bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Long-term Outcomes of Sacral Neuromodulation for Fecal Incontinence: A Single Center Experience
Authors: Martin Sarah , O’Connor Alexander D. , Selvakumar Deepak , Baraza Wal , Faulkner Gemma , Mullins Domini , Kiff Edward S. , Telford Karen , Sharma Abhiram 
Published: September 2023

BACKGROUND:
Sacral neuromodulation is an effective treatment for fecal incontinence.

OBJECTIVE:
This study aimed to assess the long-term outcomes of sacral neuromodulation and establish the outcomes of patients with inactive devices.

DESIGN:
This is an observational study of patients treated for more than 5 years. A positive outcome was defined as a >50% reduction in fecal incontinence episodes or improvement in a symptom severity score. Data were reviewed from a prospectively managed database.

SETTINGS:
This study was conducted at a single tertiary referral center.

PATIENTS:
Data from 74 patients (72 female) were available at long-term follow up.

MAIN OUTCOME MEASURES:
Bowel diary, St. Mark’s incontinence score, and Manchester Health Questionnaire data were prospectively recorded at baseline, after peripheral nerve evaluation, and at last follow-up.

RESULTS:
Patients were analyzed in cohorts based on time since sacral neuromodulation implantation: Group 1: 5-10 years (n = 20), Group 2: >10 years (n = 35), and Group 3: inactive SNM devices (n = 19). Median St. Mark’s incontinence score and Manchester Health Questionnaire improved from baseline to last follow-up in Group 1 (p ≤ 0.05) and Group 2 (p ≤ 0.05), but in Group 3 results returned to baseline levels at last follow-up. Similarly, weekly fecal incontinence episodes improved in both active device groups at last follow-up. However, in Group 3 incontinence episodes were no different from baseline (p = 0.722). Despite active devices, fecal urgency episodes increased at last follow-up after more than 10 years since peripheral nerve evaluation (p ≤ 0.05). Complete continence was reported by 44% of patients, and at least a 50% improvement in 77% with active devices.

LIMITATIONS:
This study is retrospective with some gaps in the available data at last follow-up.

CONCLUSIONS:
Sacral neuromodulation is an effective treatment for fecal incontinence in the long term, but all outcomes are adversely affected by device inactivity. Therefore, ongoing stimulation is required for continued benefit..
Dose Individualization of Cefepime for Febrile Neutropenia in Patients With Lymphoma or Multiple Myeloma: Implications for Therapeutic Drug Monitoring
Authors: Oda Kazutaka , Yamaguchi Ayami , Matsumoto Naoya , Nakata Hirotomo , Higuchi Yusuke , Nosaka Kisato , Jono Hirofumi , Saito Hideyuki 
Published: September 2023

Background:
Optimal cefepime dosing is a challenge because of its dose-dependent neurotoxicity. This study aimed to determine individualized cefepime dosing for febrile neutropenia in patients with lymphoma or multiple myeloma.

Methods:
This prospective study enrolled 16 patients receiving cefepime at a dose of 2 g every 12 hours. Unbound concentrations were determined at 0.5 hours, 7.2 hours [at the 60% time point of the 12 hours administration interval (C7.2h)], and 11 hours (trough concentration) after the first infusion (rate: 2 g/h). The primary and secondary end points were the predictive performance of the area under the unbound concentration–time curve (AUCunbound) and the effect of unbound cefepime pharmacokinetic parameters on clinical response, respectively.

Results:
The mean (SD) AUCunbound was 689.7 (226.6) mcg h/mL, which correlated with C7.2h (R2 = 0.90), and the Bayesian posterior AUCunbound using only the trough concentration (R2 = 0.66). Although higher exposure was more likely to show a better clinical response, each parameter did not indicate a statistical significance between positive and negative clinical responses (P = 0.0907 for creatinine clearance (Ccr), 0.2523 for C7.2h, 0.4079 for trough concentration, and 0.1142 for AUCunbound). Cutoff values were calculated as 80.2 mL/min for Ccr (sensitivity: 0.889, specificity: 0.714), 18.6 mcg/mL for C7.2h (sensitivity: 0.571, specificity: 1.000), and 9.2 mcg/mL for trough concentration (sensitivity: 0.571, specificity: 1.000). When aiming for a time above 100% the minimum inhibitory concentration, both continuous infusion of 4 g/d and intermittent infusion of 2 g every 8 hours achieved a probability of approximately 100% at a minimum inhibitory concentration of 8 mcg/mL.

