bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Programmed Intermittent Bolus Infusion With Continuous Infusion for the Thoracic Paravertebral Block in Patients Undergoing Thoracoscopic Surgery
Authors: Yang Lin , Huang Xinyi , Cui Yulong , Xiao Yangfan , Zhao Xu , Xu Junmei 
Published: April 2022

Background:
Continuous thoracic paravertebral block (TPVB) connected with patient-controlled analgesia (PCA) pump is an effective modality to reduce postoperative pain following thoracic surgery. For the PCA settings, the programmed intermittent bolus infusion (PIBI) and continuous infusion (CI) are commonly practiced. However, the comparative effectiveness between the 2 approaches has been inconsistent. Thus, the aim of this study was to explore the optimal PCA settings to treat postthoracotomy pain by combing PIBI and CI together.

Methods:
All enrolled patients undergoing thoracoscopic surgery accepted ultrasound-guided TPVB catheterization before the surgery and then were randomly allocated in to 3 groups depending on different settings of the PCA pump connecting to the TPVB catheter: the PIBI+CI, PIBI, and CI groups. Numerical Rating Scales were evaluated for each patient at T1 (1 h after extubation), T2 (12 h after the surgery), T3 (24 h after the surgery), T4 (36 h after the surgery), and T5 (48 h after the surgery). Besides, the consumptions of PCA ropivacaine, the number of blocked dermatomes at T3, and the requirement for extra dezocine for pain relief among the 3 groups were also compared.

Results:
First, the Numerical Rating Scale scores in the PIBI+CI group were lower than the CI group at T2 and T3 (P<0.05) when patients were at rest and were also lower than the CI group at T2, T3, and T4 (P<0.01) and the PIBI group at T3 when patients were coughing (P<0.01). Second, the 2-day cumulative dosage of PCA in the PIBI+CI group was lower than both the CI and PIBI groups (P<0.01). Third, the number of blocked dermatomes in the PIBI and PIBI+CI groups were comparable and were both wider than the CI group at T3 (P<0.01). Finally, a smaller proportion (not statistically significant) of patients in the PIBI+CI group (5.26%, 2/38) had required dezocine for pain relief when compared with the PIBI group (19.44%, 7/36) and the CI group (15.79%, 6/38).

Conclusions:
The combination of PIBI and CI provides superior analgesic modality to either PIBI or CI alone in patients undergoing thoracoscopic surgery. Therefore, it should be advocated to improve the management of postoperative pain, clinical outcomes, and ultimately patient satisfaction.
Rethinking the definition of chronic postsurgical pain: composites of patient-reported pain-related outcomes vs pain intensities alone
Authors: Hofer Debora M. , Lehmann Thomas , Zaslansky Ruth , Harnik Michael , Meissner Winfried , Stüber Frank , Stamer Ulrike M. 
Published: April 2022

Abstract
Chronic postsurgical pain (CPSP) is defined by pain intensity and pain-related functional interference. This study included measures of function in a composite score of patient-reported outcomes (PROs) to investigate the incidence of CPSP. Registry data were analyzed for PROs 1 day and 12 months postoperatively. Based on pain intensity and pain-related interference with function, patients were allocated to the groups “CPSPF” (at least moderate pain with interference), “mixed” (milder symptoms), and “no CPSPF”. The incidence of CPSPF was compared with CPSP rates referring to published data. Variables associated with the PRO-12 score (composite PROs at 12 months; numeric rating scale 0-10) were analyzed by linear regression analysis. Of 2319 patients, 8.6%, 32.5%, and 58.9% were allocated to the groups CPSPF, mixed, and no CPSPF, respectively. Exclusion of patients whose pain scores did not increase compared with the preoperative status, resulted in a 3.3% incidence. Of the patients without pre-existing pain, 4.1% had CPSPF. Previously published pain cutoffs of numeric rating scale >0, ≥3, or ≥4, used to define CPSP, produced rates of 37.5%, 9.7%, and 5.7%. Pre-existing chronic pain, preoperative opioid medication, and type of surgery were associated with the PRO-12 score (all P < 0.05). Opioid doses and PROs 24 hours postoperatively improved the fit of the regression model. A more comprehensive assessment of pain and interference resulted in lower CPSP rates than previously reported. Although inclusion of CPSP in the ICD-11 is a welcome step, evaluation of pain characteristics would be helpful in differentiation between CPSPF and continuation of pre-existing chronic pain.
Differences in Clinical Presentation of Eosinophilic Esophagitis in Pediatric Patients With Ulcerative Colitis and Crohn Disease
Authors: Splawski Judy , Aktay Atiye Nur , Perry Sharon , Baez-Socorro Virginia , DeLozier Sarah , Sferra Thomas J. , Moses Jonathan 
Published: April 2022

Significance:
Eosinophilic esophagitis (EoE) is an inflammatory condition characterized by T helper-2 (TH2) cytokines. Ulcerative colitis (UC) and Crohn disease (CD) are inflammatory conditions with different clinical presentations and immune profiles. UC is associated with TH2 cytokines and CD with TH1 cytokines. We investigated potential differences in the association of EoE with UC and CD because of these different immune profiles.

