bluuebunny/crossref_metadata_2025_split huggingface dataset:
Catabolism in Critical Illness: A Reanalysis of the REducing Deaths due to OXidative Stress (REDOXS) Trial*
Authors: Haines Ryan W. , Fowler Alexander J. , Wan Yize I. , Flower Luke , Heyland Daren K. , Day Andrew , Pearse Rupert M. , Prowle John R. , Puthucheary Zudin 
Published: February 2022

OBJECTIVES:
Ongoing risk of death and poor functional outcomes are important consequences of prolonged critical illness. Characterizing the catabolic phenotype of prolonged critical illness could illuminate biological processes and inform strategies to attenuate catabolism. We aimed to examine if urea-to-creatinine ratio, a catabolic signature of prolonged critical illness, was associated with mortality after the first week of ICU stay.

DESIGN:
Reanalysis of multicenter randomized trial of glutamine supplementation in critical illness (REducing Deaths due to OXidative Stress [REDOXS]).

SETTING:
Multiple adult ICUs.

PATIENTS:
Adult patients admitted to ICU with two or more organ failures related to their acute illness and surviving to day 7.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The association between time-varying urea-to-creatinine ratio and 30-day mortality was tested using Bayesian joint models adjusted for prespecified-covariates (age, kidney replacement therapy, baseline Sequential Organ Failure Assessment, dietary protein [g/kg/d], kidney dysfunction, and glutamine-randomization). From 1,021 patients surviving to day 7, 166 (16.3%) died by day 30. After adjustment in a joint model, a higher time-varying urea-to-creatinine ratio was associated with increased mortality (hazard ratio [HR], 2.15; 95% credible interval, 1.66–2.82, for a two-fold greater urea-to-creatinine ratio). This association persisted throughout the 30-day follow-up. Mediation analysis was performed to explore urea-to-creatinine ratio as a mediator-variable for the increased risk of death reported in REDOXS when randomized to glutamine, an exogenous nitrogen load. Urea-to-creatinine ratio closest to day 7 was estimated to mediate the risk of death associated with randomization to glutamine supplementation (HR, 1.20; 95% CI, 1.04–1.38; p = 0.014), with no evidence of a direct effect of glutamine (HR, 0.90; 95% CI, 0.62–1.30; p = 0.566).

CONCLUSIONS:
The catabolic phenotype measured by increased urea-to-creatinine ratio is associated with increased risk of death during prolonged ICU stay and signals the deleterious effects of glutamine administration in the REDOXS study. Urea-to-creatinine ratio is a promising catabolic signature and potential interventional target.
Feasibility of cabazitaxel in octogenarian prostate cancer patients
Authors: Tralongo Paolo , Bordonaro Sebastiano , Di Lorenzo Giuseppe , De Giorgi Ugo , Borsellino Nicolò , Facchini Gaetano , Rossetti Sabrina , Fornarini Giuseppe , Longo Vito , Tralongo Antonino Carmelo , Caspani Francesca , Spada Massimiliano , Calvani Nicola , Carlini Paolo 
Published: February 2022

Abstract

Background
To evaluate the effectiveness and safety of cabazitaxel in castration-resistant prostate cancer patients aged ≥80 years, we performed a retrospective study on a sample of patients from 11 Italian cancer centers.

Materials and methods
Fifty-seven patients aged ≥80 years were treated with cabazitaxel after previous failure with docetaxel; 39 completed a comprehensive geriatric assessment questionnaire (34 fit and 5 vulnerable) and 8 patients (14%) had an Eastern Cooperative Oncology Group performance status (PS) ≥2, while most had a PS of 0–1 (86%). Cabazitaxel was administered at a dose of 25 mg/m2 in 30 (52%) patients and 20 mg/m2 or adapted schedules in 27 (48%) patients. These schedules were adopted mainly in patients ≥85 years (75%), with a PS ≥2 (87.5%), and those classified as vulnerable (100%).

Results
The duration of treatment was 4.8 months and was comparable in all subgroups; disease control rate was reported in 36 patients (63%); prostate-specific antigen response was recorded in 18 patients (31.5%). Median overall survival was 13.1 months regardless of age (<85/≥85 years), but overall survival was reduced in vulnerable (7.2 months) and PS ≥ 2 patients (6.8 months). The most frequently documented grade 3–4 toxicities were neutropenia (14%) and diarrhea (10.5%). Six patients (10.5%) dropped out due to severe toxicity.

