bluuebunny/crossref_metadata_2025_split huggingface dataset:
Research on Early Identification Model of Intravenous Immunoglobulin Resistant Kawasaki Disease Based on Gradient Boosting Decision Tree
Authors: Yang Yinan , Yang Chao , Wang Lixia , Cao Shuting , Li Xiaomin , Bai Yana , Hu Xiaobin 
Published: April 2023

Background:
To construct a predictive model for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) based on the gradient boosting decision tree (GBDT), so as to early identify children with IVIG resistance and actively take additional treatment to prevent adverse events.

Methods:
The case data of KD children hospitalized in the Pediatric Department of Lanzhou University Second Hospital from October 2015 to July 2020 were collected. All KD patients were divided into IVIG responsive group and IVIG resistant group. GBDT was used to explore the influencing factors of IVIG-resistant KD and to construct a prediction model. Then compared with previous models, the optimal model was selected.

Results:
In the process of GBDT model construction, 80% of the data were used as the test set, and 20% of the data were used as the validation set. Among them, the verification set was used to adjust the hyperparameters in GDBT learning. The model performed best with a hyperparameter tree depth of 5. The area under the curve of the GBDT model constructed based on the best parameters was 0.87 (95% CI: 0.85–0.90), the sensitivity was 72.62%, the specificity was 89.04%, and the accuracy was 61.65%. The contribution degree of each feature value to the model was total bilirubin, albumin, C-reactive protein, fever time, and Na in order.

Conclusion:
The GBDT model is more suitable for the prediction of IVIG-resistant KD in this study area.
Neurologic Complications of Rotavirus Infections in Children
Authors: Slotboom David E. F. , Peeters Daphne , Groeneweg Stefan , van Rijn-Klink Anneloes , Jacobs Elke , Schoenaker Michiel H. D. , van Veen Mirjam 
Published: April 2023

Background:
Rotavirus is the leading cause of complicated gastroenteritis in children younger than 5 years in countries where rotavirus vaccination is not implemented as a routine vaccination. Besides the intestinal symptoms that are associated with ordinary gastroenteritis, rotavirus can cause neurological complications. The aim of this study is to describe the clinical characteristics of complicated rotavirus infections.

Methods:
From January 1, 2016 to January 31, 2022, all children (below the age of 18 years) with a positive rotavirus test in feces that were either hospitalized or presented at the outpatient clinic or emergency department of a large pediatric hospital in the Netherlands were included. Rotavirus was only tested in case of a severe or abnormal disease course. We described the clinical characteristics and outcomes with a particular focus on neurological manifestations.

Results:
In total, 59 patients with rotavirus were included of whom 50 (84.7%) were hospitalized and 18 (30.5%) needed intravenous rehydration. Ten patients (16.9%) had neurologic complications, of whom 6 patients (60.0%) presented encephalopathy. Two patients (20.0%) with neurological symptoms showed abnormalities on diagnostic imaging.

Conclusions:
Rotavirus can cause gastroenteritis with severe, but apparently self-limiting, neurological manifestations. Considering rotavirus in pediatric patients with neurological symptoms such as encephalopathy and encephalitis is therefore important. Early detection of rotavirus infection may predict a favorable course of the disease and may thereby prevent unnecessary treatment and should be further investigated.
Volume outcome relationship in postesophagectomy leak: a systematic review and meta-analysis
Authors: Rahouma Mohamed , Baudo Massimo , Mynard Nathan , Kamel Mohamed , Khan Faiza M. , Shmushkevich Shon , Mehta Kritika , Hosny Mohamed , Dabsha Anas , Khairallah Sherif , Demetres Michelle , Saad Reda , Mohamed Abdelrahaman , Port Jeffrey L. , Altorki Nasser K. , Gaudino Mario 
Published: April 2023

Background:
Anastomotic leak after esophagectomy carries important short- and long-term sequelae. The authors conducted a systematic review and meta-analysis to determine its association with surgical volume.

Materials and methods:
A systematic literature review was performed to identify all studies reporting on anastomotic leak after esophagectomy. Studies with less than 100 cases were excluded. The primary outcome was postesophagectomy anastomotic leak, while secondary outcomes were operative mortality overall and after anastomotic leak. Pooled event rates (PER) were calculated, and the association with annual esophagectomy volume by center was investigated.

