bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Heterotopic Ossification at 10 years after Cervical Disc Replacement
Authors: Sheng Xia-Qing , Wu Ting-Kui , Liu Hao , Meng Yang 
Published: April 2023

Study Design.
Systematic review and meta-analysis.

Objective.
This study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disc replacement (CDR).

Summary of Background Data.
HO is a common complication after CDR and may limit the range of motion (ROM) of the artificial disc. As HO usually progresses slowly, long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10 year outcomes give us the opportunity to better understand the long-term incidence of HO.

Methods.
We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity.

Results.
Eleven studies with at least 10 years of follow-up comprising 1,140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI: 60–81%) at 10 years postoperatively, 60% (95% CI: 44–75%) at 5 or 6 years postoperatively, and 50% (95% CI: 27–72%) at 1 or 2 years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI: 29–45%), and mild HO (grade 1 to 2) was 30% (95% CI: 17–44%) at 10 years of follow-up. Pooled ROM decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. Earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.

Conclusion.
This is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence ofHO appears to increase with the length of follow-up.

Level of Evidence.
III.
Novel Nomograms and Web-Based Tools Predicting Overall Survival and Cancer-specific Survival of Solitary Plasmacytoma of the Spine
Authors: Yang Sheng , Fan Guoxin , Feng Chaobo , Fan Yunshan , Xu Ningze , Zhou Hongmin , Wang Chuanfeng , Liao Xiang , He Shisheng 
Published: April 2023

Study Design.
Retrospective analysis.

Objective.
This study aimed to establish nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in patients with solitary plasmacytoma of the spine (SPS).

Summary of Background Data.
SPS is a rare type of malignant spinal tumor. A systematic study of prognostic factors associated with survival can provide guidance to clinicians and patients. Consideration of other causes of death (OCOD) in CSS will improve clinical practicability.

Methods.
A total of 1078 patients extracted from the SEER database between 2000 and 2018 were analyzed. Patients were grouped into training and testing data sets (7:3). Factors associated with OS and CSS were identified by Cox regression and competing risk regression, respectively, for the establishment of nomograms on a training data set. The testing data set was used for the external validation of the performance of the nomograms using calibration curves, Brier’s scores, C-indexes, time-dependent receiver operating characteristic curves, and decision curve analysis (DCA).

Results.
Age and grade were identified as factors associated with both OS and CSS, along with marital status, radiation for OS, and chemotherapy for CSS. Heart disease, cerebrovascular disease, and diabetes mellitus were found to be the 3 most common causes of OCOD. The nomograms showed satisfactory agreement on calibration plots for both training and testing data sets. Integrated Brier score, C-index, and overall area under the curve on the testing data set were 0.162/0.717/0.789 and 0.173/0.709/0.756 for OS and CSS, respectively. DCA curves showed a good clinical net benefit. Nomogram-based web tools were developed for clinical application.

Conclusion.
This study provides evidence for risk factors and prognostication of survival in SPS patients. The novel nomograms and web-based tools we developed demonstrated good performance and might serve as accessory tools for clinical decision-making and SPS management.

Level of Evidence.
3
Injury mechanism, risk factors and outcomes associated with blunt cardiac injury: a systematic review and meta-analysis
Authors: Jiang Yongjin , Zhou Gaoliang , Feng Jun , Ma Likun , Pan Jianyuan 
Published: April 2023

Background and purpose:
Risk factors that could be used to assess early and further improve the positive predictive value of blunt cardiac injury (BCI) are still inconclusive. We conducted a meta-analysis to quantitatively analyze the injury mechanism, risk factors, and outcomes associated with BCI in trauma patients.

Methods:
This systematic review and meta-analysis were performed to gather data on trauma patients with blunt cardiac injury. PubMed, Web of Science, and EMBASE databases were searched for studies until 20th November 2021. A pooled meta-analysis of injury mechanisms, risk factors, and outcomes concerning BCI was conducted.