Conclusions
Octogenarian patients can be treated with cabazitaxel with reduced doses or alternative schedules that are associated with less toxicity and fewer treatment interruptions. Comprehensive geriatric assessment could facilitate more appropriate patient selection.
Silicone Granulomas at the Peripheral Intravenous Cannula Puncture Site
Authors: Gil-Pallares Pedro , Vázquez-Osorio Igor , Pérez-Feal Patricia , Suárez-Peñaranda José Manuel 
Published: February 2022

Abstract:
Different adverse reactions to silicone present in cosmetic fillers, implants, or medical devices have been reported. The granulomatous reaction on the injection site due to catheters' silicone coating is an infrequent complication, which may be clinically difficult to suspect. Although the definitive diagnosis requires identification of the silicone with techniques such as X-ray spectroscopy, the possibility of involvement of silicone, as well as the histopathologic demonstration of granulomas with refractile, nonpolarizable, and nonstainable material strongly suggests this diagnosis. Moreover, the use of a low-diaphragm aperture or phase-contrast microscopy could be useful to demonstrate the presence of this, otherwise almost transparent, foreign body.
Clinical features of 162 fatal cases of COVID-19: a multi-center retrospective study
Authors: Zhou Xianlong , Ding Guoyong , Fang Qing , Guo Jun , Yang Luyu , Wang Ping , Fu Shou-Zhi , Li Ang , Xia Jian , Yu Jiangtao , Xia Jianyou , Ma Min , Hu Zhuanzhuan , Huang Lei , Liu Ruining , Jiang Cheng , Li Shaoping , Yu Mingxia , Xu Xizhu , Zhao Yan , Hu Quan , Xing Weijia , Zhao Zhigang 
Published: February 2022

Abstract

Background
The coronavirus disease 2019 (COVID-19) has affected approximately 2 million individuals worldwide; however, data regarding fatal cases have been limited.

Objective
To report the clinical features of 162 fatal cases of COVID-19 from 5 hospitals in Wuhan between December 30, 2019 and March 12, 2020.

Methods
The demographic data, signs and symptoms, clinical course, comorbidities, laboratory findings, computed tomographic (CT) scans, treatments, and complications of the patients with fatal cases were retrieved from electronic medical records.

Results
The median patient age was 69.5 (interquartile range: 63.0–77.25) years, and 80% of the patients were over 61 years. A total of 112 (69.1%) patients were men. Hypertension (45.1%) was the most common comorbidity, while 59 (36.4%) patients had no comorbidity. At admission, 131 (81.9%) patients had severe or critical COVID-19, whereas 39 (18.1%) patients with hypertension or chronic lung disease had moderate COVID-19. In total, 126 (77.8%) patients received antiviral treatment, while 132(81.5%) patients received glucocorticoid treatment. A total of 116 (71.6%) patients were admitted to the intensive care unit (ICU), and 137 (85.1%) patients received mechanical ventilation. Most patients received mechanical ventilation before ICU admission. Approximately 93.2% of the patients developed respiratory failure or acute respiratory distress syndrome. There were no significant differences in the inhospital survival time among the hospitals (P=0.14).

Conclusion
Young patients with moderate COVID-19 without comorbidity at admission could also develop fatal outcomes. The in-hospital survival time of the fatal cases was similar among the hospitals of different levels in Wuhan.
Changing Trends in Glaucoma Surgery Over the Past 5 Years in China
Authors: Qiao Chunyan , Zhang Hui , Cao Kai , Tian Jiaxin , Chung Tham Yih , Shan Jing , Han Ying , Wang Ningli ,   on Behalf of the Investigators for the Chinese Glaucoma Study Consortium
Published: February 2022

Purpose:
To analyze the trends of glaucoma surgery procedures over the past 5 years among hospitals across major provinces in China.

Materials and Methods:
This was a retrospective observational study based on medical records. We obtained the annual numbers of commonly performed glaucoma incisional surgeries from 57 hospitals of 30 provincial regions in the Chinese Glaucoma Study Consortium (CGSC) from January 2015 to September 2019. The trend of glaucoma surgery was analyzed by Cochrane-Armitage trend test.

