bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Post-Operative Spine Infection Bacterial Gram Type Affect Surgical Debridement or Antibiotic Duration?
Authors: Karamian Brian A. , Lambrechts Mark J. , Sirch Francis , Gupta Sachin , D’Antonio Nicholas D. , Levy Hannah , Reiter David , Dolhse Nico , Khan Mahir , Mao Jennifer , Canseco Jose A. , Woods Barrett I. , Kaye I. David , Hilibrand Alan , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: July 2022

Study Design.
Retrospective cohort study

Objective.
To evaluate differences in readmission rates, number of debridements, and length of antibiotic therapy when comparing bacterial gram type following lumbar spinal fusion infections.

Summary of Background Data.
Surgical site infections (SSIs) after spinal fusion serve as a significant source of patient morbidity. It remains to be elucidated how bacterial classification of the infecting organism affects the management of postoperative spinal SSI.

Methods.
Patients who underwent spinal fusion with a subsequent diagnosis of SSI between 2013-2019 were retrospectively identified. Patients were grouped based on bacterial infection type (gram-positive, gram-negative, or mixed infections). Poisson’s regressions analyzed the relationship between the type of bacterial infection and the number of incision and debridement (I&D) reoperations, and the duration of IV antibiotic therapy. Significance was set at P<0.05

Results.
Of 190 patients, 92 had gram-positive (G+) infections, 57 had gram-negative (G-) infections, and 33 had mixed (M) infections. There was no difference in 30- or 90-day readmissions for infection between groups (both P=0.051). Patients in the M group had longer durations of IV antibiotic treatment (G+: 46.4 vs G-: 41.0 vs M: 55.9 d, P=0.002). Regression analysis demonstrated mixed infections were 46% more likely to require a greater number of debridements (P=0.001) and 18% more likely to require an increased duration of IV antibiotic therapy (P<0.001), while gram-negative infections were 10% less likely to require an increased duration of IV antibiotic therapy (P<0.001) when compared to G- infections.

Conclusion.
Spinal SSI due to a mixed bacterial gram type results in an increased number of debridements and a longer duration of IV antibiotics required to resolve the infection compared to gram-negative or gram-positive infections.

Level of Evidence.
3
Development and Validation of the Medical Emergency Team-Risk Prediction Model for Clinical Deterioration in Acute Hospital Patients, at Time of an Emergency Admission*
Authors: Allen Joshua , Currey Judy , Jones Daryl , Considine Julie , Orellana Liliana 
Published: July 2022

OBJECTIVES:
To develop and validate a prediction model to estimate the risk of Medical Emergency Team (MET) review, within 48 hours of an emergency admission, using information routinely available at the time of hospital admission.

DESIGN:
Development and validation of a multivariable risk model using prospectively collected data. Transparent Reporting of a multivariable model for Individual Prognosis Or Diagnosis recommendations were followed to develop and report the prediction model.

SETTING:
A 560-bed teaching hospital, with a 22-bed ICU and 24-hour Emergency Department in Melbourne, Australia.

PATIENTS:
A total of 45,170 emergency admissions of 30,064 adult patients (≥18 yr), with an inpatient length of stay greater than 24 hours, admitted under acute medical or surgical hospital services between 2015 and 2017.

MEASUREMENTS AND MAIN RESULTS:
The outcome was MET review within 48 hours of emergency admission. Thirty candidate variables were selected from a routinely collected hospital dataset based on their availability to clinicians at the time of admission. The final model included nine variables: age; comorbid alcohol-related behavioral diagnosis; history of heart failure, chronic obstructive pulmonary disease (COPD), or renal disease; admitted from residential care; Charlson Comorbidity Index score 1 or 2, or 3+; at least one planned and one emergency admission in the last year; and admission diagnosis and one interaction (past history of COPD × admission diagnosis). The discrimination of the model was comparable in the training (C-statistics 0.82; 95% CI, 0.81–0.83) and the validation set (0.81; 0.80–0.83). Calibration was reasonable for training and validation sets.