Results:
We screened 256 records from which 11 studies published from 2000 to 2019 reporting 68,039 patients with trauma were included. Motor vehicle crash was the main injury mechanism, accounting for 65.2% of the attributed mechanisms for BCI (pool P = 0.652 [0.595–0.709]). The pooled relative risks (RRs) revealed that patients with sternal fracture, shock on arrival, and history of cardiac disease were associated with increased risk of BCI (for sternal fracture: RR = 7.21 [95% confidence interval (CI) = 3.99–13.05]; for the shock on arrival: RR = 2.45, 95% CI = 2.12–2.84; for the history of cardiac disease: RR = 1.87, 95% CI = 1.11–3.16). A significant difference was observed in the length of stay between the BCI group compared to the no BCI group, 11.68 (95% CI = 8.79–14.58 days) vs. 20.46 (95% CI = 16.78–24.14 days). The risk of mortality was significantly higher in trauma patients with BCI as compared to those without BCI (RR = 1.70, 95% CI = 1.53–1.90).

Conclusions:
BCI was associated with increased mortality in our study. Patients also tended towards a longer length of stay. In addition to electrocardiogram and TnI, we recommend screening for BCI when trauma patients are in the presence of sternal fracture, shock, and a history of cardiac disease.
Keloidal Collagen May Be Produced Directly by αSMA-positive Cells: Morphological Analysis and Protein Shotgun Analysis
Authors: Kaku Chiemi , Ichinose Shizuko , Dohi Teruyuki , Tosa Mamiko , Ogawa Rei 
Published: April 2023

Background:
Keloids are fibroproliferative lesions caused by abnormal dermal wound healing. Keloidal collagen (KC) is a pathognomic feature of keloids, but the mechanism by which it forms is unknown. This study aimed to evaluate the histopathology of KC and thereby gain clues into how it forms.

Methods:
The cross-sectional study cohort consisted of a convenience series of patients with keloids who underwent surgical excision. Skin pieces (3 mm2) were collected from the keloid center and nearby control skin. Histopathology was conducted with light and electron microscopy and immunohistochemistry. KC composition was analyzed with protein shotgun analysis.

Results:
Microscopic analyses revealed the ubiquitous close association between KC and αSMA-positive spindle-shaped cells that closely resembled myofibroblasts. Neither KC nor the spindle-shaped cells were observed in the control tissues. Compared with control skin, the collagen fibers in the KC were overall thinner, their diameter varied more, and their spacing was irregular. These features were particularly pronounced in the collagens in the vicinity of the spindle-shaped cells. Protein shotgun analysis did not reveal a specific collagen in KC but showed abnormally high abundance of collagens I, III, VI, XII, and XIV.

Conclusions:
These findings suggest that KC may be produced directly by myofibroblasts rather than simply being denatured collagen fibers. Because collagens VI and XII associate with myofibroblast differentiation, and collagen XIV associates with local mechanical stress, these collagens may reflect, and perhaps contribute to, the keloid-specific local conditions that lead to the formation of KC.
Characteristics of fibrotic-foci-like lung adenocarcinoma on 18F-FDG PET/computed tomography and HRCT
Authors: Zhang Jing , Jiang Yu-Meng , Xu Ao-Di , Lin Shuai , Fang Na , Wang Yan-Li 
Published: April 2023

Purpose
To assess the characteristics of fibrotic-foci-like lung adenocarcinoma on 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) and high-resolution computed tomography (HRCT).

Material and methods
This was a retrospective study with 20 cases in the fibrotic-foci-like lung adenocarcinoma group; the control group was old fibrotic-foci of the lung with 20 cases. The following 18F-FDG PET/CT and HRCT features were evaluated: the maximum standardized uptake value (SUVmax); the tumor-to-background ratios of SUVmax (TBRmax); the long-to-short diameter ratio (L/S); anatomic location; location type; internal characteristics; marginal characteristics and surrounding structures. In the fibrotic-foci-like lung adenocarcinoma group, a comparison of 18F-FDG uptake between the metastatic group (n = 10) and the non-metastatic group (n = 10) was performed. Finally, the comparison of diagnostic accuracy for fibrotic-foci-like lung adenocarcinoma between 18F-FDG PET/CT and HRCT was performed.

