bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infection Control With Topical Antimicrobial Prophylaxis for Mucosal Head and Neck Surgery: A Meta‐analysis
Authors: Lee Jake J. , Chibueze Stanley , Walia Amit , Yaeger Lauren H. , Zenga Joseph , Puram Sidharth V. , Jackson Ryan S. , Pipkorn Patrik 
Published: May 2022

AbstractObjectiveTo assess for differences in surgical site infection (SSI) rates and bacterial load after major mucosal head and neck surgery between patients who received topical antimicrobial prophylaxis and those who did not.Data SourcesOvid Medline, Embase, SCOPUS, Cochrane Library, and ClinicalTrials.gov from inception to May 20, 2021, with cross‐referencing of retrieved studies per PRISMA guidelines.Review MethodsInclusion criteria captured clinical trials, cohort studies, and case‐control studies with infectious outcomes of adults who underwent major mucosal head and neck surgery and received perioperative topical antimicrobial therapy to the oral cavity and/or pharynx. Studies of dental procedures were excluded. The primary outcome was SSI rate, and the secondary outcome was bacterial load. Two blinded investigators screened each text.ResultsOf 265 unique citations, 9 studies of 470 total patients were included. Topical treatments included numerous antibiotics and antiseptics directly applied over mucosa. Pooled SSI rates of 252 patients in the intervention cohort and 218 in the control cohort were 8% (95% CI, 3%‐14%; I
2 = 61.2%) and 29% (95% CI, 16%‐43%; I
2 = 79.5%), respectively. A meta‐analysis of 7 comparative studies totaling 192 patients receiving topical therapy and 218 control patients revealed a pooled relative risk of 0.44 (95% CI, 0.28‐0.68; I
2 = 0.0%) in favor of the treatment group. The studies demonstrated a short‐term decrease in bacterial counts after topical antimicrobial prophylaxis.ConclusionPatients who underwent prophylactic topical antimicrobial therapy had less than half the risk of developing SSI after mucosal head and neck surgery when compared with those who received no topical prophylaxis.
Lam Qua and Peter Parker: Portraiture of Head and Neck Surgery in 19th‐Century China
Authors: Tam Kenric , Kwan Jamie A. 
Published: May 2022

AbstractIn 1835, Peter Parker, an American surgeon and Presbyterian minister, established a hospital in Guangzhou and became the first Western head and neck surgeon in China. While Parker documented his most interesting cases in his journals, he also commissioned oil paintings of these patients from Lam Qua (), a prominent Chinese artist trained in British academic painting. Lam Qua produced 86 portraits of Dr Parker's patients, providing insight into not only the treatment of head and neck tumors but also the introduction of Western artistic techniques to 19th‐century China. Parker's pioneering surgical accomplishments and Lam Qua's portraits document the role of art and medicine in America's cultural influence in Asia.
Life-threatening altered mental status secondary to memantine in an adolescent undergoing cranial radiotherapy for medulloblastoma
Authors: Kim Kristine N , Shah Yash B , Croy Colleen , Lustig Robert A , LaRiviere Michael , Kotch Chelsea 
Published: May 2022

Introduction Memantine is used for neurocognitive protection in patients undergoing cranial radiotherapy for central nervous system tumors and is reported to be well-tolerated. Case report Presented is a case of memantine-induced altered mental status requiring an intensive care unit admission. An 18-year-old male with relapsed, progressive medulloblastoma presented with severe altered mental status shortly after the first fraction of palliative whole brain radiotherapy. At the time, the patient was on day five of memantine therapy, which had been prescribed to reduce neurocognitive toxicity risk. Management & outcome Memantine was withheld while dexamethasone, valproate, and morphine were continued for headache. Approximately 50 h after admission, the patient's confusion significantly improved. Evaluation of acute altered mental status was unrevealing, including but not limited to negative urinary toxicology screen and lack of disease progression on imaging. Whole brain radiotherapy was resumed after a two-day cessation and he was discharged home after four days with complete resolution of symptoms. Discussion Clinicians should be aware of and consider the risk of altered mental status with memantine, given the increased utilization and upcoming clinical trials in pediatric patients.
Injuries associated with hypotension after trauma: Is it always haemorrhage?
Authors: Eichinger Michael , Schreiber Martin A , Cole Elaine , Aylwin Christopher 
Published: May 2022

Introduction Restricted fluid replacement strategy is one part of damage control resuscitation for patients with trauma haemorrhage. However, not all patients presenting with physiological symptoms suggestive of haemorrhage are bleeding. This descriptive study aims to compare demographics and injuries in adult and older trauma patients presenting to the Emergency Department with hypotension versus normotension. Methods This was a retrospective, descriptive data analysis from a UK trauma registry. The records from one major trauma centre were analysed between 2014–2019, and every hypotensive (systolic blood pressure <90 mmHg) trauma patient investigated for injuries associated with hypotension. The hypotensive threshold for older patients was also adjusted to 110 mmHg for sub-cohort analysis. Results 6245 trauma patients were included, of which 255 (4.1%) arrived hypotensive at the Emergency Department. Significant blood loss was identified in 32.2% of those cases. In 27.1%, multiple potential associations obscured the underlying mechanism for the hypotension but were more commonly associated with hypotension than with normotension. Over a third (37.5%) were ≥65 years old. Neurological injuries occurred more frequently in both older hypotensive groups than younger patients. Conclusions This study sought to compare injuries of adult and older trauma patients to aid trauma teams with decision making. In severely injured hypotensive patients, significant blood loss was the principal association with hypotension. However, several factors can mimic bleeding in the hypotensive trauma patient, which should be carefully considered. A prospective study is needed to clarify the characteristics and causes of bleeding mimics.
Prenatal diagnosis of diphallia in association with bladder exstrophy: a case report
Authors: Vafaei Homeira , Roozmeh Shohreh , Bahador Ali , Khafri Maryam Zare , Ghiasi Mozhde 
Published: May 2022

Abstract
Background
Penile duplication or diphallia is a rare congenital anomaly with unclear pathophysiological cause. Most cases of diphallia are reported postnatally; however, today with the use of a high-resolution ultrasound device, in-uterine diagnosis of many congenital anomalies is possible.

Case presentation
Herein we report a multiparous mother at 25 weeks of gestation who referred due to an abnormal cystic structure protruding from a large abdominal wall defect located below the umbilicus that was noted during a routine exam. Target scan revealed two penile-like protrusions with an empty scrotal sac and double bladder in an otherwise normal fetus, which was confirmed postnatally. Neonatal microarray study and karyotype were normal.

Conclusion
Diphallia could be detected prenatally as an isolated anomaly, associated with caudal duplication syndrome, or as an exstrophy-epispadias complex. As this is a rare congenital anomaly, all sonographers should be familiar with prenatal ultrasound features and associated anomalies, an important issue in prenatal counseling with parents, delivery planning, psychological support of the family, and postnatal management.
Aerobic vaginitis in the third trimester and its impact on pregnancy outcomes
Authors: Nguyen Anh Thi Chau , Le Nguyen Na Thi , Hoang Thu Thi Anh , Nguyen Tuyen Thi , Tran Trang Thi Quynh , Tran Dan Nu Tam , Nguyen Anh Thi Kim , Tran Linh Manh , Nguyen Duc Huu Chau , Le Tam Minh , Ho Binh Duy , Rööp Tiiu , Kõljalg Siiri , Štšepetova Jelena , Van Le An , Salumets Andres , Mändar Reet 
Published: May 2022

Abstract
Background
Aerobic vaginitis (AV) is a vaginal inflammation characterized by disruption of the lactobacillus microbiota and increased counts of different aerobic bacteria. AV may result in severe complications, especially during pregnancy, including preterm delivery, neonatal and maternal infections. This study aimed to determine the prevalence of AV in the third trimester of pregnancy, and the relationship between AV and pregnancy outcomes.

Methods
A cross-sectional descriptive study included 323 pregnant women attending for routine antenatal care in the Hue University Hospital. Vaginal samples collected at the third trimester of pregnancy were evaluated for AV according to the scoring system of Donders and cultured for identification of predominant bacteria. Pregnancy was followed to its end, and pregnancy outcomes were recorded for both mothers and infants.

Results
The proportion of pregnant women diagnosed with AV in the third trimester was found to be 15.5%, with the vast majority of the cases (84%) displaying the light AV and 16% the moderate AV. The vaginal cultures in the women with AV revealed most frequently Streptococcus agalactiae (6%), followed by Enterococcus spp (4%), Staphylococcus aureus (4%), and Acinetobacter baumannii (2%). In addition, AV during the last trimester of pregnancy was associated with an increased risk of puerperal sepsis (OR 8.65, 95% CI: 1.41—53.16, p = 0.020) and there was a slightly increased risk for neonatal infections, which was statistically insignificant.

Conclusions
The proportion of AV is relatively high in Vietnamese pregnant women. Since it is associated with an increased risk of puerperal sepsis, it needs to be diagnosed and treated before delivery.
Extended lower paratracheal lymph node resection during esophagectomy for cancer – safety and necessity
Authors: Mann C. , Berlth F. , Hadzijusufovic E. , Tagkalos E. , Uzun E. , Codony C. , Lang H. , Grimminger P. P. 
Published: May 2022

Abstract
Background
The ideal extent of lymphadenectomy (LAD) in esophageal oncological surgery is debated. There is no evidence for improved survival after standardized paratracheal lymph node resection performing oncological esophagectomy. Lymph nodes from the lower paratracheal station are not standardly resected during 2-field Ivor-Lewis esophagectomy for esophageal cancer. The objective of this study was to evaluate the impact of lower paratracheal lymph node (LPL) resection on perioperative outcome during esophagectomy for cancer and analyze its relevance.

Methods
Retrospectively, we identified 200 consecutive patients operated in our center for esophageal cancer from January 2017 – December 2019. Patients with and without lower paratracheal LAD were compared regarding demographic data, tumor characteristics, operative details, postoperative complications, tumor recurrence and overall survival.

Results
103 out of 200 patients received lower paratracheal lymph node resection. On average, five lymph nodes were resected in the paratracheal region and cancer infiltration was found in two patients. Those two patients suffered from neuroendocrine carcinoma and melanoma respectively. Cases with lower paratracheal lymph node yield had significantly less overall complicated procedures (p = 0.026). Regarding overall survival and recurrence rate no significant difference could be detected between both groups (p = 0.168 and 0.371 respectively).

Conclusion
The resection of lower paratracheal lymph nodes during esophagectomy remains debatable for distal squamous cell carcinoma or adenocarcinoma of the esophagus. Tumor infiltration was only found in rare cancer entities. Since resection can be performed safely, we recommend LPL resection on demand.
Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer
Authors: Luo Yuanyuan , Lai Qianlin , Huang Hong , Luo Jiahui , Miao Jingxia , Liao Rongrong , Yang Zhihui , Zhang Lili 
Published: May 2022

Abstract
Background
Suicidal ideation in cancer patients is a critical challenge. At present, few studies focus on factors associated with suicidal ideation, and predictive models are still lacking. This study aimed at investigating the risk factors for suicidal ideation among cancer patients, and developed a predictive nomogram to screen high risk cancer patients for early prevention and intervention.

Methods
A questionnaire survey was conducted among cancer patients between May 2021 and January 2022. The factors associated with suicidal ideation were used to construct a multivariate logistic regression model, which was visualized as a predictive nomogram to evaluate the risk of suicidal ideation. Areas under the curve, calibration plot, decision curve analysis, and internal and external validation were used to validate the discrimination, calibration and clinical usefulness of the model.

Results
A total of 820 patients with cancer were recruited for this study and 213 (25.98%) developed suicidal ideation. Levels of demoralization, depression and cancer staging, marital status, residence, medical financial burden, and living condition were influence factors for suicidal ideation. Comparing nomogram with Self-rating Idea of Suicide Scale (SIOSS), the nomogram had a satisfactory discrimination ability with an AUC of 0.859 (95% CI: 0.827–0.890) and 0.818 (95% CI: 0.764–0.873) in the training and validation sets, respectively. The calibration plot and decision curve analysis revealed that this nomogram was in good fitness and could be beneficial in clinical applications.

Conclusions
Suicidal ideation is common in cancer patients. Levels of demoralization, depression and cancer staging were independent predictors of suicidal ideation. The nomogram is an effective and simple tool for predictive suicidal ideation in cancer patients.
Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data
Authors: Desai Mehul J. , Bentley Anthony , Keck William A. 
Published: May 2022

Abstract
Background
Effective symptom control in painful knee osteoarthritis (OA) may improve patient quality of life. In a randomised crossover trial (NCT03381248), COOLIEF* cooled radiofrequency ablation (CRFA) reduced pain and stiffness and improved physical function and quality of life compared with intra-articular hyaluronan (HA) injections. The present study aimed to establish the cost effectiveness of CRFA versus intra-articular HA injections for treating moderate-to-severe OA knee pain from a US Medicare perspective.

Methods
We conducted a cost-effectiveness analysis using utility data (EQ-5D) from the randomised crossover trial of CRFA versus intra-articular HA injections, which had follow-ups at 1, 3, 6, and 12 months. Patients in the HA group with unsatisfactory outcomes (e.g., continued pain) at 6 months could cross over to CRFA. Economic analysis outcomes included quality-adjusted life-years (QALYs), costs, and cost effectiveness (cost per QALY gained). Base-case analyses were modelled on a 6-month time horizon (to trial crossover). Due to limited trial data in the HA arm beyond 6 months, scenarios explored potential outcomes to 12 months if: 1) Utility with HA persisted for a further 6 months; 2) A second HA injection was received at 6 months and achieved the same utility change for the second 6 months. In both scenarios, the CRFA arm used trial data for patients who received CRFA from baseline to 12 months. Alternative costing scenarios were also explored.

Results
CRFA resulted in an incremental QALY gain of 0.020 at an incremental cost of US$1707, equating to an incremental cost-effectiveness ratio (ICER) of US$84,392 per QALY over 6 months, versus intra-articular HA injections. Extending the analysis to 12 months and assuming persistence in utility in the HA arm resulted in a larger utility gain for CRFA (0.056 QALYs) and a lower ICER of US$30,275 per QALY. If patients received a second HA injection, the incremental benefit of CRFA out to 12 months was reduced (QALY gain 0.043) but was offset by the costs of the second HA injection (incremental cost US$832). This resulted in an ICER of US$19,316 per QALY.

Conclusions
CRFA is a cost-effective treatment option for patients with OA-related knee pain considering the typical US threshold of US$100,000/QALY.
Physical activity and sperm quality: influence in sperm donors
Authors: Matorras Roberto , Navarro Alfredo , Ramos Dagoberto , Malaina Iker , Irazusta Jon , Vendrell Alberto , Fernandez Amaia , Ferrando Marcos , Quintana Fernando 
Published: May 2022

Abstract
Purpose
To ascertain whether physical activity (PA) is associated with better sperm quality in sperm donors.

Methods
A prospective case–control study was designed in an IVF center setting. A total of 207 sperm donation candidates from a relatively small geographical area were included in the study with no intervention.
Donor candidates were subjected to conventional sperm analysis according to WHO criteria. Moreover, they answered a standardized questionnaire regarding their last week PA (IPAQ), with PA expressed in metabolic equivalents (METs)-min/week. Donors were classified into 4 groups: low, moderate, high and very high PA. Specific sports were included in the questionnaire. Semen samples from 43 accepted donors were used in artificial insemination by donor (AID) and IVF. The fertilization rates (FR) and pregnancy rates (PR) were studied.

Results
Semen volume, sperm concentration, progressive spermatozoa, non-progressive spermatozoa, total motile progressive spermatozoa and sperm morphology were similar in the four PA groups. No correlation between various semen parameters studied and METs was found. Running or cycling > 1 h/week did not influence sperm parameters. The AID PR was similar in the different PA groups. However, in IVF the mean donor FR was significantly higher in the high PA group and in the very high PA group.

Conclusions
No detrimental effect was associated with PA, or even very high PA, regarding conventional sperm parameters. Moreover, a better FR was associated with high and very high PA in IVF cycles, which merits more studies.
A method for the determination of ZnDDP in lubricant oils by applying solid-phase extraction with mixed resin
Authors: Shin Kyong-Sik , Kim Eun-Yong , Lee Shin-Jong , Lee Da-Seul , Paeng Ki-Jung 
Published: May 2022

AbstractOne of the major applications of zinc dialkyldithiophosphates (ZnDDPs) is their usage as an anti-wear additive in lubricants including greases, hydraulic oils, and motor oils. ZnDDPs also could be used as corrosion inhibitors and antioxidants. In this study, GC/MS with solid-phase extraction (SPE) pretreatment was used to effectively remove base oils in lubricants and qualitative and quantitative analysis method for ZnDDPs in automotive lubricants. As a pretreatment method, liquid–liquid extraction (LLE) and SPE were applied. The SPE method using mixed absorbent containing 1.0% of active carbon in silica gel base showed the best results in both recovery and reproducibility. The LOD and LOQ of the developed method were 2.2 µg/ml and 6.7 µg/ml, respectively. And this method showed very good reproducibility of less than 0.1% RSD for the standard sample analysis. The developed method was successively applied to qualitative and quantitative analyses of ZnDDP in various real automotive lubricant samples.
Flow-controlled ventilation in moderate acute respiratory distress syndrome due to COVID-19: an open-label repeated-measures controlled trial
Authors: Van Dessel Eleni D. , De Meyer Gregory R. , Morrison Stuart G. , Jorens Philippe G. , Schepens Tom 
Published: May 2022

Abstract
Background
Flow-controlled ventilation (FCV), a novel mode of mechanical ventilation characterised by constant flow during active expiration, may result in more efficient alveolar gas exchange, better lung recruitment and might be useful in limiting ventilator-induced lung injury. However, data regarding FCV in mechanically ventilated patients with acute lung injury or acute respiratory distress syndrome (ARDS) are scarce.

Objectives
We hypothesised that the use of FCV is feasible and would improve oxygenation in moderate COVID-19 ARDS compared to conventional ventilation.

Design
Open-label repeated-measures controlled trial.

Setting
From February to April 2021, patients with moderate COVID-19 ARDS were recruited in a tertiary referral intensive care unit.

Patients
Patients with moderate ARDS (PaO2/FIO2 ratio 100–200 mmHg, SpO2 88–94% and PaO2 60–80 mmHg) were considered eligible. Exclusion criteria were: extremes of age (< 18 years, > 80 years), obesity (body mass index > 40 kg/m2), prone positioning at the time of intervention, mechanical ventilation for more than 10 days and extracorporeal membrane oxygenation. Eleven patients were recruited.

Intervention
Participants were ventilated in FCV mode for 30 min, and subsequently in volume-control mode (VCV) for 30 min.

Main outcome measures
Feasibility of FCV to maintain oxygenation was assessed by the PaO2/FiO2 ratio (mmHg) as a primary outcome parameter. Secondary outcomes included ventilator parameters, PaCO2 and haemodynamic data. All adverse events were recorded.

Results
FCV was feasible in all patients and no adverse events were observed. There was no difference in the PaO2/FIO2 ratio after 30 min of ventilation in FCV mode (169 mmHg) compared to 30 min of ventilation in VCV mode subsequently (168 mmHg, 95% CI of pseudo-medians (− 10.5, 3.6), p = 0.56). The tidal volumes (p < 0.01) and minute ventilation were lower during FCV (p = 0.01) while PaCO2 was similar at the end of the 30-min ventilation periods (p = 0.31). Mean arterial pressure during FCV was comparable to baseline.

Conclusions
Thirty minutes of FCV in patients with moderate COVID-19 ARDS receiving neuromuscular blocking agents resulted in similar oxygenation, compared to VCV. FCV was feasible and did not result in adverse events.
Trial registration: Clinicaltrials.gov identifier: NCT04894214.
A case requiring re-thoracotomy due to a significant reduction of tidal volume after commencement of chest tube drainage under pressure control ventilation following lower lobectomy
Authors: Shiraishi Taichi , Obara Shinju , Hakozaki Takahiro , Isosu Tsuyoshi , Inoue Satoki 
Published: May 2022

Abstract
Background
The use of pressure-controlled ventilation (PCV) during one lung ventilation (OLV) has been popular to avoid high airway pressure. We experienced a case of a significant reduction of tidal volume (TV) after commencement of chest tube drainage under PCV following lower lobectomy, which required re-thoracotomy to evaluate the degree of air leak.

Case presentation
A 70-year-old man was scheduled for a lower lobectomy. OLV was managed by PCV. The driving pressure was set at 15–20 cmH2O with 4 cmH2O of positive end-expiratory pressure (PEEP). A chest drainage tube was placed after completion of lobectomy. To switch OLV to two lung ventilation (TLV), PCV settings were changed to the driving pressure at 10 cmH2O with 4 cmH2O of PEEP, which generated 450 ml of TV. Immediately after applying drainage (−10 cmH2O), TV decreased down to 250 ml. To maintain 450 ml of TV, PCV was switched to volume-controlled ventilation with 450 ml of TV, which raised the plateau pressure close to 24 cmH2O. Re-thoracotomy was done; however, significant findings were not detected.

Conclusions
We experienced a case of a significant reduction of TV immediately after chest tube drainage following lower lobectomy. Probably, negative intrapleural pressure increased the residual volume, which might have significantly affected the limited lung volume after lobectomy, resulting in decreasing TV during PCV.