bluuebunny/crossref_metadata_2025_split huggingface dataset:
Silencing Pulsatile Tinnitus: A Novel Technique of Periosteal Flap Obliteration for Sigmoid Sinus Diverticulum Variants
Authors: Chua Celeste Ann , Han Jae Sang , Kim Yeonji , Seo Jae-Hyun , Park Shi Nae 
Published: February 2023

Objective
Review of a sigmoid sinus diverticuli (SSDi) variants surgically managed with a novel technique using an inferior periosteal flap.

Study Design
Case series.

Setting
Tertiary referral center.

Patients
Patients presenting with pulsatile tinnitus to a tertiary referral center between January 1, 2015, and June 31, 2021, who were diagnosed with SSDi variants on CT temporal bone and who received surgical management for these SSDi variants.

Intervention(s)
Obliteration of SSDi variants using a novel technique with an inferiorly based periosteal flap.

Main Outcome Measure(s)
Pure-tone audiometry, Tinnitus Handicap Inventory score, and visual analogue scale score for tinnitus severity (loudness, awareness, annoyance, and effect on life).

Results
Include statistical measures as appropriate.

Conclusions
We would like to propose the use of an inferiorly based periosteal flap as an option for obliteration and concomitant hemostasis of more sizeable or complex (e.g., bifid) SSDi. Further study of this technique with a long-term follow-up will be needed to evaluate its long-term safety and efficacy.
Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses
Authors: Klein Linor , Handzel Ophir , Shilo Shahaf , Oron Yahav , Abu Eta Rani , Muhanna Nidal , Ungar Omer J. 
Published: February 2023

Objectives
To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome.

Methods
A systematic literature search of “MEDLINE” via “PubMed,” “Embase,” and “Web of Science” and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days.

Results
The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25–0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26–0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I2 = 52.1%). The OR was 0.31 (95% CI, 0.21–0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I2 = 0.0%).

Conclusion
Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome.

Level of Evidence
Level I.
A new risk factor for predicting stroke in patients with atrial fibrillation: morning blood pressure surge
Authors: Gorcan Ayberk , Argan Onur , Avci Eyup , Kiris Tuncay , Safak Ozgen , Yildirim Seda Tarik , Yildirim Elcim , Lutfi Kisacik Halil , Kadi Hasan 
Published: February 2023

Background
Stroke, the most feared complication in patients with atrial fibrillation (AF), is still an important cause of mortality and morbidity. In our study, we aimed to investigate the frequency of stroke and related parameters in patients with atrial fibrillation, for whom 24-h ambulatory blood pressure monitoring (ABPM) was performed.

Method:
A total of 282 patients with permanent AF were included in this study. 24-h ABPM was performed in all patients. Morning blood pressure surge (MBPS) was defined as the difference between the mean SBP in the first 2 h after awakening and the lowest blood pressure (BP) at night. We evaluated parameters associated with stroke in patients with atrial fibrillation using univariate and multivariate Cox regression analysis.

Result
Patients were followed for 19 ± 9.3 months and 22 ischemic strokes were detected during the follow-up period. Also, strokes were significantly lower in atrial fibrillation patients with a dipper BP pattern, whereas strokes were significantly higher in atrial fibrillation patients with a reverse-dipper BP pattern. In multivariate analysis, a history of hypertension (P = 0.020), BP pattern (P < 0.001) and MBPS (P < 0.001) were found to be significantly related to stroke. MBPS levels >32.5 mmHg predicted stroke with a sensitivity of 77% and a specificity of 60% (AUC, 0.741; 95% CI, 0.647–0.834; P < 0.001).

Conclusion
MBPS, BP pattern and presence of hypertension as an independent risk factor in predicting stroke in patients with atrial fibrillation. The reduction of the MBPS may be a new therapeutic target for preventing stroke.
Healthcare Disparities Among Homeless Patients Hospitalized With Gastrointestinal Bleeding
Authors: Subramanian Kavitha , Alayo Quazim A. , Sedarous Mary , Nwaiwu Obioma , Okafor Philip N. 
Published: February 2023

Goals:
Examine outcomes among homeless patients admitted with gastrointestinal (GI) bleeding, including all-cause mortality and endoscopic intervention rates.

Background:
Hospitalizations among homeless individuals have increased steadily since at least 2007 but little is known about GI outcomes in these patients.

