bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of the etiology and peak level of markedly elevated aminotransferases with mortality: a multicenter study
Authors: Kwak Ji Yoon , Kim Hyun-gyu , Han Ji Hee , Jeon Hankyu , Cha Ra Ri , Lee Sang Soo 
Published: April 2023

Background:
Markedly elevated aminotransferase levels are commonly encountered among hospitalized patients. However, data regarding the trajectory of enzyme elevation and disease-specific prognosis are limited.

Methods:
This study included 3237 patients with at least one episode of aspartate aminotransferase or alanine aminotransferase level being higher than 400 U/L between January 2010 and December 2019 at 2 centers. Patients were classified into 5 groups comprising 13 diseases according to etiology. Factors associated with 30-day mortality were evaluated using a logistic regression analysis.

Results:
The most common disease leading to markedly elevated aminotransferase level was ischemic hepatitis (33.7%), followed by pancreatobiliary disease (19.9%), DILI (12.0%), malignancy (10.8%), and viral hepatitis (7.0%). The 30-day all-cause mortality rate was 21.6%. The mortality rate for patients from the pancreatobiliary, hepatocellular, extrahepatic, malignancy, and ischemic hepatitis groups was 1.7%, 3.2%, 13.8%, 39.9%, and 44.2%, respectively. Age, etiology, and peak aminotransferase levels were independently associated with 30-day mortality.

Conclusions:
In patients with markedly elevated liver enzymes, the etiology and peak AST level are significantly associated with mortality.
Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study
Authors: Kmiecik Matthew J. , Tu Frank F. , Clauw Daniel J. , Hellman Kevin M. 
Published: April 2023

Abstract
Multimodal hypersensitivity (MMH)—greater sensitivity across multiple sensory modalities (eg, light, sound, temperature, pressure)—is associated with the development of chronic pain. However, previous MMH studies are restricted given their reliance on self-reported questionnaires, narrow use of multimodal sensory testing, or limited follow-up. We conducted multimodal sensory testing on an observational cohort of 200 reproductive-aged women, including those at elevated risk for chronic pelvic pain conditions and pain-free controls. Multimodal sensory testing included visual, auditory, and bodily pressure, pelvic pressure, thermal, and bladder pain testing. Self-reported pelvic pain was examined over 4 years. A principal component analysis of sensory testing measures resulted in 3 orthogonal factors that explained 43% of the variance: MMH, pressure pain stimulus response, and bladder hypersensitivity. The MMH and bladder hypersensitivity factors correlated with baseline self-reported menstrual pain, genitourinary symptoms, depression, anxiety, and health. Over time, MMH increasingly predicted pelvic pain and was the only component to predict outcome 4 years later, even when adjusted for baseline pelvic pain. Multimodal hypersensitivity was a better predictor of pelvic pain outcome than a questionnaire-based assessment of generalized sensory sensitivity. These results suggest that MMHs overarching neural mechanisms convey more substantial long-term risk for pelvic pain than variation in individual sensory modalities. Further research on the modifiability of MMH could inform future treatment developments in chronic pain.
Hematological and Other Cancers in People Using Clozapine
Authors: Dawson Jessica L. , Sluggett Janet K. , Procter Nicholas G. , Myles Nicholas , Bell J. Simon 
Published: April 2023

Abstract

Background
Recent observational study evidence suggests that clozapine, unlike other antipsychotics, may be associated with a small increased risk of hematological malignancy. This study described characteristics of hematological and other cancers in those taking clozapine reported to the Australian Therapeutic Goods Administration.

Methods
We analyzed public case reports for “clozapine,” “Clozaril,” or “Clopine” from January 1995 to December 2020 classified as “neoplasm benign, malignant and unspecified” by the Australian Therapeutic Goods Administration. Data on age, sex, dose, clozapine start and cessation dates, Medical Dictionary for Regulatory Activities reaction terms, and date of cancer were extracted.

