bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying Skin Uptake of Topicals After 1,927-nm and 1,440-nm Nonablative Fractional Diode Laser Treatment
Authors: Wang Jordan V. , Friedman Paul M. , Agron Samantha , Konda Adarsh , Parker Catherine , Geronemus Roy G. 
Published: May 2022

BACKGROUND
Although the stratum corneum limits transdermal absorption of topicals, laser devices can enhance topical uptake by disrupting the skin barrier. Nonablative lasers are commonly used, but their effects on topical uptake should be quantified to optimize outcomes.

OBJECTIVE
The objective of this study is to analyze transdermal uptake of 4 topicals after nonablative fractional diode laser pretreatment.

METHODS AND MATERIALS
Human donor tissue was pretreated ex vivo with a nonablative fractional diode laser (1,927 nm or 1,440 nm, at varying treatment densities, powers, and peak energies) followed by application of either 2% salicylic acid, 10% ascorbic acid, over-the-counter mineral eye serum, or 4% hydroquinone. Topical uptake was quantified over 24 hours.

RESULTS
Despite lower power settings, pretreatment with the 1,927 nm wavelength was associated with greater uptake of 10% ascorbic acid, mineral eye serum, and 4% hydroquinone than the 1,440 nm wavelength. In addition, 1,440-nm laser pretreatment with higher density (320 microscopic treatment zones [MTZ]/cm2) and peak power (3 W) was associated with similar uptake but greater retention of 2% salicylic acid and greater uptake of 10% ascorbic acid than that with lower density (80 MTZ/cm2) and peak power (1.2 W).

CONCLUSION
When using laser pretreatment, device settings should be adjusted to balance outcomes with potential side effects.
Understanding Variation in Rotavirus Vaccine Effectiveness Estimates in the United States: The Role of Rotavirus Activity and Diagnostic Misclassification
Authors: Amin Avnika B. , Lash Timothy L. , Tate Jacqueline E. , Waller Lance A. , Wikswo Mary E. , Parashar Umesh D. , Stewart Laura S. , Chappell James D. , Halasa Natasha B. , Williams John V. , Michaels Marian G. , Hickey Robert W. , Klein Eileen J. , Englund Janet A. , Weinberg Geoffrey A. , Szilagyi Peter G. , Staat Mary Allen , McNeal Monica M. , Boom Julie A. , Sahni Leila C. , Selvarangan Rangaraj , Harrison Christopher J. , Moffatt Mary E. , Schuster Jennifer E. , Pahud Barbara A. , Weddle Gina M. , Azimi Parvin H. , Johnston Samantha H. , Payne Daniel C. , Bowen Michael D. , Lopman Benjamin A. 
Published: May 2022

Background:
Estimates of rotavirus vaccine effectiveness (VE) in the United States appear higher in years with more rotavirus activity. We hypothesized rotavirus VE is constant over time but appears to vary as a function of temporal variation in local rotavirus cases and/or misclassified diagnoses.

Methods:
We analyzed 6 years of data from eight US surveillance sites on 8- to 59-month olds with acute gastroenteritis symptoms. Children’s stool samples were tested via enzyme immunoassay (EIA); rotavirus-positive results were confirmed with molecular testing at the US Centers for Disease Control and Prevention. We defined rotavirus gastroenteritis cases by either positive on-site EIA results alone or positive EIA with Centers for Disease Control and Prevention confirmation. For each case definition, we estimated VE against any rotavirus gastroenteritis, moderate-to-severe disease, and hospitalization using two mixed-effect regression models: the first including year plus a year–vaccination interaction, and the second including the annual percent of rotavirus-positive tests plus a percent positive–vaccination interaction. We used multiple overimputation to bias-adjust for misclassification of cases defined by positive EIA alone.

Results:
Estimates of annual rotavirus VE against all outcomes fluctuated temporally, particularly when we defined cases by on-site EIA alone and used a year–vaccination interaction. Use of confirmatory testing to define cases reduced, but did not eliminate, fluctuations. Temporal fluctuations in VE estimates further attenuated when we used a percent positive–vaccination interaction. Fluctuations persisted until bias-adjustment for diagnostic misclassification.

