bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center
Authors: Hosseinpour Hamidreza , Magnotti Louis J. , Bhogadi Sai Krishna , Colosimo Christina , El-Qawaqzeh Khaled , Spencer Audrey L. , Anand Tanya , Ditillo Michael , Nelson Adam , Joseph Bellal 
Published: February 2023

BACKGROUND
Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs.

METHODS
This is a 3-year (2017–2019) analysis of the American College of Surgeons Trauma Quality Improvement Program database. All children (younger than 15 years) who were transferred from other facilities to Level I or II PTC were included and stratified by level of receiving PTCs and injury severity. Outcome measures were in-hospital mortality and major complications.

RESULTS
A total of 67,726 transferred pediatric trauma patients were identified, of which 52,755 were transferred to Level I and 14,971 to Level II. The mean ± SD age and median Injury Severity Score were 7 ± 4 years and 4 (1–6), respectively. Eighty-five percent were transported by ground ambulance. The median transfer time for Levels I and II was 93 (70–129) and 90 (66–128) minutes, respectively (p < 0.001). On multivariable regression, interfacility transfers to Level I PTCs were associated with decreased risk-adjusted odds of in-hospital mortality among the mildly to moderately injured group (adjusted odds ratio, 0.59; p = 0.037) and severely injured group with a transfer time of less than 60 minutes (adjusted odds ratio, 0.27; p = 0.002).

CONCLUSION
Every minute increase in the interfacility transfer time is associated with a 2% increase in risk-adjusted odds of mortality among severely injured pediatric trauma patients. Factors other than the level of receiving PTCs, such as estimated transfer time and severity of injury, should be considered while deciding about transferring pediatric trauma patients to higher levels of care.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
D-dimer Release From Livers During Ex Situ Normothermic Perfusion and After In Situ Normothermic Regional Perfusion: Evidence for Occult Fibrin Burden Associated With Adverse Transplant Outcomes and Cholangiopathy
Authors: Watson Christopher J.E. , MacDonald Stephen , Bridgeman Christopher , Brais Rebecca , Upponi Sara S. , Foukaneli Theodora , Swift Lisa , Fear Corrina , Selves Linda , Kosmoliaptsis Vasilis , Allison Michael , Hogg Rachel , Parsy Kourosh Saeb , Thomas Will , Gaurav Rohit , Butler Andrew J. 
Published: February 2023

Background.
Deceased donor livers are prone to biliary complications, which may necessitate retransplantation, and we, and others, have suggested that these complications are because of peribiliary vascular fibrin microthrombi. We sought to determine the prevalence and consequence of occult fibrin within deceased donor livers undergoing normothermic ex situ perfusion (NESLiP) and evaluate a role for fibrinolysis.

Methods.
D-dimer concentrations, products of fibrin degradation, were assayed in the perfusate of 163 livers taken after 2 h of NESLiP, including 91 that were transplanted. These were related to posttransplant outcomes. Five different fibrinolytic protocols during NESLiP using alteplase were evaluated, and the transplant outcomes of these alteplase-treated livers were reviewed.

Results.
Perfusate D-dimer concentrations were lowest in livers recovered using in situ normothermic regional perfusion and highest in alteplase-treated livers. D-dimer release from donation after brain death livers was significantly correlated with the duration of cold ischemia. In non-alteplase-treated livers, Cox proportional hazards regression analysis showed that D-dimer levels were associated with transplant survival (P = 0.005). Treatment with alteplase and fresh frozen plasma during NESLiP was associated with significantly more D-dimer release into the perfusate and was not associated with excess bleeding postimplantation; 8 of the 9 treated livers were free of cholangiopathy, whereas the ninth had a proximal duct stricture.

Conclusions.
Fibrin is present in many livers during cold storage and is associated with poor posttransplant outcomes. The amount of D-dimer released after fibrinolytic treatment indicates a significant occult fibrin burden and suggests that fibrinolytic therapy during NESLiP may be a promising therapeutic intervention.
Iatrogenic Botulism: A Case Treated With Botulinum Antitoxin
Authors: Gonul Oner Ozge , Gudek Hasan Can , Erturk Cetin Ozdem , Demir Serkan 
Published: February 2023

Objective
Botulinum toxin type A is widely used for the treatment of spasticity, focal dystonia, hemifacial spasm, hyperhidrosis, strabismus, chronic migraine, and also cosmetic purposes. Therapeutic use is commonly effective and safe. However, if toxin enters the vascular space and gets through to peripheral cholinergic nerve terminals, it may lead to iatrogenic botulism.