Methods:
We utilized ICD-9 and ICD-10 codes to find patients with inflammatory bowel disease (IBD) and EoE. We defined EoE as any esophageal biopsy with >15 eosinophils. We collected demographic, clinical, laboratory, endoscopic, and histological data.

Results:
Thirty patients had both EoE and IBD. 14.9% of UC patients had EoE and 5.7% of CD patients had EoE. 64.7% of UC patients presented with UC and EoE at the same time, whereas 76.9% of CD patients presented with EoE at follow up. Ten of 13 CD patients were on anti-tumor necrosis factor (TNF) at EoE diagnosis. No UC patients were on anti-TNF at EoE diagnosis. Eighty-three percent of CD patients had mild disease or were in remission, whereas 50% of UC patients had moderate to severe disease at the time of EoE diagnosis.

Conclusion:
A higher percentage of UC than CD patients had EoE. EoE was more likely to be present at the initial diagnosis of UC than CD. EoE was more likely after diagnosis and treatment of CD with anti-TNF, when CD activity was mild or in remission. The difference in presentation suggests that anti-TNF or it’s impact on inflammation may differentially impact the association of EoE with CD and UC.
External Ophthalmoplegia and Brainstem White Matter Lesions
Authors: Igreja Liliana , Ribeiro Luís , Cardoso Márcio , Vasconcelos Cristiana , Santos Ernestina 
Published: April 2022

Introduction:
Myotonic dystrophy type 1 (DM1) is an autosomal dominant condition which phenotype can be extremely variable considering its multisystem involvement, including the central nervous system. Neuromuscular findings are facial and distal extremities muscle weakness, muscle atrophy and myotonia. Standard diagnosis is obtained with molecular testing to detect CTG expansions in the myotonic dystrophy protein of the kinase gene. Brain magnetic resonance imaging typically shows characteristic subcortical white matter (WM) abnormalities located within anterior temporal lobes.

Case Report:
We present a 39-year-old male patient with a progressive external ophthalmoplegia, facial and limb muscle weakness, percussion myotonia and atypical brain magnetic resonance imaging findings, showing confluent brainstem WM lesions, affecting the pons, a rare radiologic feature in this disorder. Genetic testing confirmed the diagnosis for DM1.

Conclusion:
This presentation with external ophthalmoplegia and brainstem WM loss in DM1 can show an important correlation with clinical findings and have an important diagnostic and prognostic value.
What Can We Learn From In-Depth Analysis of Human Errors Resulting in Diagnostic Errors in the Emergency Department: An Analysis of Serious Adverse Event Reports
Authors: Baartmans Mees C. , Hooftman Jacky , Zwaan Laura , van Schoten Steffie M. , Erwich Jan Jaap H.M. , Wagner Cordula 
Published: April 2022

Introduction
Human error plays a vital role in diagnostic errors in the emergency department. A thorough analysis of these human errors, using information-rich reports of serious adverse events (SAEs), could help to better study and understand the causes of these errors and formulate more specific recommendations.

Methods
We studied 23 SAE reports of diagnostic events in emergency departments of Dutch general hospitals and identified human errors. Two researchers independently applied the Safer Dx Instrument, Diagnostic Error Evaluation and Research Taxonomy, and the Model of Unsafe acts to analyze reports.

Results
Twenty-one reports contained a diagnostic error, in which we identified 73 human errors, which were mainly based on intended actions (n = 69) and could be classified as mistakes (n = 56) or violations (n = 13). Most human errors occurred during the assessment and testing phase of the diagnostic process.