Conclusions:
Both controlling for time-varying rotavirus activity and bias-adjusting for diagnostic misclassification are critical for estimating the most valid annual rotavirus VE.
Failure of Risk Assessment After Paracetamol Overdose—A Short Communication
Authors: Boussetta-Charfi Oulfa , D'Andon Cornélie Fanton , Nguyen HoanVu , Rumack Barry H. , Launay Manon 
Published: May 2022

Background:
The accepted treatment for patients with acetaminophen/paracetamol overdose includes risk assessment based on the Rumack–Matthew (R-M) nomogram. An inaccurate use of the nomogram may result in improper treatment. Clinicians were surveyed to determine their understanding and proper use of this risk assessment tool in practice.

Methods:
Differences between visual risk assessment using the same depiction of the R-M nomogram and calculated risk assessment were determined using an online calculator developed based on the Rumack equation. An online survey was administered in French between August 25, 2021, and November 25, 2021, as a Google Form with 14 questions (the paracetamol concentration and time postingestion were stated). A total of 147 respondents with an average age of 32 years (range 23–61 years) performed risk assessment (low/possible/probable/not assessable). The mean assessment accuracy was 66.2 ± 26.7% (12.3–99.3). The sensitivity, specificity, positive predictive value, and negative predictive value were 93%, 55%, 71%, and 89%, respectively. A subcohort of n = 31 senior clinicians showed the same trends (91%, 52%, 69%, and 84%).

Results:
Approximately 7% of patients who are at risk of hepatotoxicity based on the R-M nomogram would not be treated. By contrast, N-acetylcysteine was not recommended by the R-M nomogram but would be administered to approximately 50% of patients. A concern for the latter group is that anaphylactoid reactions occur in up to 25% of patients with low paracetamol concentrations.

Conclusions:
Some patients may be undertreated, resulting in possible hepatotoxicity, and many patients may be overtreated, resulting in a high percentage of anaphylaxis. Rather than relying on visual risk assessment, physicians should use an online calculator (www.hopitox.com/?lang=en) or consult with a toxicologist or poison center to substantially improve patient care after acetaminophen/paracetamol overdose.
Evaluation of Ocular Surface Characteristics in Dry Eye Disease With and Without Soft Contact Lens Wear: A Comparative Study
Authors: Yang Tingting , Ma Baikai , Xie Jianyang , Zhou Yifan , Liu Rongjun , Duan Hongyu , Zhao Yitian , Qi Hong 
Published: May 2022

Objectives:
To investigate ocular surface alterations and in vivo confocal microscopic characteristics of the cornea in dry eye disease (DED) with contact lens wear (CLW).

Methods:
Sixty participants were divided into three groups: DED with CLW (n=20), DED without CLW (n=20), and normal control (n=20). Ocular surface parameters were evaluated. Basal tears and in vivo confocal microscopy images of the cornea were collected. Multiplex bead analysis was used to assess interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, nerve growth factor (NGF), and substance P (SP) in tears. Nerve morphology and dendritic cell density in corneal subbasal nerve images were calculated.

Results:
The DED with CLW group showed significantly higher ocular surface staining scores (P=0.022) and higher levels of IL-1β, NGF, and SP in tears (P=0.014, P=0.004 and P=0.025) than the DED without CLW group. Corneal dendritic cell density in the DED with CLW group was significantly higher than that in the normal controls (P=0.001) and DED without CLW group (P=0.043). Tear cytokine levels of IL-1β, NGF, and SP were correlated with ocular surface parameters in the DED with CLW group. Moreover, the years of CLW were positively correlated with corneal dendritic cell density (r=0.527, P=0.017) and negatively correlated with corneal nerve density (r=−0.511, P=0.021).

