bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scleroderma autoantibodies in guiding monitoring and treatment decisions
Authors: Shah Shivani , Denton Christopher P. 
Published: September 2022

Purpose of review
One of the key clinical challenges of systemic sclerosis (SSc) is diversity in clinical presentation, organ involvement and disease progression. Antinuclear autoantibodies (ANA) are central to the diagnosis of SSc. ANA specificities associated with distinct clinical patterns of organ and skin involvement. Understanding of the molecular differences and pathogenesis of scleroderma has helped further inform clinical acumen. Here, we provide an update on ANA on clinical profiling, management and future direction of SSc.

Recent findings
There has been further development in delineating clinical patterns in ANA, genetic susceptibility and antigen triggers predisposing to ANA subtypes. Sub-group analysis of recent clinical trials shows differing treatment responses to novel therapeutics.

Summary
ANA subtyping is likely to be firmly embedded into future classification systems. Beyond informing current management and monitoring of scleroderma patients, ANA subsets have implication on future research and clinical trial design.
Low Transcondylar Fractures of the Distal Humerus: A Multicenter Cohort Study
Authors: Han Sung Bin , Kim Hyungsuk , Jeong Jinyoung , Kim Yang-Soo , Ji Jong-Hun , Lee Sang-Uk , Kong Chae-Gwan , Lee Hyo-Jin , Kim Jong-Ho , Song Hyun Seok 
Published: September 2022

Objectives:
To determine the demographic characteristics and clinical and radiologic results of low transcondylar fractures and compare them with those of other types of distal humerus fractures using multicenter data and to suggest an optimal method for their treatment.

Design:
Retrospective cohort study.

Setting:
Tertiary-care university hospital.

Patients:
Between 2009 and 2019, 581 patients who underwent surgery for distal humerus fractures (OTA/AO classification A1 to C3) were enrolled at 7 university-affiliated hospitals.

Intervention:
Internal fixation of low transcondylar fractures.

Main Outcome Measures:
Demographic characteristics, including sex, age, mechanism of injury, fixation methods, and complications, were compared between low transcondylar (group A) and other distal humerus (group B) fractures. Clinical outcomes assessed included pain, stability, and range of motion. Radiographs obtained at the latest follow-up were assessed for union, delayed union, nonunion, and implant failure.

Results:
Mean age was 62.1 ± 19.1 (range, 20–95) years, and it was higher in group A (n = 100) than in group B (n = 376). Patients in group A were predominantly women. Low-energy trauma, such as that from a simple fall, was the most common cause of fracture in group A. Both column fixation, including parallel and orthogonal double plating, was performed more commonly in group A than in group B (87.4% vs. 66.4%, P < 0.001). The nonunion rate was higher in group A, but the difference was not significant. The incidence of ulnar nerve–related symptoms was higher in group A after surgery (6.3% vs. 2.0%, P = 0.003). No significant difference in clinical outcomes was found between the groups.

Conclusions:
Low transcondylar fractures occurred more frequently than other distal humerus fractures in older female patients and accounted for 21% of distal humerus fractures. The incidence of ulnar nerve–related symptoms was higher in patients with low transcondylar fractures after surgery. Clinical outcomes were not inferior in patients with low transcondylar fractures. The nonunion rate in patients with low transcondylar fractures treated with double plating was 3.6%.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery
Authors: Passias Peter G. , Krol Oscar , Williamson Tyler K. , Lafage Virginie , Lafage Renaud , Smith Justin S. , Line Breton , Vira Shaleen , Lipa Shaina , Daniels Alan , Diebo Bassel , Schoenfeld Andrew , Gum Jeffrey , Kebaish Khaled , Park Paul , Mundis Gregory , Hostin Richard , Gupta Munish C. , Eastlack Robert , Anand Neel , Ames Christopher , Hart Robert , Burton Douglas , Schwab Frank J. , Shaffrey Christopher , Klineberg Eric , Bess Shay ,   International Spine Study Group
Published: September 2022

Study Design.
Retrospective cohort study.

