bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Additional Cost of Perioperative Medication Errors
Authors: Langlieb Marin E. , Sharma Pranav , Hocevar Mark , Nanji Karen C. 
Published: May 2023

Abstract
The purpose of this report was to estimate the additional annual cost to the U.S. healthcare system attributable to preventable medication errors (MEs) in the operating room. The ME types were iteratively grouped by their associated harm (or potential harm) into 13 categories, and we determined the incidence of operations involving each ME category (number of operations involving each category/total number of operations): (1) delayed or missed required perioperative antibiotic (1.4% of operations); (2) prolonged hemodynamic swings (7.6% of operations); (3) untreated postoperative pain >4/10 (18.9% of operations); (4) residual neuromuscular blockade (2.9% of operations); (5) oxygen saturation <90% due to ME (1.8% of operations); (6) delayed emergence (1.1% of operations); (7) untreated new onset intraoperative cardiac arrhythmia (0.72% of operations); (8) medication documentation errors (7.6% of operations); (9) syringe swaps (5.8% of operations); (10) presumed hypotension with inability to obtain a blood pressure reading (2.2% of operations); (11) potential for bacterial contamination due to expired medication syringes (8.3% of operations); (12) untreated bradycardia <40 beats/min (1.1% of operations); and (13) other (13.0% of operations). Through a PubMed search, we determined the likelihood that the ME category would result in downstream patient harm such as surgical site infection or acute kidney injury, and the additional fully allocated cost of care (in 2021 U.S. dollars) for each potential downstream patient harm event. We then estimated the cost of the MEs across the U.S. healthcare system by scaling the number of MEs to the total number of annual operations in the United States (N = 19,800,000). The total estimated additional fully allocated annual cost of care due to perioperative MEs was $5.33 billion U.S. dollars.
Risk Factors for Maxillofacial Space Infection Complications: A Retrospective Analysis of 457 Patients
Authors: Li Peijun , He Yang , Zhang Yi , An Jingang , Yang Yue 
Published: May 2023

This study was performed to determine the risk factors associated with systemic complications of maxillofacial space infection (MSI), and to propose an objective evaluation index - severity score of MSI. 457 MSI patients from Jan 2010 to Dec 2020 were reviewed retrospectively. The predictor variables included demographic, origin of infection, underlying systemic disease, pre-hospital medication history, laboratory examinations and severity scores of space infection. The severity score of space infection was proposed to evaluate the airway compromise of anatomic spaces. The primary outcome variable was the complication. The impact factors of complications were analyzed using univariate analysis and multivariate logistic regression. 457 patients were included (average age 46.3 y, male to female ratio 1.43:1). Among them, 39 patients developed postoperative complications. In the complication group, there were 18 patients (46.2%) with pulmonary infection, and two patients died. We found that the history of diabetes mellitus (OR=4.74, 95% confidence interval (CI)=2.22, 10.12), high temperature (≥39°C) (OR=4.16, 95% CI=1.43, 12.06), advanced age (≥65 y) (OR=2.88, 95% CI=1.37, 6.01), and severity score of space infection (OR=1.14, 95% CI=1.04, 1.25) were independent risk factors for complications of MSI. All the risk factors needed to be closely monitored. Severity score of MSI was an objective evaluation index to predict complications.
One-Abutment at One-Time in Posterior Edentulism: A Systematic Review and Meta-Analysis
Authors: Kang Yujie , Zheng Xianghuai , Zhang Danya , Li Shaobing , Xu Shulan , Chen Lei , Zhang Zhaoqiang , Lin Xi 
Published: May 2023

Objective:
The objective of this systematic review and meta-analysis was to investigate the clinical significance of one-abutment at one-time protocol in healed posterior edentulism.

Methods:
An online search was undertaken in November 2022, which included PubMed, Cochrane Library, Wiley Online Library, and Google Scholar in addition to manual searching. The Cochrane Collaboration tool was performed to assess the quality of selected articles. Marginal bone loss (MBL) was estimated by the performance of meta-analysis. Moreover, all the pooled analyses were based on random-effect models. Subgroup analysis was applied to evaluate the effects of different variables.

