bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distal Tibial Mononeuropathy From Compression by the Posterior Tibial Artery: Clinical–Electrophysiological–Ultrasonographic Correlations
Authors: Beecher Grayson , Chompoopong Pitcha , Litchy William J. , Boon Andrea J. 
Published: May 2023

Summary:
The tibial nerve is bound tightly to the posterior tibial artery in the tarsal tunnel where expansion capacity is limited. Therefore, the nerve may be vulnerable to, and damaged by chronic pulsatile trauma from an atypically positioned overriding artery, labeled “punched-nerve syndrome”. In this article, we present a 49-year-old woman who presented with two months of severe burning pain in the left medial ankle and sole of the foot without antecedent trauma. Neurological examination identified dysesthetic sensation to light touch in the left medial sole of the foot, and both active and passive dorsiflexion worsened the painful paresthesia. Nerve conduction studies demonstrated a reduced left medial plantar mixed nerve action potential amplitude, 50% less than the right. High-resolution ultrasound (HRUS) showed an increased left tibial nerve cross-sectional area of 26 mm2 (normal <22.3 mm2) at the level of the ankle with side-to-side difference of 6 mm2 (normal <5.7 mm2). The distal tibial nerve and its medial plantar branch were atypically positioned immediately deep to the left posterior tibial artery and abnormally flattened with focal enlargement of the nerve on longitudinal view. Dynamic analysis demonstrated the nerve being compressed with each pulsation of the tibial artery immediately above. Active dorsiflexion of the ankle narrowed the space underneath the flexor retinaculum resulting in further compression of the nerve against the artery. In conclusion, HRUS as an adjunct to electrophysiological studies identified punched-nerve arterial compression as an etiology of tarsal tunnel syndrome.
Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy
Authors: Cox Jill , Isip Rachele , Reid Mary , Hulme Devin , Marra Andrew 
Published: May 2023

PURPOSE:
The purpose of this study was to identify predictors of 30- and 60-day hospital readmission in patients undergoing ileostomy or colostomy creation.

DESIGN:
A retrospective, cohort study.

SAMPLE AND SETTING:
The study sample comprised 258 patients who underwent ileostomy or colostomy creation from 2018 to 2021 in a suburban teaching hospital in the northeastern United States. The mean age of participants was 62.8 (SD 15.8) years; half were female and half were male. Slightly more than half 50.3% (n = 130) and 49.2% (n =127) underwent ileostomy surgery.

METHODS:
Data were abstracted from the electronic medical record and included the following variable categories: demographic factors, ostomy- and surgical-related factors, and ostomy- and surgical-related complications. Study outcome measures were readmission within 30 and 60 days from the index hospital admission discharge date. Predictors of hospital readmission were analyzed using bivariate testing, followed by multivariate analysis.

RESULTS:
Within 30 days of the index hospitalization, 49 patients were readmitted (19%), and 17 patients were readmitted (6.6%) within 60 days. For readmissions within 30 days, anatomical location of the stoma in the ileum and transverse colon as compared to descending/sigmoid colon stomas emerged as significant predictors (odds ratio [OR] 2.2; P = .036; confidence interval [CI] 1.05-4.85; OR 4.5; P = .036; CI 1.17-18.53, respectively). Within 60 days, length of the index hospitalization from 15 to 21 days as compared to shorter lengths of hospitalization emerged as the only significant predictor at this timeframe (OR 6.62; P = .018, CI 1.37-31.84).

CONCLUSIONS:
These factors provide a basis for identifying patients at higher risk for hospital readmission following ileostomy or colostomy surgery. For patients at higher risk for readmission following ostomy surgery, heightened surveillance and management in the immediate postoperative period may be necessary to avert potential complications.
Incidence and Predictive Model of Medical Adhesive–Related Skin Injury in Cancer Patients Managed With Central Venous Access Devices
Authors: Li Jieqiong , Hao Nan , Han Juan , Zhang Mi , Li Xiaomei 
Published: May 2023

PURPOSE:
The purpose of this study was to determine the prevalence of medical adhesive–related skin injury (MARSI) at the site of central venous access device (CVAD) implantation in patients with cancer, identify risk factors associated with MARSI in patients with cancer, and create a nomogram for predicting risk of MARSI.

DESIGN:
Retrospective, single-center study.