Method
We presented a patient who is diagnosed as iatrogenic botulism and treated with antitoxin at the 15th day of the exposure.

Results
After the antitoxin administration, dramatical response to the treatment was observed.

Conclusions
In this report, we want to evaluate a new case of iatrogenic botulism and emphasize the importance of antitoxin administration regardless the timing of the exposure for patients with progressing paralysis.
Orbicularis Oculi Muscle Immunohistochemical, Metabolic, and Morphometric Differences in Affected and Nonaffected Sides in Hemifacial Spasm vs Healthy Subjects
Authors: Osaki Tammy H. , Gameiro Gustavo R. , Osaki Midori H. , Osaki Teissy , Campos Eliene D. , Belfort Rubens , Marie Suely K. N. 
Published: February 2023

Background:
Subtle morphological alterations have been reported even in the nonaffected side of the orbicularis oculi muscle in patients with hemifacial spasm. However, no previous study assessed immunohistochemical, metabolic, and morphometric alterations in orbicularis oculi muscle fibers in affected and nonaffected sides in patients with this condition, compared with samples obtained from healthy subjects. The purpose of this study is to objectively assess and compare orbicularis oculi muscle (OOM) samples of hemifacial spasm affected and nonaffected sides and healthy subjects.

Methods:
Orbicularis oculi samples from 8 patients with hemifacial spasm who had not been previously treated and 6 healthy subjects were prepared using hematoxylin and eosin, nicotinamide adenine dinucleotide tetrazolium reductase, cytochrome oxidase, succinate dehydrogenase, Gomori staining, and monoclonal antibodies against myosin slow and myosin fast. A digital image analysis software was used for objective analysis.

Results:
OOM fiber area was significantly greater in both affected (P = 0.0379) and nonaffected sides (P = 0.0012) of HFS samples when compared with control subjects' fibers. A significantly greater number of oxidative fibers were observed in both affected and nonaffected sides of patients with HFS when compared with control subjects (P < 0.001 for both). A significantly greater percentage of slow fibers was observed in the affected side of HFS patients (P = 0.0012) compared with control subjects.

Conclusions:
This study's findings suggest that repeated contractions might lead to OOM fiber hypertrophy, increased mitochondrial metabolism, and possible conversion of fast-twitch orbicularis oculi muscle fibers into slow-twitch fibers in patients with HFS. Alterations were observed in affected and nonaffected sides, confirming initial findings that the nonaffected side is not normal in this unique condition.
Evaluation of Optic Disc Edema in Long-Duration Spaceflight Crewmembers Using Retinal Photography
Authors: Valencia William E. , Mason Sara S. , Brunstetter Tyson J. , Sargsyan Ashot E. , Schaefer Caroline M. , Tarver William J. , Van Baalen Mary G. , Gibson Charles R. , Lee Andrew G. , Danilichev Sergey N. , Hinton Patricia V. , Makarov Igor A. , Matveev Vladimir P. , Stern Claudia H. , Taniguchi-Shinojima Ari , Feldon Steven E. 
Published: February 2023

Background:
Long-duration spaceflight crewmembers are at risk for spaceflight-associated neuro-ocular syndrome (SANS). One of the earliest manifestations of SANS is optic disc edema (ODE), which could be missed using the subjective Frisén scale. The primary objective of this study is to determine the inter-rater and intrarater reliability of Frisén grade for SANS-induced ODE among a trained observer cohort. The secondary objective is to propose a standardized evaluation process for SANS-induced ODE across International Space Station Partner Agencies.

Methods:
Retrospective, double-blinded diagnostic study. Preflight and postflight fundus photographs were presented to subject matter experts who identified and graded ODE. Pairs of images were also compared side-by-side for disc ranking. Grader concordance was assessed for Frisén grading and disc ranking.

Results:
Expert graders identified Grade 1 ODE in 17.35% of images from 62 crewmembers (9 female, mean [SD] age, 47.81 [5.19] years). Grades 2 and 3 were identified less than 2% of the time. Concordance in Frisén grades among pairs of graders was 70.99%. Graders identified a difference in preflight and postflight fundus photographs 17.21% of the time when using disc ranking. Pairs of graders had complete concordance in disc ranking 79.79% of the time. Perfect intrarater agreement between Frisén grade and disc ranking occurred 77.7% of the time.