Results:
In line with the inclusion criteria, 6 trials with 446 dental implants were identified. The meta-analysis showed a total of 0.22 mm less MBL within 6 months and decreased by 0.30 mm at 1-year follow-up in favor of one-abutment at one-time protocol. A significant loss MBL was found in implants placed equicrestally using one-abutment at one-time protocol [6 months: mean difference (MD): −0.22 mm; 95% CI, −0.34 to 0.10 mm, P=0.0004; 12 months: MD: −0.32 mm; 95% CI, −0.40 to −0.24 mm, P<0.00001), whereas no difference was found between 2 groups in an implant placed subscrestally (6 months: MD: 0.14 mm; 95% CI, −0.03 to 0.22 mm; P=0.11; 12 months: MD: −0.12 mm; 95% CI, −0.32 to 0.08 mm; P=0.23).

Conclusions:
Implant platform position might greatly affect the marginal bone level. Moreover, one-abutment at one-time protocol demonstrated better bone preservation in implants placed equicrestally in healed posterior edentulism.

Clinical Relevance:
This study highlights the significant clinical application of one-abutment at one-time protocol in healed posterior edentulism.
External Z-plasty Technique for Correction of Alar Retraction in Asian Patients
Authors: Yu Bao-Fu , Zhu Hai-Jun , Chen Xiao-Xue , Wang Zi , Dai Chuan-Chang , Wei Jiao 
Published: May 2023

Background:
Current strategies for correcting alar retraction mainly include cartilage grafting and composite grafting, which are relatively complicated and may produce injury to the donor site. Herein, we introduce a simple and effective external Z-plasty technique for correcting alar retraction in Asian patients with poor skin malleability.

Methods:
Twenty-three patients were presented with alar retraction and poor skin malleability, and they were very concerned about the shape of the nose. These patients undergoing external Z-plasty surgery were analyzed retrospectively. In this surgery, no grafts were needed, and the location of the Z-plasty was according to the highest point of the retracted alar rim. We reviewed the clinical medical notes and photographs. During the postoperative follow-up period, patients’ reported satisfaction with aesthetic outcome were also evaluated.

Results:
The alar retraction of all the patients was successfully corrected. The postoperative mean follow-up period was 8 months (range: 5–28 mo). No incidents of flap loss, recurrence of alar retraction, or nasal obstruction were observed during postoperative follow-up. Within postoperative 3–8 weeks, minor red scarring was visible at the operative incisions in most patients. However, these scars turned unobvious after postoperative 6 months. There were 15 cases (15/23) being very satisfied with the aesthetic outcome of this procedure. Seven patients (7/23) were satisfied with the effect and the invisible scar of this operation. Only one patient was dissatisfied with the scar, but she was satisfied with the correction effect of the retraction.

Conclusion:
This external Z-plasty technique can be an alternative method for correction of alar retraction with no need of cartilage grafting, and the scar can be unobvious with fine surgical suture. However, the indications should be limited in patients with severe alar retraction and poor skin malleability, who should not particularly care about the scars.
NUCLEOLIN PROMOTES AUTOPHAGY THROUGH PGC-1Α IN LPS-INDUCED MYOCARDIAL INJURY
Authors: Yin Leijing , Yuan Ludong , Tang Yuting , Luo Zhengyang , Lin Xiaofang , Wang Shuxin , Liang Pengfei , Jiang Bimei 
Published: May 2023

ABSTRACT
As a multifunctional protein, nucleolin can participate in a variety of cellular processes. Nucleolin also has multiple protective effects on heart disease. Previous studies have shown that nucleolin could not only resist oxidative stress damage and inflammatory damage, but also regulate autophagy to play a protective role in cardiac ischemia. However, the specific mechanism has not been fully elucidated in LPS-induced myocardial injury. Therefore, the aim of this study is to explore the underlying mechanism by which nucleolin regulates autophagy to protect against LPS-induced myocardial injury in vivo and in vitro. In our study, we found that nucleolin could bind to PGC-1α, and we predicted that this interaction could promote autophagy and played a role in inhibiting cardiomyocyte apoptosis. Downregulation of nucleolin in H9C2 cells resulted in decreased autophagy and increased cell apoptosis during LPS-induced myocardial injury, while upregulation of PGC-1α had the opposite protective effect. Upregulation of nucleolin expression in cardiomyocytes could increase the level of autophagy during LPS-induced myocardial injury. In contrast, interference with PGC-1α expression resulted in a decrease in the protective effect of nucleolin, leading to reduced autophagy and thus increasing apoptosis. By using tandem fluorescent-tagged LC3 autophagic flux detection system, we observed autophagic flux and determined that PGC-1α interference could block autophagic lysosomal progression. We further tested our hypothesis in the nucleolin cardiac-specific knockout mice. Finally, we also found that inhibition of autophagy can reduce mitochondrial biogenesis as well as increase apoptosis, which demonstrated the importance of autophagy. Therefore, we can speculate that nucleolin can protect LPS-induced myocardial injury by regulating autophagy, and this protective effect may be mediated by the interaction with PGC-1α, which can positively regulate the ULK1, an autophagy-related protein. Our study provides a new clue for the cardioprotective effect of nucleolin, and may provide new evidence for the treatment of LPS-induced myocardial injury through the regulation of autophagy.
Caregiver Burden and Quality of Life Across Alzheimer’s Disease Severity Stages
Authors: van Hezik-Wester Valérie J. , Handels Ron L.H. , Wolfs Claire A.G. , Kanters Tim A. 
Published: May 2023

