bluuebunny/crossref_metadata_2025_split huggingface dataset:
Refractory hepatic hydrothorax is associated with increased mortality with death occurring at lower MELD-Na compared to cirrhosis and refractory ascites
Authors: Chin Allison , Bastaich Dustin R. , Dahman Bassam , Kaplan David E. , Taddei Tamar H. , John Binu V. 
Published: August 2023

Background and Aims:
Although refractory hepatic hydrothorax (RH) is a serious complication of cirrhosis, waitlisted patients do not receive standardized Model for End-stage Liver Disease (MELD) exemption because of inadequate evidence suggesting mortality above biochemical MELD. This study aimed to examine liver-related death (LRD) associated with RH compared to refractory ascites (RA).

Approach and Results:
This was a retrospective cohort study of Veterans with cirrhosis. Eligibility criteria included participants with RH or RA, followed from their first therapeutic thoracentesis/second paracentesis until death or transplantation. The primary outcome was LRD with non-LRD or transplantation as competing risk. Of 2552 patients with cirrhosis who underwent therapeutic thoracentesis/paracentesis, 177 met criteria for RH and 422 for RA. RH was associated with a significantly higher risk of LRD (adjusted HR [aHR] 4.63, 95% CI 3.31–6.48) than RA overall and within all MELD-sodium (MELD-Na) strata (<10 aHR 4.08, 95% CI 2.30–7.24, 10–14.9 aHR 5.68, 95% CI 2.63–12.28, 15–24.9 aHR 4.14, 95% CI 2.34–7.34, ≥25 aHR 7.75, 95% CI 2.99–20.12). LRD was higher among participants requiring 1 (aHR 3.54, 95% CI 2.29–5.48), 2–3 (aHR 4.39, 95% CI 2.91–6.63), and ≥4 (aHR 7.89, 95% CI 4.82–12.93) thoracenteses relative to RA. Although participants with RH and RA had similar baseline MELD-Na, LRD occurred in RH versus RA at a lower MELD-Na (16.5 vs. 21.82, p=0.002) but higher MELD 3.0 (27.85 vs. 22.48, p<0.0001).

Conclusions:
RH was associated with higher risk of LRD than RA at equivalent MELD-Na. By contrast, MELD 3.0 may better predict risk of LRD in RH.
Examination of the Corneal Endothelium in Pediatric Patients With COVID-19
Authors: Soysal Gizem Gürbostan , Seyyar Sevim Ayça , Kimyon Sabit , Mete Alper , Güngör Kıvanç 
Published: August 2023

Purpose:To investigate the effects of coronavirus disease 2019 (COVID-19) infection on the corneal endothelium in children.Methods:This retrospective study included 46 pediatric patients with COVID-19 infection and 38 healthy controls. Specular microscopy measurements were analyzed, and measurements were obtained from images showing at least 100 cells with clear borders. Mean endothelial cell density, mean hexagonal cell percentage (HEX), mean coefficient of variation (CV), central corneal thickness, and mean cell area were evaluated.Results:Specular microscopy data showed that the CV values were 2.442±6.517 in the healthy control group (HCG) and 2.659±5.119 in the COVID-19–affected group (CAG) (P=0.003). The hexagonality of the HCG and CAG were 6.916±8.271 and 6.683±5.885, respectively (P=0.011).Conclusion:A decrease in the HEX and an increase in the CV were observed in the corneal specular microscopic examination of children with COVID-19 infection. These results are important in demonstrating the corneal effects of COVID-19 infection in children.
Osteoarticular Infections: Younger Children With Septic Arthritis and Low Inflammatory Patterns Have a Better Prognosis in a European Cohort
Authors: Gouveia Catarina , Subtil Ana , Aguiar Pedro , Canhão Helena , Norte Susana , Arcangelo Joana , Varandas Luís , Tavares Delfin 
Published: August 2023

Background:
Osteoarticular infections (OAI) are associated with complications and sequelae in children, whose prediction are of great importance in improving outcomes. We aimed to design risk prediction models to identify early complications and sequelae in children with OAI.