Conclusions:
These findings demonstrate intergrader and intragrader variability when using the Frisén scale to identify SANS-induced ODE, which is typically milder in presentation than terrestrial cases of idiopathic intracranial hypertension. It is possible to miss early ODE on fundoscopy alone, making it insufficient as a sole criterion for the diagnosis of SANS. A more sensitive and objective method of surveillance is necessary to monitor international crewmembers for ODE, perhaps using a multimodal approach that includes technology such as optical coherence tomography.
Intracranial Pressure Fluctuations Mimicking Seizures in a Patient With Shunt Malfunction
Authors: Abramovici Sergiu , Blackburn Kaitlyn , Phinney Trevor , Mayoglou Lazarus 
Published: February 2023

Summary:
This case describes a patient with new onset of multiple daily paroxysmal stereotyped episodes with alteration of arousal and responsiveness. These episodes pose a diagnostic challenge because they may be misdiagnosed as epileptic seizures because of stereotypy, similarities in semiology, risk factors such as structural abnormality, and rhythmic EEG pattern. A 20-year-old woman with Chiari malformation, spina bifida, and ventriculoperitoneal shunt presented with paroxysmal episodes of change in responsiveness, concerning for seizure activity. Anti-seizure medication was started without amelioration. During the stereotyped episodes, she suffered from paroxysmal headache, drowsiness, poor responsiveness, and relative bradycardia. EEG confirmed relative bradycardia and revealed rapid buildup of generalized rhythmic delta activity without ictal features. Improvement with ICP lowering, and lack of epileptiform activity on EEG or localizing ictal semiology, prompted obtaining shunt imaging and brain MRI. The patient was subsequently diagnosed with shunt malfunction and underwent shunt revision, resulting in complete resolution of her paroxysmal spells. Although common differential diagnosis of brief paroxysmal stereotyped spells includes seizures or psychogenic nonepileptic attacks, this patient's case demonstrates clinical paroxysms caused by intracranial pressure fluctuations (plateau waves). When evaluating patients with possible intracranial pressure abnormality for paroxysmal spells, shunt malfunction should be considered as well.
Silent information regulator 1 mediates H2S-inhibited chronic restraint stress-induced depressive-like behaviors by regulating hippocampal autophagy
Authors: Du Lv , Chen Lei , Luo Bang , Chen Yong-Jun , Zhang Ping , Tang Yi-Yun , Jiang Jia-Mei , Zou Wei 
Published: February 2023

Objectives
Our previous study has demonstrated that hydrogen sulfide (H2S), a novel gasotransmitter, attenuates excessive autophagy and depressive-like behaviors in chronic restraint stress (CRS)-exposed rats, but the underlying molecular mechanism remains to be elucidated. Silent information regulator 1 (SIRT1), a deacetylase at the consumption of NAD+ plays an important regulatory role in depression. Hence, this study aimed to investigate whether SIRT1 mediates the protective effect of H2S on CRS-induced depressive-like behaviors by regulating hippocampal autophagy.

Methods
Adult male Sprague-Dawley (SD) rats were subjected to CRS (6 h × 28 days) to induce depression-like behavior. Rats were injected with sodium hydrosulfate (NaHS, 100 μmol/kg/d, i.p.), as a donor of H2S, alone or in combination with Sirtinol (a SIRT1 inhibitor; 10 nmol, i.c.v.) during CRS process. The depression-like characteristics of rats were assessed by the novelty-suppressed feeding test (NSFT), tail suspension test (TST), forced swimming test (FST) and open field test (OFT). The number of hippocampal autophagosomes was detected by transmission electron microscopy. The expressions of hippocampal autophagy-related proteins were measured by western blotting analysis.

Results
Sirtinol blocked the inhibitory effect of H2S on depressive-like behaviors in CRS-exposed rats according to NSFT, TST, FST and OFT. In addition, sirtinol reversed the protective response of H2S to CRS-induced excessive autophagy, as proved by the increases in the number of autophagosomes and the expression of Beclin-1 as well as a decrease in the expression of P62 in the hippocampus.

Conclusion
These results indicated that SIRT1 contributes to the antidepressant-like function of H2S during CRS via reducing hippocampal autophagy.
Symptom Burden in Patients with Malignant Bowel Obstruction Treated With or Without Surgery
Authors: Ayabe Reed , Mendoza Tito , Yennu Sriram , Bruera Eduardo , Williams Loretta A , Badgwell Brian 
Published: February 2023

Background:
Gastrointestinal obstruction is the most common indication for palliative surgical consultation. We sought to assess patient-reported outcomes (PRO) and survival after surgical and non-surgical treatment of malignant bowel obstruction.