Introduction:
The objective is to estimate the caregiver burden in terms of informal care time, health-related quality of life (HRQoL), and societal costs by disease severity (mild, moderate, or severe) and living situation (community-dwelling or institutionalized) of persons with AD (PwAD); and PwAD HRQoL.

Methods:
Caregivers were recruited through an online panel provider in the Netherlands. The survey used validated instruments, including iMTA Valuation of Informal Care Questionnaire, CarerQoL, and EQ-5D-5L.

Results:
One hundred two caregivers participated. PwADs received, on average, 26 hours of informal care per week. Informal care costs were higher for community-dwelling PwADs compared with institutionalized PwADs (€480 and €278, respectively). On the EQ-5D-5L, caregivers scored on average 0.797, reflecting a utility decrement of 0.065 compared with an age-matched population. Proxy-rated utility scores for PwADs decreased with increasing disease severity (0.455, 0.314, and 0.212 for mild, moderate, and severe AD, respectively). Institutionalised PwADs had lower utility scores than community-dwelling PwADs (0.590 vs. 0.421). There was no difference in informal care time, societal costs, CarerQol scores, and caregiver EQ-5D-5L scores between disease severities.

Conclusion:
The burden of AD extends to caregivers in terms of HRQoL and time investment, regardless of the disease severity of the target population. These impacts should be incorporated into the evaluation of new AD interventions.
A Deep Learning Approach to Accurately Discriminate Between Optic Disc Drusen and Papilledema on Fundus Photographs
Authors: Sathianvichitr Kanchalika , Najjar Raymond P. , Zhiqun Tang , Fraser J. Alexander , Leng Yau Christine Wen , Girard Michael Julien Alexandre , Costello Fiona , Lin Mung Yan , Lagrèze Wolf Alexander , Vignal-Clermont Catherine , Fraser Clare L. , Hamann Steffen , Newman Nancy J. , Biousse Valérie , Milea Dan ,   the BONSAI Group
Published: May 2023

AbstractObjectiveTo assess the performance of a deep learning system (DLS) to discriminate between optic disc drusen (ODD) and papilledema caused by intracranial hypertension, using standard color ocular fundus photographs collected in a large international multi-ethnic population.DesignRetrospective study.ParticipantsThe study included 4,508 color fundus images in 2,180 patients from 30 neuro-ophthalmology centers (19 countries) participating in the Brain and Optic Nerve Study with Artificial Intelligence (BONSAI) Group.MethodsWe trained, validated, and tested a dedicated DLS for binary classification of ODD vs. papilledema (including various subgroups within each category), on conventional mydriatic digital ocular fundus photographs. For training and internal validation, we used 857 ODD images and 3,230 papilledema images, in 1,959 patients. External-testing was subsequently performed on an independent dataset (221 patients) including 207 images with ODD (96 visible and 111 buried), provided by 3 centers of the Optic Disc Drusen Studies Consortium, and 214 images of papilledema (92 mild-to-moderate and 122 severe) from a previously validated study.Main outcome measuresArea under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to discriminate between ODD and papilledema.ResultsOverall, the DLS could accurately distinguish between all ODD and papilledema (all severities included): AUC 0.97 (95% confidence interval [CI], 0.96 to 0.98), accuracy 90.5% (95% CI, 88.0% to 92.9%), sensitivity 86.0% (95% CI, 82.1% to 90.1%), and specificity 94.9% (95% CI, 92.3% to 97.6%). The performance of the DLS remained high for discrimination of buried ODD from mild-to-moderate papilledema: AUC 0.93 (95% CI, 0.90 to 0.96), accuracy 84.2% (95% CI, 80.2%-88.6%), sensitivity 78.4% (95% CI, 72.2% to 84.7%), and specificity 91.3% (95% CI, 87.0% to 96.4%).ConclusionsA dedicated DLS can accurately distinguish between ODD and papilledema caused by elevated intracranial pressure, even when considering buried ODD vs mild-to-moderate papilledema. Future studies are required to validate the utility of this DLS in clinical practice.
Bridging Gaps: Improving access to general practice for and with marginalised patients- “it’s quite joyful for us, it’s really improved our work”
Authors: Potter Lucy C , Stone Tracey , Swede Julie ,   BG group, Connell Florrie , Cramer Helen , McGeown Helen , Carvalho Maria , Horwood Jeremy , Feder Gene , Farr Michelle 
Published: May 2023