SUBJECTS AND SETTING:
The sample comprised 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019; their mean age was 55.7 years (SD: 13.9). Data were collected at the First Affiliated Hospital of Xi'an Jiaotong University, located in Xi'an, China.

METHODS:
Demographic and pertinent clinical data were collected from patient records. Routine dressing changes were performed every 7 days for peripherally inserted central venous catheters (PICCs) or 28 days for ports except in patients with existing skin injuries. Skin injuries related to use of medical adhesives and persisting for more than for 30 minutes were classified MARSI. Data were used to develop a nomogram for predicting MARSI. The accuracy of the nomogram was verified by calculating the concordance index (C-index) and drawing a calibration curve.

RESULTS:
Among the 1172 patients, 330 (28.2%) had undergone PICC implantation, and 282 (24.1%) experienced 1 or more MARSIs representing an incidence rate of 1.7 events per 1000 CVAD days. Statistical analysis identified previous MARSI history, the need for total parenteral nutrition support, other catheter-related complications, a history of allergy, and PICC implantation as associated with a higher likelihood of developing for MARSI. Based on these factors, we established a nomogram for predicting the risk of developing MARSI in patients with cancer who underwent CVAD implantation. The C-index of the nomogram was 0.96, and the calibration curve of the nomogram showed that the predictive ability of the nomogram was strong.

CONCLUSIONS:
We evaluated patients with cancer who were undergoing CVAD and identified that previous MARSI history, patients needing total parenteral nutrition support, other catheter-related complications, allergic history, and PICC implantation (compared with ports) were associated with a higher likelihood for developing MARSI. The nomogram we developed showed a good ability for predicting the risk of developing MARSI and may assist nurses to predict MARSI in this population.
CTGF is a Modifiable Mediator of Flow-dependent Atherosclerosis under Peripheral Artery Disease Conditions
Authors: Li Feifei , Kumar Sandeep , Pokutta-Paskaleva Anastassia , Omojola Victor , Kang Dong-won , Kim Chanwoo , Raykin Julia , Hoffmann Carson , Teichmann Maiko , Ma Jing , Yanigasawa Hiromi , Leask Andrew , Timmins Lucas , Cui Xiangqin , Sutliff Roy , Gleason Rudy L. , Jo Hanjoong , Brewster Luke 
Published: May 2023

AbstractBackgroundPeripheral arterial disease (PAD) is the 3rdleading type of atherosclerotic disease (ASD) morbidity. Arterial stiffness is intimately connected to the onset and progression of peripheral artery disease (PAD). The role of arterial stiffening on flow-mediated atherosclerotic plaque formation is not well understood. The objective of this study is to discover endothelial cell (EC) pathways under PAD conditions and test the modifiability of these pathways on ASD.MethodsPAD conditions in mice were conferred by partial carotid ligation to induce disturbed Flow (D-flow) in pre-stiffened Fibulin-5 knockout (KO) mice that lack normal elastin function. EC pathways, including Connective tissue growth factor (CTGF/CCN) were quantified by gene analysis and histology. Atherogenic mice had PCSK9 infection + high fat diet. CTGF was inhibited in an EC-specific knockout (ECKOCTGF) and with a CTGF antibody (FG-3149). Human vascular tissue was used to validate PAD biomechanics and CTGF upregulation.ResultsBiomechanical testing demonstrated that d-flow KO arteries mimic biomechanics of PAD arteries. RNA microarray, qPCR, and immunohistochemistry identified EC plasticity in these arteries compared to WT and KO under stable flow. Under atherogenic conditions, KO arteries demonstrated vulnerable plaques not seen in WT animals. CTGF expression was increased by d-flow, in KO arteries, in aged (18 months) WT arteries, and vascular tissue under d-flow. CTGF inhibition by ECKOCTGFfavorably improved plaque characteristics in male but not female animals. FG-3149 treatment of ECWTCTGFmale animals delivered similar benefits to plaque characteristics and arterial compliance.ConclusionECs in PAD arteries exist under a complex hemodynamic environment that integrates stiffness and d-flow into an atherogenic and inflammatory environment. Stiffness + d-flow stimulates precocious onset of EC plasticity and a vulnerable plaque phenotype. CTGF is a matricellular protein that can tune fibro-inflammatory pathways. CTGF is a prominent mediator of D-flow-mediated arterial remodeling and focal atherosclerotic plaque remodeling. Inhibition of CTGF improves plaque phenotype and arterial compliance. CTGF-associated pathways hold promise as therapeutic targets for PAD patients.
The clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery
Authors: Li Yinan , Bie Dongyun , Xiong Chao , Shi Sheng , Fang Zhongrong , Lu Zhongyuan , Wang Jianhui 
Published: May 2023

AbstractBackgroundMultiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). Moreover, combination of biomarkers with conventional criteria to define AKI substages so that we can identify high-risk patients and improve diagnostic accuracy were recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages were associated with worse outcomes.MethodsWe prospectively included 2519 pediatric patients (<16yrs) undergoing cardiac surgery with cardiopulmonary bypass in our cohort between March 2022 to February 2023 in Fuwai Hospital. Demographic and clinical variables we collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on SCr or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay, duration of mechanical ventilation, length of hospital stay and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic curve and cutoff value of CysC at different timepoints to predict AKI.Results507 (20.8%) patients developed SCr-AKI, with 337 (13.8%) in stage 1, 77(3.2%) in stage 2 and 93 (3.8%) in stage 3 respectively. Of the 1925 patients without SCr-AKI, 256 (14.3%) met the definition of sub-AKI. Of the 507 patients with SCr-AKI, 281 (55.4%) patients were defined as AKI substage A, while others (226, 44.6%) were defined as AKI substage B. After adjusting for BSA, neonates, STAT mortality score≥4, previous sternotomy and CPB time>120min, the postoperative LOIS, LOHS and DMV were prolonged with increasing hospitalization expense (P<0.05) in patients with SCr-AKI and/or CysC-AKI. Meanwhile, only the hospitalization expense was increased in patients with SCr-AKI(P<0.05) after the same adjustment. The AUC was 0.691, 0.720 and 0.817 respectively in ROC curves of preoperative, relative variation of or postoperative serum CysC. Delong’ test showed that postoperative serum CysC might have better diagnostic performance characteristic than preoperative or relative variation of CysC (P<0.001), with a cutoff point at 1.29 mg/dL (Specificity, 0.77; Sensitivity, 0.71)ConclusionsOur analysis indicates defining AKI with both CysC and SCr might more significantly affecting clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.
Physician Engagement in Quality Improvement: A Cross-Sectional Pilot Study
Authors: Shea Christine , Perrier Laure , Prokopy Melissa , Herbert Monique , Sodhi Sundeep , Karsan Alia , Simard Julie , Perreira Tyrone A. 
Published: May 2023

ABSTRACTBackgroundTo confirm the reliability of a survey investigating physician engagement in quality improvement (QI) among Ontario physicians. We conducted a pilot study to test the survey on physicians, evaluate a recruitment strategy, and assess preliminary data.MethodsAll Ontario physicians were invited to participate in the survey through province-wide online physician and hospital organization newsletters.ResultsResults indicate a need for solutions and standards for training physicians interested in participating in QI initiatives. Study objectives were reached, but recruitment remains challenging.ConclusionThis pilot study supports conducting a full-scale survey that would result in more robust results.
Genome-wide association study identifies a new susceptibility locus inPLA2G4Cfor Multiple System Atrophy
Authors: Nakahara Yasuo , Mitsui Jun , Date Hidetoshi , Porto Kristine Joyce , Hayashi Yasuhiro , Yamashita Atsushi , Kusakabe Yoshio , Matsukawa Takashi , Ishiura Hiroyuki , Yasuda Tsutomu , Iwata Atsushi , Goto Jun , Ichikawa Yaeko , Momose Yoshio , Takahashi Yuji , Toda Tatsushi , Ohta Rikifumi , Yoshimura Jun , Morishita Shinichi , Gustavsson Emil K , Christy Darren , Maczis Melissa , Farrer Matthew J. , Kim Han-Joon , Park Sung-Sup , Jeon Beomseok , Zhang Jin , Gu Weihong , Scholz Sonja W. , Singleton Andrew B. , Houlden Henry , Yabe Ichiro , Sasaki Hidenao , Matsushima Masaaki , Takashima Hiroshi , Kikuchi Akio , Aoki Masashi , Hara Kenju , Kakita Akiyoshi , Yamada Mitsunori , Takahashi Hitoshi , Onodera Osamu , Nishizawa Masatoyo , Watanabe Hirohisa , Ito Mizuki , Sobue Gen , Ishikawa Kinya , Mizusawa Hidehiro , Kanai Kazuaki , Kuwabara Satoshi , Arai Kimihito , Koyano Shigeru , Kuroiwa Yoshiyuki , Hasegawa Kazuko , Yuasa Tatsuhiko , Yasui Kenichi , Nakashima Kenji , Ito Hijiri , Izumi Yuishin , Kaji Ryuji , Kato Takeo , Kusunoki Susumu , Osaki Yasushi , Horiuchi Masahiro , Yamamoto Ken , Shimada Mihoko , Miyagawa Taku , Kawai Yosuke , Nishida Nao , Tokunaga Katsushi , Dürr Alexandra , Brice Alexis , Filla Alessandro , Klockgether Thomas , Wüllner Ullrich , Tanner Caroline M. , Kukull Walter A. , Lee Virginia M.-Y. , Masliah Eliezer , Low Phillip A. , Sandroni Paola , Ozelius Laurie , Foroud Tatiana , Tsuji Shoji 
Published: May 2023