Results:
Trabeculectomy, cataract extraction combined with goniosynechialysis, cataract extraction combined with trabeculectomy, and surgical peripheral iridotomy (SPI) were the top 4 surgical procedures percentages of which have the most substantial change over the course of 2015 to 2019 (all P
trend <0.001). Numbers of trabeculectomies decreased significantly from 47.59% in 2015 to 31.21% in 2019; cataract extraction combined with goniosynechialysis increased from 12.12% to 28.48%; cataract extraction combined with trabeculectomy increased from 13.11% to 15.97%; and SPI decreased from 9.03% to 6.34%. The proportion of internal drainage surgery increased from 24.31% in 2015 to 39.29% in 2019 while external drainage surgery decreased from 69.20% to 54.64% (All P
trend <0.001). The microinvasive glaucoma surgeries including AB-interno Canaloplasty, gonioscopy-assisted transluminal trabeculotomy, and Trabectome, increased from 0.62% to 1.40% (P
trend<0.001). Across all study hospitals, the trends were similar, except for the Tibet Autonomous Region Eye Center, where SPI and trabeculectomy remained the most common anti-glaucoma surgeries.

Conclusion:
In the past 5 years, we observed substantial reduction in trabeculectomy, and increase in combination cataract-glaucoma procedures across major hospitals in China. The proportion of internal drainage surgery increased, while external drainage surgery decreased significantly. Detailed understanding of shifting trends in glaucoma surgeries can facilitate better health care resource allocation and training of glaucoma subspecialists in China.
Efficacy, Feasibility, and Safety of Endoscopic Ultrasound-guided Fine-needle Biopsy for the Diagnosis of Gastrointestinal Subepithelial Lesions
Authors: Tan Yandi , Tang Xinyi , Huang Ju , Li Rui 
Published: February 2022

Background:
Endoscopic ultrasound (EUS) fine-needle biopsy (FNB) has become an efficient method for diagnosing gastrointestinal (GI) subepithelial lesions (SELs). However, recent guidelines have not regarded FNB as the primary strategy for diagnosing GI SELs. We performed this study to systematically measure the efficacy, feasibility, and safety of EUS-FNB in diagnosing GI SELs.

Materials and Methods:
Relevant studies were searched in PubMed and EMBASE and published after January 2015 were included. The overall rates of diagnostic yield, technical success, and adverse events were calculated as outcome measures. The Jadad scale and the Newcastle-Ottawa scale were used to evaluate the quality of the trials, funnel plots and Egger’s test were used to measure publication bias, and sensitivity and subgroup analyses were performed to explore the variance of heterogeneity and sensitivity, respectively.

Results:
Sixteen studies analyzing 969 patients between 2015 and 2020 were included. Studies showed little change in sensitivity, and 13 were considered high quality. A certain degree of publication bias existed in the diagnostic accuracy rate. The overall rates of diagnostic yield, technical success, and adverse events were [85.69% (95% confidence interval (CI): 82.73-88.22, I
2=41.8%), 98.83% (95% CI: 96.73-99.97, I
2=54.3%), and 1.26% (95% CI: 0.35-2.54, I
2=0.0%)]. No clinical influencing factors were identified in the subgroup analysis.

Conclusions:
EUS-FNB is a promising technology with a relatively superior diagnostic yield, technical success, and security, which is an optimal option for the diagnosis of SELs.
Histologic Remission (NANCY Index) is Superior to Endoscopic Mucosal Healing in Predicting Relapse Free Survival in Patients With Ulcerative Colitis in Clinical and Endoscopic Remission
Authors: Wang Hunter , Fewings Ingrid , Bornman Lee , Shadbolt Bruce , Fadia Mitali , Subramaniam Kavitha 
Published: February 2022

Background:
Histologic activity is recognized as an important predictor of relapse in ulcerative colitis (UC) patients. Current treatment targets aim at mucosal healing; however, many patients continue to have histologic activity.

Goals:
The aim was to assess histologic activity using the validated Nancy histologic index (NHI) score as a predictor of future relapse amongst UC patients in endoscopic and clinical remission.

Study:
In this retrospective cohort study, UC patients in clinical and endoscopic remission at a single tertiary center between 2015 and 2018, who underwent a surveillance colonoscopy were included. Clinical remission was defined by partial Mayo score (MSp) <2, and endoscopic remission was defined by Mayo endoscopic subscore (MES) ≤1. Histologic remission was defined by NHI <2. Predictive factors associated with the primary endpoint of clinical relapse were analyzed.