Conclusions:
Patients with DED with CLW showed greater epithelial damage, elevated inflammatory cytokines and neuromediators in tears, and higher corneal dendritic cell density than patients with DED without CLW. The immune and nervous systems may be involved in contact lens–related DED.
Gastrointestinal and non-gastrointestinal complication rates associated with diagnostic esophagogastroduodenoscopy under sedation
Authors: Jang Ji Min , Park Su Bee , Yoon Jin Young , Kwak Min Seob , Cha Jae Myung 
Published: May 2022

Abstract
Esophagogastroduodenoscopy (EGD) under sedation may result in gastrointestinal (GI) and non-GI complications. However, no previous studies have reported 30-day GI and non-GI complications after diagnostic EGD under sedation.
We conducted a retrospective, observational study of 30-day GI and non-GI complication rates after outpatient diagnostic EGD under sedation in subjects ≥18 years between January 2012 and December 2017 based on a common data model database. Thirty-day complication rates were compared with EGD under sedation or not, type of sedation drugs (midazolam only vs midazolam/propofol) and age groups (18-64 year vs ≥65 year) for GI (bleeding and perforation) and non-GI complications (pneumonia, acute myocardial infarction, congestive heart failure and cerebral stroke).
In total, 39,910 were performed with sedation (midazolam only, n = 16,033 and midazolam/propofol, n = 23,864) and 22,894 were performed without sedation. Elderly patients significantly favored EGD without sedation (P < .01). GI and non-GI complication rates were similar between EGD under sedation and without sedation (all P > .1) except for acute myocardial infarction rate, which was significantly higher in EGD without sedation than EGD under sedation (1.7/10,000 vs 0.3/10,000 persons, P = .043). All GI and non-GI complications were also similar between the midazolam/propofol and midazolam only groups as well as between young and old patients (all P > .1).
Outpatient diagnostic EGD under sedation has an excellent safety profile. In addition, it can be safely performed with midazolam only or midazolam/propofol and in young and old patients.
Analysis of risk factors for pulmonary tuberculosis with persistent severe inflammation
Authors: Shimoda Masafumi , Yoshiyama Takashi , Okumura Masao , Tanaka Yoshiaki , Morimoto Kozo , Kokutou Hiroyuki , Osawa Takeshi , Furuuchi Koji , Fujiwara Keiji , Ito Koki , Yoshimori Kozo , Ohta Ken 
Published: May 2022

Abstract

Introduction:
Patients with pulmonary tuberculosis (TB) sometimes show persistent severe inflammation for more than 1 month, even if TB treatment is effective. Although this inflammation can be improved through continuous antituberculous therapy, the risk factors for persistent inflammation remain unclear. Therefore, we sought to study the characteristics of patients with persistent severe inflammation.

Materials and methods:
We retrospectively analyzed 147 hospitalized adult patients with C-reactive protein (CRP) levels of 5 mg/dL or more on admission to Fukujuji Hospital from April 2019 to March 2021. The patients were divided into 2 groups: 40 patients (27.2%) had CRP levels of 5 mg/dL or more at 4 weeks after admission (persistent inflammation group), and 107 patients (72.8%) had CRP levels that fell below 5 mg/dL within 4 weeks of admission (improved inflammation group).

Results:
The median CRP level on admission in the persistent inflammation group was 10.8 mg/dL (interquartile range 9.1–14.5), which was higher than that in the improved inflammation group (median 8.2 mg/dL [6.5–12.1], P = .002). Patients in the persistent inflammation group had a higher prevalence of large cavities, defined as cavities ≥4 cm in diameter, on chest computed tomography (CT) (n = 20 [50.0%] vs n = 12 [11.2%], P < .001).

Discussion and conclusions:
This study showed that 27.2% of patients who had high or moderate inflammation on admission did not achieve low CRP levels within 4 weeks after admission. Risk factors for persistent severe inflammation in patients with TB were presence of a large cavity (cavity diameter ≥4 cm) on chest CT and a high CRP level on admission. Therefore, in a patient with a large cavity on chest CT and/or CRP ≥9.0 mg/dL on admission, long-term inflammation may occur despite antituberculous therapy if other diseases are ruled out.
Translation Into Simplified Chinese and Cultural Validation of the Pediatric Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Using Cognitive Interviewing
Authors: Shen Nanping , Ruan Haishan , Sun Jiwen , Li Yihan , He Mengxue , Yuan Changrong , Chang Lilu 
Published: May 2022

Background
The original English Pediatric Patient-Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) captures symptomatic adverse events (AEs) in cancer clinical trials from the perspective of pediatric patients. A Chinese version was needed to encourage the use of the Pediatric PRO-CTCAE among Chinese pediatric oncology patients.

