bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Timing of Chemoprophylaxis and Its Impact on Thromboembolism and Bleeding Following Major Abdominal Surgery: A Multicenter Cohort Study
Authors:   PROTECTinG investigators,   VERITAS Collaborative
Published: February 2023

AbstractBackgroundMajor abdominal surgery is associated with bleeding and venous thromboembolism (VTE) risks. Chemoprophylaxis prevents VTE but increases bleeding risk. When compared with pre‐ and intra‐operative chemoprophylaxis, recent evidence suggests that starting chemoprophylaxis postoperatively lowers the risk of bleeding without compromising VTE protection. This study investigates whether an optimal window exists in the postoperative period for initiating chemoprophylaxis in patients undergoing major abdominal surgery.MethodsAnalysis of pooled data from four multicenter PROTECTinG studies, which investigated the timing of perioperative chemoprophylaxis on bleeding and VTE outcomes following major abdominal surgery. Patients that commenced chemoprophylaxis postoperatively were separated into quartiles based on timing of administration within the first 24 h post‐surgery.ResultsOverall, 4729 (Abdominal visceral resection N = 668, cholecystectomies N = 573, major ventral hernia repair N = 1701, antireflux surgery N = 1787) consecutive patients had chemoprophylaxis commenced within 24 h following elective surgery. Baseline characteristics were comparable between quartiles. Across quartiles and within each procedural type, the timing of starting chemoprophylaxis was not associated with bleeding (2.6, 1.7, 2.7 and 3.2%, p = 0.130) or clinical VTE (0.8, 0.2, 0.8 and 0.5%, p = 0.131), and did not predict their occurrences on multivariate analysis.ConclusionChemoprophylaxis can be safely started at any time within 24 h post‐skin closure in major abdominal surgery, without affecting bleeding or VTE risks. This finding encourages the standardization of chemoprophylaxis timing in the postoperative period to pre‐defined times during the day to improve workflow efficiency and chemoprophylaxis compliance.
Fall‐Related Injuries in Malawi: Outcomes and Trends Over Time
Authors: An Selena J. , Ngwira Natasha , Davis Dylane , Gallaher Jared , Charles Anthony 
Published: February 2023

AbstractBackgroundFall‐related injury (FRI) is a leading cause of injuries worldwide. Data on injury patterns and trends over time are lacking in resource‐limited settings.MethodsWe performed a retrospective analysis of FRI at Kamuzu Central Hospital in Malawi from 2009 to 2021. Outcomes were compared between patients presenting with FRI and those with other injury mechanisms. Bivariate and multivariate regressions were used to determine predictors of presentation following falls and mortality. We also analyzed time trends.ResultsA total of 166,047 patients were included, of which 41,695 were patients presenting after falls (25.7%). Most FRI patients were between 5 and 45 (67.2%) and male (66.9%). Most falls occurred at home (67.3%) and resulted in extremity injuries (51.6%). The predicted probability of hospital presentation after falling is highest for children ≤  5 years and adults >  60 years and decreases over time. On multivariate analysis, patients between 5 and 15 [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.63–1.77] and > 60 (AOR 1.14, 95% CI 1.07–1.22) and women (AOR 1.13, 95% CI 1.10–1.16) are more likely to present with FRI. Compared to patients with non‐FRI, those with FRI were more likely to have been injured at school (AOR 2.16, 95% CI 2.01–2.32) and during sports and recreation (AOR 4.53, 95% CI 4.24–4.85).ConclusionFRI is the most common injury presentation after motor vehicle injury in this low‐resource setting. This study provides essential information about FRI in Malawi over time. Our findings can help inform resource allocation and injury prevention initiatives.
Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions—a retrospective MRI analysis
Authors: Stranger Nikolaus , Kaulfersch Christian , Mattiassich Georg , Mandl Jürgen , Hausbrandt Peter A. , Szolar Dieter , Schöllnast Helmut , Tillich Manfred 
Published: February 2023

Abstract
Objectives
To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions.