Results:
A total of 74 of 184 UC patients were included in the study. Amongst this cohort, 33 patients (45%) demonstrated histologic activity (NHI >1) at enrollment. The median follow-up time was 42 months (interquartile range: 26 to 63 mo) with median relapse free period of 30 months (interquartile range: 18 to 48 mo). Kaplan-Meier analysis demonstrated patients with MES 0 (P=0.02) and histologic remission (P<0.0001) had significantly longer relapse free survival. On multivariate analysis only histologic activity remained an independent risk factor of future clinical relapse (hazard ratio: 4.36, confidence interval: 1.68-11.27, P=0.002).

Conclusion:
Histologic remission using the NHI independently predicts significantly longer relapse free survival and may be a superior therapeutic target than endoscopic remission.
Drug-resistant tuberculosis: advances in diagnosis and management
Authors: Günther Gunar , Ruswa Nunurai , Keller Peter M. 
Published: February 2022

Purpose of review
Diagnosis and treatment of drug-resistant tuberculosis (DR-TB) is undergoing substantial changes, owing availability of new diagnostic tools and drugs, coupled with global underdiagnosis and undertreatment. Recent developments are reviewed.

Recent findings
Molecular diagnostics, for Mycobacterium tuberculosis complex detection and prediction of drug resistance, implemented in the last decade, accelerated TB diagnosis with improved case detection. Nevertheless, access and coverage of drug-resistance testing remain insufficient. Genome sequencing-technologies, based on targeted next-generation sequencing show early potential to mitigate some of the challenges in the future. The recommendation to use an all oral, bedaquiline based regimen for treatment of multidrug-resistant/rifampicin-resistant TB is major advancement in DR-TB care. TB regimen using new and repurposed TB drugs demonstrate in recent clinical trials like, NIX-TB, ZeNIX and TB PRACTECAL considerable treatment success, shorten treatment duration and reduce toxicity. Their optimal use is threatened by the rapid occurrence and spread of strains, resistant to new drugs. Children benefit only very slowly from the progress.

Summary
There is notable progress in improved diagnosis and treatment of drug-resistant TB, but complicated by the COVID-19 pandemic the majority of TB patients worldwide don’t have (yet) access to the advances.
Small bowel Crohn's disease: optimal modality for diagnosis and monitoring
Authors: Carretero Cristina 
Published: February 2022

Purpose of review
This paper reviews different imaging options for small bowel (SB) Crohn's disease (CD) patients.

Recent findings
In total, 80% of patients suffering from CD have SB involvement, being the exclusive manifestation in 30% of cases. As the proximal disease is related to poor response to treatment, a higher rate of stenosis and a greater need for surgical treatment, a SB assessment should be performed. This evaluation should be done not only once the disease has been diagnosed but periodically. The former to determine the extent of the disease, and the latter according to a treat-to-target strategy. Available techniques such as magnetic resonance imaging, intestinal ultrasound and capsule endoscopy (CE) have shown good accuracy parameters in CD patients. Cross-sectional studies are superior for penetrating and stricturing disease, whereas CE is excellent for proximal involvement and mucosal healing. Local expertise and availability may lead the election between techniques, nevertheless, they should not be considered as competitors but as complementary tools.

Summary
SB involvement in CD patients is frequent and related to poorer outcomes. Hence, SB evaluation should be screened after diagnosis and routinely during the follow-up.
Focal therapy: definition and rationale
Authors: Clark Roderick , Klotz Laurence 
Published: February 2022

Purpose of review
The role of focal therapy for the treatment of prostate cancer is expanding in clinical practice. The aim of this review is to introduce readers to controversies in the use of focal therapy and its rationale.

Recent findings
There is a growing body of literature regarding the short-term and medium-term cancer control parameters and quality of life outcomes. These are mostly observational studies without a comparative arm. There is a need for high-quality randomize control trials comparing these treatments to definitive standard of care interventions (e.g. surgery or radiotherapy) in appropriate patient populations.

Summary
Focal therapy for prostate cancer has become an established therapeutic strategy. Evidence continues to accrue regarding its effectiveness. It is a useful treatment option for the appropriately selected patient, with the appeal of improved quality of life compared with standard therapies.
Outcome of Extracorporeal Membrane Oxygenation for Pediatric Patients With Neoplasm: An Extracorporeal Life Support Organization Database Study (2000–2019)
Authors: Suzuki Yota , Cass Samuel H. , Kugelmann Andrew , Mobli Keyan , Taylor Williams P. , Radhakrishnan Ravi S. 
Published: February 2022

OBJECTIVES:
This study update in usage and outcomes of pediatric extracorporeal membrane oxygenation (ECMO) for patients with neoplasm analyzed according to demographics, clinical variables, and complications.

