bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Collagenase A on Descemet Membrane Endothelial Keratoplasty Scroll Tightness
Authors: Moolla Luqmaan , Mimouni Michael , Din Nizar , Cohen Eyal , Slomovic Allan R. , Rootman David S. , Chan Clara C. 
Published: July 2022

Purpose:
The scrolling properties of the Descemet membrane endothelial keratoplasty (DMEK) graft are essential for surgical success. Currently, there is limited knowledge on what dictates the tightness of the DMEK scroll. The purpose of this study was to determine the impact of temperature and protein digestion on DMEK graft scroll tightness.

Methods:
For the temperature experiment, a total of 28 eyes were used for this study. Scrolls in the cold group were kept at 4°C while scrolls in the hot group were kept at 37°C. Scroll width was recorded at the 5-, 15-, and 30-minute mark. For the protein digestion experiment, a total of 18 eyes were exposed to collagenase A (10 CDU/mL) in Optisol solution. Scroll width was recorded at the time points of 1, 3, 5, 10, and 20 minutes.

Results:
The results of the temperature experiment did not yield any statistically significant changes in the mean scroll width of the DMEK scrolls across both temperature ranges and observation times. For the protein digestion experiment, the mean scroll width grew from 1.85 mm to 2.13 mm from the beginning of the experiment until the final observation at 20 minutes. This is a 14.7% change over 20 minutes with a P value (<0.001), exemplifying a statistically significant change in scroll width.

Conclusions:
Temperature did not have any significant effect over scroll tightness, but scroll tightness decreased with collagenase exposure.
Incidence, Characteristics, and Outcomes of Clinically Undetected Bacteremia in Children Discharged Home From the Emergency Department
Authors: Golan Naama , Mor Meirav , Yaniv Noga , Berant Ron , Bressan Silvia , Altberg Gal , Samuel Nir 
Published: July 2022

Background:
Despite a recent decline in the rates of invasive infections, bacteremia in young children remains a significant challenge. We aimed to describe patient characteristics, microbial etiology, and outcomes of bacteremic, well-appearing children 3–36 months of age who were discharged home from the pediatric emergency department (PED) on their index visit.

Methods:
A retrospective cohort study in the PED of a tertiary children’s hospital from 1 June 2015 until 30 June 2021. We included all well appearing, immunocompetent infants 3–36 months old evaluated for fever and discharged home from the PED after a blood culture was drawn. We extracted demographic, clinical and laboratory data from the patient’s electronic medical records for the index visit and subsequent encounters.

Results:
During the study period, 17,114 children evaluated for fever met the inclusion criteria. Seventy-two patients (0.42%) had positive cultures for known pathogens. Thirty-six (50%) were male and 36 (50%) younger than 1 year. The most common isolates were S. pneumonia 26%. (n = 19), K. Kingae 25%. (n = 18) and Salmonella spp. 13.9% (n = 10). Sixty patients (85.7%) were recalled to the ED or had a scheduled appointment, 10 (14.3%) returned spontaneously and two were followed up by phone. The median time between visits was 28.7 hours (IQR 19.1–41.1). One patient was admitted to intensive care during the course of hospitalization. There were no deaths.

Conclusion:
The rate of undetected true bacteremia in our study was low and our data suggest that significant clinical deterioration during the first 24 hours is rare.
Two-Year Outcomes of Transcutaneous Non-Image Guided Bleomycin Sclerotherapy in Conjunctival Lymphatic Malformations: A Protocol-Based Management in 16 Eyes
Authors: Dave Tarjani Vivek , Walvekar Priyanka 
Published: July 2022

Objectives:
To study the efficacy and the 2-year outcomes of treating conjunctival lymphatic malformations (LM) with protocol-based bleomycin sclerotherapy.

Methods:
A retrospective interventional study of 16 eyes with conjunctival LM treated with bleomycin sclerotherapy between December 2016 and 2019. A clinical resolution was assessed as poor (less than 25% decrease in size), fair (25%–50% decrease in size), good (50%–75% decrease in size), excellent (more than 75% decrease in size), and complete resolution.