Methods:
This observational study included children (>3 months–17 years old) with acute OAI admitted to a tertiary-care pediatric hospital between 2008 and 2018. Clinical treatment, complications and sequelae were recorded. We developed a multivariable logistic predictive model for an acute complicated course (ACC) and another for sequelae.

Results:
A total of 240 children were identified, 17.5% with ACC and 6.0% and 3.6% with sequelae at 6 and 12 months of follow-up, respectively. In the multivariable logistic predictive model for ACC, predictors were fever at admission [adjusted odds ratio (aOR): 2.98; 95% confidence interval (CI): 1.10–8.12], C-reactive protein ≥100 mg/L (aOR: 2.37; 95% CI: 1.05–5.35), osteomyelitis (aOR: 4.39; 95% CI: 2.04–9.46) and Staphylococcus aureus infection (aOR: 3.50; 95% CI: 1.39–8.77), with an area under the ROC curve of 0.831 (95% CI: 0.767–0.895). For sequelae at 6 months, predictors were age ≥4 years (aOR: 4.08; 95% CI: 1.00–16.53), C-reactive protein ≥110 mg/L (aOR: 4.59; 95% CI: 1.25–16.90), disseminated disease (aOR: 9.21; 95% CI: 1.82–46.73) and bone abscess (OR: 5.46; 95% CI: 1.23–24.21), with an area under the ROC curve of 0.887 (95% CI: 0.815–0.959).

Conclusions:
In our model we could identify patients at low risk for complications and sequelae, probably requiring a less aggressive approach.
Interpretation bias and the transition from acute to chronic pain
Authors: Todd Jemma , Pickup Brydee , Sharpe Louise 
Published: August 2023

Abstract
Most theories of pain emphasize cognitive factors in the development of chronicity, but they have rarely been studied in the context of the transition from acute to chronic pain. The aim of the present study was to assess the role of interpretation bias, pain anxiety, and pain avoidance in acute and chronic pain and the transition from acute to chronic pain. Study 1 recruited a sample of N = 85 adults with chronic pain. Study 2 recruited a sample of N = 254 adults with acute pain and followed them up 3 months later. Both studies assessed interpretation bias with the word association task, as well as measuring pain-related anxiety, pain avoidance, pain severity, and pain interference. In study 2, pain outcomes at 3 months were also assessed. Across both acute and chronic pain samples, interpretation bias was associated with pain interference, but not pain severity. Path analysis mediation models for study 2 showed that interpretation bias was associated with increased pain anxiety, which predicted both pain severity and pain interference 3 months later. Pain anxiety was also associated with pain avoidance, but pain avoidance did not predict pain outcomes. This research provides further insight into the transition from acute to chronic pain, suggesting that interpretation bias in acute pain may play a role in pain-related anxiety that drives pain interference, thus maintaining chronic pain. These findings hold promise for further research into potential large-scale preventative interventions targeting interpretation bias and pain anxiety in acute pain.
Longitudinal Auditory Benefit for Elderly Patients After Cochlear Implant for Bilateral Hearing Loss, Including Those Meeting Expanded Centers for Medicare & Medicaid Services Criteria
Authors: Shen Sarek , Sayyid Zahra , Andresen Nicholas , Carver Courtney , Dunham Rachel , Marsiglia Dawn , Yeagle Jennifer , Della Santina Charley C. , Bowditch Steve , Sun Daniel Q. 
Published: August 2023