Results:
Of the 3932 retrieved articles, 472 were included (n=177 566 patients). The PER of anastomotic leak was 8.91% [95% CI=8.32; 9.53%]. The PER of early mortality overall and after an anastomotic leak was 2.49% [95% CI=2.27; 2.74] and 11.39% [95% CI=9.66; 13.39], respectively. Centers with less than 37 annual esophagectomies had a higher leak rate compared to those with greater than or equal to 37 annual esophagectomies (9.58% vs. 8.34%; P=0.040). On meta-regression, surgical volume was inversely associated with the PER of esophageal leak and of early mortality.

Conclusions:
The frequency of anastomotic leaks after esophagectomy, perioperative, and leak associated mortality are inversely associated with esophagectomy volume.
Lateral Tarsal Strip versus Tensor Fascia Lata Sling for Paralytic Ectropion - Comparison and Long-Term Outcomes
Authors: Sanchez Cristina V. , Thachil Roshni , Mitchell Dalia N. , Reisch Joan S. , Rozen Shai M. 
Published: April 2023

Background:
Paralytic ectropion increases risk for corneal injury in facial palsy patients. While a lateral tarsal strip (LTS) provides corneal coverage through supero-lateral lower eyelid pull, the unopposed lateral force may result in lateral displacement of the lower eyelid punctum and overall worsening asymmetry. A tensor fascia lata (TFL) lower eyelid sling may overcome some of these limitations. This study quantitatively compares scleral show, punctum deviation, lower marginal reflex distance (MRD), and peri-orbital symmetry between the two techniques.

Methods:
Retrospective review was performed on facial paralysis patients who underwent a LTS or TFL sling with no prior lower lid suspension procedures. Standardized pre- and post-operative images in primary gaze position were used to measure scleral show and lower punctum deviation using ImageJ, and lower MRD using Emotrics.

Results:
Of 449 facial paralysis patients, 79 met inclusion criteria. Fifty-seven underwent a LTS and twenty-two a TFL sling. Compared to pre-operatively, lower medial scleral show significantly improved with both LTS (10.9 mm2, p<0.01) and TFL (14.7 mm2, p<0.01). The LTS group showed significant worsening of horizontal and vertical lower punctum deviation when compared to the TFL group (both p<0.01). While the LTS group failed to achieve periorbital symmetry between the healthy and paralytic eye across all parameters measured post-operatively (p<0.01); the TFL group achieved symmetry in medial scleral show, lateral scleral show, and lower punctum deviation.

Conclusions:
In patients with paralytic ectropion, TFL sling provides similar outcomes to LTS with added advantages of symmetry without lateralization or caudalization the lower medial punctum.
Enhancing Philtrum Morphology Using Fat Grafting Combined with Percutaneous Rigottomy in Repaired Unilateral Cleft Lip: Three-Dimensional Morphometric- and Panel Assessment-Based Outcome Study
Authors: Denadai Rafael , Tangco Ivy , Valentine Maria , Wallace Christopher Glenn , Hsiao Yen-Chang , Huang Jung-Ju , Chang Frank Chun-Shin , Lo Lun-Jou , Chen Jyh-Ping , Chen Yu-Ray 
Published: April 2023

Summary:
Improving the philtrum morphology of patients with a secondary cleft lip deformity has been a challenge in cleft care. Combining fat grafting with percutaneous rigottomy has been advocated for treatment of volumetric deficiency associated with a scarred recipient site. This study assessed the outcome of synchronous fat grafting and rigottomy for improvement of cleft philtrum morphology. Consecutive young adult patients (n=13) with a repaired unilateral cleft lip who underwent fat grafting combined with rigottomy expansion technique for enhancement of philtrum morphology were included. Preoperative and postoperative three-dimensional facial models were used for 3D morphometric analyses including philtrum height, projection, and volume parameters. Lip scar was qualitatively judged by a panel composed by two blinded external plastic surgeons using a 10-point visual analogue scale. 3D morphometric analysis revealed a significant (all p<0.05) postoperative increase of the lip height-related measurements for cleft philtrum height, noncleft philtrum height, and central lip length parameters, with no difference (p>0.05) between cleft and noncleft sides. The postoperative 3D projection of the philtral ridges was significantly (p<0.001) larger in cleft (1.01±0.43 mm) than noncleft sides (0.51±0.42 mm). The average philtrum volume change was 1.01±0.68 cm3, with an average percentage fat graft retention of 43.36±11.35 percent. The panel assessment revealed significant (p<0.001) postoperative scar enhancement for qualitative rating scale, with mean preoperative and postoperative scores of 6.69±0.93 and 7.88±1.14, respectively. Synchronous fat grafting and rigottomy improved philtrum length, projection, and volume and lip scar in patients with repaired unilateral cleft lip.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
“Autologous Cranioplasty Using a Dental SafeScraper Device.”
Authors: Ng Jinggang J. , Blum Jessica D. , Cheung Liana , Cho Daniel Y. , Romeo Dominic J. , Kalmar Christopher L. , Villavisanis Dillan F. , Bartlett Scott P. , Taylor Jesse A. , Swanson Jordan W. 
Published: April 2023