Results:
Mean age at presentation was 18 ± 13.09 (15 years, 3 to 59 years) years. The conjunctival component was classified based on clinical appearance as conjunctival mass (12) and microcystic LM (4). Mean clock hours of involvement were 3.32 ± 5.29 clock hours (4, 2–9 clock hours). An average per session dose of 1.8 ± 0.3 IU (median 2 IU, range 1–2 IU) and a cumulative dose of 3 ± 1.5 IU (3, 1–6 IU) of bleomycin were injected over an average of 1.6 ± 0.7 (median 2, range 1–3) treatment sessions per patient. Excellent response was observed in 11 (69%) cases. A residual lesion requiring surgical debulking was noted in 1 case. Recurrence was noted in 2 (13%) cases one of which was treated with repeat sclerotherapy resulting in complete resolution. Adverse reactions included restricted extraocular motility in extreme gaze in 2 eyes (13%). Sustained tumor resolution was observed over a mean follow-up of 29.24 + 9.45 months (24, 24–38 months).

Conclusions:
Bleomycin sclerotherapy gives excellent response in conjunctival LMs and is an effective first-line therapy in these cases.
How Much Does Filler Apparatus Influence Ease of Injection (and Hence, Potential Safety)?
Authors: Ginter Anna , Lee Terry , Woodward Julie 
Published: July 2022

Purpose:
To document the relative contributions of intrinsic filler fluid dynamics versus delivery systems for ease of injection—specifically, to measure extrusion force variability across different syringes and needles (with the characterization of intrinsic rheological fluid properties vs. delivery apparatus contributions to ease of injection).

Methods:
Six different fillers were tested: Belotero balance (Bel), Juvederm Voluma XC (Vol), Revanesse Versa (Rev), Restylane Lyft (Res), Radiesse (Rad), and Teosyal RHA3 (RHA). Extrusion force was measured in Newtons (N) for each by testing using the provided injection apparatus (needle + syringe), and also by standardizing all fillers to the same syringe and then varying needle sizes (30-ga, 27-ga, 25-ga/1.5-inch, 25-ga/2-inch, and 22-ga). Five trials were conducted for each scenario, with comparison via t-test (2-tailed, unpaired, assuming unequal variance).

Results:
The following results were noted: (1) in order of least to highest extrusion force in box-provided syringe + needle at 0.2 ml volume, the following were noted: Vol < RHA = Bel (27-ga) < Bel (30-ga) < Rev < Res = Rad; (2) for each filler (except for Vol which was similar), the box-provided syringe involved greater extrusion force than the standardized syringe used in this study (each 1-cc, p < 0.05); (3) for 27-ga and 30-ga needles, after standardization of delivery syringe at 0.2 ml volume, a significant difference was noted (proportional to increasing resistance): Bel = Vol = RHA3 < Res < Rev < Rad (for needles of 30-ga [p < 0.05] and 27-ga [p < 0.01]); (4) for testing cannulas after standardization of syringes no reproducible order was noted with increasing resistance when using 25-ga/1.5-inch long, 25-ga/2-inch, and 22g/2-inch cannulae; and (5) confirming expectation (validating study technique), the extrusion force was significantly higher for smaller needles and longer needles.

Conclusions:
The delivery apparatus appeared to be the most influential contributor to filler injection extrusion force, with significant changes in ease of injection correlated to the filler’s intrinsic rheological properties, such as viscosity (when standardized to the same syringe for needles tested). Knowledge of such data could influence the injector’s ability to maximize patients’ safety and clinical results.
Simvastatin is Efficacious in Treating Cirrhosis
Authors: Zhang Haifu , Zhang Qinxia , Li Shuojun , Xie Biyun 
Published: July 2022

Background:
Statins can improve prognosis of patients with liver cirrhosis by suppressing inflammation and lowering portal pressure. Here, we performed a meta-analysis to evaluate the clinical efficacy of simvastatin in liver cirrhosis patients.

Methods:
We searched PubMed, EMBASE, and Cochrane library databases for randomized controlled trials targeting simvastatin in patients with liver cirrhosis. The primary and secondary outcomes were the efficacy of simvastatin on clinical outcomes and its safety, respectively.