Methods
In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson’s chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni’s correction was applied.

Results
ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL.

Conclusions
ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions.

Key Points
• ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases.
• Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME.
• ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.
CT colonography: can we achieve an adequate bowel preparation without diet restriction?
Authors: Rengo Marco , Tiberia Filippo , Vicini Simone , Bellini Davide , Celestre Michela , Trionfera Gianfranco , Laghi Andrea , Carbone Iacopo 
Published: February 2023

Abstract
Objective
To evaluate if an adequate bowel preparation for CT colonography, can be achieved without diet restriction, using a reduced amount of cathartic agent and fecal tagging. To investigate the influence of patients’ characteristics on bowel preparation and the impact on patients’ compliance.

Methods
In total, 1446 outpatients scheduled for elective CT colonography were prospectively enrolled. All patients had the same bowel preparation based on a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) the day before the exam and a fecal tagging agent (60 ml of hyperosmolar oral iodinated agent) the day of the exam. No dietary restrictions were imposed before the exam. The bowel preparation was evaluated using a qualitative and quantitative score. Patients were grouped by age, gender, and presence of diverticula in both scores. Patients’ compliance has been evaluated with a questionnaire after the end of the exam and with a phone-calling interview the day after the exam.

Results
According to the qualitative score, adequate bowel preparation was achieved in 1349 patients (93.29%) and no statistical differences were observed among the subgroups of patients. Quantitative scores demonstrated that colon distension was significantly better in younger patients and without diverticula. A good patients’ compliance was observed and most patients (96.5%) were willing to repeat it.

Conclusions
The lack of diet restriction does not affect the quality of CTC preparation and good patient’s compliance could potentially increase the participation rate in CRC screening programs.

Key Points
• An adequate quality bowel preparation for CT colonography can be achieved without diet restriction, using a reduced amount of cathartic agent (120 g of macrogol in 1.5 l of water) and fecal tagging (60 ml of hyperosmolar oral iodinated agent).
• A bowel preparation based on the combination of a reduced amount of cathartic agent and fecal tagging, without diet restriction, allows obtaining good quality in more than 90% of patients.
• The bowel preparation scheme proposed reduces the distress and discomfort experienced by the patients improving adherence to CTC.
Evaluation of a deep learning-based reconstruction method for denoising and image enhancement of shoulder MRI in patients with shoulder pain
Authors: Feuerriegel Georg C. , Weiss Kilian , Kronthaler Sophia , Leonhardt Yannik , Neumann Jan , Wurm Markus , Lenhart Nicolas S. , Makowski Marcus R. , Schwaiger Benedikt J. , Woertler Klaus , Karampinos Dimitrios C. , Gersing Alexandra S. 
Published: February 2023

Abstract
Objectives
To evaluate the diagnostic performance of an automated reconstruction algorithm combining MR imaging acquired using compressed SENSE (CS) with deep learning (DL) in order to reconstruct denoised high-quality images from undersampled MR images in patients with shoulder pain.

Methods
Prospectively, thirty-eight patients (14 women, mean age 40.0 ± 15.2 years) with shoulder pain underwent morphological MRI using a pseudo-random, density-weighted k-space scheme with an acceleration factor of 2.5 using CS only. An automated DL-based algorithm (CS DL) was used to create reconstructions of the same k-space data as used for CS reconstructions. Images were analyzed by two radiologists and assessed for pathologies, image quality, and visibility of anatomical landmarks using a 4-point Likert scale.

Results
Overall agreement for the detection of pathologies between the CS DL reconstructions and CS images was substantial to almost perfect (κ 0.95 (95% confidence interval 0.82–1.00)). Image quality and the visibility of the rotator cuff, articular cartilage, and axillary recess were overall rated significantly higher for CS DL images compared to CS (p < 0.03). Contrast-to-noise ratios were significantly higher for cartilage/fluid (CS DL 198 ± 24.3, CS 130 ± 32.2, p = 0.02) and ligament/fluid (CS DL 184 ± 17.3, CS 141 ± 23.5, p = 0.03) and SNR values were significantly higher for ligaments and muscle of the CS DL reconstructions (p < 0.04).