Study Design:
This was a prospective observational study enrolling patients with advanced malignancy who underwent surgical consultation at a tertiary cancer center. PROs were evaluated using a previously validated inventory, the MDASI-GIO, administered at enrollment and 7 other time points for up to 90 days.

Results:
We enrolled 125 patients, of whom 37 underwent surgery and 88 did not. Patients treated non-surgically were more likely to have carcinomatosis on imaging (71% vs 49%, P=0.02). Pain medicine, palliative care, and chaplaincy consultations occurred in 17%, 30%, and 15% of patients within the first month of enrollment. Higher mean symptom scores were noted by surgical patients although the only single scores with effect sizes ≥0.5 were symptom interference with general activity and work. The composite score for interference in work, activity, and walking had the largest effect size at -0.37, indicating greater interference in patients undergoing surgery. Patients selected for surgery had extended overall survival (median 15 vs 3 months, P<0.01). Carcinomatosis, palliative care evaluation, and venting gastrostomy tube were associated with increased risk of death, while ability to receive subsequent chemotherapy and surgical management were positive prognostic indicators.

Conclusion:
In this first study evaluating PROs after treatment for malignant bowel obstruction we found that selection for surgical treatment was associated with improved survival, but also more symptom interference in general activities and work. These results may be useful in palliative surgical decision-making and informing patients during consultation for malignant bowel obstruction.
Less Is More: Parathyroidectomy and the Association with Postoperative Hypocalcemia in Dialysis Patients
Authors: Wang Rongzhi , Disharoon Mitchell , Frazier Rachel , Xie Rongbing , Moses Cara , Gillis Andrea , Fazendin Jessica , Lindeman Brenessa , Gutierrez Orlando M , Chen Herbert 
Published: February 2023

Background:
Parathyroidectomy (PTx) is the most effective treatment for secondary hyperparathyroidism (HPT). Literature regarding the effect of surgical approaches on postoperative hypocalcemia is limited and mainly focuses on postoperative calcium levels. This study aims to evaluate the association of subtotal PTx and total PTx with auto-transplantation (AT) for secondary HPT with postoperative hypocalcemia.

Study Design:
We reviewed all dialysis patients who underwent PTx (n=143) at our institution from 2010 to 2021. Postoperative hypocalcemia adverse events were defined as postoperative intravenous (IV) calcium requirement or 30-day readmission due to hypocalcemia. Postoperative hypocalcemia adverse events, length of stay, and oral calcium requirement at 1-month follow-up were compared between the two groups.

Results:
Of the 143 patients, 119(83.2%) underwent total PTx with AT, and 24(16.8%) underwent subtotal PTx. Patients who underwent subtotal PTx had shorter mean (±SD) length of stay (1.8 ± 1.7 vs. 3.5 ± 3.2, p=0.002), were less likely to develop hypocalcemia adverse events (8.3% vs. 47.1%, p<0.001) and required less median elemental calcium supplementation at 1-month follow-up (1558 vs.3193 mg, p<0.001). There was no significant difference in surgical success between the two groups (91.7% vs. 89.1%, p=0.706). Stepwise multivariable regression demonstrated that patients who underwent total PTx with AT were 11.9 times more likely to develop hypocalcemia adverse events (aOR 11.9 95%CI 2.2-66.2, p=0.004), had 1.24-day longer length of stay (95%CI 0.04-2.44, p=0.044) and required 1776.1 mg more elemental calcium (95%CI 661.5-2890.6 mg, p=0.002).

Conclusion:
Subtotal parathyroidectomy is associated with less postoperative hypocalcemia and provides similar surgical cure for dialysis patients with secondary hyperparathyroidism.
Thirty-Day Perioperative Clinical Outcomes of Transcarotid Artery Revascularization vs Carotid Endarterectomy in a Single-Center Experience
Authors: AbuRahma Ali F , Santini Adrian , AbuRahma Zachary T , Lee Andrew , Seal Kimberly , Veith Christina , Dean Scott , Davis Elaine 
Published: February 2023

Background:
Transcarotid Artery Revascularization (TCAR) has been proposed as a alternative to carotid endarterectomy (CEA) and transfemoral carotid artery stenting in high-risk patients. Recently CMS expanded coverage for TCAR to include standard surgical risk patients within the SVS Vascular Quality Initiative TCAR surveillance project (TSP). Few single centers compared the clinical outcome of TCAR to CEA. This study compares 30-day perioperative clinical outcomes between TCAR and CEA.