AbstractTo elucidate the molecular basis of multiple system atrophy (MSA), a neurodegenerative disease, we conducted a genome-wide association study (GWAS) in a Japanese MSA case/control series followed by replication studies in Japanese, Korean, Chinese, European and North American samples. In the GWAS stage rs2303744 on chromosome 19 showed a suggestive association (P= 6.5 × 10−7) that was replicated in additional Japanese samples (P= 2.9 × 10−6. OR = 1.58; 95% confidence interval, 1.30 to 1.91), and then confirmed as highly significant in a meta-analysis of East Asian population data (P= 5.0 × 10-15. Odds ratio= 1.49; 95% CI 1.35 to 1.72). The association of rs2303744 with MSA remained significant in combined European/North American samples (P=0.023. Odds ratio=1.14; 95% CI 1.02 to 1.28) despite allele frequencies being quite different between these populations. rs2303744 leads to an amino acid substitution inPLA2G4Cthat encodes the cPLA2γ lysophospholipase/transacylase. The cPLA2γ-Ile143 isoform encoded by the MSA risk allele has significantly decreased transacylase activity compared with the alternate cPLA2γ-Val143 isoform that may perturb membrane phospholipids and α-synuclein biology.
Epigenomic signature of major congenital heart defects in newborns with Down syndrome
Authors: Mouat Julia S. , Li Shaobo , Myint Swe Swe , Laufer Benjamin I. , Lupo Philip J. , Schraw Jeremy M. , Woodhouse John P. , de Smith Adam J. , LaSalle Janine M. 
Published: May 2023

ABSTRACTBackgroundCongenital heart defects(CHDs)affect approximately half of individuals with Down syndrome(DS)but the molecular reasons for incomplete penetrance are unknown. Previous studies have largely focused on identifying genetic risk factors associated with CHDs in individuals with DS, but comprehensive studies of the contribution of epigenetic marks are lacking. We aimed to identify and characterize DNA methylation differences from newborn dried blood spots(NDBS)of DS individuals with major CHDs compared to DS individuals without CHDs.MethodsWe used the Illumina EPIC array and whole-genome bisulfite sequencing(WGBS)to quantitate DNA methylation for 86 NDBS samples from the California Biobank Program: 1) 45 DS-CHD (27 female, 18 male) and 2) 41 DS non-CHD (27 female, 14 male). We analyzed global CpG methylation and identified differentially methylated regions(DMRs)in DS-CHD vs DS non-CHD comparisons (both sex-combined and sex-stratified) corrected for sex, age of blood collection, and cell type proportions. CHD DMRs were analyzed for enrichment in CpG and genic contexts, chromatin states, and histone modifications by genomic coordinates and for gene ontology enrichment by gene mapping. DMRs were also tested in a replication dataset and compared to methylation levels in DS vs typical development(TD)WGBS NDBS samples.ResultsWe found global CpG hypomethylation in DS-CHD males compared to DS non-CHD males, which was attributable to elevated levels of nucleated red blood cells and not seen in females. At a regional level, we identified 58, 341, and 3,938 CHD-associated DMRs in the Sex Combined, Females Only, and Males Only groups, respectively, and used machine learning algorithms to select 19 Males Only loci that could distinguish CHD from non-CHD. DMRs in all comparisons were enriched for gene exons, CpG islands, and bivalent chromatin and mapped to genes enriched for terms related to cardiac and immune functions. Lastly, a greater percentage of CHD-associated DMRs than background regions were differentially methylated in DS vs TD samples.ConclusionsA sex-specific signature of DNA methylation was detected in NDBS of DS-CHD compared to DS non-CHD individuals. This supports the hypothesis that epigenetics can reflect the variability of phenotypes in DS, particularly CHDs.
Epidemiology and Survival of Primary Extraosseous Plasmacytoma: Insights from A Population-Based Study with A 20-Year Follow-Up
Authors: Wang Fan 
Published: May 2023