Results:
A total of 554 relevant articles were downloaded, of which 9 (comprising 648 participants) were eligible and were finally included in the analysis. Four studies revealed the impact of simvastatin on patient mortality, with the overall death rate found to be significantly lower in the simvastatin relative to the control group [risk ratio (RR): 0.46; 95% confidence interval (CI), 0.29 to 0.73; P<0.01]. Further analysis of the cause of death showed that simvastatin significantly reduces incidence of fatal bleeding (RR: 0.35; 95% CI, 0.13 to 0.95; P=0.04), as well as cholesterol [mean difference (MD): −31.48; 95% CI, −52.80 to −10.15; P<0.01] and triglyceride (MD: −25.88; 95% CI, −49.90 to −1.86; P=0.03) levels. At the same time, simvastatin did not significantly elevate levels of alanine aminotransferase (ALT) (MD: 2.34; 95% CI, −31.00 to 35.69; P=0.89) and was not associated with incidence of other side effects.

Conclusions:
The use of simvastatin in cirrhotic patients lowers mortality rates by suppressing incidences of fatal bleeding.
Prognostic factors of elderly patients with hepatocellular carcinoma: should we be more courageous in treatment?
Authors: Karaoğullarindan Ümit , Gümürdülü Yüksel , Üsküdar Oguz , Odabaş Emre , Güler Hasan Selim , Delik Anil , Kuran Sedef 
Published: July 2022

Objectives
Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increases with age. The risk of developing HCC is highest in the seventh decade. In this study, we aimed to determine the clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC in the elderly and young populations.

Methods
All patients aged ≥18 years who were diagnosed histologically between 2016 and 2020 were included in the study. Patients were divided into two groups: <70 years and ≥70 years. The clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC were compared in the elderly and young populations.

Results
A total of 407 patients were evaluated. There were 164 patients (40.3%) in the geriatric age group. There was no significant difference in the female/male ratio, the laboratory values, survival time between the two groups. There was no significant difference between the two groups in terms of tumor focality and portal vein invasion (P > 0.05). The presence of NAFLD, maximal tumor diameter (MTD), and portal invasion were found to be significant for survival according to the univariate analysis in elderly group (P < 0.05). In the multivariate analysis, presence of NAFLD etiologically, and MTD independent risk factors were observed in elderly group (P < 0.05).

Conclusion
If the clinicomorphological features of the tumor and prognostic risk factors can be determined by examining the patients in detail, all treatments can be easily applied in the geriatric group.
Risk factors for gastric cancer in patients with Lynch syndrome
Authors: Ortigão Raquel , Brito Mariana , Pinto Cláudia , Sá Inês , Libânio Diogo , Dinis-Ribeiro Mário , Brandão Catarina 
Published: July 2022

Introduction
The cumulative lifetime risk of gastric cancer (GC) in patients with Lynch syndrome (LS) is reported to be 8%. There is limited evidence on specific risk factors for GC and no agreement among guidelines on gastric endoscopic surveillance schedule in LS patients.

Aims and methods
We conducted a retrospective cohort study to identify risk factors for gastric precancerous conditions (chronic atrophic gastritis and intestinal metaplasia) and GC in patients with LS and a case–control study to compare the prevalence of these conditions with a control group.

Results
We included 385 LS patients (40.5% male, mean age 49.0 years). During a median follow-up period of 48 months (interquartile range, 24–84 months), precancerous conditions were identified in 110 patients (34%) and the prevalence of advanced stages of atrophic gastritis was 3% for OLGA III/IV and 0.6% OLGIM III/IV. Family history of GC was significantly associated with OLGA III/IV (P = 0.020). Among LS patients, 10 patients (2.6%) were diagnosed with GC (incidence rate of 5/1000 persons-year). Older age and OLGA III/IV were identified as risk factors for GC (P < 0.001). When compared with controls, patients with LS had significantly higher rates of Hp infection (P = 0.035) and lower OLGA and OLGIM stages (P < 0.001 and P = 0.026, respectively).