Conclusion
Evaluation of shoulder pathologies was feasible using a DL-based algorithm for MRI reconstruction and denoising. In clinical routine, CS DL may be beneficial in particular for reducing image noise and may be useful for the detection and better discrimination of discrete pathologies.

Summary statement

Assessment of shoulder pathologies was feasible with improved image quality as well as higher SNR using a compressed sensing deep learning–based framework for image reconstructions and denoising.

Key Points
• Automated deep learning–based reconstructions showed a significant increase in signal-to-noise ratio and contrast-to-noise ratio (p < 0.04) with only a slight increase of reconstruction time of 40 s compared to CS.
• All pathologies were accurately detected with no loss of diagnostic information or prolongation of the scan time.
• Significant improvements of the image quality as well as the visibility of the rotator cuff, articular cartilage, and axillary recess were detected.
Taylor expansion of the correlation metric for an individual forecast evaluation and its application to East Asian sub-seasonal forecasts
Authors: Oh Seol-Hee , Ham Yoo-Geun 
Published: February 2023

AbstractThis study develops a skill evaluation metric for an individual forecast by applying a Taylor expansion to the commonly-used temporal correlation skill. In contrast to other individual forecast evaluation metrics, which depend on the amplitude of forecasted and observed anomalies, the so-called “association strength (AS) skill” is less affected by the anomaly amplitude and mainly depends on the degree of similarity between the forecasted and the observed values. Based on this newly developed index, the forecast skill is evaluated for an individual case, then, a group is categorized with respect to the AS skill. The cases with the highest AS skill exhibit the highest correlation skill than any group randomly selected, indicating that the AS skill is a powerful metric to evaluate the non-dimensionalized forecast skill. This strategy is adopted for the subseasonal East Asian summer precipitation forecasts produced by the UK Met Office’s ensemble Global Seasonal forecast system version 5 (GloSea5). In the group with the highest AS skill of the East Asian summer precipitation index (i.e., highest AS cases), the geopotential height anomalies showed quasi-stationary Rossby waves from the North Atlantic to East Asia. The spatial distribution of the dominant subseasonal anomalies for cases with the highest AS is distinct from the cases or groups with the lowest AS skill. Furthermore, the dominant pattern with the highest AS is not solely explained by any well-known typical subseasonal climate patterns, such as the Madden–Julian Oscillation, circumglobal teleconnection pattern, Pacific-Japan pattern, or the Summer North Atlantic Oscillation. This implies that the excitation of well-known climate patterns only partly contributes to increasing the mid-latitude climate predictability in the GloSea5.
Quantitative attribution of vertical motions responsible for the early spring drought conditions over southeastern China
Authors: Yin Zejiang , Yang Song , Wei Wei 
Published: February 2023

AbstractThe interannual variability and long-term trend of the drought conditions over southeastern China during early spring (from February to April) are investigated by analyzing the standardized precipitation evapotranspiration index in 1979–2020. Results from an attribution analysis show that precipitation deficiency and atmospheric water demand contributes about 96.5 and 6.7% to the drought conditions on interannual time scale, and about 72.8 and 22.3% to the long-term trend, respectively. The precipitation deficiency is primarily contributed by moisture divergence via the descending anomalies throughout the troposphere over southeastern China. A further diagnosis with the omega equation reveals that the descending anomalies are dominated by the strong negative zonal vorticity advection in the upper troposphere and the enhanced meridional cold advection throughout the troposphere. They are controlled by a barotropic anomalous anticyclone over the eastern Tibetan Plateau and an anomalous cyclone over the western North Pacific. Non-negligibly, the contribution of potential evapotranspiration to the drying trend in early spring over southeastern China is about four times larger than that to the interannual variability. Given that potential evapotranspiration may increase in a warming climate, it may be critical for the change in drought conditions in future. This study serves as a basis for fully understanding the severity of recent droughts and for model simulation of the drought conditions over southeastern China.
Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature
Authors: Escolino Maria , Kalfa Nicolas , Castagnetti Marco , Caione Paolo , Esposito Giovanni , Florio Luisa , Esposito Ciro 
Published: February 2023