Study:
The 2010-2014 Healthcare Utilization Project (HCUP) State Inpatient Databases from New York and Florida were used to identify adults admitted with a primary diagnosis of acute upper or lower GI bleed. Homeless patients were 1:3 matched with nonhomeless patients using a propensity-score greedy-matched algorithm. The primary outcome (all-cause in-hospital mortality) and secondary outcomes (30-day readmission rates, endoscopy utilization, length of stay, and total hospitalization costs) were compared.

Results:
We matched 4074 homeless patients with 12,222 nonhomeless patients. Most hospitalizations for homeless individuals were concentrated in 113 (26.4%) of 428 hospitals. Homeless adults were more likely to be younger, male, African American or Hispanic, and on Medicaid. They experienced significantly higher odds of all-cause inpatient mortality compared with nonhomeless patients admitted with GI bleeding (OR 1.37, 95% CI 1.11-1.69). Endoscopy utilization rates were also lower for both upper (OR 0.62, 95% CI 0.55-0.71) and lower (OR 0.76, 95% CI 0.68-0.85) GI bleeding, though upper endoscopy rates within the first 24 hours were comparable (OR 1.11, 95% CI 1.00-1.23). Total hospitalization costs were lower ($9,715 vs. $12,173, P<0.001) while 30-day all-cause readmission rates were significantly higher in the homeless group (14.9% vs. 18.4%, P<0.001).

Conclusions:
Homeless patients hospitalized for GI bleeding face disparities, including higher mortality rates and lower endoscopy utilization.
The Overlap Subgroup of Functional Dyspepsia Exhibits More Severely Impaired Gastric and Autonomic Functions
Authors: Cheng Jiafei , Guo Jie , Xu Luzhou , Shi Zhaohong , Xu Feng , Xu Yuemei , Yan Guangjun , Li Jie , Yang Yi , Duan Zhijun , Yang Jie , Yin Lu , Liu Dengke , Wei Wei , Wang Meifeng , Bu Xiaoling , Sha Weihong , Lv Litao , Wang Jiaxiu , Huang Yan , Feng Qiaoqun , Li Xueliang , Gong Shan , Mao Hua , Jin DanDan , Lin Lin , Chen Jiande D. Z. 
Published: February 2023

Goals:
A combination of multiple tests was introduced to noninvasively investigate the differences in pathophysiologies among functional dyspepsia (FD) subgroups, including postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and overlap.

Background:
It has not been extensively evaluated whether different pathophysiologies are involved in FD subgroups.

Study:
This multicenter study included 364 FD patients fulfilling Rome IV criteria and 47 healthy controls. A combined noninvasive gastric and autonomic function test was performed: The electrogastrogram and electrocardiogram were recorded simultaneously in the fasting state and after a drink test. Symptoms after drinking were recorded using visual analog scale.

Results:
(1) Compared with HC, FD patients showed a decreased maximum tolerable volume (MTV) (P<0.01) and percentage of normal gastric slow waves [normal gastric slow waves (%NSW)] (P<0.01), and increased postdrinking symptoms, anxiety (P<0.01), and depression (P<0.01). The drink reduced %NSW in both FD patients and HC; however, the effect was more potent in patients. (2) The PDS and overlap groups displayed a reduced MTV (P<0.05). The overlap group exhibited a higher symptom score at 30 minutes after drinking, and higher anxiety and depression scores, and a higher sympathovagal ratio than the EPS (P<0.05 for all) and PDS (P<0.01 for all). (3) In the PDS subgroup, the MTV, postprandial sympathovagal ratio, and depression were associated with the overall dyspepsia symptom scale (DSS, P=0.034, 0.021, 0.043, respectively). No significant associations were found in the other 2 subgroups.

Conclusions:
The combination of multiple tests can detect pathophysiological abnormities in FD patients. Overall, patients with overlap symptoms display more severe pathophysiologies.
Adverse Events of Endoscopic Clip Placement
Authors: Ramai Daryl , Deliwala Smit S. , Mozell Daniel , Facciorusso Antonio , Chandan Saurabh , Persaud Alana , Singh Kelita , Anderloni Andrea , Barakat Monique T. 
Published: February 2023

Background:
Clips are endoscopic mechanical devices with tensile and closure strength that can approximate tissue and provide hemostasis through a tamponade effect. Clips are ubiquitously used in endoscopic practice, and numerous studies have validated the clinical efficacy of clips, with recent guidelines recommending them as a first-line intervention for recurrent and persistent nonvariceal gastrointestinal bleeding. However, the safety profile for these devices has yet to be delineated, thus, we aim to investigate this feature by examining the adverse events reported to the Food and Drug Administration.