Conclusion
In our cohort, the incidence of GC and advanced stages of atrophic gastritis was low. Older age and OLGA III/IV were associated with a higher risk of GC. Identification of risk factors for GC in LS patients can help tailoring endoscopic surveillance.
ICU Admission Tool for Congenital Heart Catheterization (iCATCH): A Predictive Model for High Level Post-Catheterization Care and Patient Management
Authors: Quinn Brian P. , Shirley Lauren C. , Yeh Mary J. , Gauvreau Kimberlee , Ibla Juan C. , Kotin Sarah G. , Porras Diego , Bergersen Lisa J. 
Published: July 2022

Objectives:
Currently, there are no prediction tools available to identify patients at risk of needing high-complexity care following cardiac catheterization for congenital heart disease. We sought to develop a method to predict the likelihood a patient will require intensive care level resources following elective cardiac catheterization.

Design:
Prospective single-center study capturing important patient and procedural characteristics for predicting discharge to the ICU. Characteristics significant at the 0.10 level in the derivation dataset (July 1, 2017 to December 31, 2019) were considered for inclusion in the final multivariable logistic regression model. The model was validated in the testing dataset (January 1, 2020 to December 31, 2020). The novel pre-procedure cardiac status (PCS) feature, collection started in January 2019, was assessed separately in the final model using the 2019 through 2020 dataset.

Setting:
Tertiary pediatric heart center.

Patients:
All elective cases coming from home or non-ICU who underwent a cardiac catheterization from July 2017 to December 2020.

Interventions:
None.

Measurements and Main Results:
A total of 2,192 cases were recorded in the derivation dataset, of which 11% of patients (n = 245) were admitted to the ICU, while 64% (n = 1,413) were admitted to a medical unit and 24% (n = 534) were discharged home. In multivariable analysis, the following predictors were identified: 1) weight less than 5 kg and 5–9.9 kg, 2) presence of systemic illness, 3) recent cardiac intervention less than 90 days, and 4) ICU Admission Tool for Congenital Heart Catheterization case type risk categories (1–5), with C-statistics of 0.79 and 0.76 in the derivation and testing cohorts, respectively. The addition of the PCS feature fit into the final model resulted in a C-statistic of 0.79.

Conclusions:
The creation of a validated pre-procedural risk prediction model for ICU admission following congenital cardiac catheterization using a large volume, single-center, academic institution will improve resource allocation and prediction of capacity needs for this complex patient population.
The Relationship of Liver and Pancreas Density With Chest Computed Tomography Score Progression and Laboratory Findings in Patients With COVID-19
Authors: Gul Yeliz , Kilicarslan Gulhan , Cilengir Atilla Hikmet , Balaban Mehtap , Gul Evrim 
Published: July 2022

Objective
Abdominal involvement of COVID-19 is a current issue. We aimed to evaluate hepatic and pancreatic density alterations on computed tomography (CT) and to analyze whether these alterations had a relationship with chest CT score and laboratory findings.

Methods
Patients with reverse transcription-polymerase chain reaction-confirmed COVID-19 from March 11, 2020, to February 6, 2021, were retrospectively analyzed. Patients were divided into nonprogressive and progressive groups according to their chest CT scores. Liver and pancreas density, and liver-to-spleen (L/S) ratio were calculated. Laboratory findings, medication, intensive care unit stay, and survival were noted.

Results
There were 51 patients in the nonprogressive group and 123 patients in the progressive group. The median (minimum to maximum) L/S value of the nonprogressive group was 1 (0.28–1.53) at admission and 1.06 (0.33–1.83) at follow-up (P < 0.001). In the progressive group, the median L/S value was 1.08 (0.35–1.51) at admission and 0.92 (0.33–1.75) at follow-up (P < 0.001). A significant difference was found between the 2 groups at admission and follow-up (P = 0.010 and P < 0.001, respectively). Pancreatic density measured at follow-up was significantly lower in the progressive group (P = 0.045). In the progressive group, aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values were higher; albumin and lymphocyte values were lower (P < 0.05).

