bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Feeding Outcomes in Infants Born With Neonatal Abstinence Syndrome
Authors: Nagy Stephanie , Dow Kimberly , Fucile Sandra 
Published: April 2023

Objective:
Breastfeeding is the optimal source of nutrition for all infants, but there are limited data on feeding outcomes in infants with neonatal abstinence syndrome (NAS) who are admitted in the neonatal intensive care unit (NICU).

Methods:
A retrospective cohort study was conducted at a level II/III NICU. Study sample consisted infants with a diagnosis of NAS and those diagnosed with respiratory distress syndrome. The primary outcome was attainment of independent oral feeds, defined as the number of days to transition from full-tube to full oral feeds. Secondary outcomes included length of hospital stay and method (breast or bottle) of oral feeds at the start, at attainment of independent oral feeds, and at hospital discharge.

Results:
Infants with NAS took significantly longer to attain independent oral feeds than controls (P = .021) and received significantly fewer breastfeeds at the start of oral feeds, at independent oral feeds, and at hospital discharge (P = .000). There was no difference in length of hospital stay between groups.

Conclusion:
These results suggest that infants with NAS can experience difficulties achieving independent oral feeds and are less likely to receive breastfeeds. Additional support is required to enhance oral feeds in infants with NAS in the NICU.
Catastrophic antiphospholipid syndrome immediately after coronary angiography: the unexpected complication
Authors: Raccis Mario , Dossi Filippo , Bernardelli Alice , Aste Milena , Berisso Giovanni , Parodi Guido 
Published: April 2023

A 44-year-old woman with obstetric antiphospholipid syndrome (APS) presented to our institution with suspected non ST-elevation myocardial infarction (NSTEMI). Shortly after coronary angiography, she developed diplopia, hypotension and chest pain with inferior ST elevation in 12-lead ECG. According to multidisciplinary evaluation, she promptly underwent systemic thrombolysis, with clinical and haemodynamic improvement. Eventually, a diagnosis of catastrophic APS was made, with multiorgan ischemic involvement confirmed by blood examinations and multimodal imaging techniques. A pluridisciplinary approach was central to define optimal medical therapy and in-hospital management that lead to clinical condition improvement at discharge.
In this case, catastrophic APS was triggered or worsened by catheters insertion and invasive manoeuvres within the arterial lumen during coronary angiography. Recognizing catastrophic APS and its potential triggers, can be helpful to deliver prompt and accurate medical assistance. Moreover, in APS patients undergoing coronary angiography, preventive strategies are important to prevent possible unfavourable evolution in catastrophic APS.
Treatment of primary squamous cell carcinoma of the endometrium and review of previous literature: A case report
Authors: Song Liyun , Wu Qi , Bai Suning , Xu Ren , Wang Xiaona , Yang Yanyan 
Published: April 2023

Rationale:
Primary squamous cell carcinoma of the endometrium (PSCCE) has been occasionally reported. Treatment of this disease poses a challenge to clinicians because of its rarity. Herein, we report the case of a 56-year-old woman with typical clinical manifestations and a pathological diagnosis classified by molecular typing as having high microsatellite instability (MSI-H) PSCCE. Based on a review of the previous literature, we summarized the treatment options for this rare disease and proposed new opinions.

Patient concerns:
A 56-year-old woman was admitted to our hospital with irregular vaginal bleeding and lower abdominal swelling.

Diagnosis:
The patient was diagnosed with squamous cell carcinoma of the endometrium (stage IIIC1; MSI-H).

Interventions:
The patient underwent total abdominal hysterectomy, bilateral salpingo-ovariectomy (bso), and pelvic lymph node dissection. Following the surgery, the patient received adjuvant chemoradiotherapy.

Outcomes:
The patient was followed up regularly. No recurrence or metastasis has been reported to date.

Lessons:
Curettage specimens may show only well-differentiated squamous epithelium, which is indistinguishable from normal squamous epithelium. It is difficult to infer from the histological morphology that the curettage specimens originate from the uterine cavity, which makes it difficult to diagnose PSCCE before the operation. We suggest that when an imaging examination indicates a tumor in the uterine cavity, even if multiple curettage specimens indicate normal or well-differentiated squamous epithelium, it indicates the possibility of PSCCE.
Shear wave elastography measured liver stiffness-spleen size-to-platelet ratio for the prediction of high-risk oesophageal varices: a meta-analysis
Authors: Xuan Jingjing , Shi Zhewei 
Published: April 2023

Objectives
The potential predictive role of shear wave elastography (SWE) measured liver stiffness-spleen size-to-platelet ratio score (LSPS) for high-risk oesophageal varices (HREV) in patients with cirrhosis remains controversial. A systematic review and meta-analysis was performed to investigate the diagnostic efficacy of SWE-measured LSPS for HREV.