Objective
This study translated and linguistically validated a simplified Chinese version of the Pediatric PRO-CTCAE for oncological patients aged 7 to 18 years.

Methods
Following the Functional Assessment of Chronic Illness Therapy translation methodology, 130 questions were translated into Chinese. Semistructured cognitive interviews investigated the comprehensibility and clarity of terms for symptoms, attributes, and response options. Two rounds of interviews were conducted with 48 native Chinese-speaking children aged 7 to 18 years who were undergoing chemotherapy or radiotherapy treatment.

Results
Most items, response options, and recall periods were well understood by children across the age range in round 1. Nineteen items posed comprehension difficulties for 9 participants and were revised and retested without further difficulties.

Conclusions
The Pediatric PRO-CTCAE was successfully developed and linguistically validated among Chinese oncology patients. The results indicated that the Chinese Pediatric PRO-CTCAE was semantically and conceptually equivalent to the English version.

Implications for Practice
The availability of the simplified Chinese Pediatric PRO-CTCAE will facilitate the generation of patient-reported outcome data about symptomatic AEs for children with cancer in China and thus improve our understanding of children’s experience of treatment-related symptoms.
Effects of Creative Arts Intervention on Anxiety, Depression and Sleep Quality Among Bone Marrow Transplantation Patients During Protective Isolation
Authors: Sertbaş Gülçin , Ok Elif , Unver Vesile 
Published: May 2022

Background
Protective isolation remains part of the standard of care for patients undergoing hematopoietic stem cell transplant in many places of the world. The consequences of protective isolation include increased anxiety and depressive symptoms.

Objective
The aim of this study was to determine the effects of creative interventions performed during the protective isolation period on anxiety, depression symptoms, and sleep quality of patients who underwent bone marrow transplantation (BMT).

Interventions/Methods
This study was a randomized, controlled, pre-post pilot design. A total of 20 patients made up the sample group. Participants were randomly assigned to the experimental (n = 9) or control group (n = 11). Hospital Anxiety and Depression Scale was applied to patients on the first day of admission to the unit and on the day of discharge. Questions prepared by researchers on sleep quantity and quality were administered every day during the patients’ hospitalization. The patients in the experimental group carried out creative arts intervention for a total of 60 minutes a day, 3 to 4 days a week, while they were in the unit.

Results
There was no difference in depression, anxiety, and sleep quality scores between the groups after intervention. However, depression and anxiety scores significantly decreased after the intervention in the experimental group, and sleep quality scores improved significantly.

Conclusion
Creative arts intervention may be beneficial for anxiety, depression, and sleep problems among patients undergoing BMT.

Implications for Practice
Creative arts intervention is effective in coping with anxiety, depression, and sleep problems that patients may experience due to social isolation during the BMT process.
Expanding Criteria for Limb Salvage in Comorbid Patients with Nonhealing Wounds: The MedStar Georgetown Protocol and Lessons Learned after 200 Lower Extremity Free Flaps
Authors: Nigam Manas , Zolper Elizabeth G. , Sharif-Askary Banafsheh , Abdou Salma A. , Charipova Karina , Bekeny Jenna C. , Fan Kenneth L. , Steinberg John S. , Attinger Christopher E. , Evans Karen K. 
Published: May 2022