Summary
Conventional methods to reconstruct cortical bone defects introduced by pediatric cranial vault remodeling (CVR) procedures have shortcomings. Use of bone burr shavings as graft material leads to variable ossification and harvesting split-thickness cortical grafts is time-intensive and often not possible in thin infant calvaria. Since 2013, our team has used the Geistlich SafeScraper (Baden-Baden, Germany), originally developed as a dental instrument, to harvest cortical and cancellous bone grafts during CVR. We assessed the effectiveness of this technique by analyzing postoperative ossification using computed tomography (CT) scans among 52 patients, comparing cohorts treated with the SafeScraper versus those who received conventional methods of cranioplasty during fronto-orbital advancement (FOA). The SafeScraper cohort had a greater reduction in total surface area of all defects (-83.1 ± 14.9 versus -68.9 ± 29.8%, p = 0.034), demonstrating a greater and more consistent degree of cranial defect ossification compared to conventional methods of cranioplasty, suggesting potential adaptability of this tool. This is the first study that describes the technique and efficacy of the SafeScraper in reducing cranial defects in CVR.
A self-help virtual therapeutic experience intervention for overcoming psychological distress related to the COVID-19 pandemic: Results from the European multicentric COVID Feel Good trial
Authors: Riva Giuseppe , Di Lernia Daniele , Tuena Cosimo , Bernardelli Luca , Gutiérrez Maldonado Jose , Ferrer-Garcia Marta , Porras-Garcia Bruno , Meyer Marie , Shiban Youssef , Castelnuovo Gianluca , Pagnini Francesco , Pedroli Elisa , Sforza Francesca , Clementi Alex , Sansoni Maria , Wiederhold Brenda K. , Serino Silvia 
Published: April 2023

Abstract

Objective
The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries.

Methods
We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (Study 1- N = 40; Study 2: N = 29; Study 3: N = 38). The randomized controlled trial (Study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness.

Results
Using separate linear mixed-effect models, the most consistent result across countries was a reduction in perceived stress following the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effect meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress [mean standardized effect size for general distress in the treatment groups compared to the control conditions was -0.52 (p = 0.008, 95% CI: -0.89, -0.14)] and an increase in the perceived social connection [mean standardized effect size for social connection using COVID Feel Good compared to the control conditions was 0.50 (p = < 0.001, 95% CI: 0.25, 0.76)].

Conclusion
Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.

Trial registration: ISRCTN63887521
Racial Differences in Mental Stress-Induced Transient Endothelial Dysfunction and Its Association with Cardiovascular Outcomes
Authors: Okoh Alexis K. , Young An , Garcia Mariana , Sullivan Samaah , Almuwaqqat Zakaria , Hu Yingtian , Liu Chang , Moazzami Kasra , Uphoff Irina , Lima Bruno B. , Ko Yi-An , Elon Lisa , Jajeh Nour , Rout Pratik , Gupta Shishir , Shah Amit J. , Bremner J. Douglas , Lewis Tene , Quyyumi Arshed , Vaccarino Viola 
Published: April 2023

ABSTRACT

OBJECTIVES
To investigate differences in transient endothelial dysfunction (TED) with mental stress in Black and non-Black individuals with coronary heart disease (CHD), and their potential impact on cardiovascular outcomes.

METHODS
We examined 812 patients with stable CHD between June 2011 and March 2016 and followed through February 2020 at a University-affiliated hospital network. Flow mediated vasodilation (FMD) was assessed before and 30 minutes after mental stress. TED was defined as a lower post-stress FMD than pre-stress FMD. We compared pre-stress FMD, post-stress FMD, and TED between Black and non-Black participants. In both groups, we examined the association of TED with an adjudicated composite end point of cardiovascular death or nonfatal myocardial infarction (First and recurring events) after adjusting for demographic, clinical, and socioeconomic factors.

RESULTS
Pre-stress FMD was lower in Black than non-Black participants: 3.7 (2.8) vs. 4.9 (3.8), p < 0.001, and significantly declined with mental stress in both groups. TED occurred more often in Black (76%) than non-Black patients (67%); multivariable-adjusted odds ratio, 1.6, 95% CI, 1.5-1.7. Over a median (interquartile range) follow-up period of 75 (65-82) months, 142 (18%) patients experienced either cardiovascular death or nonfatal myocardial infarction. Black participants had a 41.9% higher risk of the study outcome than non-Black participants (95% CI, 1.01-1.95). TED with mental stress explained 69% of this excess risk.