Results
Overall, 384 spontaneous reports of cancers in people taking clozapine were analyzed. The mean age of patients was 53.9 years (SD, 11.4 years), and 224 (58.3%) were male. The most frequent cancers were hematological (n = 104 [27.1%]), lung (n = 50 [13.0%]), breast (n = 37 [9.6%]), and colorectal (n = 28 [7.3%]). The outcome was fatal for 33.9% of cancer reports. Lymphoma comprised 72.1% of all hematological cancers (mean patient age, 52.1 years; SD, 11.6 years). The median daily dose of clozapine at the time of hematological cancer report was 400 mg (interquartile range, 300–543.8 mg), and the median duration of clozapine use before hematological cancer diagnosis was 7.0 years (interquartile range, 2.8–13.2 years).

Conclusions
Lymphoma and other hematological cancers are overrepresented in spontaneous adverse event reports compared with other cancer types. Clinicians should be aware of the possible association with hematological cancers and monitor for and report any hematological cancers identified. Future studies should examine histology of lymphomas in people using clozapine and corresponding blood level of clozapine.
An Evaluation of the Multifactorial Model of Cancer-Related Cognitive Impairment
Authors: Oppegaard Kate R. , Mayo Samantha J. , Armstrong Terri S. , Kober Kord M. , Anguera Joaquin , Wright Fay , Levine Jon D. , Conley Yvette P. , Paul Steven , Cooper Bruce , Miaskowski Christine 
Published: April 2023

Abstract

Background
Up to 45% of patients report cancer-related cognitive impairment (CRCI). A variety of characteristics are associated with the occurrence and/or severity of CRCI. However, an important gap in knowledge of risk factors for CRCI is the relative contribution of each factor. The Multifactorial Model of Cancer-Related Cognitive Impairment (MMCRCI) is a conceptual model of CRCI that can be used to evaluate the strength of relationships between various factors and CRCI.

Objectives
The purpose of this study was to use structural regression methods to evaluate the MMCRCI using data from a large sample of outpatients receiving chemotherapy (n = 1,343). Specifically, the relationships between self-reported CRCI and four MMCRCI concepts (i.e., social determinants of health, patient-specific factors, treatment factors, and co-occurring symptoms) were examined. The goals were to determine how well the four concepts predicted CRCI and determine the relative contribution of each concept to deficits in perceived cognitive function.

Methods
This study is part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving chemotherapy. Adult patients were diagnosed with breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding 4 weeks; were scheduled to receive at least two additional cycles of chemotherapy; were able to read, write, and understand English; and gave written informed consent. Self-reported CRCI was assessed using the Attentional Function Index. Available study data were used to define the latent variables.

Results
On average, patients were 57 years of age, college educated, with a mean Karnofsky Performance Status score of 80. Of the four concepts evaluated, while co-occurring symptoms explained the largest amount of variance in CRCI, treatment factors explained the smallest amount of variance. A simultaneous structural regression model that estimated the joint effect of the four exogenous latent variables on the CRCI latent variable was not significant.

Discussion
These findings suggest that testing individual components of the MMCRCI may provide useful information on the relationships among various risk factors, as well as refinements of the model. In terms of risk factors for CRCI, co-occurring symptoms may be more significant than treatment factors, patient-specific factors, and/or social determinants of health in patients receiving chemotherapy.
Illicit drug and alcohol use and measures of musculoskeletal function and mental health in orthopaedic trauma patients
Authors: Spratt James , Adkins Zachary , Warda Danny , Smith Michele , Bruggers Jennifer , Weiss Paul , Becher Stephen 
Published: April 2023

Abstract

Objectives:
The objective of this study was to describe the relationship between positive toxicology screens and measures of preinjury mental health and physical function in an orthopaedic trauma population

Design:
This was a cross-sectional study.

Setting:
Urban Level 1 trauma center.

Patients:
A total of 125 trauma patients gave written consent for this study.