Conclusions
Patients with COVID-19 with progressive CT scores may have a decrease in L/S values, and their pancreatic density is lower than nonprogressives. Aspartate aminotransferase, total bilirubin, creatinine, urea, C-reactive protein, D-dimer, and white blood cell values tend to be higher in patients with a high chest CT score.
Quality of Recovery and Innate Immune Homeostasis in Patients Undergoing Low-pressure Versus Standard-pressure Pneumoperitoneum During Laparoscopic Colorectal Surgery (RECOVER)
Authors: Albers Kim I. , Polat Fatih , Helder Leonie , Panhuizen Ivo F. , Snoeck Marc M.J. , Polle S. (Bas) W. , de Vries Hilbert , Dias Esther M. , Slooter Gerrit D. , de Boer Hans D. , Diaz-Cambronero Oscar , Mazzinari Guido , Scheffer Gert-Jan , Keijzer Christiaan , Warlé Michiel C. ,   RECOVER Study Collaborators
Published: July 2022

Objective:
To study the effects of intra-abdominal pressure on the quality of recovery and innate cytokine production capacity after laparoscopic colorectal surgery within the enhanced recovery after surgery program.

Background:
There is increasing evidence for the safety and advantages of low-pressure pneumoperitoneum facilitated by deep neuromuscular blockade (NMB). Nonetheless, there is a weak understanding of the relationship between clinical outcomes, surgical injury, postoperative immune dysfunction, and infectious complications.

Methods:
Randomized controlled trial of 178 patients treated at standard-pressure pneumoperitoneum (12 mm Hg) with moderate NMB (train-of-four 1–2) or low pressure (8 mm Hg) facilitated by deep NMB (posttetanic count 1–2). The primary outcome was the quality of recovery (Quality of Recovery 40 questionnaire) on a postoperative day 1 (POD1). The primary outcome of the immune substudy (n=100) was ex vivo tumor necrosis factor α production capacity upon endotoxin stimulation on POD1.

Results:
Quality of Recovery 40 score on POD1 was significantly higher at 167 versus 159 [mean difference (MD): 8.3 points; 95% confidence interval (CI): 2.5, 14.1; P=0.005] and the decline in cytokine production capacity was significantly less for tumor necrosis factor α and interleukin-6 (MD: −172 pg/mL; 95% CI: −316, −27; P=0.021 and MD: −1282 pg/mL; 95% CI: −2505, −59; P=0.040, respectively) for patients operated at low pressure. Low pressure was associated with reduced surgical site hypoxia and inflammation markers and circulating damage-associated molecular patterns, with a less impaired early postoperative ex vivo cytokine production capacity. At low pressure, patients reported lower acute pain scores and developed significantly less 30-day infectious complications.

Conclusions:
Low intra-abdominal pressure during laparoscopic colorectal surgery is safe, improves the postoperative quality of recovery and preserves innate immune homeostasis, and forms a valuable addition to future enhanced recovery after surgery programs.
Development and Validation of a Model for Predicting Surgical Site Infection After Pelvic Organ Prolapse Surgery
Authors: Sheyn David , Gregory W. Thomas , Osazuwa-Peters Oyomoare , Jelovsek J. Eric 
Published: July 2022

Importance
Surgical site infection (SSI) is a common and costly complication. Targeted interventions in high-risk patients may lead to a reduction in SSI; at present, there is no method to consistently identify patients at increased risk of SSI.

Objective
The aim of this study was to develop and validate a model for predicting risk of SSI after pelvic organ prolapse surgery.

Study Design
Women undergoing surgery between 2011 and 2017 were identified using Current Procedural Terminology codes from the Centers for Medicare and Medicaid Services 5% Limited Data Set. Surgical site infection ≤90 days of surgery was the primary outcome, with 41 candidate predictors identified, including demographics, comorbidities, and perioperative variables. Generalized linear regression was used to fit a full specified model, including all predictors and a reduced penalized model approximating the full model. Model performance was measured using the c-statistic, Brier score, and calibration curves. Accuracy measures were internally validated using bootstrapping to correct for bias and overfitting. Decision curves were used to determine the net benefit of using the model.

Results
Of 12,334 women, 4.7% experienced SSI. The approximated model included 10 predictors. Model accuracy was acceptable (bias-corrected c-statistic [95% confidence interval], 0.603 [0.578–0.624]; Brier score, 0.045). The model was moderately calibrated when predicting up to 5–6 times the average risk of SSI between 0 and 25–30%. There was a net benefit for clinical use when risk thresholds for intervention were between 3% and 12%.

Conclusions
This model provides estimates of probability of SSI within 90 days after pelvic organ prolapse surgery and demonstrates net benefit when considering prevention strategies to reduce SSI.