ObjectiveTo examine the effect of patient age on longitudinal speech understanding outcomes after cochlear implantation (CI) in bilateral hearing loss.Study DesignRetrospective cohort study.SettingTertiary academic centerPatientsOne thousand one hundred five adult patients with bilateral hearing loss receiving a unilateral CI between 1987 and 2022InterventionsNone.Main Outcome MeasuresPostoperative speech recognition outcomes, including AzBio sentences, consonant-nucleus-consonant word, and Hearing in Noise Test in quiet were analyzed at short-term (<2 yr), medium-term (2–8 y), and long-term (>8 yr) term postoperative intervals.ResultsEighty-six very elderly (>80 yr), 409 elderly (65–80 yr), and 709 nonelderly (18–65 yr) patients were included. Short-term postoperative AzBio scores demonstrated similar magnitude of improvement relative to preoperative scores in the very elderly (47.6, 95% confidence interval [CI], 28.9–66.4), elderly (49.0; 95% CI, 39.2–58.8), and nonelderly (47.9; 95% CI, 35.4–60.4). Scores for those older than 80 years remained stable after 2 years after implant, but in those 80 years or younger, scores continued to improve for up to 8 years (elderly: 6.2 [95% CI, 1.5–12.4]; nonelderly: 9.9 [95% CI, 2.1–17.7]) after implantation. Similar patterns were observed for consonant-nucleus-consonant word scores. Across all age cohorts, patients with preoperative Hearing in Noise Test scores between 40 and 60% had similar scores to those with preoperative scores of less than 40%, at short-term (82.4, 78.9; 95% CI, −23.1 to 10.0), medium-term (77.2, 83.9; 95% CI, −15.4 to 8.2), or long-term (73.4, 71.2; 95% CI, −18.2 to 12.2) follow-up.ConclusionsPatients older than 80 years gain significant and sustained auditory benefit after CI, including those meeting expanded Centers for Medicare & Medicaid Service criteria for implantation. Patients younger than 80 years demonstrated continued improvement over longer periods than older patients, suggesting a role of central plasticity in mediating CI outcomes as a function of age.
Incidence of Vestibular Schwannoma in Patients with Unilateral Tinnitus: A Systematic Review and Meta-Analysis
Authors: Javed Azfar , Okoh Magnus , Mughal Zahir , Javed Faisal , Gupta Keshav 
Published: August 2023

Objectives
Vestibular schwannoma (VS) is a tumor of the vestibulocochlear nerve. Current literature indicates that 1.6% of patients undergoing magnetic resonance imaging of the internal auditory meatus (MRI IAM) for audiovestibular symptoms are diagnosed with a VS. However, there is limited research reporting on patients who present with unilateral tinnitus without asymmetrical hearing loss. This study is a systematic review and meta-analysis evaluating how many of those patients had a VS diagnosed on MRI IAM.

Databases Used
Online searches of PubMed, Medline, and Embase databases were performed up to October 2022.

Methods
This meta-analysis was undertaken aligning with PRISMA guidelines. Articles reporting on patients having MRI IAM for unilateral tinnitus without asymmetrical hearing loss were included. Outcomes measures were patient demographics, VS cases, incidental findings, size, and management of tumor. A meta-analysis of proportions was performed using a random-effects model with the restricted maximum likelihood method. Quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.

Results
Seven case series were included in the review: a total of 1,394 patients. Seven patients had a VS, with a median size of 4 mm. The pooled detection rate for VS was 0.08% (95% confidence interval = 0.00–0.45). Subsequent management was reported in six cases of which four were actively monitored and two surgically excised. The most common incidental finding was sinus disease (49 patients).

Conclusion
Our findings indicate that MRI IAM has a low diagnostic yield for VS detection in patients presenting with unilateral tinnitus without asymmetrical hearing loss, with mostly small tumors that are conservatively managed.
Incomplete Partition Type II Cochlear Malformations: Delineating the Three-Dimensional Structure from Digitized Human Histopathological Specimens
Authors: Swords Chloe , Geerardyn Alexander , Zhu MengYu , O'Malley Jennifer T. , Wu Peizhe , Arenberg Julie G. , Podury Archana , Brassett Cecilia , Bance Manohar , Quesnel Alicia M. 
Published: August 2023