Methods:
Postmarketing surveillance data from the Food and Drug Administration Manufacturer And User Facility Device Experience database were analyzed from January 2012 to January 2021. The Manufacturer And User Facility Device Experience database is a reporting software and does not independently verify the details of complications.

Results:
Two thousand five hundred forty reports were issued, of which 287 were patient adverse events and 2766 were device problems. Activation, separation, and positioning issues were most common. No consequences or clinically significant impact on patients were seen in 1968 reports. Foreign bodies were seen in 97 cases, hemorrhage in 57 cases, tissue damage in 42 cases, embedded clips in tissues/plaques in 16 cases, perforation in 15 cases, lacerations in 6 cases, and infection in 3 cases.

Conclusions:
While the most commonly reported device problems involved activation, separation, and positioning, most patients were clinically unaffected. Moreover, perforation and infection were exceedingly rare, further highlighting the safety profile of endoscopic clips.
Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness
Authors: Gressies Carla , Schuetz Philipp 
Published: February 2023

Purpose of review
ICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation.

Recent findings
While feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex – suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently.

Summary
Adequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.
Dysregulated amino acid metabolism in heart failure: role of gut microbiome
Authors: Tang W.H. Wilson 
Published: February 2023

Purpose of review
The importance of amino acid metabolism in heart failure has often been overlooked, especially in advanced stages. Metabolism of dietary compounds by gut microbiota generates a wide range of metabolites that can directly or indirectly modulate end-organ functions in their hosts. Herein, we describe recently discovered mechanistic links between various gut microbial metabolic pathways of amino acids and their derivatives in the pathophysiology of heart failure.

Recent findings
Growing evidence points to incremental prognostic value in amino acid profiling in patients with heart failure. Reducing branched-chain amino acid levels in the failing heart may have a cardioprotective role. Gut microbiome-related amino acid, including amino acid supplementation, dietary interventions, or microbial enzyme inhibition, can be targeted to modify cardiovascular risks.

Summary
Interplay between the gut microbiome and amino acid metabolism may contribute to disease progression in heart failure. Further investigations are warranted to uncover opportunities for intervention.
Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA
Authors: Kucharska-Newton Anna M. , Halladay Jacquie R. , Psioda Matthew A. , Jones Sara B. , Johnson Anna M. , Coleman Sylvia W. , Cummings Doyle M. , Freburger Janet K. , Daras Laurie C. , Rosamond Wayne D. , Duncan Pamela W. , Bushnell Cheryl D. 
Published: February 2023

Background and Objectives:
We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States.

Methods:
Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol.

Results:
Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR=1.27 (95% CI: 1.14–1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR=1.87 (95% CI: 1.54–2.27)].

Discussion:
The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers.
Long-term Outcomes of a 1-year Hypertension Quality Improvement Initiative in a Large Health System
Authors: Pfoh Elizabeth R. , Dalton Jarrod , Jones Robert , Rothberg Michael B. 
Published: February 2023

Background:
Understanding whether practices retain outcomes attained during a quality improvement (QI) initiative can inform resource allocation.

Objective:
We report blood pressure (BP) control and medication intensification in the 3 years after a 2016 QI initiative ended.

Research Design:
Retrospective cohort

Subjects:
Adults with a diagnosis of hypertension who had a primary care visit in a large-integrated health system between 2015 and 2019

Measures:
We report BP control (<140/90 mm Hg) at the last reading of each year. We used a multilevel regression to identify the adjusted propensity to receive medication intensification among patients with an elevated BP in the first half of the year. To examine variation, we identified the average predicted probability of control for each practice. Finally, we grouped practices by the proportion of their patients whose BP was controlled in 2016: lowest performing (<75%), middle (≥75%–<85%), and highest performing (≥85%).

Results:
The dataset contained 184,981 patients. From 2015 to 2019, the percentage of patients in control increased from 74% to 82%. In 2015, 38% of patients with elevated BP received medication intensification. This increased to 44% in 2016 and 50% in 2019. Practices varied in average BP control (from 62% to 91% in 2016 and 68% to 90% in 2019). All but one practice had a substantial increase from 2015 to 2016. Most maintained the gains through 2019. Higher-performing practices were more likely to intensify medications than lower-performing practices.

Conclusions:
Most practices maintained gains 3 years after the QI program ended. Low-performing practices should be the focus of QI programs.
Novel immune directed therapies in myelodysplastic syndromes and acute myeloid leukemia
Authors: Brunner Andrew M. 
Published: February 2023

Purpose of review
Therapies that target the immune system are increasingly used across oncology, including in hematologic malignancies such as myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). While allogeneic transplant has been a key therapy in these cancers, new approaches that target the immune system are being explored including immune checkpoint therapies, antibody−drug conjugates, and cellular therapies.