Results
The SUVmax [2.6 (1.7–7.9) vs. 1.0 (0.7–1.4)], TBRmax [2.9 (2.1–9.9) vs. 1.3 (1.2– 1.7)], L/S [2.4 (1.7–3.8) vs. 4.0 (3.2–6.3)], ground-glass opacity (GGO) [13/20 (65.0%) vs. 4/20 (20.0%)], and vessel convergence [7/20 (35.0%) vs. 1/20 (5.0%)] were found to be statistically significant differences between the fibrotic-foci-like lung adenocarcinoma group and the old fibrotic-foci group (P < 0.05). SUVmax [7.9 (4.7–8.8) vs. 1.7 (1.2–2.2)] and TBRmax [9.9 (6.5–11.0) vs. 2.1 (1.6–2.9)] were found to be statistically significant differences between the metastatic group and the non-metastatic group (P < 0.05). 18F-FDG PET/CT showed the higher diagnostic accuracy for fibrotic-foci-like lung adenocarcinoma than HRCT [95.0% (19/20) vs. 65.0% (13/20), P < 0.05].

Conclusion
The specific characteristics of fibrotic-foci-like lung adenocarcinoma on 18F-FDG PET/CT and HRCT were high 18F-FDG uptake, GGO, and vessel convergence, which could be distinguished from old fibrotic-foci of the lung.
Examining the Evidence for Escalating Antimicrobial Regimens in Febrile Oncology and Hematopoietic Stem Cell Transplant Patients Admitted to the PICU: An Observational Study*
Authors: Prince Remi D. , Blumenthal Jennifer A. , Geva Alon 
Published: April 2023

OBJECTIVES:
To examine whether escalating antimicrobial treatment in pediatric oncology and hematopoietic cell transplantation (HSCT) patients admitted to the PICU is supported by culture data or affects patient outcomes.

DESIGN:
Retrospective cross-sectional study.

SETTING:
Quaternary care PICU.

PATIENTS:
Patients younger than 18 years old who were admitted to the PICU at Boston Children’s Hospital from 2012 to 2017 with a diagnosis of cancer or who had received HSCT and who had suspected sepsis at the time of PICU admission.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 791 PICU admissions for 544 patients that met inclusion criteria, 71 (9%) had escalation of antimicrobial therapy. Median Pediatric Logistic Organ Dysfunction (PELOD) score was higher in the escalation group (4 vs 3; p = 0.01). There were 14 admissions (20%) with a positive culture in the escalation group and 110 (15%) in the no escalation group (p = 0.31). In the escalation group, there were only 2 (3%) cultures with organisms resistant to the initial antimicrobial regimen, compared with 28 (4%) cultures with resistant organisms in the no escalation group (p = 1). Mortality in the escalation group was higher (17%) compared with the nonescalation group (5%; p < 0.001). The escalation group had more acute kidney injury (AKI) (25%) during treatment compared with the no escalation group (15%; p = 0.04), although this difference was not statistically significant when controlling for age, neutropenia, and PELOD-2 score (odds ratio, 1.75; 95% CI, 0.95–3.08; p = 0.06).

CONCLUSIONS:
Few patients who had escalation of antimicrobials proved on culture data to have an organism resistant to the initial antimicrobials, and more patients developed AKI during escalated treatment. While the escalation group likely represents a sicker population, whether some of these patients would be safer without escalation of antimicrobial therapy warrants further study.
Evaluating Demographic Data to Improve Confidence in Equity Analytics in a Children’s Hospital
Authors: Straus Anna M. , Hayes Alissa , Simon Jodi , Sims Andrea , Skerlong Karen , Wilmoth Michele , Bigham Michael T. 
Published: April 2023

Introduction:
Healthcare institutions are placing greater emphasis on equitable care. To accurately track and validate equity metrics, Akron Children’s Hospital evaluated how key fields are collected, analyzed, and visualized throughout the organization. Standardized recommendations in this area vary, and this investigation provided specific ways to advance analytics in this field. In addition, the technical infrastructure needed a comprehensive evaluation to increase confidence in using demographic data.

