus clearly adding prognostic value to AFP alone.
Asymmetric Ocular Vestibular Evoked Myogenic Potentials in Pediatric Vestibular Migraine
Authors: Hwa Tiffany Peng , Patel Vir , Field Erin , Windsor Alanna , Spencer Lyndsey M. , Caine Melissa , O'Reilly Robert C. 
Published: April 2023

Objective
Although ocular vestibular evoked myogenic potentials (oVEMP) abnormalities have been associated with vestibular migraine (VM) in adults, no studies have evaluated this in pediatric patients with VM. oVEMP asymmetry with normal cervical VEMP (cVEMP) findings may be a reliable VM biomarker in adults. We characterize VEMP results among pediatric patients with VM and benign recurrent vertigo of childhood (BRVC), a migraine precursor, and compare these results with VEMP findings from pediatric patients with nonmigrainous vestibular diagnoses.

Methods
Four hundred seventy-four pediatric patients were evaluated over a 3-year period in a multidisciplinary pediatric vestibular clinic, 139 of whom met the inclusion criteria. Records were reviewed for history, audiometry, and vestibular testing results. VEMP testing was performed with a 500-Hz tone burst. Based on adult normative data, oVEMP asymmetry was defined as greater than 33% interaural difference; cVEMP asymmetry was defined as greater than 41%.

Results
Eighty subjects had VM or BRVC (mean [standard deviation] 12.8 [3.8] yr; range, 4.3–18.2 yr). Fifty-nine subjects received vestibular diagnoses other than VM or BRVC (nonmigrainous group; mean [standard deviation] age, 13.0 [3.6] yr; range, 5.14–18.9 yr). A greater proportion of the VM/BRVC group demonstrated oVEMP asymmetry with normal cVEMP as compared with the nonmigrainous group (22.5% versus 10.1%; p < 0.05). Zero subjects in the VM/BRVC group demonstrated cVEMP asymmetry versus three subjects (4.9%) of the nonmigrainous group.

Conclusions
VM and BRVC are notable causes of migraine-related vertigo among pediatric patients. Of VM/BRVC patients, 22.5% had oVEMP asymmetry with normal cVEMP. Similar to the adult VM population, this finding may be a useful biomarker in the right clinical setting for pediatric VM.

Level of Evidence
4.
Should Positive Cytology Revealed by Intraoperative Lavage Preclude Radical Resection in Resectable Pancreatic Cancer?
Authors: Li Bing-Qi , Wang Hang-Yan , Li Lei , Jiang Bin , Ma Chao-Lai , Yuan Chun-Hui , Xiu Dian-Rong 
Published: April 2023

Objectives
The aims of this review were to determine whether positive peritoneal lavage cytology (CY+) precludes radical resection in pancreatic cancer and to propose prospections for future studies.

Methods
MEDLINE, Embase, and Cochrane Central were searched for related articles. Dichotomous variables and survival outcomes were analyzed with the estimation of odds ratio and hazards ratio (HR), respectively.

Results
A total of 4905 patients were included, of which 7.8% were CY+. Positive peritoneal lavage cytology was correlated with poor overall survival (univariate survival analysis [HR, 2.35; P < 0.00001]; multivariate analysis [HR, 1.62; P < 0.00001]), poor recurrence-free survival (univariate survival analysis [HR, 2.50; P < 0.00001]; multivariate analysis [HR, 1.84; P < 0.00001]), and higher initial peritoneal recurrence rate (odds ratio, 5.49; P < 0.00001).

Conclusions
Although CY+ predicts poor prognosis and a higher risk of peritoneal metastasis after curative resection, it is not sufficient to preclude curative resection based on the current evidence, and high-quality trials should be conducted to assess the prognostic impact of operation among resectable CY+ patients. In addition, more sensitive and accurate methods to detect peritoneal exfoliated tumor cells and more effective comprehensive treatment for resectable CY+ pancreatic cancer patients are clearly warranted.
Short- and Long-Term Outcomes After Multimodal Treatment of Pancreatic Duct Leakage in Patients With Chronic Pancreatitis
Authors: Roug Stine , Novovic Srdan , Hansen Erik Feldager , Hadi Amer , Schmidt Palle Nordblad , Jørgensen Henrik Løvendahl , Karstensen John Gàsdal 
Published: April 2023

Objectives
In patients with chronic pancreatitis, pancreatic duct leakage is associated with a prolonged disease course and serious complications. We aimed to assess the efficacy of this multimodal treatment of pancreatic duct leakage.

Methods
In a retrospective design, patients with chronic pancreatitis, an amylase content greater than 200 U/L in either ascites or pleural fluid and treated between 2011 and 2020, were evaluated. The primary end point was treatment success.

Results
Twenty-seven patients (22 males, median age 60, median American Society of Anesthesiologists score 3) were included.
Endoscopic retrograde pancreatography was performed in 23 patients (85%) with transpapillary stenting of the main pancreatic duct in 22 patients (96%). Pancreatic sphincterotomy and dilation of the main pancreatic duct were done in 14 patients (61%) and 17 patients (74%), respectively. Twelve patients (44%) were treated with somatostatin analogs, parenteral nutrition, and were “nil by mouth” for a median of 11 days (range, 4–34 days). Six patients (22%) had extracorporeal shock wave lithotripsy due to pancreatic duct stones. One patient (4%) was referred for surgery. All 23 patients (100%) were treated with success after a median of 21 days (range, 5–80 days).

Conclusions
Multimodal treatment of pancreatic duct leakage is effective, with minimal need for surgery.
Value of Dual-Energy Computed Tomography for Detecting Small Pancreatic Ductal Adenocarcinoma
Authors: Fujisaki Yosuke , Fukukura Yoshihiko , Kumagae Yuichi , Ejima Fumitaka , Yamagishi Ryoji , Nakamura Shinya , Kamizono Junki , Kurahara Hiroshi , Hashimoto Shinichi , Yoshiura Takashi 
Published: April 2023

Objective
The aim of the study is to evaluate the usefulness of virtual monoenergetic imaging (VMI) generated from dual-energy computed tomography (DECT) in detecting small pancreatic ductal adenocarcinomas (PDACs).

Methods
This study included 82 patients pathologically diagnosed with small PDAC (≤30 mm) and 20 without pancreatic tumors who underwent triple-phase contrast-enhanced DECT. To assess diagnostic performance for small PDAC detection via a receiver operating characteristic analysis, 3 observers reviewed 2 image sets (conventional computed tomography [CT] set and combined image set [conventional CT + 40-keV VMI from DECT]). The tumor-to-pancreas contrast-to-noise ratio was compared between conventional CT and 40-keV VMI from DECT.

Results
The area under the receiver operating characteristic curve of the 3 observers were 0.97, 0.96, and 0.97 in conventional CT set and 0.99, 0.99, and 0.99 in combined image set (P = 0.017–0.028), respectively. The combined image set yielded a better sensitivity than the conventional CT set (P = 0.001–0.023), without a loss of specificity (all P > 0.999). The tumor-to-pancreas contrast-to-noise ratios of 40-keV VMI from DECT were approximately threefold higher than those of conventional CT at all phases.

Conclusions
The addition of 40-keV VMI from DECT to conventional CT had better sensitivity for detecting small PDACs without compromising specificity.
A Comparison of Machine Learning Methods and Conventional Logistic Regression for the Prediction of In-Hospital Mortality in Acute Biliary Pancreatitis
Authors: Luthra Anjuli K. , Porter Kyle , Hinton Alice , Chao Wei-Lun , Papachristou Georgios I. , Conwell Darwin L. , Krishna Somashekar G. 
Published: April 2023

Objectives
For population databases, multivariable regressions are established analytical standards. The utilization of machine learning (ML) in population databases is novel. We compared conventional statistical methods and ML for predicting mortality in biliary acute pancreatitis (biliary AP).

Methods
Using the Nationwide Readmission Database (2010–2014), we identified patients (age ≥18 years) with admissions for biliary AP. These data were randomly divided into a training (70%) and test set (30%), stratified by the outcome of mortality. The accuracy of ML and logistic regression models in predicting mortality was compared using 3 different assessments.

Results
Among 97,027 hospitalizations for biliary AP, mortality rate was 0.97% (n = 944). Predictors of mortality included severe AP, sepsis, increasing age, and nonperformance of cholecystectomy. Assessment metrics for predicting the outcome of mortality, the scaled Brier score (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.16–0.33 vs 0.18; 95% CI, 0.09–0.27), F-measure (OR, 43.4; 95% CI, 38.3–48.6 vs 40.6; 95% CI, 35.7–45.5), and the area under the receiver operating characteristic (OR, 0.96; 95% CI, 0.94–0.97 vs 0.95; 95% CI, 0.94–0.96) were comparable between the ML and logistic regression models, respectively.

Conclusions
For population databases, traditional multivariable analysis is noninferior to ML-based algorithms in predictive modeling of hospital outcomes for biliary AP.
Wave resonances and hydroelastic wave motion
Authors: Dora R. , Saha S. , Lu D. Q. , Mohanty S. K. 
Published: April 2023

Three different types of resonances, i.e. blocking, trapping and Bragg resonance, associated with flexural gravity wave motion in the presence of current and permeable bottom are discussed. Also, using the different modes of wave propagation, the interconnection among all these resonances is analysed. An uneven pattern in the plate deflection is seen inside the blocking resonance zone. The uniform convergence of the infinite series associated with the trapped mode is proved. We have found that the trapped mode does not exist if the magnitude of the opposing current is higher or whenever we move the cylinder away from the platecovered surface. It is also observed that two propagating modes within the blocking frequencies create the environment for the occurrence of trapped waves. At the same time, all three modes have a remarkable contribution to Bragg resonance. The Bragg reflection increases in the blocking zone and decreases outside of it. We have seen that the amplitude of the Bragg reflection increases with the increase in current speed and porosity parameter. Also, the discontinuities in Bragg reflection coefficients are seen at blocking frequencies. The model is also carefully validated numerically for trapped and Bragg resonances against the results available in the existing literature.