Recent findings
This review outlines updates in the preclinical rationale for immune directed therapies in MDS and AML, as well as recent clinical trials exploring these therapies. This manuscript summarizes the development of therapies targeting T cell immunoglobulin and mucin domain-containing protein 3 (TIM-3) and CD47, which are being evaluated in late phase studies in MDS and AML. It also reviews the landscape of other immune based therapies including antibody-drug conjugates, chimeric antigen receptor-T cells, bispecific antibodies, and tumor vaccines.

Summary
The treatment landscape in MDS and AML is rapidly changing; with a goal of improving the quality and duration of responses, a number of immune based therapies are under investigation. This review outlines recent advances with these therapies as well as some of the challenges that remain to incorporate them into leukemia care.
Systematic Review of Antimicrobial Lock Solutions for Prevention of Bacteremia in Pediatric Patients With Intestinal Failure
Authors: Gibson Bridget , McNiven Claire , Sebastianski Meghan , Vandermeer Ben , Persad Rabin , Robinson Joan L. 
Published: February 2023

Objectives:The goal of this systematic review was to determine whether antimicrobial lock (AML) solutions prevent catheter-related bloodstream infections (CRBSI) in children with intestinal failure (IF).Methods:Electronic databases were searched: Ovid MEDLINE (1946–), Ovid Embase (1974–), Wiley Cochrane Library (inception–), and Web of Science Core Collection via Clarivate Analytics (1900–). Randomized and nonrandomized trials, case or cohort studies that studied any AML solution, and used comparator groups were included if they studied children with IF. A meta-analysis compared the rates of CRBSI with AML solutions versus controls, and a Boucher analysis was used to indirectly compare AML solutions.Results:Twenty-eight studies met eligibility criteria (1 open label and 27 observational studies). Quality was good (N = 13), fair (N = 9), and poor (N = 6). All but 4 studied ethanol and taurolidine. Of 15 ethanol studies, 11 reported a decrease and 3 reported a trend toward a decreased incidence of CRBSI compared to controls; 1 reported no difference. Of 9 taurolidine studies, 7 reported a decrease and 2 a trend toward decreased CRBSI rates. There was a decrease in CRBSI with ethanol versus control (P= 0.008) and with taurolidine-citrate versus control (P< 0.0005). Using Bucher indirect comparison of the pooled estimates from ethanol versus control to taurolidine versus control, the estimated difference was −0.99 (−4.125, 2.27;P= 0.55).Conclusions:There were no randomized trials and over half of the 28 included studies were fair or poor quality. All but 1 reported at least a trend toward reduction in CRBSI. AML solutions appear to prevent CRBSI.
Perioperative and Long-Term Outcome in Patients Treated for Jejunoileal Atresia
Authors: Røkkum Henrik , Johannessen Hanna , Bjørnland Kristin 
Published: February 2023

Objectives:
Jejunoileal atresia is a common cause of neonatal intestinal obstruction. Results of long-term outcome are very limited. The aim of this study was to describe perioperative and postoperative outcome, and to evaluate long-term gastrointestinal quality of life (QoL) in patients treated for jejunoileal atresia.

Methods:
We conducted a combined retrospective and cross-sectional observational study of patients treated for jejunoileal atresia during 2001–2019. Perioperative data were registered, and complications were classified according to the Clavien-Dindo classification. To evaluate long-term clinical status and QoL, the PedsQL Gastrointestinal Symptoms Scales questionnaire and a self-designed questionnaire were used. Approval from the Data Protection Office was obtained.

Results:
Seventy patients were included in the retrospective part of the study. Of these, 70% got a primary anastomosis. Concomitant anomalies were registered in 46%. Median length of stay was 28 (5–140) days. Early (<28 days) complication rate was 66%. Early abdominal surgical reinterventions were performed in 11%, most frequently due to anastomotic leak. Late (>28 days) abdominal surgical reinterventions were performed in 21%, and most commonly for bowel obstruction. Overall mortality rate was 4%. Thirty-two patients with median 8 (2–19) years returned the questionnaires. Overall gastrointestinal QoL was good. However, concomitant gastrointestinal anomalies were associated with impaired outcome. Embarrassment of the scar was reported in 38%. Three (9%) patients used medication (laxatives, proton pump inhibitor) for gastrointestinal symptoms.

Conclusions:
Jejunoileal atresia is associated with significant morbidity during initial treatment. Despite this, the majority of the patients have excellent long-term outcomes.