Main Outcome Measurements:
Questionnaires such as, Patient Health Questionnaire-9, General Anxiety Disorder-7, PCL-5, and Short Musculoskeletal Function Assessment, were used to survey patients after surgical intervention.

Results:
Patient Health Questionnaire-9 (P = 0.05) and PCL-5 (P = 0.04) were not found to have significant differences between positive and negative toxicology screens. Both General Anxiety Disorder-7 (P = 0.004) and Short Musculoskeletal Function Assessment function (P = 0.006) were significantly higher in patients with positive toxicology screens.

Conclusions:
Positive toxicology seems to be associated with preinjury anxiety. Patient reported preinjury function was not adversely affected by the presence of illicit substances or alcohol, nor were levels of post-traumatic stress disorder and depression found to be higher in patients with positive toxicology screens.

Level of Evidence:
Level IV Cross-Sectional Study.
Relational empathy, holistic care and quality of life in persons with spinal cord injuries: A cross-sectional study.
Authors: Mohan Meenakshi , Singh Virendra Vikram , Deb Roumi 
Published: April 2023

Abstract

Introduction
High-quality health systems are built on the concept of patient-centred approach which includes holistic care and empathy. With time, this has progressively been recognized as a valuable paradigm for better health outcomes, particularly in chronic diseases.

Objectives
The study aims to determine the patient's perception during his/her consultation and to assess the relationship between CARE measure with demographic/injury variables and Quality of Life.

Methods
The present cross-sectional study was conducted among 226 SCI individuals. Data was collected via structured questionnaire, WHOQOL-BREF, and CARE measure. Independent t- test is used to compare WHOQOL-BREF domains with two groups of CARE measure. Logistic regression was used to determine the significant factors of CARE measure.

Results
In the logistic regression analysis, it was observed that higher quality of life score has significantly higher odds of getting higher CARE score with a remarkable odds ratio(O.R 1.0264, 1.0121,1.0261,95% C.I,P-value = 0.0001,0.0472, 0.0001).

Conclusion
The quality of life of the present population is closely associated with greater perceptions of holistic care and empathy in the therapeutic patient-provider relationship. Lack of coordination, poor quality of life and limited communication between patient and provider may arise when the latter focuses only on treating disease rather than treating a patient as a “Whole person”.
Potentially Preventable Readmissions after Acute Inpatient Rehabilitation
Authors: Herrmann Amanda A. , Chrenka Ella A. , Seth Srishti , Nyamao Tiffan M. , Niemioja Gretchen M. , Hanson Leah R. , Hussein Haitham M. 
Published: April 2023

Abstract

Objective
To identify causes and risk factors for potentially preventable readmissions (PPRs) of patients discharged from an inpatient rehabilitation facility (IRF).

Design
Our hospital billing database was used to identify patients discharged from our IRF between 2013-2018 and experienced a PPR within 90 days (n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the IRF who did not experience a PPR, a group of age- and sex-matched controls (n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses.

Results
Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a PPR if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common PPR diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection.

Conclusion
Identifying patients with the common causes for PPRs, in addition to the noted risk factors, are important considerations for inpatient rehabilitation discharge planning.
The Montreal Children’s Hospital Experience Managing the Robin Sequence Population: An Analysis of Outcomes and Algorithmic Approach for Surgical Technique Selection
Authors: Chocron Yehuda , Cote Aurore , Alabdulkarim Abdulaziz , Barone Natasha , Gilardino Mirko S. 
Published: April 2023

Background:
The development of mandibular distraction osteogenesis (MDO) and tongue-lip adhesion (TLA) has led to significant improvements in respiratory outcomes for the Robin Sequence (RS) population. Despite such advances, there continues to be debate regarding management strategies. We present our experience managing the RS population with insights on technique selection.

Methods:
A retrospective review of RS patients treated at our institution from 2003-2021 was conducted. Baseline patient demographics and clinical parameters including feeding and respiratory status were recorded. Outcomes included the need for tracheostomy or tracheostomy decannulation rates and feeding status. Patients were evaluated through overnight oximetry and drug-induced sleep endoscopy (DISE). Outcomes were stratified according to management technique (MDO, TLA, vs. conservative) and compared through statistical analysis.