Methods
Relevant studies were retrieved by searching PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies comparing the diagnostic efficacy of SWE-measured LSPS with oesophagogastroduodenoscopy for HREV in patients with cirrhosis were included. Pooled sensitivity and specificity were calculated with a random-effect model.

Results
Overall, eight cohorts were included. Four of them used point SWE (pSWE) and the other four used 2D-SWE. Pooled results showed that a high LSPS measured by pSWE and 2D-SWE were both associated with satisfying diagnostic efficacy for endoscopic-evidenced HREV, with pooled sensitivity, specificity, diagnostic odds ratio, and pooled area under receiver operating characteristic curve of 0.86, 0.86, 39.36, and 0.92 for pSWE-derived LSPS, and 0.77, 0.86, 20.64, and 0.89 for 2D-SWE-derived LSPS. No significant difference was observed in the diagnostic efficacy between pSWE- and 2D-SWE-derived LSPS (P all > 0.05). Significant heterogeneity was observed. However, further subgroup and meta-regression analysis failed to show that differences in study design, sex, diagnosis (compensated or overall cirrhosis), or LPSP cutoffs may lead to heterogeneity (P for subgroup difference > 0.05).

Conclusion
A high LSPS with liver stiffness measured by pSWE or 2D-SWE shows satisfying predictive accuracy for HREV in patients with cirrhosis.
Predictive indicators for determining red blood cell transfusion strategies in the emergency department
Authors: Song Junhyup , Kim Sinyoung , Chung Hyun Soo , Park Incheol , Kwon Soon Sung , Myung Jinwoo 
Published: April 2023

Background and importance
Appropriate decision-making is critical for transfusions to prevent unnecessary adverse outcomes; however, transfusion in the emergency department (ED) can only be decided based on sparse evidence in a limited time window.

Objectives
This study aimed to identify factors associated with appropriate red blood cell (RBC) transfusion in the ED by analyzing retrospective data of patients who received transfusions at a single center.

Outcome measures and analysis
This study analyzed associations between transfusion appropriateness and sex, age, initial vital signs, an ED triage score [the Korean Triage and Acuity Scale (KTAS)], the length of stay, and the hemoglobin (Hb) concentration.

Main results
Of 10 490 transfusions, 10 109 were deemed appropriate, and 381 were considered inappropriate. A younger age (P < 0.001) and a KTAS level of 3–5 (P = 0.028) were associated with inappropriate transfusions, after adjusting for O2 saturation and the Hb level.

Conclusions
In this single-center retrospective study, younger age and higher ED triage scores were associated with the appropriateness of RBC transfusions.
Concomitant cavernous sinus thrombosis and central serous chorioretinopathy in a patient with total ophthalmoplegia and monocular blindness: a case report
Authors: Fikriyah Lathifatul , Hidayati Hanik Badriyah , Ardhi Mohammad Saiful 
Published: April 2023

Introduction:
Cavernous sinus thrombosis (CST) is an unusual condition that can result in high mortality and morbidity rate if not treated immediately.

Case presentation:
An Indonesian male, 47 years old, presented with total right ocular ophthalmoplegia followed by blindness, headache, ptosis, periorbital swelling, and hypoesthesia over the left V1 region. MRI of the brain showed suitable cavernous thickening until the right orbital apex, which in contrast showed enhancement suggestive of right Tolosa–Hunt syndrome. The patient was treated with a high dose of steroids, but the patient’s complaints did not improve. The patient underwent digital subtraction angiography and found CST. The optical coherence tomography was found to be central serous chorioretinopathy. He was treated with an antibiotic, anticoagulant, and extraction of the right maxillary molar was performed to remove the source of the infection. After 3 weeks, visual acuity and optical coherence tomography examination were improved.

Discussion:
A comprehensive examination, such as digital subtraction angiography, is essential to confirm CST diagnosis for the patient to obtain the right therapy. This report highlighted the value of the prompt diagnosis of CST through neuroimaging and the importance of proper therapy in patient management.

Conclusions:
Early diagnosis, comprehensive examination, and proper treatment of CST will increase good prognosis.
Retrovesical hydatid cyst: an unusual location of hydatid disease about a case series
Authors: Hermi Amine , Saadi Ahmed , Mokadem Seif , Boussaffa Hamza , Zaghbib Selim , Haroun Ayed , Bouzouita Abderrazak , Derouiche Amine , Chakroun Marouene , Ben Slama Mohamed Riadh 
Published: April 2023

Introduction and importance:
Hydatid disease is an endemic zoonosis in regions with temperate climates where pastoral farming is common. Retrovesical localization is rare. Given the rarity of this entity, the lack of personal clinical experience, and the difficulty with detecting early symptoms, the diagnosis remains elusive for years.

Methods:
This is a 30-year retrospective, descriptive and analytic study of seven patients who were hospitalized and operated on in the Department of Urology during 30 years (1990–2019).

Outcomes:
The average patient age was 54 years (range: 28–76). Signs of bladder irritation were the predominant presenting complaint. No cases of hydaturia were noted. Preoperative diagnosis was based on ultrasonography and serology tests. Hydatid serology was positive for three patients. In three cases, a hydatid cyst of the liver was associated. A partial cystopericystectomy was performed for five patients, it was total for one patient. The resection of the prominent dome was realized once. No cystovesical fistula was found. The mean postoperative stay was 16 days. The postoperative course was uneventful for five patients. Urinary fistula occurred in one patient. One case of infection of the residual cavity was observed. One patient had a retroperitoneal cyst recurrence requiring reoperation.

Conclusion:
The preoperative diagnosis of retrovesical hydatid cysts is based mainly on ultrasonography. Open surgery is the treatment of choice. Different approaches are possible. Given the rarity of this entity, management should be guided by experienced experts.
Comparison of spinal versus general anesthesia on the perioperative blood glucose levels in patients undergoing lower abdominal and pelvic surgery: a prospective cohort study, Ethiopia
Authors: Samuel Hirbo , Girma Betelihem , Negash Mestawet , Muluneh Esubalew 
Published: April 2023

Introduction:Surgery is linked with fear and stress that disrupt metabolic and neuroendocrine activities, which impair normal maintained glucose metabolism that leads to stress hyperglycaemia. This study aimed to compare the effect of general and spinal anaesthesia on perioperative blood glucose levels in patients undergoing lower abdominal and pelvic surgery.Methods:This prospective observational cohort study recruits 70 adult patients who underwent lower abdominal and pelvic surgery under general and spinal anaesthesia; 35 in each group. A systematic random sampling technique was used to select study participants. Capillary blood glucose was measured at four perioperative times. An independentt-test, dependentt-test, and Manny–Whitney U test were used for statistical analysis, as appropriate.Pvalues less than 0.05 were considered statistically significant.Results:No statistically significant difference was observed in mean blood glucose levels at baseline and 5 min after induction of general anaesthesia and complete blocks of spinal anaesthesia. But at the end of surgery and 60 min after the end of surgery the mean blood glucose levels were statistically significantly higher in the general anaesthesia group compared with the spinal anaesthesia group (P<0.05). And the blood glucose level was significantly increased from baseline compared with the different time intervals in the general anaesthesia group.Conclusion:The mean blood glucose levels were lower in patients undergoing surgery under spinal anaesthesia compared with general anaesthesia. The authors recommend spinal over general anaesthesia whenever possible for patients undergoing lower abdominal and pelvic surgery.
Clinical Instability Is a Sign of Severity of Illness: A Cohort Study
Authors: Pollack Murray M. , Trujillo Rivera Eduardo , Morizono Hiroki , Patel Anita K. 
Published: April 2023

OBJECTIVES:
Test the hypothesis that within patient clinical instability measured by deterioration and improvement in mortality risk over 3-, 6-, 9-, and 12-hour time intervals is indicative of increasing severity of illness.

DESIGN:
Analysis of electronic health data from January 1, 2018, to February 29, 2020.

SETTING:
PICU and cardiac ICU at an academic children’s hospital.

PATIENTS:
All PICU patients. Data included descriptive information, outcome, and independent variables used in the Criticality Index-Mortality.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
There were 8,399 admissions with 312 deaths (3.7%). Mortality risk determined every three hours using the Criticality Index-Mortality, a machine learning algorithm calibrated to this hospital. Since the sample sizes were sufficiently large to expect statical differences, we also used two measures of effect size, the proportion of time deaths had greater instability than survivors, and the rank-biserial correlation, to assess the magnitude of the effect and complement our hypothesis tests. Within patient changes were compared for survivors and deaths. All comparisons of survivors versus deaths were less than 0.001. For all time intervals, two measures of effect size indicated that the differences between deaths and survivors were not clinically important. However, the within-patient maximum risk increase (clinical deterioration) and maximum risk decrease (clinical improvement) were both substantially greater in deaths than survivors for all time intervals. For deaths, the maximum risk increase ranged from 11.1% to 16.1% and the maximum decrease ranged from –7.3% to –10.0%, while the median maximum increases and decreases for survivors were all less than ± 0.1%. Both measures of effect size indicated moderate to high clinical importance. The within-patient volatility was greater than 4.5-fold greater in deaths than survivors during the first ICU day, plateauing at ICU days 4–5 at 2.5 greater volatility.

CONCLUSIONS:
Episodic clinical instability measured with mortality risk is a reliable sign of increasing severity of illness. Mortality risk changes during four time intervals demonstrated deaths have greater maximum and within-patient clinical instability than survivors. This observation confirms the clinical teaching that clinical instability is a sign of severity of illness.
An Evaluation of Native Breast Dimension and Tissue Expander Inflation Rate on the Risk of Capsular Contracture Development in Postmastectomy Reconstruction
Authors: Chen Yunchan , Qin Nancy , Wang Marcos Lu , Black Grant G. , Vaeth Anna , Asadourian Paul , Chinta Malini , Bernstein Jaime L. , Otterburn David M. 
Published: April 2023

IntroductionCapsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk.MethodsA data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status.ResultsGreater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture (P< 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996;P< 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture.ConclusionSmaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.
Chronic Exertional Compartment Syndrome Requiring Bilateral Fasciotomy
Authors: Frecentese Grace I. , Roche Aidan D. , Cederna Paul S. 
Published: April 2023

Abstract
Stiff skin syndrome (SSS) is a rare cutaneous disorder characterized by cutaneous fibrosis resulting in the early onset of thickened and indurated skin, joint mobility restrictions, and contractures. We describe a father and son with familial SSS who presented with bilateral exertional pain and a confirmed diagnosis of chronic exertional compartment syndrome on 4-compartment pressure testing. Patients experienced restored functionality with bilateral 4-compartment fasciotomy. Chronic exertional compartment syndrome should be considered in the differential diagnosis of patients with SSS and chronic pain of the lower limbs.
Legislation and Policy Recommendations on Organ and Tissue Donation and Transplantation From an International Consensus Forum
Authors: Toews Maeghan , Chandler Jennifer A. , Pope Thaddeus , Pape Roger , Weiss Matthew , Sandiumenge Alberto 
Published: April 2023

Background.
There is a shared global commitment to improving baseline donation and transplantation performance metrics in a manner consistent with ethics and local cultural and social factors. The law is one tool that can help improve these metrics. Although legal systems vary across jurisdictions, our objective was to create expert, consensus guidance for law and policymakers on foundational issues underlying organ and tissue donation and transplantation (OTDT) systems around the world.

Methods.
Using the nominal group technique, a group composed of legal academics, a transplant coordinator/clinician, and a patient partner identified topic areas and recommendations on foundational legal issues. The recommendations were informed by narrative literature reviews conducted by group members based on their areas of expertise, which yielded a range of academic articles, policy documents, and sources of law. Best practices were identified from relevant sources in each subtopic, which formed the basis of the recommendations contained herein.

Results.
We reached consensus on 12 recommendations grouped into 5 subtopics: (i) legal definitions and legislative scope, (ii) consent requirements for donation‚ (iii) allocation of organs and tissue‚ (iv) operation of OTDT systems‚ and (v) travel for transplant and organ trafficking. We have differentiated between those foundational legal principles for which there is a firm basis of support with those requiring further consideration and resolution. Seven such areas of controversy are identified and discussed alongside relevant recommendations.

Conclusions.
Our recommendations encompass some principles staunchly enshrined in the OTDT landscape (eg, the dead donor rule), whereas others reflect more recent developments in practice (eg, mandatory referral). Although some principles are widely accepted, there is not always consensus as to how they ought to be implemented. As the OTDT landscape continues to evolve, recommendations must be reconsidered for the law to keep pace with developments in knowledge, technology, and practice.
Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum
Authors: Walton Phil , Pérez-Blanco Alicia , Beed Stephen , Glazier Alexandra , Ferreira Salomao Pontes Daniela , Kingdon Jennifer , Jordison Kim , Weiss Matthew J. 
Published: April 2023

Background.
Consent model and intent to donate registries are often the most public facing aspects of an organ and tissue donation and transplantation (OTDT) system. This article describes the output of an international consensus forum designed to give guidance to stakeholders considering reform of these aspects of their system.

Methods.
This Forum was initiated by Transplant Québec and cohosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This article describes the output of the consent and registries domain working group, which is 1 of 7 domains from this Forum. The domain working group members included administrative, clinical, and academic experts in deceased donation consent models in addition to 2 patient, family, and donor partners. Topic identification and recommendation consensus was completed over a series of virtual meetings from March to September 2021. Consensus was achieved by applying the nominal group technique informed by literature reviews performed by working group members.

Results.
Eleven recommendations were generated and divided into 3 topic groupings: consent model, intent to donate registry structure, and consent model change management. The recommendations emphasized the need to adapt all 3 elements to the legal, societal, and economic realities of the jurisdiction of the OTDT system. The recommendations stress the importance of consistency within the system to ensure that societal values such as autonomy and social cohesion are applied through all levels of the consent process.

Conclusions.
We did not recommend one consent model as universally superior to others, although considerations of factors that contribute to the successful deployment of consent models were discussed in detail. We also include recommendations on how to navigate changes in the consent model in a way that preserves an OTDT system’s most valuable resource: public trust.