DESIGN:
Retrospective database review of the Extracorporeal Life Support Organization registry from the last 2 decades (2000–2019). The data were divided between two decades in order to compare patients’ backgrounds and outcomes over time.

SETTING:
ECMO centers reporting to Extracorporeal Life Support Organization.

PATIENTS:
Patients equal to or younger than 18 years old with International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes that referred to neoplasms who were managed with ECMO.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Demographics, cancer subtype, clinical variables, and ECMO complications were assessed in relation to the primary study outcome of survival to hospital discharge. Nine-hundred two patients met inclusion criteria; 699 patients were in the latest decade, which is more than three times the number from the previous decade (203 patients). On univariate analysis, compared with the previous decade, in the later decade, ECMO was more frequently applied in patients with pre-ECMO cardiac arrest (31.3% vs 17.1%; p < 0.001), and/or lower oxygenation index (38.0 vs 48.1; p < 0.001). We failed to identify a difference in survival between the 2 decades (42.8% vs 37.9%; p = 0.218). On multivariable analysis, diagnosis of hematologic malignancy, post-cardiopulmonary resuscitation support type, hematopoietic stem cell transplant, and age older than seven were each associated with greater odds of mortality.

CONCLUSIONS:
The use of ECMO in children with neoplasm has expanded over the latest decade with changes in patient selection. Mortality remains unchanged. Hence, although the clinician still should stay cautious in its application, ECMO can be considered as an option to rescue pediatric oncologic patients in the setting of worsening cardiopulmonary status in the PICU.
Differential patterns of postmigration HIV-1 infection acquisition among Portuguese immigrants of different geographical origins
Authors: Pimentel Victor Figueiredo , Pingarilho Marta , Sole Giordano , Alves Daniela , Miranda Mafalda , Diogo Isabel , Fernandes Sandra , Pineda-Pena Andrea , Martins M. Rosário O. , Camacho Ricardo , Gomes Perpétua , Abecasis Ana B. 
Published: February 2022

Objective:
To investigate the dynamics of phylogenetic transmission clusters involving immigrants of Portuguese Speaking Countries living in Portugal.

Design/methods:
We included genomic sequences, sociodemographic and clinical data from 772 HIV migrants followed in Portugal between 2001 and 2017. To reconstruct HIV-1 transmission clusters, we applied phylogenetic inference from 16 454 patients: 772 migrants, 2973 Portuguese and 12 709 global controls linked to demographic and clinical data. Transmission clusters were defined using: clusters with SH greater than 90% (phylogenetic support), genetic distance less than 3.5% and clusters that included greater than 66% of patients from one specific geographic origin compared with the total of sequences within the cluster. Logistic regression was performed to assess factors associated with clustering.

Results:
Three hundred and six (39.6%) of migrants were included in transmission clusters. This proportion differed substantially by region of origin [Brazil 54% vs. Portuguese Speaking African Countries (PALOPs) 36%, P < 0.0001] and HIV-1 infecting subtype (B 52%, 43% subtype G and 32% CRF02_AG, P < 0.001). Belonging to a transmission cluster was independently associated with treatment-naive patients, CD4+ greater than 500, with recent calendar years of sampling, origin from PALOPs and with seroconversion. Among Brazilian migrants – mainly infected with subtype B – 40.6% were infected by Portuguese. Among migrants from PALOPs – mainly infected with subtypes G and CFR02_AG – the transmission occurred predominantly within the migrants’ community (53 and 80%, respectively).

Conclusion:
The acquisition of infection among immigrants living in Portugal differs according to the country of origin. These results can contribute to monitor the HIV epidemic and prevent new HIV infections among migrants.
Vaginectomy in Transmasculine Patients: A Review of Techniques in an Emerging Field
Authors: Coulter Madeline , Diamond David A. , Estrada Carlos , Grimstad Frances , Yu Richard , Doyle Paula 
Published: March 2022

Purpose
This report reviews the various techniques for vaginal obliterative surgery in the transmasculine patient population, including advantages and drawbacks with differing methods and reflects on the focus of future research and surgical efforts.

Findings
Existing techniques for vaginal obliterative surgery by vaginectomy or colpocleisis vary without strong evidence to identify a superior approach.

Summary
The increasing number of transmasculine patients seeking vaginectomy as a part of gender-affirming surgery must be matched by evidence-based techniques that provide a safe, long-term outcome.