Background:Lower extremity salvage in the setting of nonhealing wounds requires a multidisciplinary approach for successful free tissue transfer. Patients with comorbidities including diabetes mellitus and peripheral vascular disease were previously considered poor candidates for free tissue transfer. However, amputation leads to functional decline and severely increased mortality. The authors present their institutional perioperative protocol in the context of 200 free tissue transfers performed for lower extremity salvage in a highly comorbid population.Methods:The authors reviewed an institutional database of 200 lower extremity free tissue transfers performed from 2011 to 2019. Demographics, comorbidities, wound cause and location, intraoperative details, flap outcomes, and complications were compared between the first and second 100 flaps. The authors document the evolution of their institutional protocol for lower extremity free tissue transfers, including standard preoperative hypercoagulability testing, angiography, and venous ultrasound.Results:The median Charlson Comorbidity Index was 3, with diabetes mellitus and peripheral vascular disease found in 48 percent and 22 percent of patients, respectively. Thirty-nine percent of patients tested positive for more than three hypercoagulable genetic conditions. The second group of 100 free tissue transfers had a higher proportion of patients with decreased vessel runoff (35 percent versus 47 percent;p< 0.05), rate of endovascular intervention (7.1 percent versus 23 percent;p< 0.05), and rate of venous reflux (19 percent versus 64 percent;p< 0.001). Flap success (91 percent versus 98 percent;p< 0.05) and operative time (500 minutes versus 374 minutes;p< 0.001) improved in the second cohort.Conclusions:Standardized evidence-based protocols and a multidisciplinary approach enable successful limb salvage. Although there is a learning curve, high levels of salvage can be attained in highly comorbid patients with improved institutional knowledge and capabilities.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
Perioperative Risk Stratification Model for Readmission after Panniculectomy
Authors: Ali Barkat , Petersen Timothy R. , McKee Rohini G. 
Published: May 2022

Background:
Readmission is an important metric for surgical quality of care. This study aimed to develop a validated risk model that reliably predicts readmission after panniculectomy using the American College of Surgeons National Surgical Quality Improvement Program database.

Methods:
The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients who had undergone panniculectomy from 2005 to 2018. The outcome of interest was 30-day readmission. The cohort was divided randomly into 70 percent development and 30 percent validation groups. Independent predictors of 30-day readmission were identified using multivariable logistic regression on the development group. The predictors were weighted according to beta coefficients to generate an integer-based clinical risk score predictive of readmission, which was validated against the validation group.

Results:
For the model selection, 22 variables were identified based on criteria of p < 0.05 percent and complete data availability. Variables included in the development model included inpatient surgery, hypertension, obesity, functional dependence, chronic obstructive pulmonary disease, wound class greater than or equal to 3, American Society of Anesthesiologists class greater than 3, and liposuction. Receiver operating characteristic curve analysis of the validation group rendered an area under the curve of 0.710, which demonstrates the accuracy of this prediction model. The predicted incidence within each risk stratum was statistically similar to the observed incidence in the validation group (p < 0.01), further highlighting the accuracy of the model.

Conclusions:
The authors present a validated risk stratification model for readmission following panniculectomy. Prospective studies are needed to determine whether the implementation of the authors’ clinical risk score optimizes safety and reduces readmission rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Robotic Distal Gastrectomy Reduces Drain Amylase Values in Patients With a Small Pancreas-left Gastric Artery Angle
Authors: Teranishi Ryugo , Takahashi Tsuyoshi , Kurokawa Yukinori , Sugase Takahito , Saito Takuro , Yamamoto Kazuyoshi , Yamashita Kotaro , Tanaka Koji , Makino Tomoki , Yamasaki Makoto , Motoori Masaaki , Omori Takeshi , Nakajima Kiyokazu , Eguchi Hidetoshi , Doki Yuichiro 
Published: May 2022

Purpose:
Pancreatic fistula is a severe complication after laparoscopic distal gastrectomy (LDG). We previously evaluated the pancreas-left gastric artery angle (PLA) as a risk indicator for developing a pancreatic fistula after LDG. This study evaluated the incidence of pancreatic fistula with robotic distal gastrectomy (RDG) in comparison to LDG from the view of the PLA.

Materials and Methods:
An association between the PLA and the incidence of pancreatic fistula in 165 patients who underwent either RDG (n=45) or LDG (n=120) was investigated retrospectively.

Results:
RDG patients had significantly lower drain amylase values (postoperative day 2) than LDG patients. As opposed to LDG patients, drain amylase values were similar for patients with small (PLA <62 degrees) and large (PLA ≥62 degrees) PLA in RDG patients.

Conclusion:
Robotic surgery may reduce the risk of postoperative pancreatic fistula in patients with a small PLA.