CONCLUSIONS:
Using only nine predictor variables available to clinicians at the time of admission, the MET-risk model can predict the risk of MET review during the first 48 hours of an emergency admission. Model utility in improving patient outcomes requires further investigation.
An elevated platelet-to-lymphocyte ratio is associated with a higher risk of intracranial atherosclerotic stenosis
Authors: Huang Yanhua , Wang Zuoteng , Zhao Bing , Ma Yahui , Ou Yanan , Hu Hao , Hou Xiaohe , Yu Jintai , Tan Lan 
Published: July 2022

Abstract

Background:
Previous studies have shown that inflammation plays an important role in intracranial atherosclerotic stenosis (ICAS). The platelet-to-lymphocyte ratio (PLR) has recently emerged as a potential inflammatory biomarker. This study aimed to explore the association of the PLR with ICAS in a Chinese Han population.

Methods:
A total of 2134 participants (518 with ICAS, 1616 without ICAS) were enrolled in this study. ICAS was defined as atherosclerotic stenosis >50% or the occlusion of several main intracranial arteries. Multivariable logistic regression analyses were used to assess the association of the PLR with ICAS. Additional subgroup analyses were performed according to age (<60 vs. ≥60 years) and acute ischemic stroke.

Results:
Multivariate regression analysis showed that a high PLR was associated with a higher risk of ICAS in all participants (P < 0.001). Compared with the lowest quartile, the fourth PLR quartile was significantly associated with ICAS (OR 1.705, 95% confidence interval 1.278–2.275, P < 0.001). In the subgroups stratified by age, an association between the PLR and ICAS was found in the late-life group (P < 0.001), but not in the mid-life group (P = 0.650). In the subgroups stratified by acute ischemic stroke, the relationship between an elevated PLR and a higher risk of ICAS remained unchanged (stroke group, P < 0.001; non-stroke group, P = 0.027).

Conclusions:
An elevated PLR was associated with a higher risk of ICAS in a Chinese Han population. The PLR might serve as a potential biomarker for ICAS in the elderly population.
Robotic Surgery for the Ileal Pouch
Authors: Lynch A. Craig 
Published: July 2022

BACKGROUND:
A robotic approach to total colectomy/proctectomy and ileal pouch reconstruction would seem to be a sensible use of the platform’s enhanced reach, visualization, and dexterity.

OBJECTIVE:
The study aimed to discuss current published data for robotic ileal pouch surgery.

STUDY SELECTION:
The study selection included a paucity of published data to date, representing early learning curves and case series with small numbers.

CONCLUSIONS:
Current robotic platforms may offer advantages, particularly in the low pelvis beyond what is found with a laparoscopic approach.
Complicated Facial Fillers: Management Algorithm
Authors: Ghareeb Fouad Mohamed , Hassan Medhat Sami Ali , El Nahas Mohamed Abdalla , Salem Mahmoud Sadek el Sayed 
Published: July 2022

Background:
Various materials have been developed as skin fillers to correct wrinkles of the face. Dermal fillers are classified based on their biodegradability into bioresorbable versus nonbioresorbable. All dermal fillers have a potential risk of complications, which can be classified as early and late onset events. Among all the complications of filler injections, inflammatory nodules and granulomas are the most annoying and disfiguring. The purpose of the study was to provide a surgical treatment algorithm that allows us to deal with the complications of facial fillers through three surgical techniques.

Methods:
Thirty-one patients with complaints of facial contour abnormalities after filler injection, three surgical techniques were adopted according to the presenting case including face lift incision, needle aspiration and intraoral excision after preoperative preparation of the case with postoperative follow-up for 6 months.

Results:
Among our studied patients treated by these surgical techniques, dissection was difficult owing to the fibrosis and the granulomatous reaction post complicated filler injection. There were two cases of hematoma, 1 case of seroma, and 1 case of facial nerve injury that improved after 4 months, in which marked improvement of facial contour and skin quality was observed.

Conclusions:
The use of the facelift technique as a surgical treatment for post filler complication granuloma excision provides a useful and satisfactory method for patients complaining of major facial deformities following repeated complicated filler injections. Despite being more difficult than other techniques it is more satisfactory in facial rejuvenation post complicated facial fillers.
Refractive shifts due to belantamab mafodotin–associated corneal toxicity
Authors: Mittal Aman , Garg Sumit (Sam) 
Published: July 2022

Introduction:
This report describes a case of belantamab mafodotin–associated corneal toxicity. The patient presented with refractive changes, which has not been previously reported with this condition.

Patient and Clinical Findings:
A 58-year-old man with refractory multiple myeloma and myopia presented for screening before the initiation of belantamab mafodotin (belamaf or Blenrep, an antibody-drug conjugate [ADC] with known corneal toxicity). After 1 infusion, he returned complaining of loss of uncorrected near vision and was found to have bilateral keratopathy with microcyst-like epithelial changes (MECs) in the midperipheral cornea.

Diagnosis, Intervention, and Outcomes:
A hyperopic refractive error was seen with manifest refraction, and central flattening was seen on corneal topography. The patient was diagnosed with corneal epithelial toxicity secondary to belamaf. The medication was discontinued, and the MECs migrated centrally causing a refractive shift and eventually resolving. The patient was ultimately happy with his visual outcome because his uncorrected vision returned to baseline.

Conclusions:
Any vision changes in patients on ADCs should be carefully worked up, including with manifest refraction and appropriate testing, because they may indicate early ocular side effects that can be treated. This case introduces evidence of hyperopic and myopic changes directly correlating with slitlamp examination findings and imaging of a patient with belamaf-induced MECs.
Acute appendicitis in pregnant women: A Tunisian center experience
Authors: Mejri Atef , Arfaoui Khaoula , Trigui Emna 
Published: July 2022

Acute appendicitis is the most common surgical pathology during pregnancy. It occurs in about 1 in 500 to 1 in 635 pregnancies per year,[1] and appendectomy is the gold standard in the treatment approach.[2] However, its diagnosis represents a challenge to both surgeons and obstetrician-gynecologists. In addition, the role of laparoscopy remains controversial.
This study discusses the diagnostic approach and reviews the appropriate surgical approach while evaluating the part of laparoscopy.
This is a retrospective descriptive analysis reviewing 36 patients who underwent surgery for acute appendicitis during pregnancy at the “Surgery Department of Jendouba Hospital from January 1, 2005 to December 31, 2019. Data include age, comorbidities, previous abdominal surgery, symptoms, physical examination findings, complementary exams results, operative treatment details, the emergency status of the procedure, associated medical treatment, antibiotics and tocolysis, the pathology reports, and follow-up.
The mean age of patients was 27 years. Twenty-one patients (58, 33%) were in the second trimester of pregnancy, 6 patients (16, 66 %) were in the first trimester, and 9 (25%) in the third one. The physical examination reported a right iliac fossa tenderness in 27 patients (75%). The abdominal ultrasound was performed in all cases and guided the diagnosis in 24 cases (66, 66%). 18 patients (50%) underwent laparoscopy, 12 patients (33, 33%) underwent laparotomy. The remaining 6 patients (16, 66%) required a conversion from laparoscopic to open surgery.
The clinical presentation of appendicitis in pregnancy is often misguiding. Therefore, an abdominal ultrasound should be performed for all pregnant patients having abdominal pain. The difficulty of operating under laparoscopy increases with the pregnancy term, leading to a higher risk of conversion, which increases the operating time and the doses of anesthetics, causing a maternal and fetal risk.
Effectiveness of acupuncture for irritable bowel syndrome: Protocol for a scoping review of systematic reviews and meta-analyses
Authors: Li Yachen , Peng Sike , Liang Fangyuan , Liu Suzhen , Li Jia 
Published: July 2022

Background:
Irritable bowel syndrome (IBS) is a common functional bowel disorder. Many systematic reviews/meta-analyses indicate that acupuncture and related therapies are effective for IBS. However, the robustness of the results in the systematic reviews and meta-analyses has not been evaluated. This scoping review aims to ascertain the credibility of current evidence of acupuncture therapy for IBS, to provide clinical research investigators with reliable information.

Methods:
Searches of China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), China Biology Medicine disc (CBMdisc), and Wanfang Database since the establishment of the database to February 2022. Study selection and data extraction will be conducted by 2 reviewers, and the quality will be assessed by 2 trained reviewers. We will use Assessment of Multiple Systematic Reviews-2 (AMSTAR2) for methodological quality assessment, Preferred Reporting Items for Systematic Reviews and Meta-Analyses for report quality assessment, Grading of Recommendations, Assessment, Development, and Evaluation for the quality of evidence assessment, and the Risk of Bias in Systematic Reviews for the bias assessment.

Results:
The results will be published in a peer-reviewed journal.

Trial registration number:
INPLASY202210117.

Conclusion:
This scoping review will provide comprehensive evidence of acupuncture for patients with irritable bowel syndrome.

Ethics and dissemination:
This scoping review does not require ethical approval as it is a secondary assessment of available literature.
De Novo mutation in Epidermal growth factor receptor (EGFR)-D761Y responding to third generation tyrosine kinase inhibitor Osimertinib: A case report
Authors: Ding Yingying , Dong Hongliang , Li YongCheng , Liu Lei , Cai Ying , Wang Ying , Tian Shengya , Dai Chengtao 
Published: July 2022

Introduction:
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Epidermal growth factor receptor (EGFR) mutations are the most common accurate gene targets. However, the lack of case reports or cohort studies on the exceptionally rare mutations limit the acquisition of deeper insights.

Patient concerns:
A 76-year-old female nonsmoker presented to our hospital with a one-week disease history of cough accompanied by shortness of breath.

Diagnosis:
Contrast-enhanced CT scan showed right pleural effusion with scattered inflammation and consolidation in the right upper lung. Tumor marker display showed obvious increased. Histopathology of the pulmonary mass combined with Immunohistochemical staining indicated lung adenocarcinoma. Contrast-enhanced magnetic resonance imaging suggested brain metastases. ECT scan showed bone metastasis. The patient was thus diagnosed as right lung adenocarcinoma of stage IV (cT3N3M1c). Next generation sequencing was performed to profile the mutation status of known oncogenic driver mutations, and only EGFR-D761Y in exon 19 (allelic frequency, AF: 0.53%) mutation was found.

Interventions:
The patient was accordingly treated with the third generation EGFR-Epidermal growth factor receptor tyrosine kinase inhibitor (TKI) Osimertinib (80 mg, qd). Accompanied with whole brain radiotherapy (DT3000c Gy/10f) for brain metastases, technetium methylene diphosphonate injection was performed for bone metastases.

Outcomes:
The efficacy of the first-line Osimertinib treatment for 1 month was assessed as PR per RECIST version 1.1. The NSCLC patient harboring EGFR-D761Y mutation detected prior to the EGFR L858R mutation was benefited from the third-generation EGFR-TKI Osimertinib and had a worse prognosis than with other EGFR mutations according to data from previous case reports.

Conclusions:
This case reported a NSCLC patient with de novo mutation of EGFR-D761Y responding to third generation TKI Osimertinib.
Influence of the COVID-19 pandemic on regular clinic visits and medication prescriptions among people with diabetes: Retrospective cohort analysis of health care claims
Authors: Maeda Toshiki , Nishi Takumi , Harada Masataka , Tanno Kozo , Nishiya Naoyuki , Asayama Kei , Okuda Nagako , Sugiyama Daisuke , Yatsuya Hiroshi , Okayama Akira , Arima Hisatomi 
Published: July 2022

The aim of this study was to investigate the effect of the COVID-19 pandemic on regular clinic visits among people with diabetes and to elucidate the factors related to visit patterns among these patients during the pandemic.
This was a longitudinal study using anonymized insurance claims data from the Joint Health Insurance Society in Tokyo from October 2017 to September 2020. First, we identified patients with diabetes who were fully enrolled in the health plan from fiscal year 2017 until September 2020 and who were regularly receiving glucose-lowering medications (every 1–3 months) from October 2017 to September 2018. We divided follow-up into the pre-pandemic period (October 2018 to March 2020) and the pandemic period (April 2020 to September 2020). A multilevel logistic regression model was used to determine the risks of delayed clinic visits/medication prescriptions (i.e., >3 months after a previous visit/prescription) during the pandemic period.
We identified 1118 study participants. The number of delayed clinic visits/medication prescriptions during the pre-pandemic and pandemic periods was 188/3354 (5.6%) and 125/1118 (11.2%), respectively. There was a significant increase in delayed clinic visits during the pandemic (adjusted odds ratio 3.68 (95% confidence interval 2.24 to 6.04, P < .001), even after controlling for confounding factors. We also found a significant interaction between sex and delayed visits; women had significantly fewer clinic visits during the COVID-19 pandemic than men.
We clarified the relationship of the COVID-19 pandemic with delays in regular clinic visits and medication prescriptions among people with diabetes. The response to the COVID-19 pandemic differed between men and women.
Centrilobular zonal necrosis is a unique subtype of autoimmune hepatitis: A cohort study
Authors: Ueda Kaoru , Aizawa Yoshio , Kinoshita Chika , Nagano Tomohisa , Ishida Jinya , Saeki Chisato , Oikawa Tsunekazu , Harada Toru , Hokari Atsushi , Saruta Masayuki 
Published: July 2022

Backgrounds:
Centrilobular zonal necrosis (CZN) is described as a histological feature present in a small number of autoimmune hepatitis (CZN-AIH) patients. CZN may be detected in the absence of significant interface hepatitis, which is the most important histological finding of AIH. The clinical and histopathological spectra of CZN-AIH were not homogeneous, and the concept of CZN-AIH as a distinctive subtype of AIH remains controversial, due to the rarity of CZN-AIH and the ambiguous definition of CZN.

Methods:
To elucidate the clinical and immunogenetic features of CZN-AIH, a total of 102 biopsy samples of AIH, obtained at The Jikei University Katsushika Medical Center and Jikei University Hospital from 2000 to 2018, were reviewed. The 32 patients whose biopsies showed CZN were selected as the CZN-AIH group, and the remaining 70 were grouped as the non-CZN-AIH controls (control AIH). Data on clinical, histopathologic, and immunogenetic features were statistically compared between the CZN-AIH and the control AIH group. Additionally, the impact of the onset pattern (acute or chronic) and coexistent significant interface hepatitis in CZN-AIH was determined.

Results:
In CZN-AIH, the frequency of acute-onset cases was significantly higher than that in control AIH (56.2% vs 32.9%; P < .05), and the number of cases with moderate-to-severe interface hepatitis in liver histology was significantly lower (37.5% vs 87.1%; P < .001). Compared to the control AIH, cases of CZN-AIH had lower immunoglobulin G level (P < .001), lower antinuclear antibodies titer (P < .001), and lower AIH score (P < .001). The immunogenetic disproportionate distribution of HLA-DR phenotypes in control AIH (increased HLA-DR4 and decreased HLA-DR9) was not found in CZN-AIH. Moreover, CZN-AIH was less frequently relapsed (P < .05). For the acute-onset CZN-AIH cases, the clinical features were hardly indistinguishable from the chronic CZN-AIH cases. Similarly, the existence of interface hepatitis did not influence on the pathophysiology of CZN-AIH. Moreover, the acute-onset CZN-AIH cases is clinically distinguishable from acute-onset control AIH

Conclusion:
CZN can characterize as a distinct AIH subtype, regardless of onset-pattern or coexistence of significant interface hepatitis. To further strengthen this hypothesis, collection of more CZN-AIH cases is needed.
Clinical, radiological, and magnetic resonance imaging characteristics of axial spondyloarthritis with late onset
Authors: Chung Ho Yin , Huang Jin Xian , Chan Shirley Chiu Wai , Lee Kam Ho , Tsang Helen Hoi Lun , Lau Chak Sing 
Published: July 2022

We aimed to investigate the clinical, diagnostic, and imaging features of patients with late onset axial spondyloarthritis (SpA) with initial symptom manifestation aged over 45 years.
Participants with axial SpA were consecutively recruited. Clinical, demographic, blood, and imaging parameters were compared between the groups with early (≤45 years) and late onset (>45 years) at a cross-sectional level. Logistic regressions were used to determine the independent associations with axial SpA with late onset.
A total of 455 participants were recruited. Among them, 70 (15.4%) had late onset disease. Multivariate analyses showed that axial SpA with late onset was associated with higher C-reactive protein based ankylosing spondylitis disease activity index (ASDAS-CRP) (B = 0.10; P = .04), higher intensity of spinal inflammation as measured by maximum apparent diffusion coefficient (spinal ADC max) (B = 0.27; P = .03) and mean ADC (spinal ADC mean) (B = 0.30; P = .004), lower modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) (B = –0.12; P = .02), more tender joint count (B = 0.12; P = .02), and fewer inflammatory back pain (IBP) (OR = 0.26; P < .001).
Axial SpA with late onset had higher clinical disease activity, higher intensity of spinal MRI inflammation, less radiographic damage, and more tender joint count. There was also less inflammatory back pain, which could make the diagnosis more difficult.