Methods:
First, we reviewed how staff are trained to collect data at registration. Next, the electronic health record team standardized race and ethnicity fields with federal definitions. We found that fields were not consistently accessible across reporting tools. However, when present, all fields are sourced from the same electronic health record field. Finally, 6 months of encounters were analyzed and validated, with limitations to a seldom-populated Race 2 field.

Results:
We compared data, including and excluding null values, to provide concise recommendations for standard visualizations. We uncovered many consistencies and a few inconsistencies that informed the next steps.

Conclusions:
The results informed 7 recommendations to align Akron Children’s Hospital’s advancement in analytics for health equity data: standardize race and ethnicity fields across all reporting tools, add Child Opportunity Index 2.0 to the enterprise data warehouse, utilize data at the time of the patient’s encounter, include null fields (patient refused, unknown, and not specified) in analysis, increase reporting capabilities for social determinants of health (SDOH), standardize multiracial data visualizations, and optimize reliable upstream data collection to increase reliability for all health equity measures.
Recognizing Nonaccidental Trauma in a Pediatric Tertiary Hospital: A Quality Improvement Imperative
Authors: Greene H. Michelle , Letson Megan M. , Spencer Sandra P. , Dolan Kevin , Foster Jeanette , Crichton Kristin G. 
Published: April 2023

Introduction:
Abusive injuries can go unrecognized or improperly managed by medical providers. This study sought to standardize the nonaccidental trauma (NAT) workup and improve NAT evaluation completion for children <7 months with concerning injuries in the pediatric emergency department (PED) and inpatient settings at an urban, tertiary care children’s hospital.

Methods:
The quality improvement (QI) team created hospital guidelines for suspected NAT, including age-based recommendations (care bundle). The team embedded an order for NAT evaluation into the electronic health record (EHR). The QI team provided education on child abuse identification and evaluation across the hospital. Hospital providers received written guides focused on enhancing communication with families. Outcome measures included monthly NAT bundle use and cases between incomplete bundles in children with suspicious injuries. Chart review of incomplete bundles helped accurately identify patients who needed NAT bundles and improved accurate NAT bundle completion for appropriate patients.

Results:
Appropriate NAT bundle completion increased from 31% during the baseline period in January 2019 to 100% in April 2020 and remained at 100% for the remainder of the study period, ending June 2021. The number of patients between missed bundles was 11 from August 2019 until March 2020, when it increased to 583. There were no missed bundles from March 2020 through June 2021.

Conclusions:
Standardizing NAT evaluation and creating a NAT care bundle to facilitate the appropriate evaluation preceded an increase in appropriate bundle completion in patients <7 months old with possible NAT in the PED and inpatient units.
Determinants of Blood Culture Use in Critically Ill Children: A Multicenter Qualitative Study
Authors: Woods-Hill Charlotte Z. , Nelson Maria N. , Eriksen Whitney , Rendle Katharine A. , Beidas Rinad S. , Bonafide Christopher P. , Brajcich Michelle R. , Milstone Aaron M. , Shea Judy A. 
Published: April 2023

Introduction:
Blood cultures are fundamental in diagnosing and treating sepsis in the pediatric intensive care unit (PICU), but practices vary widely. Overuse can lead to false positive results and unnecessary antibiotics. Specific factors underlying decisions about blood culture use and overuse are unknown. Therefore, we aimed to identify perceived determinants of blood culture use in the PICU.

Methods:
We conducted semistructured interviews of clinicians (M.D., D.O., R.N., N.P., P.A.) from 6 PICUs who had participated in a quality improvement collaborative about blood culture practices. We developed interview questions by combining elements of the Consolidated Framework for Implementation Research and behavioral economics. We conducted telephone interviews, open-coded the transcripts, and used modified content analysis to determine key themes and mapped themes to elements of Consolidated Framework for Implementation Research and behavioral economics.