Study Design:
This is retrospective analysis of prospectively collected data from TSP of TCAR patients enrolled in our institution and compared with CEAs done in the same time/providers. The primary outcome was stroke and/or death. Secondary outcome included stroke, death, MI, cranial nerve injury (CNI), bleeding, etc. Propensity matching was done to analyze outcomes.

Results:
The study analyzed 501 patients (347 CEA, 154 TCAR). There were no significant differences in symptomatic status (43% for CEA vs 38% for TCAR, p 0.3032). TCAR had higher patients with hypertension (p 0.0395), CAD (p 0.028), CHF (p 0.0392). The 30-day perioperative complication rates for CEA vs TCAR were: stroke 1% vs 3% (p 0.1416), stroke/death 1% vs 3% (p 0.1854), MI 0.6% vs 0.7% (p 1), death 0.6% vs 0% (p 1), stroke/death/MI 2% vs 4% (p 0.233), CNI 4% vs 2% (p 0.4117), major hematoma (requiring re-intervention) 2% vs 3% (p 1). After matching 154 CEA patients and 154 TCAR, 30-day perioperative complication rates were: stroke 2% vs 3% (p 0.7229), stroke/death 3% vs 3% (p 1), death 1.3% vs 0% (p 0.4984), MI 0.7% vs 0.7% (p 1), stroke/death/MI 3% vs 4% (p 0.7588).

Conclusion:
This study showed that using propensity match analysis both CEA and TCAR have similar 30-day perioperative outcomes. Further long-term data is needed.
Combined Tumor Burden Score and Carbohydrate Antigen 19-9 Grading System to Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma
Authors: Moazzam Zorays , Alaimo Laura , Endo Yutaka , Lima Henrique A , Ruzzenente Andrea , Guglielmi Alfredo , Aldrighetti Luca , Weiss Matthew , Bauer Todd W , Alexandrescu Sorin , Poultsides George A , Maithel Shishir K , Marques Hugo P , Martel Guillaume , Pulitano Carlo , Shen Feng , Cauchy François , Koerkamp Bas Groot , Endo Itaru , Cloyd Jordan , Ejaz Aslam , Pawlik Timothy M 
Published: February 2023

Background:
The interplay of CA19-9 and tumor burden score (TBS) in intrahepatic cholangiocarcinoma (ICC) remains ill-defined. We evaluated the role of TBS and CA19-9 relative to overall survival (OS) and recurrence, as well as the predictive ability of the Combination of TBS and CA 19-9 (CTC) grading system.

Study Design:
Patients who underwent liver resection for ICC between 2000-2020 were identified using a multi-institutional database. The impact of CA19-9 and TBS on 5-year OS and 3-year recurrence was assessed, along with the prognostic accuracy of the CTC system (a composite score of CA19-9 and TBS).

Results:
Among 831 patients, the median age was 58.2 years and 482 (58.0%) were male. The median CA19-9 level was 49.7 (17.0–221.0) U/mL, while median TBS was 6.1 (IQR 4.1–8.3). Median and 5-year OS were 36.9 (IQR 32.3–43.1) months and 38.9%, respectively; overall 3-year recurrence was 68.9%. Survival varied relative to CA19-9 (low: 49.0% vs. high: 19.7%) and TBS (low: 53.6% vs. high: 26.9%) had worse 5-year survival (both p<0.001). On multivariable analysis, high CA19-9 (HR 2.02, 95%CI 1.64–2.49) and high TBS (HR1.64, 95%CI 1.32–2.06) remained independently associated with OS. In turn, the CTC grading score stratified 5-year OS (low CTC: 57.7% vs. intermediate CTC: 39.9% vs. high CTC: 12.6%; p<0.001), and remained an independent prognostic factor (referent: low CTC; intermediate CTC HR 1.54, 95%CI 1.18–2.01; high CTC: HR 3.28, 95%CI 2.47–4.36).

Conclusion:
The interplay between tumor morphology and biology dictated long-term prognosis after liver resection for ICC. Prognostic models such as the CTC grading system may inform discussions around prognosis, as well as help identify which patients with ICC may benefit more from neoadjuvant chemotherapy rather than up-front surgery.