CONCLUSIONS
Among CHD patients, Black individuals are more likely than non-Black individuals to develop endothelial dysfunction with mental stress, which in turn explains a substantial portion of their excess risk of adverse events.
Direct and Indirect Effects of Race and Socioeconomic Deprivation on Outcomes After Lower Extremity Bypass
Authors: Powell Chloé A. , Albright Jeremy , Culver Jacob , Osborne Nicholas H. , Corriere Matthew A. , Sukul Devraj , Gurm Hitinder , Henke Peter K. 
Published: April 2023

Objective:
To evaluate the potential pathway, through which race and socioeconomic status, as measured by the social deprivation index (SDI), affect outcomes after lower extremity bypass chronic limb-threatening ischemia (CLTI), a marker for delayed presentation.

Background:
Racial and socioeconomic disparities persist in outcomes after lower extremity bypass; however, limited studies have evaluated the role of disease severity as a mediator to potentially explain these outcomes using clinical registry data.

Methods:
We captured patients who underwent lower extremity bypass using a statewide quality registry from 2015 to 2021. We used mediation analysis to assess the direct effects of race and high values of SDI (fifth quintile) on our outcome measures: 30-day major adverse cardiac event defined by new myocardial infarction, transient ischemic attack/stroke, or death, and 30-day and 1-year surgical site infection (SSI), amputation and bypass graft occlusion.

Results:
A total of 7077 patients underwent a lower extremity bypass procedure. Black patients had a higher prevalence of CLTI (80.63% vs 66.37%, P < 0.001). In mediation analysis, there were significant indirect effects where Black patients were more likely to present with CLTI, and thus had increased odds of 30-day amputation [odds ratio (OR): 1.11, 95% CI: 1.068–1.153], 1-year amputation (OR: 1.083, 95% CI: 1.045–1.123) and SSI (OR: 1.052, 95% CI: 1.016–1.089). There were significant indirect effects where patients in the fifth quintile for SDI were more likely to present with CLTI and thus had increased odds of 30-day amputation (OR: 1.065, 95% CI: 1.034–1.098) and SSI (OR: 1.026, 95% CI: 1.006–1.046), and 1-year amputation (OR: 1.068, 95% CI: 1.036–1.101) and SSI (OR: 1.026, 95% CI: 1.006–1.046).

Conclusions:
Black patients and socioeconomically disadvantaged patients tended to present with a more advanced disease, CLTI, which in mediation analysis was associated with increased odds of amputation and other complications after lower extremity bypass compared with White patients and those that were not socioeconomically disadvantaged.
The Goal of Intraoperative Blood Loss in Major Hepatobiliary Resection for Perihilar Cholangiocarcinoma
Authors: Kawakatsu Shoji , Mizuno Takashi , Yamaguchi Junpei , Watanabe Nobuyuki , Onoe Shunsuke , Sunagawa Masaki , Baba Taisuke , Igami Tsuyoshi , Yokoyama Yukihiro , Imaizumi Takahiro , Ebata Tomoki 
Published: April 2023

Objective:
To determine the goal of intraoperative blood loss in hepatectomy for perihilar cholangiocarcinoma.

Background:
Although massive bleeding can negatively affect the postoperative course, the target value of intraoperative bleeding to reduce its adverse impact is unknown.

Methods:
Patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2010 and 2019 were included. Intraoperative blood loss was adjusted for body weight [adjusted blood loss (aBL)], and the overall postoperative complications were evaluated by the comprehensive complication index (CCI). The impact of aBL on CCI was assessed by the restricted cubic spline regression.

Results:
A total of 425 patients were included. The median aBL was 17.8 (interquartile range, 11.8–26.3) mL/kg, and the CCI was 40.6 (33.7–49.5). Sixty-three (14.8%) patients had an aBL<10 mL/kg, nearly half (45.4%) of the patients were in the range of 10 ≤aBL<20 mL/kg, and 37 (8.7%) patients had an aBL >40 mL/kg. The spline regression analysis showed a nonlinear incremental association between aBL and CCI; CCI remained flat with an aBL under 10 mL/kg; increased significantly with an aBL ranging from 10 to 20 mL/kg; grew gradually with an aBL over 20 mL/kg. These inflection points of ~10 and 20 mL/kg were almost consistent with the cutoff values identified by the recursive partitioning technique. After adjusting for other risk factors for the postoperative course, the spline regression identified a similar model.