AbstractBackgroundPrimary extraosseous plasmacytoma (PEP) is a rare and localized form of plasmacytoma that is not well understood. This study aimed to investigate the clinical features and prognostic factors associated with PEP.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, patients diagnosed with PEP between 2000 and 2019 were extracted. Survival curves were calculated with the Kaplan-Meier method, and prognostic factors were identified based on the univariate and multivariate Cox regression analyses. A nomogram was constructed to predict survival at 3 and 5 years after diagnosis.ResultsA total of 1044 PEP patients were included in this study. The average age was 60.3 ± 15.2 years, with 64.3% being male (male: female = 1.8:1) and 53.8% being over 60 years old. The most affected sites were the upper aerodigestive tract (42.6%). Most patients received radiotherapy (60.7%), followed by surgery (52.8%) and chemotherapy (15.1%). Overall survival (OS) rates were 88.3% at 1 year, 78.1% at 3 years, 70.7% at 5 years, and 56.0% at 10 years. Corresponding cancer-specific survival (CSS) rates were 92.1%, 85.8%, 82.5%, and 78.1%, respectively. Multivariate cox analysis indicated that age, race, marital status at diagnosis, radiotherapy, chemotherapy, and surgery were independent prognostic factors for OS, while age, race, radiotherapy, chemotherapy, and surgery were independent prognostic factors for CSS. Nomograms were further constructed to predict the possibility of OS and CSS with good performances.ConclusionsThe survival outcome of patients with PEP depends on several factors including age, race, marital status, and treatment options such as chemotherapy, radiotherapy, and surgery, which were also identified as independent predictors of OS for PEP. Patients who were younger, Asian or Pacific Islander, American Indian or Native American, and received radiotherapy or surgery had a more favorable prognosis, while those who underwent chemotherapy had poorer outcomes. This study provides valuable insights into the management of PEP.
Development and Validation of a Multiplex Real-Time PCR Assay for Detection and Quantification ofStreptococcus pneumoniaein Pediatric Respiratory Samples
Authors: Butler Molly , Breazeale Garrett , Mwangi Eric , Dowell Elaine , Dominguez Samuel R , Lamberth Linda , Hultén Kristina , Jung Sarah A 
Published: May 2023

AbstractStreptococcus pneumoniae(Spn) is a bacterial pathogen that causes a range of disease manifestations in children, from acute otitis media to pneumonia, septicemia, and meningitis. PrimarySpnlaboratory diagnostic identification methods include culture, antigen testing, single-plex real-time PCR, and syndromic PCR panels. However, each method lacks sensitivity, specificity, and/or cost efficiency. We developed and validated a quantitative, multiplex PCR assay that uses threeSpngenomic targets (lytA, piaB, and SP2020) for improved sensitivity and specificity to detectSpnin pleural fluid (PF), bronchoalveolar lavage (BAL), tracheal aspirate (TA), and upper respiratory (UR, research only) samples. Validation testing included analytical sensitivity (limit of detection), specimen storage, analytical specificity (cross-reactivity), and accuracy studies. Limit of detection is 500 genome copies/mL in lower respiratory samples and 100 copies/mL in upper respiratory specimens, with quantification range of 1,000 to 10,000,000 copies/mL. Specimens can be stored frozen at least 60 days andSpnDNA is stable through 3 freeze-thaw cycles. No cross-reactivity was observed against 20 closely related microorganisms and/or microorganisms that can be detected in similar sample types, includingStreptococcus pseudopneumoniae. In reference range testing,Spnwas detected in 5 of 23 (21.7%) PF, 2 of 19 (10.5%) BAL, 1 of 20 (5.0%) TA, and 44 of 178 (24.7%) UR residual specimens. For accuracy studies, 98 specimens were tested and overall percent agreement with a qualitative,lytA-based comparator assay was 96.9% across all sample types. This multiplex, quantitative PCR assay is a sensitive and specific method forSpndetection in pediatric respiratory samples.