Conclusions:
Therapeutic drug monitoring by sampling at C7.2h or trough can facilitate rapid dose optimization. Continuous infusion of 4 g/d was recommended. Intermittent dosing of 2 g every 8 hours was alternatively suggested for patients with a Ccr of 60–90 mL/min.
Recurrent Lateral Abdominal Wall Hernias: Options for Reconstruction
Authors: Mattison Gennaya Lynn , Lee Seung Ah , Wong Daniel Enjay , Leevan Elyse , Carmichael Joseph Christopher , Evans Gregory Randolph Dean 
Published: September 2023

Summary:
Management of lateral abdominal wall hernias presents a surgical challenge, and best management is controversial. Flank hernias as a surgical sequela occur more commonly, whereas flank hernias resulting from trauma are a rare occurrence. In this article, we present a review of the literature and a case of flank hernia presenting after trauma and recurring after repair. An anchored suture repair was performed and reinforced by the addition of a polyester underlay mesh.
Clinical and genetic definition of serum bilirubin levels for the diagnosis of Gilbert syndrome and hypobilirubinemia
Authors: Poynard Thierry , Deckmyn Olivier , Peta Valentina , Sakka Mehdi , Lebray Pascal , Moussalli Joseph , Pais Raluca , Housset Chantal , Ratziu Vlad , Pasmant Eric , Thabut Dominique ,   for the FibroFrance Group
Published: September 2023

Background and Aims:
Gilbert syndrome (GS) is genotypically predetermined by UGT1A1*28 homozygosity in Europeans and is phenotypically defined by hyperbilirubinemia using total bilirubin (TB) cutoff ≥1mg/dL (17 μmol/L). The prevalence of illnesses associated with GS and hypobilirubinemia has never been studied prospectively. As TB varies with UGT1A1*28 genotyping, sex, and age, we propose stratified definitions of TB reference intervals and report the prevalence of illnesses and adjusted 15 years survival.

Methods:
UK Biobank with apparently healthy liver participants (middle-aged, n=138,125) were analyzed after the exclusion of of nonhealthy individuals. The stratified TB was classified as GS when TB >90th centile; <10th centile indicated hypobilirubinemia, and between the 10th and 90th centile was normobilirubinemia. We compared the prevalence and survival rates of 54 illnesses using odds ratio (OR), logistic regression, and Cox models adjusted for confounders, and causality by Mendelian randomizations.

Results:
In women, we identified 10% (7,741/76,809) of GS versus 3.7% (2,819/76,809) using the historical cutoff of ≥1 mg/dL (P<0.0001). When GS and hypobilirubinemia participants were compared with normobilirubinemia, after adjustment and Mendelian randomizations, only cholelithiasis prevalence was significantly higher (OR=1.50; 95% CI [1.3–1.7], P=0.001) in men with GS compared with normobilirubinemia and in causal association with bilirubin (

P

=0.04). No adjusted survival was significantly associated with GS or hypobilirubinemia.

Conclusions:
In middle-aged Europeans, the stratified TB demonstrates a careless GS underestimation in women when using the standard unisex 1 mg/dL cutoff. The prevalence of illnesses is different in GS and hypobilirubinemia as well as survivals before adjusting for confounding factors. With the exception of cholelithiasis in men, these differences were no more significant after adjustment and Mendelian randomization.
SAVE Testis-sparing score: A multicenter retrospective study of a novel predictive tool for quantifying testicular tumors
Authors: Liu Zhenhua , Xie Junyi , Gao Xiaofeng , Lin Yuan , Sun Mengkui , Sun Yubo , Peng Ding , Xie Haibiao , Li Xiangdong , Li Zhiyong , Cai Taonong , Chen Pengyu , Wu Zhiming , Guo Shengjie , Li Yonghong , Zhang Zhilin , Qin Zike , Han Hui , He Zhisong , Liu Jiumin , Fu Wen , Li Shoulin , Xia Dan , Wang Xiang , Deng Chunhua , Xu Zhe , Zhou Fangjian , Yao Kai , Yu Wei , Ye Yunlin , Liu Zhuowei 
Published: September 2023

Background:
Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described.

Materials and Methods:
We developed a scoring method known as SAVE testis-sparing score based on four critical and accessible anatomical features of testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes (low, medium, high, and extremely high) to evaluate the feasibility of TSS, wherein low risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children’s centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE.

Results:
The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic/endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors.

Conclusion:
The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.
Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis
Authors: An Yongkang , Gao Jihua , Xu Jiancheng , Qi Wenyue , Wang Linyue , Tian Maosheng 
Published: September 2023

Background:
Considering the difficulty of treating complex anal fistula (CAF), various surgical techniques exist in clinical work. However, none are ideal. Evidence on the efficacy and safety of different surgical treatments is scarce. We aimed to compare the outcomes of the 13 surgical techniques and tried to find the best surgical method for treating CAF.

Materials and Methods:
We searched worldwide databases, including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed, from inception to March 2023. All randomized controlled trials (RCTs) comparing the outcomes of 13 surgical techniques were included according to the PICO principles. The indicators of the cure rate, the recurrence rate, the complication rate, the operating time, the postoperative pain on day 1 (VAS), and the postoperative incontinence in month 1 (Wexner) were extracted and analyzed using STATA software 15.1, Review Manager 5.4, and GeMTC14.3.

Results:
Twenty-eight RCTS with a total of 2274 patients were included in the network meta-analysis. There was no statistically significant difference in the comparison among any surgical interventions in terms of the cure rate (P>0.05 Table 2) and recurrence rate (P>0.05 Table 3). However, in terms of complication rate, fistulectomy was lower than FPS (Median: 0.14; 95% CI: 0.02, 0.70) or fistulotomy (Median: 0.09; 95% CI: 0.01, 0.55), and fistulotomy was lower than EAFR (Median: 0.24; 95% CI: 0.05, 0.84), LIFT (Median: 0.17; 95% CI: 0.02, 0.66) or LIFT-EAFR(Median: 0.11; 95% CI: 0.01, 0.69) (P>0.05 Table 4). The surface estimated the advantages and disadvantages under the cumulative ranking (SUCRA). The ranking results indicated that fistulectomy might have the lowest complication rate (SUCRA=7.9%). Because the network results of the operating time, the postoperative pain, and the postoperative incontinence contained no closed loops, the results of their probability ranking could only be referenced, demonstrating that fistulectomy might have the shortest operating time (SUCRA=23.4%), VAMLIFT might have the lowest postoperative pain on day 1 (VAS) (SUCRA=0.4%) and LIFT might have the lowest postoperative incontinence in month 1(Wexner) (SUCRA=16.2%).

Conclusion:
Fistulectomy might have the lowest complication rate, which might be the relatively superior surgical technique for treating CAF.
Low-molecular-weight heparin is associated with lower venous thromboembolism events than factor Xa inhibitors in patients with severe blunt trauma: a cohort study from the trauma quality improvement program
Authors: Chan Sheng-Yu , Huang Jen-Fu , Cheng Chi-Tung , Hsu Chih-Po , Liao Chien-Hung , Fu Chih-Yuan 
Published: September 2023

Background:
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common complication of major trauma. Pharmacological VTE prophylactics are widely used, and low-molecular-weight heparin (LMWH) is recommended. Factor Xa inhibitors are increasingly being used for VTE prophylaxis in both medical and surgical patients. Evidence comparing LMWH and factor Xa inhibitors as VTE prophylactics for severe blunt trauma is lacking. This study aims to compare the efficacy and safety of factor Xa inhibitors and LMHW in VTE prophylaxis.

Materials and Methods:
Patients with severe blunt trauma who received LMWH or a factor Xa inhibitor for VTE prophylaxis in the Trauma Quality Improvement Program between 2017 and 2019 were included. The comparison was performed after using propensity score matching. The outcomes included mortality and incidence of DVT, PE, post-prophylactics hemorrhage control procedures and length of stay.

Results:
After 2:1 propensity score matching, 1,128 patients (n=752, LMHW group; n=376, factor Xa inhibitor group) were included in the analysis. Patients in the LMWH group had fewer VTE events than those in the factor Xa inhibitor group (DVT, 3.7% vs. 7.2%, P=0.013; PE, 0.4% vs. 3.2%, P <0.001). VTE risk was higher in the factor Xa group (DVT: odds ratio [OR], 1.97; 95% confidence interval [95%CI], 1.12–3.44; P=0.018 and PE: OR, 9.65; 95%CI, 2.91–44.12; P=0.001). The mortality rate was higher in the LMWH group; however, there was no significant difference (4.0% vs. 1.9%; P=0.075). The difference in the risk of undergoing hemorrhage control surgery after VTE prophylaxis between both groups was insignificant (0.3% vs. 0.0%; P=0.333).

Conclusions:
LMWH was associated with a lower risk of VTE than factor Xa inhibitors in patients with severe blunt trauma. The mortality rate was higher in the LMWH group; however, there was no statistically significant difference observed.
A quantitative comparison of bone resection margin distances in virtual surgical planning versus histopathology: A prospective study
Authors: Pu Jane J , Lo Anthony W I , Wong May C M , Choi Wing-Shan , Ho Grace , Yang Wei-Fa , Su Yu-Xiong 
Published: September 2023

Background:
Positive bone margins have been shown to be associated with worse locoregional control and survival performance in oral oncology patients. With the application of computer-assisted surgery (CAS) and patient-specific surgical guides, we can accurately execute the preoperative osteotomy plan. However, how well we can predict the margin distance in the final histopathology with a preoperative CT scan, the factors associated with it, and how much leeway we should spare when designing the osteotomy planes during virtual surgical planning remain to be investigated.

Materials and Methods:
Patients from Jan 2021 to Dec 2022 with benign or malignant jaw tumors and with signs of bone marrow involvement in the preoperative CT scan in our center were prospectively recruited to the study. Virtual surgical planning (VSP) and measurement of the closest margin distance in the CT scan were performed by the single team of surgeons. The resection specimen was processed, and the margin distances were measured by a dedicated senior pathologist with the knowledge of orientation of the osteotomy planes.

Results:
A total of 35 patients were recruited, with 21 malignant and 14 benign cases. Sixty-eight bone margins were quantitatively analyzed. No significant difference in margin distances measured from the CT scan and final histopathology was detected (P=0.19), and there was a strong correlation between the two (rs=0.74, P<0.01). A considerable amount of variance was detected in the level of discrepancy between margin distances measured in CT scan and final histopathology (overall SD=6.26▓mm, malignancy SD=7.44▓mm, benign SD=4.40▓mm). No significant correlation existed between the two margin distances when only maxilla tumor margins were assessed (P=0.16).

Conclusion:
Bone margin distance in VSP is reliably correlated to final pathological margin distance. A leeway distance of 15▓mm and 9▓mm should be considered when designing the osteotomy planes for malignancy and benign cases respectively. Extra attention should be paid to maxilla cases when pre-determining the osteotomy planes during virtual surgical planning.
Risk factors prediction of 6-month mortality after non-cardiac surgery of older patients in China: A multicentre retrospective cohort study
Authors: Wu Xiao-Dong , Wang Qian , Song Yu-Xiang , Chen Xian-Yang , Xue Teng , Ma Li-Bin , Luo Yun-Gen , Li Hao , Lou Jing-Sheng , Liu Yan-Hong , Wang Di-Fen , Wu Qing-Ping , Peng Yu-Ming , Mi Wei-Dong , Cao Jiang-Bei 
Published: September 2023

Background:
Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large data sets can assist patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after non-cardiac surgery using the clinical data from 11,894 older patients in China.

Materials and Methods:
A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. We retrospectively included 11,894 patients (aged ≥ 65 years) who underwent non-cardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality.

Results:
We predicted 12 preoperative risk factors associated with 6-month mortality in older patients after non-cardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By random forest model, we constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97).

Conclusion:
We identified 12 preoperative risk factors associated with 6-month mortality in non-cardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.
Hospital-physician Integration and Value-based Payment
Authors: Thai Ngoc H. , Post Brady , Young Gary J. 
Published: September 2023

Background:
Hospital-physician integration is often justified as a driver of clinical quality improvement due to joint resources covering a broad spectrum of care. Value-based programs, such as the Medicare Merit-Based Incentive Payment System (MIPS), are intended to tie financial incentives to clinical quality, which may confer an advantage on such integrated practices.

Objectives:
We assessed the relationship between hospital-physician integration and MIPS performance by comparing hospital-integrated practices and independent practices.

Research Design:
This was a cross-sectional study using data from the Quality Payment Program for the performance year 2020.

Subjects:
Physician practices with a valid MIPS composite score in performance year 2020.

Measures:
Hospital integration was based on whether at least 75% of a practice’s physicians either billed most of their services using hospital outpatient department codes or billed through a hospital tax identifier. The primary outcome was the MIPS quality category score, and the secondary outcomes were the specific quality measures reported by practice groups.

Results:
Of the 20 most frequently reported measures, 14 were common in both groups. No difference was observed in the quality category score between hospital-integrated practices and independent practices in either unadjusted comparisons or after adjusting for practice characteristics, including practice size, geography, specialty mix, and case mix. In the secondary outcome models for specific quality measures, hospital-integrated practices achieved higher scores on most overlap measures but not all.

Conclusions:
The findings on quality category score suggest that hospital integration does not confer much advantage in the context of MIPS quality performance.
Effect of Adaptive Seating Systems on Postural Control and Activity Performance: A Systematic Review
Authors: Acharya Bishnu Dutta , Karki Arpita , Prasertsukdee Saipin , Reed Darren , Rawal Lal , Baniya Prem Laxmi , Boyd Roslyn N. 
Published: September 2023

Purpose:
To systematically review the effectiveness of adaptive seating systems on sitting posture, postural control, and seated activity performance in children with cerebral palsy (CP).

Summary of Key Points:
From 5 databases, 3 of 21 (14%) articles were of good quality based on the Downs and Black checklist. Commercial modular contoured seating and paper-based low-cost, and contoured foam seating were effective at improving sitting posture, postural control, and seated activity performance. Parents and service providers reported that seating systems reduced stress, burden and psychosocial well-being, and quality of life in children with CP.

Conclusion:
Limited evidence demonstrated that adaptive seating systems were effective at improving sitting ability and postural control. Randomized controlled trials with objective outcome measures of seating performance in children with CP are needed to evaluate effectiveness.

Recommendations for Clinical Practice:
Adaptive seating devices are preferred by parents and therapists for children with CP; however, objective measures of seating outcomes are needed.