Discussion
The combination of different instruments and information-rich SAE reports allowed for a deeper understanding of the mechanisms underlying diagnostic error. Results indicated that errors occurred most often during the assessment and the testing phase of the diagnostic process. Most often, the errors could be classified as mistakes and violations, both intended actions. These types of errors are in need of different recommendations for improvement, as mistakes are often knowledge based, whereas violations often happen because of work and time pressure. These analyses provided valuable insights for more overarching recommendations to improve diagnostic safety and would be recommended to use in future research and analysis of (serious) adverse events.
A Historical Perspective on the Management of Facial Paralysis
Authors: Horen Sydney R. , Gantiwala Shahina , Hamidian Jahromi Alireza , Konofaos Petros 
Published: April 2022

Abstract
Documented evidence of facial nerve paralysis (FNP) and its treatment have been discovered in many early civilizations dating back centuries. Early records are present in art and scripts across ancient civilizations and have laid the groundwork for the implementation of many managements used in modern practice. Although the current management of FNP is still evolving, it includes a complex and multimodal spectrum of options ranging from pharmacologic therapy to facial physical therapy and neuromuscular training, and surgical facial reanimation interventions via static and dynamic procedures. The aim of this review is not to provide an up-to-date glossary of modern management options but rather to discuss the historical evidence of FNP and treatments leading up to current techniques and practices.
Clinical description, molecular delineation and genotype-phenotype correlation in 340 patients with KBG syndrome: Addition of 67 new patients
Authors: Martínez-Cayuelas Elena , Blanco-Kelly Fiona , López-Grondona Fermina , Tahsin-Swafiri Saoud , López-Rodríguez Rosario , Pozo Rebeca Losada-Del , Mahillo Ignacio , Moreno Beatriz , Rodrigo-Moreno María , Casas-Alba Dídac , López-González Aitor , García-Miñaur Sixto , de los Ángeles Mori María , Pacio-Mínguez Marta , Rikeros-Orozco Emi , Santos-Simarro Fernando , Cruz-Rojo Jaime , Quesada-Espinosa Juan Francisco , Teresa Sánchez-Calvin María , Pozo Jaime Sánchez-del , Bernadó-Fonz Raquel , Isidoro-García María , Ruiz-Ayucar Irene , Álvarez María Isabel , Blanco-Lago Raquel , De Azua-Brea Begoña , Eirís Jesús , García-Peñas Juan José , Gil- Fournier Belén , Gómez-Lado Carmen , Irazabal Nadia , López Vanessa , Madrigal Irene , Málaga Ignacio , Martínez-Menéndez Beatriz , Ramiro-Leon María Soraya , García-Hoyos María , Prieto-Matos Pablo , López-Pisón Javier , Aguilera-Albesa Sergio , de Andrés Sara Álvarez , Fernández-Jaén Alberto , Llano-Rivas Isabel , Gener Blanca , Ayuso Carmen , Arteche-López Ana , Palomares-Bralo María , Cueto Anna , Valenzuela Irene , Martínez-Monseny Antonio F. , Lorda-Sánchez Isabel , Almoguera Berta 
Published: April 2022

SUMMARYBackgroundKBG syndrome is a highly variable neurodevelopmental disorder and clinical diagnostic criteria have changed as new patients have been published. Both loss-of-function sequence variants and large deletions (CNVs) involving ANKRD11 have been involved in KBG, but no genotype-phenotype correlation has been reported to date. This study presents the clinical and molecular characteristics of 67 new patients with KBG syndrome and the results of the first genotype-phenotype correlation leveraging data on 273 patients previously published.Methods67 patients with KBG syndrome were recruited through a Spanish collaborative effort and were assessed using a custom phenotypic questionnaire. The frequency of all features was calculated. Manifestations present in >50% of the patients and a “severity score” were used to perform a genotype-phenotype correlation in the 340 KBG patients.ResultsNeurodevelopmental delay (95%), comorbidites (82.8%), macrodontia (80.9%), triangular face (71%), characteristic ears (76%), nose (75.9%) and eyebrows (67.3%) were the most prevalent features in the 67 patients. The genotype-phenotype correlation yielded significant associations with the triangular face (71.1% in patients with sequence variants vs 45.2% in CNVs, p=0.015), short stature (62.5% variants in exon 9 vs. 27.8% outside; p=0.009) and macrodontia (with larger deletions, p=0.028), ID/ADHD/ASD (70.4% in c.1903_1907del vs. 89.4%; p=0.012) and a higher phenotypic score in patients with sequence variants compared with CNVs (p=0.005).ConclusionsWe present a detailed phenotypic description of KBG syndrome in the largest series of patients reported to date, provide evidence of a genotype-phenotype correlation between some KBG features and specific ANKRD11 aberrations, and propose updated clinical diagnostic criteria based on our findings.
High-resolution characterization of recent tuberculosis transmission in Botswana using geospatial and genomic data – the Kopanyo Study
Authors: Baker Chelsea R. , Barilar Ivan , de Araujo Leonardo S. , Rimoin Anne W. , Parker Daniel M. , Boyd Rosanna , Tobias James L. , Moonan Patrick K. , Click Eleanor S. , Finlay Alyssa , Oeltmann John E. , Minin Vladimir N. , Modongo Chawangwa , Zetola Nicola M. , Niemann Stefan , Shin Sanghyuk S. 
Published: April 2022