Results:
Fifty-nine RS patients were included. Twenty-eight were managed conservatively, 19 underwent MDO, 10 underwent TLA, one underwent both TLA and MDO and one underwent tracheostomy primarily. Overall, 1.7% of the cohort required a tracheostomy and 86% achieved oral feeding post-procedure. The MDO cohort had lower APGAR scores and mean birth weight compared to the conservative and TLA cohorts (p<0.05). There were no statistical differences in respiratory and feeding outcomes across all three cohorts.

Conclusion:
A therapeutic algorithm was developed with insight on the use of DISE and risk stratification with overnight oximetry to guide procedural selection. Using this approach, safe and satisfactory respiratory outcomes were achieved with a low tracheostomy rate. Risk stratification is possible without polysomnography and DISE is a promising tool (that requires further validation) for procedural selection in this population.
Facial palsy after orthognathic surgery: Incidence, causative mechanism, management, and outcome
Authors: Hattori Yoshitsugu , Huang Po-Cheng , Chang Chun-Shin , Chen Yu-Ray , Lo Lun-Jou 
Published: April 2023

Background:
Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be under-reported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome.

Methods:
A retrospective review of orthognathic surgery records between January 1981 and May 2022 was conducted in our craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiological images and photographs were collected.

Results:
A total of 20,953 sagittal split ramus osteotomy (SSRO) was performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than Hunsuck technique using the manual twist splitting (p<0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median (interquartile range) duration of 3 (2.75 - 6) months after surgery, whereas 11.1% remained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster recovery period than the complete palsy patients (median (interquartile range); 3 (2 - 3) months versus 6 (4 - 6.25) months, respectively, p = 0.02).

Conclusion:
The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated.
“Free chimeric SCIAP flap in reconstructing the distal complex extensor tendon injury.”
Authors: Chu Tinggang , Xiao Jian , Zhou Xijie , Lin Kang , Tao Zhenyu 
Published: April 2023

Summary:
The distal complex extensor tendon injury, presented as traumatic skin, zone Ⅰ-Ⅱ of EPL/EHL, and its bony insertion loss, still represents a challenging issue and requires well-vascularized skin paddle, tendinous graft and insertional reconstruction. Guided by the “all-in-one-step-reconstruction” rule, the chimeric superficial circumflex iliac artery perforator (SCIAP) flap, generally considered as a promising multiple-type tissue provider (vascularized skin paddle, fascia, or iliac flap), can fulfill the reconstructive demands and has an edge over the two-staged countermeasure. Here, we adopted the tripartite SCIAP flaps to reconstruct the distal complex thumb or toe injuries for 8 cases (6 thumbs and 2 halluces), all of which were re-attached with vascularized fascia lata-iliac crest conjunctions using the “pull-out” technique. All SCIAP flaps survived uneventfully without donor site complications. The remodeled interphalangeal joints regained near-normal radiologic manifestation. The chimeric SCIAP may be a promising technique for distal complex extensor tendon injury, providing vascularized skin paddle and fascia lata-iliac crest graft, it also qualifies for the “all-in-one-stage” reconstruction concept.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV
The Impact of Orbital Volume on Post-traumatic Enophthalmos: A Systematic Review and Meta-analysis
Authors: Murray-Douglass Alexander , Peters Matthew C. , Johnson Nigel R. , Harris Richard 
Published: April 2023

Purpose:
Orbital volume increase has been previously linked with post-traumatic enophthalmos. However, this varies and some studies show no correlation. This systematic review and meta-analysis aimed to synthesize the correlation between orbital volume and enophthalmos and to determine if surgical intervention, enophthalmos measurement method, fracture location, or timing affect this correlation.

Methods:
Automation tools were used to assist in this review of 6 databases. Searches were performed across all dates. Included studies quantitatively reported orbital volume and enophthalmos following traumatic orbital wall fractures in at least 5 adult subjects. Correlational data were extracted or calculated. Random-effects meta-analysis was used with subgroup analyses for each of the secondary aims.

Results:
Twenty-five articles describing 648 patients were included. The pooled correlation between orbital volume and enophthalmos was r=0.71 (R
2=0.50, P<0.001). Operative status, enophthalmos measurement method, and fracture location did not affect pooled correlation. The delay between trauma or surgery and enophthalmos measurement was not shown to modulate correlation for unoperated patients (R
2=0.05, P=0.22) but showed a negative relationship for postoperative patients (z=−0.0281, SE=0.0128, R
2=0.63, P=0.03), but this was heavily influenced by a single article. All results had high residual heterogeneity. Studies were rated as moderate, low, or very low quality with few stating explicit hypotheses or limitations.

Conclusions:
Bony orbital volume expansion accounts for around 50% of post-traumatic enophthalmos. The other half is probably explained by soft tissue or geometric bony, rather than volumetric, changes.
An Esthetic Scoring System for Scaphocephaly Assessment and Outcomes: A Pilot Study
Authors: Van Carlen Martin , Dawes William , Hennedige Anusha , Sinha Ajay , Bordbar Patrishia , Parks Chris , Vaiude Partha , Nayar Rakhee , Quirk Debbie , Richardson David , Duncan Christian 
Published: April 2023

Scaphocephaly is the commonest form of craniosynostosis with a varied presentation consisting of many morphological components and a range of possible surgical interventions. However, with regard to esthetic assessment, there is no universally applied assessment system.
The aim was to develop a simple assessment tool encompassing multiple phenotypic components of scaphocephaly. This was done by piloting a red/amber/green (RAG) scoring system to judge esthetic outcomes following scaphocephaly surgery using photographs and experienced observers.
Standard photographic views of 20 patients who had undergone either passive or anterior 2/3 vault remodelling were scored by 5 experienced assessors. Using a RAG scoring system before and after scaphocephaly correction according to 6 morphological characteristics: visual impression of cephalic index, calvarial height, bitemporal pinching, frontal bossing, posterior bullet, and displacement of the vertex. All 5 assessors were asked to score the preoperative and postoperative views independently. The RAG scores were each assigned a number (1–3) and added to give a composite score (range 6–18) and these were averaged between the 5 assessors.
There was a highly statistically significant difference between both preoperative and postoperative composite scores (P<0.0001). A subgroup analysis of the postoperative composite score between the 2 surgical techniques showed no significant difference (P=0.759).
The RAG scoring system can be used to assess esthetic change following scaphocephaly correction and it provides both a visual analogue and a numerical indicator of change. This assessment method needs further validation but is a potentially reproducible way to score and compare esthetic outcomes in scaphocephaly correction.
Flap Necrosis Associated With Furlow’s Palatoplasty
Authors: Rossell-Perry Percy 
Published: April 2023

Background:
Numerous authors have reported their outcomes after using Furlow’s palatoplasty for cleft palate repair. However, little attention has been given to the operative complications associated with this technique. The present study was carried out to present cases and analyze the various factors influencing the development of this complication accompanying Furlow’s palatoplasty.

Materials and Methods:
This is a case report study of patients with cleft palate admitted to our center due to sequelae after primary cleft palate repair using Furlow palatoplasty between 2003 and 2021. Patient information was identified from the Smile Train cleft charity organization, parents’ reports, and hospital records (intake forms and operating room registries).

Results:
Five patients were identified as having secondary cleft palate with palatal flap necrosis and associated with Furlow palatoplasty during patient evaluation at our center between 2003 and 2021. The observed prevalence was 1.54%.

Conclusions:
Palatal flap necrosis is a rare but serious complication after primary Furlow’s palatoplasty. The occurrence of this complication can be reduced by careful preoperative planning, and prevention is possible.