AbstractHypothesisThere are clinically relevant differences in scalae anatomy and spiral ganglion neuron (SGN) quantity between incomplete partition type II (IP-II) and normal cochleae.BackgroundIP-II is a commonly implanted cochlear malformation. Detailed knowledge of intracochlear three-dimensional (3D) morphology may assist with cochlear implant (CI) electrode selection/design and enable optimization of audiologic programming based on SGN maps.MethodsIP-II (n = 11) human temporal bone histological specimens were identified from the National Institute on Deafness and Other Communication Disorders National Temporal Bone Registry and digitized. The cochlear duct, scalae, and surgically relevant anatomy were reconstructed in 3D. A machine learning algorithm was applied to map the location and number of SGNs.Results3D scalae morphology of the basal turn was normal. Scala tympani (ST) remained isolated for 540 degrees before fusing with scala vestibuli. Mean ST volume reduced below 1 mm2after the first 340 degrees. Scala media was a distinct endolymphatic compartment throughout; mean ± standard deviation cochlear duct length was 28 ± 3 mm. SGNs were reduced compared with age-matched norms (mean, 48%; range, 5–90%). In some cases, SGNs failed to ascend Rosenthal's canal, remaining in an abnormal basalward modiolar location. Two forms of IP-II were seen: type A and type B. A majority (98–100%) of SGNs were located in the basal modiolus in type B IP-II, compared with 76 to 85% in type A.ConclusionHallmark features of IP-II cochleae include the following: 1) fusion of the ST and scala vestibuli at a mean of 540 degrees, 2) highly variable and overall reduced SGN quantity compared with normative controls, and 3) abnormal SGN distribution with cell bodies failing to ascend Rosenthal's canal.
Rates of Delayed Postcochlear Implant Pain in the Pediatric Population—Role of Proactive Approach
Authors: Rotlevi Tomer , Ziv Oren , Hazan Itai , Cohen Oded , Al Jaar Hasan , Alkrenawi Mohamad , Kaplan Daniel M. 
Published: August 2023

Objective
To investigate the rates of delayed postoperative cochlear implantation pain (DPCIP) in the pediatric population, using a “reach-out” proactive approach. Secondary aims included the possible impact of surgery extent or the patient ethnicity on DPCIP rates.

Materials and methods
A cross-sectional study was conducted at Soroka University Medical Center in Israel. Demographics and data regarding the surgery and surgical complications were collected from the medical records of the patients. A telephone questionnaire was conducted for parents of all children who underwent cochlear implantation (CI) between 2007 and 2020. The questions addressed pain at four time periods: during hospitalization after surgery, 3 months, 2 years, and 5 years after surgery.

Results
Out of 213 patients, 129 (60%) were included in this study. The mean age was 41 months (±40). Unilateral CI was performed in 72 (56%) patients. At 3 months and 2 years after surgery, 8.5% of patients reported pain (visual analog scale [VAS] ≥ 1). Five years after surgery, a slight increase in the number of patients who reported pain (12%) was observed. Of those experiencing pain 2 years and 5 years after surgery, 10/12 (83%) and 11/16 (69%), respectively, reported a new onset of the pain. Surgery extent and cultural background were not significantly associated with DPCIP rates. No correlations were found between patients complaining of pain and any surgical complications.

Conclusions
DPCIP rates may be underrecognized and higher than previously reported, reaching up to 12%. This long-term effect should be acknowledged and discussed with parents upon informed consent.
Free Flap Reconstruction in the Era of Commercial Price Transparency – What are We Paying For?
Authors: Rochlin Danielle H. , Rizk Nada M. , Mehrara Babak , Matros Evan , Sheckter Clifford C. 
Published: August 2023

Background:
Commercial rates for free flap reconstruction were not known publicly prior to the 2021 Hospital Price Transparency Final Rule. The purpose of this study was to examine commercial facility payments to characterize nationwide variation for microsurgical operations and identify opportunities to improve market effectiveness.

Methods:
A cross-sectional study was performed using 2022 commercial insurance pricing merged with hospital performance data. Facility payment rates were extracted for nine CPT codes for free flap operations. Price variation was quantified via across-hospital ratios (AHRs) and within-hospital ratios (WHRs). Mixed effects linear models evaluated commercial rates relative to value, outcomes, and equity performance metrics, in addition to facility-level factors that included healthcare market concentration.

Results:
20,528 commercial rates across 675 hospitals were compiled. AHRs ranged from 5.85–7.95, while WHRs ranged from 1.00–1.71. Compared to the lowest scoring hospitals (grade D), hospitals with an outcome grade of A and equity grades of B or C were associated with higher commercial rates (p<0.04); there were no significant differences in rate based on value. Higher commercial rates were also associated with nonprofit status and more concentrated markets (p<0.006). Lower commercial rates were correlated with safety-net and teaching hospitals (p<0.001).

Conclusion:
Commercial rates for free flaps varied substantially both across and within hospitals. Associations of higher commercial rates with less competitive markets, and the lack of consistent association with value and equity, identify pricing failures. Additional work is needed to improve market efficiency for free flap operations.
Comparison of Patient Demographics, Utilization Trends, and Costs of Treatment for Dupuytren’s Disease in the United States From 2012 to 2019
Authors: Gordon Adam M. , Nian Patrick P. , Miller Chaim , Schwartz Jake M. , Choueka Jack 
Published: August 2023

Introduction
Dupuytren’s disease is a fibroproliferative disorder of the palm leading to flexion deformities of the digits that impair hand function. Studies have evaluated treatment trends for patients with Dupuytren’s disease; however, most conclude in 2012 shortly after collagenase clostridium histolyticum (CCH) injection was introduced to the market. It is unknown how provider preferences have been influenced since its introduction. We aimed to compare treatment options with regard to (1) patient demographics, (2) annual utilization rates, and (3) costs.

Methods
The PearlDiver nationwide administrative claims database from 2012 to 2019 was analyzed for patients diagnosed with Dupuytren’s disease (N = 47,813). Patients receiving procedural treatment were identified using codes for percutaneous needle aponeurotomy (PNA) (current procedural terminology [CPT] 26040), open fasciotomy (CPT 26045), open fasciectomy (CPT 26121, 26123, 26125), and CCH injection (CPT 20527). Fasciectomies were further analyzed by examining the number of patients receiving release of 1 or more digits (CPT 26123, 26125) versus palmar-only surgery (CPT 26121). Outcomes included comparing patient comorbidities comprising the Elixhauser Comorbidity Index (ECI), frequencies of each procedure annually, and costs. Linear regressions evaluated changes in utilization over time. Analysis of variance compared costs. P values less than 0.05 were significant.

Results
Patient demographics for each treatment differed with respect to age, sex, and the presence of multiple comorbidities comprising the ECI. Open fasciectomy (60.7%) was the predominant treatment, followed by CCH injection (22.9%), PNA (10.1%), and open fasciotomy (6.3%) (P < 0.001). Multiple patient comorbidities comprising the ECI differed for each treatment. Relative to total annual procedures from 2012 to 2019, PNA declined (10.2% to 9.5%, P = 0.037), open fasciotomy declined (6.8% to 5.6%, P = 0.007), palmar fasciectomy remained constant (14.5% to 14.2%, P = 0.710), fasciectomy of digits increased (46.3% to 47.5%, P = 0.030), and CCH injection remained constant (22.2% to 23.3%, P = 0.623). Day of procedure costs were significantly different for PNA ($573), open fasciotomy ($1176), palmar open fasciectomy ($1410), open fasciectomy digits ($1560), and CCH injection ($1250) (P < 0.001).

Conclusions
The overall annual Dupuytren’s disease treatment did not change over time. Treatment with open fasciectomy continues to be preferred. Collagenase clostridium histolyticum utilization has remained constant since its introduction. This study may assist hand surgeons in educating patients on the treatment and costs related to Dupuytren’s disease.
A Vessel Wall MRI Investigation in Patients With Moyamoya or Quasi-Moyamoya Disease: Diagnosis, Features, and Outcomes
Authors: Yu Le-Bao , Shen Mi , Zhang Qian , Zhang Dong 
Published: August 2023

Background and Purpose:
None of the previous studies have investigated the pathologic authenticity of affected arteries in moyamoya disease (MMD) and Quasi-MMD diagnosed by angiography. This study aimed to confirm the angiographic diagnosis of moyamoya as well as investigate the pathologic mechanisms in angiographically proven MMD and Quasi-MMD using high-resolution magnetic resonance imaging (MRI) in a large sample.

Methods:
We prospectively studied 116 patients who had angiographically proven MMD and Quasi-MMD. Each affected internal carotid artery, and middle cerebral artery was independently evaluated. In addition, clinical features and postoperative outcomes were compared between hemispheres with MMD and moyamoya syndrome (MMS).

Results:
Among 116 patients analyzed, 88 and 22 patients had angiographically proven MMD and Quasi-MMD, respectively. high-resolution magnetic resonance imaging confirmed bilateral MMD in 73 (83.0%) patients, 1 hemisphere with MMD and the other with intracranial atherosclerotic disease (ICAD) in 10 (11.4%) patients, and bilateral hemispheres with different vasculopathies in 5 (5.7%) patients. Detailed analysis of 204 affected hemispheres showed that several combinations of different vasculopathies were observed in the internal carotid artery and middle cerebral artery of the same hemisphere, such as ICAD-ICAD, ICAD-MMD, dissection-ICAD, and dissection-MMD. Hemispheres were assigned to MMD and MMS groups according to their vasculopathies. Transient ischemic attack occurred more frequently in hemispheres with MMD (48.1% versus 21.1%, P=0.024), whereas symptomatic ischemia was more common in hemispheres with MMS (57.9% versus 24.9%, P=0.002). However, postoperative cerebral infarction, symptom improvement and neo-formative collaterals showed no significant difference between hemispheres with MMD and MMS (P>0.05).

Conclusions:
Patients with angiographically proven MMD or Quasi-MMD needed more accurate evaluation combined with high-resolution magnetic resonance imaging. Highly selected patients with MMS might also obtain benefits from surgical revascularization.
Benefit of higher blood pressure target in severe acute kidney injury (AKI) treated by continuous renal replacement therapy (CRRT)
Authors: Matsuura Ryo , Komaru Yohei , Hamasaki Yoshifumi , Nangaku Masaomi , Doi Kent 
Published: August 2023

Abstract

Introduction
The optimal target of mean arterial pressure (MAP) during CRRT is unknown.

Method
We retrospectively collected the hourly MAP data in AKI patients requiring CRRT who admitted to the intensive care unit in the University of Tokyo hospital during 2011-2019. Patients who died within 48 hours of CRRT start and whose average value of hourly MAPs during the first 48 hours was <65 mmHg were excluded. When the average value of MAP was≤75 mmHg or > 75 mmHg, patients were allocated to the low or high target group. We estimated the effect of MAP on mortality and RRT independence at 90-day, using multivariable Cox regression model and Fine and Gray model.

Result
Of 275 patients we analyzed, 95 patients were in the low group. There are no differences in gender, baseline kidney function, disease severity. At 90 day, the low target group had higher mortality with 38 deaths (40.0%) compared with 57 deaths (31.7%) in the high target group (p < 0.05). The adjusted hazard ratio of the low target group (≤75 mmHg) for mortality was 1.72 (95%CI, 1.08-2.74). In addition, the low target group had lower rate of RRT independence, with 60 (63.2%) patients compared with 136 (75.6%) patients in the high target group (p < 0.05). The multivariable analysis revealed that adjusted hazard ratio of the low target group for RRT independence was 0.74 (95%CI, 0.54-1.01).

Conclusion
This study found the association with low MAP and mortality. The association with low MAP and delayed renal recovery was not revealed.