AbstractIntroductionCombining genomic and geospatial data can be useful for understandingMycobacterium tuberculosis(Mtb) transmission in high tuberculosis burden settings.MethodsWe performed whole genome sequencing (WGS) on Mtb DNA extracted from sputum cultures from a population-based tuberculosis study conducted in 2012–2016 in Gaborone, Botswana. We used kernel density estimation, spatialK-functions, and created spatial distributions of phylogenetic trees. WGS-based clusters of isolates ≤5 single nucleotide polymorphisms were considered recent transmission, and large WGS-based clusters (≥10 members) were considered outbreaks.ResultsWe analyzed data from 1449 participants with culture-confirmed TB. Among these, 946 (65%) participants had both molecular and geospatial data. A total of 62 belonged to five large outbreaks (10–19 participants each). Geospatial clustering was detected in two of the five large outbreaks, suggesting heterogeneous spatial patterns within the community.ConclusionsIntegration of genomic and geospatial data identified distinct patterns of tuberculosis transmission in a high-tuberculosis burden setting. Targeted interventions in these smaller geographies may interrupt on-going transmission.
The Dawn is Coming —— the Description and Prediction of Omicron SARSCoV-2 Epidemic Outbreak in Shanghai by Mathematical Modeling
Authors: Jiang Minghao , Meng Guoyu , Wu Geng 
Published: April 2022

AbstractThe COVID-19 Omicron outbreak in Shanghai has been going on for >1 month and 25 million population is subjected to strict lock-down quarantine. Until now, it is not clear how long this epidemic might end. Here, we present a time-delayed differentiation equation model to evaluate and forecast the spreading trend. Our model provides important parameters such as the average quarantine ratio, the detection interval from being infected to being tested positive, and the spreading coefficient to better understand the omicron progression. After data fitting, we concluded on 11 April that the maximum overall number infected in Shanghai would exceed 300,000 on 14 April and the turning point would be in the coming days around 13-15 April, 2022, which is perfectly in line with the real-life infection number. Furthermore, the quarantine ratio in Shanghai was found to be greater than 1, supportive of the effectiveness of the strict lockdown policy. Altogether, our mathematical model helps to define how COVID-19 epidemic progresses under the Shanghai lock-down unprecedented in human history and the Chinese zero tolerance policy.
Previous SARS-CoV-2 infection or a third dose of vaccine elicited cross-variant neutralizing antibodies in vaccinated solid organ transplant recipients
Authors: Chang Chih-Chao , Vlad George , Vasilescu Elena Rodica , Li Ping , Husain Syed A. , Silvia Elaine A. , Cohen David J , Ratner Lloyd E. , Sun Wei-Zen , Mohan Sumit , Suciu-Foca Nicole 
Published: April 2022

AbstractThe SARS-CoV-2 pandemic poses a great threat to global health, particularly in solid organ transplant recipients (SOTRs). Although a 3-dose mRNA vaccination protocol has been implemented for the majority of SOTRs, its effectiveness was still largely unknown. We analyzed 113 vaccinated SOTRs, and 30 healthy controls (HCs), some of whom had recovered from COVID, for their immune responses against the original vaccine strain and variants of concern (VOC), including the highly mutated-omicron variant. Here, we report that 3 doses of the mRNA vaccine had only a modest effect in eliciting anti-viral responses against all viral strains in the fully vaccinated SOTRs who did not contract the virus. Only 34.0% (16/47) of this group of patients demonstrated both detectable anti-RBD IgG and neutralization activities against alpha, beta, and delta variants, and only 8.5% (4/47) of them showed additional omicron-neutralizing capacities. In contrast, 79.5% (35/44) of the vaccinated recovered-SOTRs demonstrated both higher anti-RBD IgG levels and neutralizing activities against all VOC, including omicron. These findings illustrate a significant impact of previous infection on the development of anti-COVID immune responses in vaccinated SOTRs and highlight the need for alternative strategies to protect a subset of a lesser-vaccine responsive population.
Distinct metabolic features of genetic liability to type 2 diabetes and coronary artery disease: a reverse Mendelian randomization study
Authors: Smith Madeleine L , Bull Caroline J , Holmes Michael V , Davey Smith George , Anderson Emma L , Bell Joshua A 
Published: April 2022