Results:
We reached thematic saturation in 24 interviews. Seven core themes emerged across 3 Consolidated Framework for Implementation Research domains: individual characteristics [personal belief in the importance of blood cultures, the perception that blood cultures are a low-risk test]; inner setting [adherence to site-specific usual practices, site-specific overall approach to PICU care (collaborative versus hierarchical), influence of non-PICU clinicians on blood culture decisions]; and outer setting [patient-specific risk factors, sepsis guidelines]. In addition, outcome bias, default bias, and loss aversion emerged as salient behavioral economics concepts.

Conclusions:
Determinants of blood culture use include individual clinician characteristics, inner setting, and outer setting, as well as default bias, outcome bias, and loss aversion. These determinants will now inform the development of candidate strategies to optimize culture practices.
Gram-positive bacteria increase breast implant related complications: Prospective analysis of 100 revised implants.
Authors: Flores Tonatiuh , Kerschbaumer Celina , Jaklin Florian J. , Rohrbacher Alexander , Weber Michael , Luft Matthias , Aspöck Christoph , Ströbele Barbara , Kitzwögerer Melitta , Lumenta David B. , Bergmeister Konstantin D. , Schrögendorfer Klaus F. 
Published: April 2023

Background:
Breast implant-related complications can be reduced by strict antiseptic precautions during insertion, but bacteria can often be found on implant surfaces on the occasion of revision surgery. We prospectively analyzed the association of bacteria found on breast implant surfaces with implant-related complications in breast implant revision cases.

Methods:
We analyzed a total of 100 breast implant revisions in in 66 patients between August 2018 and January 2021. Capsular swabs and capsular samples were taken intraoperatively. Analyses upon the occurrence of bacteria and the occurrence of implant-related complications were performed. Additionally, correlations between bacterial contaminated breast implant surfaces and implant-related complications were performed.

Results:
Implant-related complications (perforation, rupture, capsular contraction) were observed in 42 implant sites; in eight unilateral and 34 bilateral cases. In total 16 swabs showed positive bacterial growth, 10 of which were associated with a breast implant-related complication (X
2 = x.yz, p = 0.006). The most common implant-based complication at contaminated prosthetics was implant rupture. The association of contaminated breast implants and implant rupture was statistically significant.

Conclusion:
We identified a correlation between implant complications and gram-positive bacteria found on breast implant surfaces. The most common implant-based complication seen at simultaneously positive samples was implant rupture in 50% of our cases. Here, no capsular contraction or other complications were seen.
Patient-perceived hand function measured can predict treatment for Dupuytren’s disease
Authors: van den Berge Bente A. , Blom Paula C.A. , Werker Paul M.N. , Broekstra Dieuwke C. 
Published: April 2023

Background:
Web based patient-reported outcome measures (PROMs) could aid surgeons to remotely assess the need for examination and subsequent treatment of Dupuytren’s disease (DD) patients. We studied whether the Unité Rhumatologique des affections de la Main (URAM) and the Michigan Hand Questionnaire (MHQ) could predict DD treatment.

Methods:
In this prospective cohort study, we compared MHQ and URAM scores of treated patients with untreated patients. For the treatment group, we selected a score closest to one year before treatment. For controls we randomly selected a score. Additionally, we tested the predictive value of a one-year change score between 15 months and 6 weeks before treatment. The primary outcome measure was DD treatment.
The predictive value was determined using the Area Under the Curve (AUC). An AUC >0.70 was considered as good predictive ability, 0.70-0.50 as poor predictive ability and <0.50 as no predictive ability.

Results:
We included 141 patients for the MHQ analysis and 145 patients for the URAM analysis. The AUC of the MHQ and URAM scores measured one year before treatment were 0.80 (95% CI 0.71-0.88) and 0.75 (95% CI 0.68-0.82), respectively. The one-year change score resulted in an AUC of <0.60 for both questionnaires.

Conclusions:
Our results show that both the MHQ and URAM score measured around one year before treatment can predict treatment for DD. If future studies show that telemonitoring of DD patients with PROMs is also cost-effective, web-based PROMs could optimise patient care and treatment effectiveness of DD.