bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atopic dermatitis and ocular allergy: common mechanisms and uncommon questions
Authors: Ghosh Debajyoti , Mersha Tesfaye B. 
Published: August 2023

Purpose of review
Atopic dermatitis (AD) and ocular allergy aka allergic eye disease (AED) are two common conditions that often coexist in patients. However, molecular connections between these two conditions are incompletely understood. While common etiologic components including Th2 immune signaling have been suggested for AD and AED, the mechanism how current Th2-targetd therapies (dupilumab, tralokinumab) for AD can augment conjunctivitis is not well understood.

Recent findings
Differentially regulated genes and pathways relevant for AD disease manifestation are known. In contrast, similar information is not yet available for AED, which could be largely addressed by emerging noninvasive ocular sampling techniques. Emerging evidence indicated a reduction in goblet cell number and mucin production in a subpopulation of AD patients with AD leading to adverse ocular outcomes, while other potential mechanisms could also be involved. Involvement of particular barrier function protein(s) in AED needs further investigation.

Summary
Modern cytokine-targeted therapies for AD showed elevated risk for developing conjunctivitis. Recently developed noninvasive sampling techniques should be leveraged to identify AD endotypes associated with AED and with dupilumab-associated ocular outcomes.
Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty
Authors: Fenton Joshua J. , Fang Shao-You , Ray Monika , Kennedy John , Padilla Katrine , Amundson Russell , Elton David , Haldeman Scott , Lisi Anthony J. , Sico Jason , Wayne Peter M. , Romano Patrick S. 
Published: August 2023

Study Design:
Retrospective cohort study.

Objective:
To compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

Summary of Background Data:
Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.

Methods:
De-identified administrative claims and electronic health record data were derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States. Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

Results:
The cohort included 770,326 patients with new-onset neck pain visits. The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%). Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty. Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty. While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists. Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.

Conclusion:
Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up.

Level of Evidence:
3.
Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique
Authors: Umar Sanusi , Khanna Raveena , Lohlun Boudin , Maldonado Juan Carlos , Zollinger Maria , Osei-Tutu Achiamah , Gonzales Alejandro , Chouhan Kavish , Nusbaum Aron 
Published: August 2023

BACKGROUND
Follicular unit excision is a favored minimally invasive hair transplantation method. However, it is suboptimal for many patients of African descent because of wide variations in hair and skin characteristics.

OBJECTIVE
To evaluate the performance of a skin-responsive follicular unit excision device, which accommodates hair curliness, skin thickness, and firmness in patients of African descent.

MATERIALS AND METHODS
The authors retrospectively evaluated patients who underwent scalp follicular unit (FU) excision using a skin-responsive technique at 7 multinational clinics. The preoperative donor grading for the anticipated difficulty used a scale with Class V indicating the highest degree of hair curliness, skin thickness, and firmness.

RESULTS
Of 64 eligible patients (45 males and 19 females), 28 had Class V FU excision donor grades. The mean transection rate for all patients was 3%–6%, which was highest in class V patients. Skin thickness and firmness had a greater effect on the maximum transection rate than hair curliness. Only 19 or 18 G punches were used.

CONCLUSION
The authors report consistence success of a new skin-responsive FU excision device for all patients of African descent with a mean graft transection rate of less than 10%. The findings support skin thickness and firmness as major influencers of graft attrition rate.
The Discovery of Radiocesium-bearing Microparticles Directly Delivered to a Person in Tokyo as a Result of the Fukushima Daiichi Nuclear Disaster
Authors: Higaki Shogo 
Published: August 2023

Abstract
The plume from Fukushima Dai-ichi Nuclear Power Plant (FDNPP) Unit 2, which reached the Tokyo metropolitan area on 15 March 2011 immediately after the FDNPP disaster, contained insoluble radiocesium-bearing microparticles (CsMPs). This study aimed to reanalyze a mask worn during the disaster to determine the ratio of CsMPs to radiocesium that directly arrived in the Tokyo metropolitan area as a plume immediately after the disaster. CsMPs were isolated from the non-woven masks worn at the Hongo Campus of the University of Tokyo from 15–16 March 2011 that trapped radioactive material from the accident. Twenty-two CsMPs with diameters in the range of 1.9–3.6 μm were found in the mask worn outdoors by one person. The CsMP radioactive ratio to overall radiocesium content of the mask was 9.9%. The CsMPs were collected more efficiently by the mask than by a suspended particulate matter filter. A face mask might trap CsMPs in a plume more efficiently than a suspended particulate matter filter. Determining the amount of CsMPs led to a reassessment of the internal dose by CsMPs that were inhaled by the public immediately after the FDNPP accident.
Alternative career paths for ophthalmologists
Authors: Callaway Natalia F. , Cunningham Emmett T. 
Published: August 2023