ABSTRACTType 2 diabetes (T2D) and coronary artery disease (CAD) both have known genetic determinants, but the mechanisms through which their associated genetic variants lead to disease onset remain poorly understood. Here, we used large-scale metabolomics data to directly compare the metabolic features of genetic liability to T2D and to CAD. We performed two-sample reverse Mendelian randomization (MR) to estimate effects of genetic liability to T2D and CAD on 249 circulating metabolites from targeted nuclear magnetic resonance spectroscopy in the UK Biobank (N=118,466). We examined the potential for medication use to distort effect estimates by examining effects of disease liability on metformin and statin use and by conducting age-stratified metabolite analyses. Using inverse variance weighted (IVW) models, higher genetic liability to T2D was estimated to decrease high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) (e.g., HDL-C: -0.05 SD; 95% CI -0.07, -0.03, per doubling of liability), whilst increasing all triglyceride groups and branched chain amino acids (BCAAs). Estimates for CAD liability suggested an effect on reducing HDL-C as well as raising very-low density lipoprotein cholesterol (VLDL-C) and LDL-C, and LDL triglycerides. Liability to each disease was estimated to decrease apolipoprotein-A1, whilst only CAD liability was estimated with IVW to increase apolipoprotein-B (0.10 SD; 95% CI 0.03, 0.17). In pleiotropy-robust sensitivity models, T2D liability was still estimated to increase BCAAs, but several effect estimates for higher CAD liability reversed and supported decreased LDL-C and apolipoprotein-B. Estimated effects of CAD liability differed uniquely and substantially by age for non-HDL-C traits in particular, with, e.g., pleiotropy-robust models suggesting that higher CAD liability lowers LDL-C only at older ages when use of statins is common. Our results from pleiotropy-robust models support largely distinct metabolic features of genetic liability to T2D and to CAD, particularly higher BCAAs in T2D and lower LDL-C and apolipoprotein-B in CAD. Such apparently favourable effects of CAD liability differ substantially by age and likely reflect mediation by statin use in adulthood.
Genetic risk and incident venous thromboembolism in middle-aged and older adults following Covid-19 vaccination
Authors: Xie Junqing , Prats-Uribe Albert , Maranon Maria Gordillo , Strauss Victoria Y. , Gill Dipender , Prieto-Alhambra Daniel 
Published: April 2022

BACKGROUNDCovid-19 vaccination has been associated with an increased risk of venous thromboembolism (VTE). However, it is unknown whether genetic predisposition to VTE is associated with an increased risk of thrombosis following vaccination.METHODSUsing data from the UK Biobank, which contains in-depth genotyping data and linked vaccination and health outcomes information, we generated a polygenic risk score (PRS) using 299 genetic variants identified from a previous large genome-wide association study. We prospectively assessed associations between PRS and incident VTE after first and the second-dose vaccination separately. We conducted sensitivity analyses stratified by vaccine type (adenovirus- and mRNA-based) and using two historical unvaccinated cohorts. We estimated hazard ratios (HR) for PRS-VTE associations using Cox models.RESULTSOf 359,310 individuals receiving one dose of a Covid-19 vaccine, 160,327 (44.6%) were males, and the mean age at the vaccination date was 69.05 (standard deviation [SD] 8.04) years. After 28- and 90-days follow-up, 88 and 299 individuals developed VTE respectively, equivalent to an incidence rate of 0.88 (95% confidence interval [CI] 0.70 to 1.08) and 0.92 (95% CI 0.82 to 1.04) per 100,000 person-days. The PRS was significantly associated with a higher risk of VTE (HR per 1 SD increase in PRS, 1.41 (95% CI 1.15 to 1.73) in 28 days and 1.36 (95% CI 1.22 to 1.52) in 90 days). Similar associations were found after stratification by vaccine type, in the two-dose cohort and across the historical unvaccinated cohorts.CONCLUSIONSThe genetic determinants of post-Covid-19-vaccination VTE are similar to those seen in historical data. This suggests that, at the population level, post-vaccine VTE has similar aetiology to conventional VTE. Additionally, the observed PRS-VTE associations were equivalent for adenovirus- and mRNA-based vaccines.