AbstractIn the last 20 years, endoscopic injection (EI) has affirmed as a valid alternative to open surgery for management of pediatric vesicoureteral reflux (VUR). This study aimed to investigate and discuss some debated aspects such as indications, bulking agents and comparison, techniques of injection and comparison, predictive factors of success, use in specific situations. EI is minimally invasive, well accepted by patients and families, with short learning curve and low-morbidity profile. It provides reflux resolution rates approaching those of open reimplantation, ranging from 69 to 100%. Obviously, the success rate may be influenced by several factors. Recently, it is adopted as first-line therapy also in high grade reflux or complex anatomy such as duplex, bladder diverticula, ectopic ureters. The two most used materials for injection are Deflux and Vantris. The first is absorbable, easier to inject, has lower risk of obstruction, but can lose efficacy over time. The second is non-absorbable, more difficult to inject, has higher risk of obstruction, but it is potentially more durable. The two main techniques are STING and HIT. To date, the ideal material and technique of injection has not yet clearly established, but the choice remains dependent on surgeon’s preference and experience.
Total hip arthroplasty through the direct anterior approach for sequelae of Legg–Calvé–Perthes disease
Authors: Hasler Julian , Flury Andreas , Hoch Armando , Cornaz Frédéric , Zingg Patrick O. , Rahm Stefan 
Published: February 2023

Abstract
Introduction
Due to multiplanar deformities of the hip, total hip arthroplasty (THA) for sequelae of Legg–Calvé–Perthes disease (LCPD) is often technically demanding. This study aimed to compare the clinical and radiographic outcomes of patients with sequelae of LCPD undergoing THA through the direct anterior approach (DAA) and non-anterior approaches to the hip.

Methods
All patients with sequelae of LCPD who underwent primary THA between 2004 and 2018 (minimum follow-up: 2 years) were evaluated and separated into two groups: THA through the DAA (Group AA), or THA through non-anterior approaches to the hip (Group non-AA). Furthermore, a consecutive control group of patients undergoing unilateral THA through the DAA for primary hip osteoarthritis (Group CC) was retrospectively reviewed for comparison.

Results
Group AA comprises 14 hips, group non-AA 17 hips and group CC 30 hips. Mean follow-up was 8.6 (± 5.2; 2–15), 9.0 (± 4.6; 3–17) and 8.1 (± 2.2; 5–12) years, respectively. At latest follow-up, Harris Hip Score was 90 (± 20; 26–100), 84 (± 15; 57–100), and 95 (± 9; 63–100) points, respectively. Overall, 6 patients treated for LCPD (each 3 patient in the AA and non-AA group) developed postoperative sciatic nerve palsy, of which only one was permanent. Complication-related revision rate at the latest follow-up was 15% in the AA-group and 25% in the non-AA group, respectively.

Conclusion
THA through the DAA might be a credible option for the treatment of sequelae of LCPD with comparable complication rates and functional outcomes to non-anterior approaches.
Primary ossiculoplasties provide better hearing results than revisions: a retrospective cohort study
Authors: Kálmán Judit , Horváth Tamás , Dános Kornél , Tamás László , Polony Gábor 
Published: February 2023

Abstract
Purpose
To evaluate the efficacy of ossicular chain reconstruction (OCR) in primary and revision surgeries, and to investigate the impact of the number of previous surgeries on hearing outcomes.

Methods
Retrospective analysis of cases with OCR due to chronic otitis in a tertiary center between January 2018 and September 2021.

Results
Altogether, 147 cases of ossicle involvement were assessed. In 91.83% (n = 135) OCR was performed, 96.26% of them with titanium TORP/PORP (n = 130), two cases with autologous prosthesis and three with piston. Mean follow-up was 8.8 months. The ABG significantly improved in the total group (TORP/PORP) from a mean (SD) of 30.94 (15.55) to 19.76 (13.36) dB (p < 0.0001) with 60.86% success. The best results were achieved in primary OCR with PORP implantation without cholesteatoma (89.47%). Primary cases have a significantly higher success rate in contrary to revision surgeries (72.27%, vs. 52.00%, p = 0.032). The only relevant predictive factor proved to be the fact of revision (p = 0.029). A statistically significant correlation between the number of previous surgeries and hearing results could not be proved. There was no difference in hearing outcomes between patients with only one or more than one previous surgeries in the revision groups. Neither the presence of cholesteatoma, nor the type of OCR (TOPR/PORP) and the indication of revision had an impact on postoperative ABG.

Conclusions
Titanium prostheses are effective in OCR both in primary and revision cases. It is not the number of previous surgeries, but the fact of revision that influences postoperative hearing results.
Esophageal rupture through extreme sadomasochistic practice
Authors: Koelzer Sarah C. , Bunzel Lena M. , Holz Franziska , Birngruber Christoph G. , Verhoff Marcel A. 
Published: February 2023

AbstractWe report the case of a woman in her thirties who suffered an esophageal rupture while participating in extreme sadomasochistic practices. After herself seeking help in a hospital for complaints alleged to be from a fall, she was initially diagnosed with several broken ribs and a pneumothorax. The cause of the pneumothorax was later discovered to be an esophageal rupture. When confronted with this atypical injury for a fall, the woman admitted to have accidentally swallowed an inflatable gag, which her partner had afterwards inflated. In addition to the esophageal rupture, the patient also had numerous other externally visible injuries of various ages, reportedly also from sadomasochistic acts. Although an in-depth police investigation was conducted and a “slave contract” was found, the woman’s consent to the extreme sexual practices performed by her life partner could not be substantiated conclusively. The man was convicted for intentional infliction of serious as well as dangerous bodily injury and sentenced to a long term in prison.
Levodopa–carbidopa intestinal gel in advanced Parkinson’s disease: long-term results from COSMOS
Authors: Fasano Alfonso , García-Ramos Rocío , Gurevich Tanya , Jech Robert , Bergmann Lars , Sanchez-Soliño Olga , Parra Juan Carlos , Simu Mihaela 
Published: February 2023

AbstractBackgroundWhile immediate benefits of levodopa–carbidopa intestinal gel (LCIG) are evident in patients with Parkinson’s disease (PD), long-term LCIG effects require further study.ObjectivesWe explored long-term LCIG on motor symptoms, nonmotor symptoms (NMS), and LCIG treatment settings in patients with advanced PD (APD).MethodsData were obtained (medical records and patient visit) from COSMOS, a multinational, retrospective, cross-sectional post-marketing observational study in patients with APD. Patients were stratified into 5 groups based on LCIG treatment duration at the patient visit, from 1–2 to > 5 years LCIG. Between-group differences were assessed for changes from baseline in LCIG settings, motor symptoms, NMS, add-on medications, and safety.ResultsOut of 387 patients, the number of patients per LCIG group was: > 1– ≤ 2 years LCIG (n = 156); > 2– ≤ 3 years LCIG (n = 80); > 3– ≤ 4 years LCIG (n = 61); > 4– ≤ 5 years LCIG (n = 30); > 5 years LCIG (n = 60). Baseline values were similar; data reported are changes from the baseline. There were reductions in “off” time, dyskinesia duration, and severity across LCIG groups. Prevalence, severity, and frequency of many individual motor symptoms and some NMS were reduced amongst all LCIG groups, with few differences between groups. Doses for LCIG, LEDD and LEDD for add-on medications were similar across groups both at LCIG initiation and patient visit. Adverse events were similar across all LCIG groups and consistent with the established safety profile of LCIG.ConclusionsLCIG may provide sustained, long-term symptom control, while potentially avoiding increases in add-on medication dosages.Trial registrationClinicalTrials.gov Identifier: NCT03362879. Number and date: P16-831, November 30, 2017.