Purpose
Traditionally, ophthalmologists complete training and then choose a clinical care setting. The skills required to become an ophthalmologist can be applied to a variety of alternative career paths within and beyond healthcare. Not unexpectedly, therefore, there is a growing trend for ophthalmologists to explore alternative career paths in both healthcare and the life science industry more broadly. In this invited editorial, we summarize the more commonly considered ‘alternative career paths,’ and provide personal perspectives that have helped us and others when weighing such options.

Recent findings
Prior to pursuing an alternative career path, it is important to reflect on one's motivations and goals. A number of alternative careers paths are available, and the choice of when and what to pursue is both personal and personalizable. While it can be difficult to know a priori whether and to what extent a given path will be both enjoyable and rewarding, insights and advice from those who have walked that path before you can be invaluable. We review the more common paths of administrative leadership, entrepreneurship and innovation, product development, healthcare policy, nonprofit organizations, and investing, noting that these are just examples of the many options currently available.

Summary
Ophthalmologists should feel empowered to design a career that is both purposeful and personally meaningful, as this will result ultimately in the greatest happiness and fulfillment. There is a world of opportunity available to those who are willing to explore and create their own path.
Anatomical resection improve relapse-free survival in colorectal liver metastases patients with KRAS/NRAS/BRAF mutation or right-sided colon cancer: a retrospective cohort study
Authors: Chang Wenju , Chen Yijiao , Zhou Shizhao , Ren Li , Xu Yuqiu , Zhu Dexiang , Tang Wentao , Ye Qinghai , Wang Xiaoying , Fan Jia , Wei Ye , Xu Jianmin 
Published: August 2023

Background:
The type of liver resection (anatomical resection, AR or nonanatomical resection, NAR) for colorectal liver metastases (CRLM) is subject to debate. The debate may persist because some prognostic factors, associated with aggressive tumor biological behavior, have been overlooked.

Objective:
Our study aimed to investigate the characteristics of patients who would benefit more from anatomical resection for CRLM.

Methods:
729 patients who underwent hepatic resection of CRLM were retrospectively collected from June 2012 and May 2019. Treatment effects between AR and NAR were compared in full subgroup analyses. Tumor relapse-free survival (RFS) was evaluated by a stratified log-rank test and summarized with the use of Kaplan-Meier and Cox proportional hazards methods.

Results:
Among 729 patients, 235 (32.2%) underwent AR and 494 (67.8%) underwent NAR, we showed the favorable trends in RFS for AR compared with NAR in the patients with KRAS/NRAS/BRAF mutation (interaction P <0.001) or right-sidedness (interaction P <0.05). Patients who underwent AR had a markedly improved RFS compared with NAR, in the cohorts of RAS/NRAS/BRAF mutation (median RFS 23.2 VS 11.1 months, P <0.001) or right-sidedness (median RFS 31.6 VS 11.5 months, P <0.001); upon the multivariable analyses, AR (gene mutation: hazard ratio [HR] =0.506, 95% CI = 0.371-0.690, P <0.001; right-sidedness: HR =0.426, 95% CI =0.261-0.695, P =0.001) remained prognostic independently. In contrast, patients who underwent AR had a similar RFS compared with those who underwent NAR, in the cohorts of patients with gene wild-type tumors (median RFS 20.5 VS 21.6 months, P =0.333). or left-sidedness (median RFS 15.8 VS 19.5 months, P =0.294).

Conclusions:
CRLM patients with gene mutation or right-sidedness can benefit more from AR rather than from NAR.
Perioperative ketamine administration to prevent delirium and neurocognitive disorders after surgery: a systematic review and meta-analysis
Authors: Souad Fellous , Dubost Baptiste , Cambriel Amélie , Bonnet Marie-Pierre , Verdonk Franck 
Published: August 2023

Background:
Surgery induces high rates of cognitive disorders, persisting for up to 12 months in elderly adults. This review aimed to assess the currently debated preventive effect of perioperative ketamine on postoperative delirium and postoperative neurocognitive disorders (POND).