Objective.
Understand the benefit of addressing malalignment in revision surgery for proximal junctional kyphosis (PJK).

Summary of Background Data.
PJK is a common cause of revision surgery for adult spinal deformity patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbopelvic mismatch.

Materials and Methods.
Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor (proximal extension of fusion alone compared with combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbopelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria [Global Alignment and Proportionality (GAP), Roussouly-type, and Sagittal Age-Adjusted Score (SAAS)].

Results.
A total of 151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP postrevision had lower rates of recurrent PJK [23% vs. 42%; odds ratio (OR): 0.3, 95% confidence interval (CI): 0.1–0.8, P=0.024]. Following adjusted analysis, patients who were ideally aligned in one of three criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%; OR: 0.4, 95% CI: 0.1–0.9, P=0.035) and recurrent PJF (OR: 0.1, 95% CI: 0.02–0.7, P=0.015). Patients ideally aligned in two of three criteria avoid any development of PJF (0% vs. 16%, P<0.001).

Conclusions.
Following revision surgery for PJK, patients with persistent poor sagittal alignment showed increased rates of recurrent PJK compared with patients who had abnormal lumbopelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.
Neurothekeoma With PI3K w552*, ALK P1469S, SMO G461S, and ERBB3 L77M Genetic Alterations
Authors: Ortega Mahatma , Sparks Jessica , Nava Victor E. , Smith Shane D. B. 
Published: September 2022

Abstract:
Neurothekeoma, a lesion of possible fibrohistiocytic origin, is a rare, benign, superficial soft tissue tumor, histologically subclassified in 3 types: myxoid, cellular, or mixed. It clinically presents as a solitary, pink to brown nodule, ranging from 0.3 to 2.0 cm. Four point mutations (PI3K w552*, ALK P1469S, SMO G461S, and ERBB3 L77M) were identified by next-generation sequencing of a neurothekeoma presenting in the left inner thigh of a 53-year-old man. We highlight novel genetic alterations (SMO G461S and ERBB3 L77M) and previously known mutations (PI3KCA w552* and ALK P1469S) that play a role in other pathogenic pathways, but to the best of our knowledge, these have not yet been reported in neurothekeoma.
Merkel Cell Carcinosarcoma With a Bland Sarcomatous Component
Authors: Ireland Amanda M. , Leecy Tamazin N. , Wood Benjamin A. , Mirzai Bob , Giardina Tindaro , Mesbah Ardakani Nima 
Published: September 2022

Abstract:
Merkel cell carcinoma with a sarcomatous component is very rare, with only 12 cases reported in the literature, often with overtly malignant myoid differentiation. We report a case of metastatic Merkel cell carcinosarcoma presenting in a lymph node 6 months after a diagnosis of cutaneous Merkel cell carcinoma with conventional histologic features. The metastatic lesion showed a unique biphasic appearance with admixed populations of neuroendocrine epithelial cells and fascicles of mitotically active spindle cells with mild cytological atypia. In addition to the immunomorphological features, a common molecular profile between the epithelial and mesenchymal components further supported the notion of carcinosarcoma in this case. To the best of our knowledge, a bland sarcomatous component has not been previously described in Merkel cell carcinosarcoma, which can be easily overlooked as a reactive stromal reaction microscopically.
Feedback Interaction Between Apelin and Endoplasmic Reticulum Stress in the Rat Myocardium
Authors: Jin Sheng , Wang Yipu , Ma Liuchang , Zhang Jiaqi , Huang Panna , Zhang Haozhe , Liu Xinxia , Wu Yuming , Wang Xiaoning , Teng Xu 
Published: September 2022

Abstract:
Apelin is an endogenous active peptide, playing a crucial role in regulating cardiovascular homeostasis. This study aimed to investigate the interaction between apelin and endoplasmic reticulum stress (ERS). Tunicamycin (Tm) and dithiothreitol (DTT) were used to induce ERS in the ex vivo cultured myocardium of rats. Myocardial injury was determined by the activities of lactate dehydrogenase and creatine kinase-MB in the culture medium. The protein levels of an ERS-associated molecule, apelin, and its receptor angiotensin domain type 1 receptor-associated proteins (APJ) in the myocardium were determined by western blot analysis. The level of apelin in the culture medium was determined by enzyme immunoassay. Administration of Tm and DTT triggered ERS activation and myocardial injury, and led to a decrease in protein levels of apelin and APJ, in a dose-dependent manner. Integrated stress response inhibitor, an inhibitor of eukaryotic initiation factor 2α phosphorylation that is commonly used to prevent activation of protein kinase R-like ER kinase cascades, blocked ERS-induced myocardial injury and reduction of apelin and APJ levels. The ameliorative effect of integrated stress response inhibitor was partially inhibited by [Ala]-apelin-13, an antagonist of APJ. Furthermore, apelin treatment inhibited activation of the 3 branches of ERS induced by Tm and DTT in a dose-dependent manner, thereby preventing Tm-induced or DTT-induced myocardial injury. The negative feedback regulation between ERS activation and apelin/APJ suppression might play a critical role in myocardial injury. Restoration of apelin/APJ signaling provides a potential target for the treatment and prevention of ERS-associated tissue injury and diseases.
Traumatic Brain Injury Classification Variability During the Afghanistan/Iraq Conflicts: Surveillance, Clinical, Research, and Policy Implications
Authors: Adams Rachel Sayko , Hoover Peter , Forster Jeri E. , Caban Jesus , Brenner Lisa A. 
Published: September 2022

Objective:
Challenges associated with case ascertainment of traumatic brain injuries (TBIs) sustained during the Afghanistan/Iraq military operations have been widespread. This study was designed to examine how the prevalence and severity of TBI among military members who served during the conflicts were impacted when a more precise classification of TBI diagnosis codes was compared with the Department of Defense Standard Surveillance Case-Definition (DoD-Case-Definition).

Setting:
Identification of TBI diagnoses in the Department of Defense's Military Health System from October 7, 2001, until December 31, 2019.

Participants:
Military members with a TBI diagnosis on an encounter record during the study window.

Design:
Descriptive observational study to evaluate the prevalence and severity of TBI with regard to each code set (ie, the DoD-Case-Definition and the more precise set of TBI diagnosis codes). The frequencies of index TBI severity were compared over time and further evaluated against policy changes.

Main Measures:
The more precise TBI diagnosis code set excludes the following: (1) DoD-only extender codes, which are not used in other healthcare settings; and (2) nonprecise TBI codes, which include injuries that do not necessarily meet TBI diagnostic criteria.

Results:
When comparing the 2 TBI classifications, the DoD-Case-Definition captured a higher prevalence of TBIs; 38.5% were classified by the DoD-Case-Definition only (>164 000 military members). 73% of those identified by the DoD-Case-Definition only were diagnosed with nonprecise TBI codes only, with questionable specificity as to whether a TBI occurred.

Conclusion:
We encourage the field to reflect on decisions made pertaining to TBI case ascertainment during the height of the conflicts. Efforts focused on achieving consensus regarding TBI case ascertainment are recommended. Doing so will allow the field to be better prepared for future conflicts, and improve surveillance, screening, and diagnosis in noncombat settings, as well as our ability to understand the long-term effects of TBI.
Affluence and Contact Lens Prescribing
Authors: Efron Nathan , Morgan Philip B. 
Published: September 2022

Objectives:
To assess the impact of national affluence on the extent of prescribing of various types of soft contact lenses.

Methods:
Using information derived from a large bank of contact lens prescribing data, the relationship between the percentage prescribing of daily disposable, toric, silicone hydrogel, and multifocal contact lenses versus the gross domestic product at purchasing parity per capita (GDP [PPP]) was determined for all countries in which contact lens prescribers returned survey forms relating to greater than 100 contact lens fits between 2017 and 2021, inclusive.

Results:
Data from 39 countries were analyzed, comprising 94,181 contact lens fits. The relationship between percentage contact lens prescribing versus GDP (PPP) was highly statistically significant for daily disposable lenses (r2=0.35, P<0.0001), marginally significant for toric lenses (r2=0.08, P=0.06), and not significant for silicone hydrogel lenses (r2=0.01, P=0.42) or multifocal lenses (r2=0.02, P=0.35).

Conclusions:
The rate of prescribing daily disposable contact lenses, and to a lesser extent toric lenses, is related to national affluence. The contact lens industry, practitioners, and governments/regulatory bodies should remain cognizant of this association and, where possible, reduce cost barriers to the purchase of such contact lens products so that they can be prescribed based on important clinical, refraction, and lifestyle considerations.
The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care
Authors: Vigdal Ørjan Nesse , Storheim Kjersti , Killingmo Rikke Munk , Småstuen Milada Cvancarova , Grotle Margreth 
Published: September 2022

Abstract
Back pain and comorbidity are common in older adults. Comorbidity is a promising prognostic factor for the clinical course of back-related disability, but confirmatory studies assessing its prognostic value are needed. Thus, the aims of this study were to describe the clinical course of back-related disability during 1-year follow-up in patients aged ≥55 years visiting primary care (general practitioner, physiotherapist, or chiropractor) with a new episode of back pain and assess the prognostic value of comorbidity on back-related disability during 1-year follow-up. A prospective cohort study was conducted, including 452 patients. The outcome measure was Roland–Morris Disability Questionnaire (RMDQ, range 0-24) measured at baseline and at 3-, 6-, and 12-month follow-up. The Self-Administered Comorbidity Questionnaire was used to assess comorbidity count (CC, range 0-15) and comorbidity burden (CB, range 0-45). The RMDQ scores improved from median (interquartile range) 9 (4-13) at baseline to 4 (1-9), 4 (0-9), and 3 (0-9) at 3, 6, and 12 months, respectively. Using linear mixed-effects models, we found that CC and CB were independently associated with RMDQ scores. A 1-point increase in CC was associated with an increase in RMDQ score of 0.76 points (95% confidence interval [0.48-1.04]) over the follow-up year, adjusted for known prognostic factors. A 1-point increase in CB was associated with an increased RMDQ score of 0.47 points (95% confidence interval [0.33-0.61]). In conclusion, the clinical course of back-related disability for older adults presenting in primary care was favorable, and increased comorbidity was an independent prognostic factor for increased disability levels.
Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy
Authors: Yang Ching-Wei , Wang Hsiao-Hsien , Hassouna Mohamed Fayez , Chand Manish , Huang William JS , Chung Hsiao-Jen 
Published: September 2022

Background:
Nerve-sparing (NS) techniques could potentially increase positive surgical margins (PSM) after robot-assisted radical prostatectomy (RARP). Nevertheless, the available studies have revealed ambiguous results among distinct groups. This study purposed to clarify the details of NS techniques to accurately estimate their influence on margin status.

Methods:
We studied RARPs performed by one surgeon from 2010 to 2018. Surgical margins were evaluated by the laterality and levels of NS techniques in site-specific prostate lobes. The multivariable analysis evaluated the effects of nerve-sparing procedures, combined with other covariate factors, on margin status.

Results:
Overall, four hundred nineteen RARPs involving 838 prostate lobes were analyzed. Notably, 181 patients (43.4%) had pT2-stage, and 236 (56.6%) had pT3-stage cancer. The PSM rates for patients who underwent unilateral, bilateral, and non NS procedures were 30.3%, 28.8%, and 50%, respectively (p = 0.233) or in stratification by pT2 (p = 0.584) and pT3 (p = 0.116) stage. The posterolateral PSM rates among site-specific prostate lobes were 10.9%, 22.4%, and 18.9% for complete, partial, and non NS techniques, respectively (p = 0.001). The partial NS group revealed a significant increase in PSM rate compared with the complete NS (OR 2.187, 95% CI 1.19-4.03) and non NS (OR 2.237, 95% CI 1.01-4.93) groups in site-specific prostate lobes.