Conclusions:
aBL had a nonlinear aggravating effect on CCI after hepatectomy for perihilar cholangiocarcinoma. The primary goal of aBL should be <10 mL/kg to minimize CCI.
Discordance Between Conventional and Detailed Lymph Node Analysis in Resected, Node-negative Pancreatic or Ampullary Adenocarcinomas and Association With Adverse Survival Outcomes
Authors: Elshami Mohamedraed , Ammoun Alwalid K. , Mneimneh Wadad S. , Stitzel Henry J. , Hue Jonathan J. , Wu Victoria S. , Kyasaram Ravi K. , Shanahan John , Musonza Tashinga , Ammori John B. , Hardacre Jeffrey M. , Winter Jordan M. , ElHag Mohamed , Ocuin Lee M. 
Published: April 2023

Objective:
To assess the frequency of occult metastases (OM) in patients with resected pancreatic ductal adenocarcinoma (PDAC) or ampullary adenocarcinoma (AA) discovered on detailed pathologic examination on lymph nodes (LNs) previously considered negative by conventional analysis and to examine the association between OM and overall survival (OS).

Background:
Poor prognosis of patients with no pathologic evidence of LN metastases may be due to OM that is not detected on conventional LN analysis.

Methods:
Patients with LN-negative resected PDAC or AA (2010–2020) were identified from our institutional database. Original hematoxylin and eosin (H and E) slides were reanalyzed. In addition, selected LN were analyzed by H and E (3 sections/LN) and pan-cytokeratin (AE1-AE3/PCK26) immunohistochemistry.

Results:
A total of 598 LNs from 74 LN-negative patients were reexamined. Nineteen patients (25.7%) had OM; 9 (47.4%) were found with immunohistochemistry but not on H and E. The number of positive LNs ranged from 1 to 3. No clinicodemographic, pathologic, or treatment-related factors were associated with OM. On conventional LN analysis, 3/19 patients (15.8%) had stage IA, 9/34 (26.5%) had stage IB, and 7/19 (36.8%) had stage IIA. On detailed LN analysis, 11/19 patients (57.9%) were upstaged to IIB, whereas 8/19 (42.1%) had isolated tumor cells only (N0i+). OM was associated with shorter OS (median OS: 22.3 vs 50.5 months; hazard ratio=3.95, 95% CI: 1.58–9.86).

Conclusions:
There is a 26% discordance rate between conventional and detailed LN pathologic analysis in resected PDAC and AA. The presence of OM is associated with shorter OS.
Macroperiodic Oscillations: A Potential Novel Biomarker of Outcome in Neonatal Encephalopathy
Authors: Keene Jennifer C. , Loe Maren E. , Fulton Talie , Keene Maire , Mathur Amit , Morrissey Michael J. , Tomko Stuart R. , Vesoulis Zachary A. , Zempel John M. , Ching ShiNung , Guerriero Réjean M. 
Published: April 2023

Purpose:
Neonatal encephalopathy (NE) is a common cause of neurodevelopmental morbidity. Tools to accurately predict outcomes after therapeutic hypothermia remain limited. We evaluated a novel EEG biomarker, macroperiodic oscillations (MOs), to predict neurodevelopmental outcomes.

Methods:
We conducted a secondary analysis of a randomized controlled trial of neonates with moderate-to-severe NE who underwent standardized clinical examination, magnetic resonance (MR) scoring, video EEG, and neurodevelopmental assessment with Bayley III evaluation at 18 to 24 months. A non-NE cohort of neonates was also assessed for the presence of MOs. The relationship between clinical examination, MR score, MOs, and neurodevelopmental assessment was analyzed.

Results:
The study included 37 neonates with 24 of whom survived and underwent neurodevelopmental assessment (70%). The strength of MOs correlated with severity of clinical encephalopathy. MO strength and spread significantly correlated with Bayley III cognitive percentile (P = 0.017 and 0.046). MO strength outperformed MR score in predicting a combined adverse outcome of death or disability (P = 0.019, sensitivity 100%, specificity 77% vs. P = 0.079, sensitivity 100%, specificity 59%).

Conclusions:
MOs are an EEG-derived, quantitative biomarker of neurodevelopmental outcome that outperformed a comprehensive validated MRI injury score and a detailed systematic discharge examination in this small cohort. Future work is needed to validate MOs in a larger cohort and elucidate the underlying pathophysiology of MOs.