Materials and Methods:
Systematic review and meta-analysis including all RCTs investigating the effects of perioperative ketamine administration in adult patients compared to placebo or no intervention on postoperative delirium and/or POND between January 2007 and April 2022. Database searches were conducted in PubMed Medline, Embase, Scopus, Central. Random effects models were used to pool overall estimates. The GRADE approach was used to assess the quality of evidence.

Results:
From 1379 records screened, 14 RCTs with 1618 patients randomized met our inclusion criteria with a high level of consensus among reviewers, amongst whom 50% were at low-moderate risk of bias. There was no between-group difference in postoperative delirium (8 trials, 1265 patients, OR 0.93, 95%CI [0.51; 1.70], I2=28%) and POND (5 trials, 494 patients, OR 0.52, 95%CI [0.15; 1.80]; I2=78%). There was no significant between-group difference in postoperative psychological adverse effects, level of pain, hospital length of stay, or mortality. Between-group subgroup analyses showed no difference in delirium or POND incidence according to surgical setting, ketamine dose, mode of administration, combination or not with other drug(s), and assessment timing or definition of cognitive disorders.

Conclusion:
Perioperative ketamine does not prevent postoperative delirium or POND. Significant study heterogeneity suggests that standardized measures for POND assessment and a specific focus on patients at high-risk for POND should be used to improve the comparability of future studies.
Identification and initial validation of maximal tumor area as a novel prognostic factor for overall and disease-free survival in patients with resectable colon cancer: a retrospective study
Authors: Ning Fei-Long , Gu Wan-Jie , Dai Lin-Zheng , Du Wan-Ying , Zeng Yong-Ji , Zhang Jia-Kui , Abe Masanobu , Liu Yan-Long , Zhang Rui , Zhang Chun-Dong 
Published: August 2023

Background:
Tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer.

Methods:
This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between TNM staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P<0.05 was considered statistically significant.

Results:
A total of 3,051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P<0.001; iAUC for DFS, 0.694, P<0.001) showed a better prognostic discrimination than the TNM staging system (T stage + N stage; iAUC for OS, 0.664; iAUC for DFS, 0.658). Similar results were observed in an independent validation cohort.

Conclusions:
Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.
Aspirin and lipoprotein(a) in primary prevention
Authors: Bhatia Harpreet S. 
Published: August 2023

Purpose of review
Lipoprotein(a) [Lp(a)] is casually associated with cardiovascular diseases, and elevated levels are highly prevalent. However, there is a lack of available therapies to address Lp(a)-mediated risk. Though aspirin has progressively fallen out of favor for primary prevention, individuals with high Lp(a) may represent a high-risk group that derives a net benefit.

Recent findings
Aspirin has been demonstrated to have a clear benefit in secondary prevention of cardiovascular disease, but recent primary prevention trials have at best demonstrated a small benefit. However, individuals with elevated Lp(a) may be of high risk enough to benefit, particularly given interactions between Lp(a) and the fibrinolytic system / platelets, and the lack of available targeted medical therapies. In secondary analyses of the Women's Health Study (WHS) and the Aspirin in Reducing Events in the Elderly (ASPREE) trial, aspirin use was associated with a significant reduction in cardiovascular events in carriers of genetic polymorphisms associated with elevated Lp(a) levels. Further studies are needed, however, as these studies focused on narrower subsets of the overall population and genetic markers.

Summary
Individuals with elevated Lp(a) may benefit from aspirin therapy in primary prevention, but further study with plasma Lp(a) levels, broader populations, and randomization of aspirin are needed.
Evaluation of Intestinal Microbiota in Children With Sickle Cell Disease
Authors: Karahan Feryal , Yilmaz Serap Süzük , Bayrakdar Fatma , Tezol Özlem , Kuyucu Necdet , Kiliç Selçuk , Türkegün Merve , Ünal Selma 
Published: August 2023

Background and Aims:
Sickle cell disease (SCD) is a chronic hemolytic anemia that may be life-threatening due to multisystemic effects. Identification of the factors which affect the pathophysiology of the disease is important in reducing mortality and morbidity. This study aimed to determine gut microbial diversity in children and adolescents with SCA compared with healthy volunteers and to evaluate the clinical impact of microbiota.