Conclusion:
Partial NS procedures have a potential risk of increasing the PSM rate than complete and non NS procedures do. Therefore, correct case selection is required before performing partial NS techniques.
Developing Action Plans Based on Machine Learning Analysis to Prevent Sick Leave in a Manufacturing Plant
Authors: Kurisu Ken , Song You Hwi , Yoshiuchi Kazuhiro 
Published: September 2022

Objective
We aimed to develop action plans for employees' health promotion based on a machine learning model to predict sick leave at a Japanese manufacturing plant.

Methods
A random forest model was developed to predict sick leave. We developed plans for workers' health promotion based on variable importance and partial dependence plots.

Results
The model showed an area under the receiving operating characteristic curve of 0.882. The higher scores on the Brief Job Stress Questionnaire stress response, younger age, and certain departments were important predictors for sick leave due to mental disorders. We proposed plans to effectively use the Brief Job Stress Questionnaire and provide more support for younger workers and managers of high-risk departments.

Conclusions
We described a process of action plan development using a machine learning model, which may be beneficial for occupational health practitioners.
Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm
Authors: Yin Zhikun , Li Ji , Yang Weilin , Huang Weifeng , Xu Dong , Lei Xiaoyi , Zhang Jinyan 
Published: September 2022

Background:
Underwater endoscopic mucosal resection (UEMR) is increasingly applied in the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs). This meta-analysis aimed to assess the efficacy and safety of UEMR for SNADETs ≤20 mm in comparison with conventional endoscopic mucosal resection (CEMR).

Methods:
The following electronic databases were searched from 2012 until November 20, 2021: PubMed, Embase, Scopus, Web of Science databases, and Cochrane Library. The primary outcomes were the rates of en bloc resection and complete (R0) resection, and the secondary outcomes were procedure time, adverse events (delayed bleeding and delayed perforation), and recurrence rate.

Results:
A total of 6 studies with 679 lesions (331 underwent UEMR and 348 CEMR) were included in this study. The pooled analysis showed that UMER achieves a similar en bloc resection rate (87.6 vs. 89.9%; odds ratio [OR], 1.29; 95% confidence interval [CI], 0.45 to 3.73; P=0.64; I

2
=74%), a similar R0 resection rate (67.3 vs. 73.6%; OR, 1.11; 95% CI, 0.55 to 2.23; P=0.78; I

2
=59%), a shorter procedure time (min) (mean difference [MD], −4.05, 95% CI: −6.40 to −1.71; P=0.0007; I

2
=70%) compared with CEMR. There were no significant differences in the rates of delayed bleeding, delayed perforation, and recurrence (2.4 vs. 1.7%, 0 vs. 0.6%, 2.2 vs. 4.4%, respectively).

Conclusion:
This meta-analysis demonstrated that UEMR appears to be an effective and safe alternative to CEMR for SNADETs ≤20 mm.
Micro-RNA in obstructive sleep apnoea: biomarker of cardiovascular outcome?
Authors: Zapater Andrea , Barbé Ferran , Sánchez-de-la-Torre Manuel 
Published: September 2022

Purpose of review
Obstructive sleep apnoea (OSA) is a global health problem with important cardiovascular consequences. Risk assessment tools are essential in OSA to identify patients at increased risk of cardiovascular disease and to achieve a cost-effective clinical management of the disease in the era of precision medicine. The objective is to provide an updated perspective on the role of microRNAs (miRNAs) in OSA as a biomarker of cardiovascular risk.

Recent findings
Specific miRNAs have already been associated with patients with OSA and specific cardiovascular diseases such as hypertension, myocardial infarction or endothelial dysfunction. Numerous studies have addressed the use of miRNAs to identify the cardiovascular risk associated with OSA, both in patients and in animals with in vivo hypoxia models. Thus, these studies identified profiles of differentially expressed miRNAs in patients with OSA. In addition, the in vitro studies suggest that therapies with miRNA inhibitors that could help reduce cardiovascular risk. Therefore, this review highlights the primary approaches of the potential of miRNAs as biomarkers at the prognostic, diagnostic and therapeutic strategy levels.

Summary
Given the heterogeneity of OSA and its cardiovascular consequences, miRNAs have emerged as powerful biomarkers that can help improve the clinical management of OSA and its cardiovascular risk.