AbstractBackgroundPeople with severe and multiple disadvantage (SMD-combinations of homelessness, substance misuse, violence, abuse and poor mental health) have high health needs and poor access to primary care.AimTo explore perceptions and experiences of improving access to general practice for people with SMD in healthcare staff and people with lived experience.Design and SettingBridging Gaps is a collaboration between healthcare staff, researchers, women with lived experience of SMD and a charity that supports them in a UK city. We co-produced a project to improve access to general practice for marginalised patients, that was further developed with 3 inner city general practices.MethodWe observed six collaborative service improvement meetings at three general practices and conducted documentary analysis of minutes of a further three meetings. We interviewed nine practice staff and four participants with lived experience. Three participants with lived experience and one staff member who supports them participated in a focus group. Data was analysed inductively and deductively using thematic analysis.ResultsEnabling motivated general practice staff with time and funding opportunities, galvanised by lived experience involvement, resulted in sustained service changes. These included: care coordinators and patient lists to support access to patients in greater need and an information sharing tool. The process and outcomes improved connections within and between general practices, support organisations and marginalised patients.ConclusionThese co-produced strategies could be locally adapted and evaluated elsewhere. Investing in this different way of working may improve inclusion of marginalised groups, health equity and staff wellbeing.How this fits inThis study builds on previous work showing that continuity of care, being able to develop a trusting relationship and being proactive are of particular importance in providing care to highly marginalised patients(4, 5, 6, 7, 8). This work describes co-produced strategies including using care coordinators, patient lists and an information sharing tool to support access and continuity to patients in greater need, in addition to rich contextual information on how to shift ways of working to achieve this. In addition to a small team focused on marginalised patients, this study supports the literature highlighting the need for a trauma-informed approach throughout the whole practice team. These co-produced strategies could be adapted and piloted in other practices and areas. Investing in this focused way of working may improve inclusion of marginalised groups, health equity and staff wellbeing.
Non-Invasive markers of inflammation and protein loss augment diagnosis of celiac disease
Authors: Sutton Kimberly A , He Mai , Ma Changqing , Liu Ta-Chiang , Faubion William A. , Hoffman Julie , Linneman Laura , Rodriguez Cynthia , Holtz Lori R 
Published: May 2023

AbstractBackgroundCirculating tissue transglutaminase IgA (TTG IgA) concentrations are sensitive and specific indicators of celiac disease, but discrepancies between serologic and histologic findings still occur. We hypothesized that fecal markers of inflammation and protein loss would be greater in patients with untreated celiac disease than in healthy controls. Our study aims to evaluate multiple fecal and plasma markers in celiac disease and correlate these findings with serologic and histologic findings as non-invasive means of evaluating disease activity.MethodsParticipants with positive celiac serologies and controls with negative celiac serologies were enrolled at the time of upper endoscopy. Blood, stool and duodenal biopsies were collected. Concentrations of fecal lipocalin-2, calprotectin and alpha-1-antitrypsin and plasma lipcalin-2 were determined. Biopsies underwent modified Marsh scoring. Significance was tested between cases and controls, modified Marsh score and TTG IgA concentration.ResultsLipocalin-2 was significantly elevated in the stool (p=0.007) but not the plasma of participants with positive celiac serologies compared to controls. There was no significant difference in fecal calprotectin or alpha-1 antitrypsin between participants with positive celiac serologies and controls. Fecal alpha-1 antitrypsin >100mg/dL was specific, but not sensitive for biopsy proven celiac disease.ConclusionsLipocalin-2 is elevated in the stool but not the plasma of patients with celiac disease suggesting a role in the local inflammatory response. Calprotectin was not a useful marker in the diagnosis of celiac disease and did not correlate with degree of histologic changes on biopsy. While random fecal alpha-1 antitrypsin was not significantly elevated in cases compared to controls, an elevation of greater than 100mg/dL was 90% specific for biopsy proven celiac disease.
Association between lifestyle factors and weight in Japan university students during COVID-19 mild lockdown: a quantitative study
Authors: Arimori Haruka , Abiru Norio , Morimoto Shimpei , Nishino Tomoya , Kawakami Atsushi , Kamada Akie , Kobayashi Masakazu 
Published: May 2023

AbstractWe investigated the lifestyle factors influencing weight gain in university students during restrictions (mild lockdown) imposed owing to the novel coronavirus disease pandemic in Japan. In this cross-sectional study, a questionnaire survey of Nagasaki University students undergoing health examinations was conducted in 2021. Students reporting ≥3 kg weight gain were included in the weight gain group; the remaining students were in the non-weight gain group. Fisher’s exact test and binary logistic regression were performed to detect the associations between weight gain and each lifestyle factor. We included 3,059 respondents (response rate: 45.7%), and 9.5% respondents reported ≥3 kg weight gain. The following factors were associated with weight gain (odds ratio, 95% confidence interval, p value from Fisher’s exact test): dining out for ≥4 times/week (2.16 [1.40, 3.32], p = 8.7 × 10−4), gaming time of ≥4 h/day (2.26 [1.45, 3.47], p = 2.4 × 10−4). Binary logistic regression among the four highest odds ratios showed that after adjusting for other factors frequently dining out and prolonged gaming time were significantly associated with weight gain. Prolonged gaming and frequently dining out were associated with weight gain in students during the mild lockdown.
Patient Risk-Benefit Preferences for Transcatheter versus Surgical Mitral Valve Repair
Authors: Hung Anna , Yang Jui-Chen , Wallace Matthew , Zwischenberger Brittany A. , Vemulapalli Sreekanth , Mentz Robert J. , Thoma Elizabeth , Goates Scott , Lewis John , Strong Susan , Reed Shelby D. 
Published: May 2023

ABSTRACTBACKGROUNDTranscatheter repair of mitral regurgitation (MR) is less invasive than surgery, but has greater five-year mortality and re-intervention risks, as well as more limited functioning. The study objective was to quantify patient preferences for risk-benefit tradeoffs associated with transcatheter and surgical options for MR.METHODSA discrete-choice experiment survey was administered to patients with MR recruited through a patient advocacy organization. Attributes (and levels) included: procedure type (transcatheter versus surgical); risk of 30-day mortality (2%, 5%, and 10%); risk of five-year mortality (20%, 30%, and 45%) and physical functioning for five years (corresponding to improvements from New York Heart Association [NYHA] class III to I or class III to II); number of hospitalizations (1, 4, and 8) in the next five years; and risk of additional surgery in the next five years (10%, 20%, and 30% or 40%). A mixed-logit regression model was fit to estimate preference weights.RESULTS201 individuals completed the survey: 63% were female; mean age was 74 years. On average, respondents preferred transcatheter repair over surgery. To undergo a less invasive procedure (i.e., transcatheter repair), respondents would accept up to a 13.3% (95% confidence interval [CI]: 8.7% to 18.5%) increase in re-intervention risk above a baseline of 10%, 4.6 (95% CI: 3.1 to 6.2) more hospitalizations above a baseline of one, a 9.3% (95% CI: 5.2% to 14.3%) increase in mortality risk above a baseline of 20%, or more limited physical functioning representing nearly one NYHA class (0.8, 95% CI: 0.5 to 1.3) over five years.CONCLUSIONSPatients in general preferred a transcatheter procedure over surgery. When holding constant all other factors, a functional improvement from NYHA class III to class I maintained over five years would be needed, on average, for patients to prefer surgery over a transcatheter procedure.