Materials and Methods:
The study included 34 children and young adolescents with SCD and 41 healthy volunteer participants. The microbiome was assessed by 16S rRNA sequencing in stool samples. Laboratory parameters of all participants, such as complete blood count and C-reactive protein values and clinical characteristics of SCD patients, were determined and compared, as well as clinical conditions of the patients, such as vascular occlusive crisis and/or acute chest syndrome, frequency of transfusions, intake of penicillin, hydroxyurea, and chelation therapy were recorded.

Results:
White blood cell count, hemoglobin, immature granulocyte and C-reactive protein levels were significantly higher in the patient group (P<0.05). Microbiota analysis revealed 3 different clusters among subjects; controls and 2 clusters in the SCD patients (patient G1 and G2 groups). Bacteroides spp. were more prevalent, while Dialester spp. and Prevotella spp. were less prevalent in SCD compared with controls (t=2.142, P<0.05). Patient G2 (n=9) had a higher prevalence of Bacteroides and a lower prevalence of Prevotella than patient G1 (n=25).

Conclusion:
In our study, there was a difference between SCD patients and the control group, while 2 different microbiota profiles were encountered in SCD patients. This difference between the microbiota of the patients was not found to affect the clinical picture (such as vascular occlusive crisis, acute chest syndrome).
National Association of Medical Examiners Position Paper
Authors: Utley Suzanne , Arunkumar Ponni , Das Tara , Fierro Marcella F. , Fudenberg John , Harding Brett E. , Hoffmann Bryan A. , Keyes Kelly A. , Lewis Adele , Maloney Katherine , O'Neal Bobbi Jo , Pinneri Kathryn , Rapkiewicz Amy , Sathyavagiswaran Lakshmanan , Weedn Victor , Williams Tiffany 
Published: August 2023

Abstract
Collecting and reporting accurate disaster mortality data are critical to informing disaster response and recovery efforts. The National Association of Medical Examiners convened an ad hoc committee to provide recommendations for the documentation and certification of disaster-related deaths. This article provides definitions for disasters and direct, indirect, and partially attributable disaster-related deaths; discusses jurisdiction for disaster-related deaths; offers recommendations for medical examiners/coroners (ME/Cs) for indicating the involvement of the disaster on the death certificate; discusses the role of the ME/C and non-ME/C in documenting and certifying disaster-related deaths; identifies existing systems for helping to identify the role of disaster on the death certificate; and describes disaster-related deaths that may require amendments of death certificates. The recommendations provided in this article seek to increase ME/C's understanding of disaster-related deaths and promote uniformity in how to document these deaths on the death certificate.
Neonatal complicated intraabdominal infection
Authors: Rauh Jessica L. , Lehane Alison J. , Sieren Leah M. , Neff Lucas P. 
Published: August 2023

Purpose of review
The purpose of this review is to summarize the treatment of complicated intraabdominal infections (cIAIs) in premature infants.

Recent findings
Recent work has continued to define the complex nature of cIAIs and necrotizing enterocolitis (NEC). This includes new findings on the microbiome, breast milk and risk factors associated with NEC. The treatment of cIAIs employs a combination of both surgical and medical treatment. Further look at what type and timing of surgical intervention is used as well as the ideal antibiotic regimen. Upcoming research is highlighted in future directions of NEC treatment.

Summary
cIAIs in premature infants is a challenging disease with more research needed to further delineate the pathophysiology and treatment options.
A Prospective Cohort Analysis of the Prevalence and Predictive Factors of Delayed Discharge After Laparoscopic Cholecystectomy in Italy: The DeDiLaCo Study
Authors: Cillara Nicola , Podda Mauro , Cicalò Enrico , Sotgiu Giovanni , Provenzano Maria , Fransvea Pietro , Poillucci Gaetano , Sechi Raffaele ,   the DeDiLaCo Study Collaborative Group
Published: August 2023

Background:
The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge >24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC.

Methods:
This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units.

Results:
A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged >24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge >24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (>24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class (P<0.0001), Charlson’s Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P<0.0001), operative time >60 min (P<0.0001), drain placement (P<0.0001), pain (P=0.001), postoperative vomiting (P=0.001) and complications (P<0.0001) were independent predictors of delayed discharge >24 hours.

Conclusions:
The majority of delayed discharges >24 hours after LC in our study were unrelated to the surgery itself. ASA class >II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge.