bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renocolic fistula
Authors: Yilmaz Grozdena , Ranasinghe Buddima , Teper Ervin 
Published: November 2019

ABSTRACT
Renocolic fistulas are abnormal connections between the upper urinary tract and the colon. Chronic renal obstruction and delayed treatment of obstructive renal stones can lead to loss of renal function, inflammation of the kidney and surrounding structures, and the development of fistulas. However, due to the increased availability of CT scans and cystoscopy for diagnosis and treatment, renocolic fistulas resulting from obstructing renal stones have become rare. This article describes a patient who was found to have a renocolic fistula on antegrade percutaneous nephrostogram. The patient was treated with a laparoscopic nephrectomy and minimally invasive colon repair and recovered.
The importance of protein intake and strength exercises for older adults
Authors: Paproski Justina Jane , Finello Gabriella Celeste , Murillo Alexandra , Mandel Ellen 
Published: November 2019

ABSTRACT
Sarcopenia, the progressive deterioration of muscle mass, quality, and strength, is prevalent among older adults. Since the first Baby Boomers reached age 65 years in 2010, primary care providers have faced a challenge to address sarcopenia in this growing older population. Preventing sarcopenia is essential for reducing falls, preventing chronic disease, and improving longevity. This article reviews new dietary and exercise guidelines for sarcopenia prevention in older adults.
Contraception options for patients with known hereditary risk for ovarian cancer
Authors: Joy Kelly M. 
Published: November 2019

ABSTRACT
For patients with a known hereditary risk of ovarian cancer, primary prevention typically is accomplished through prophylactic bilateral salpingo-oophorectomy. However, some patients may wish to preserve fertility or delay menopause and its associated comorbidities. This article discusses appropriate methods of contraception for these patients.
Honoring Medicine’s Social Contract: A Scoping Review of Critical Consciousness in Medical Education
Authors: Manca Annalisa , Gormley Gerard J. , Johnston Jennifer L. , Hart Nigel D. 
Published: November 2019

Purpose
To explore how the construct of critical consciousness has been conceptualized within the medical education literature and identify the main elements of critical consciousness in medical education so as to inform educational strategies to foster socially conscious physicians.

Method
In March 2019, the authors conducted a literature search of 4 databases and Google Scholar, seeking articles discussing critical consciousness in medical education published any time after 1970. Three of the authors screened articles for eligibility. Two transcribed data using a data extraction form and identified preliminary emerging themes, which were then discussed by the whole research team to ensure agreement.

Results
Of the initial 317 articles identified, 20 met study inclusion criteria. The publication of academic articles around critical consciousness in medical education has expanded substantially since 2017. Critical consciousness has been conceptualized in the medical education literature through 4 overlapping themes: (1) social awareness, (2) cultural awareness, (3) political awareness, and (4) awareness of educational dynamics.

Conclusions
Critical consciousness has been conceptualized in medical education as an intellectual construct to foster a reflexive awareness of professional power in health care, to unearth the values and biases legitimizing medicine as currently practiced, and to foster transformation and social accountability. Scholars highlighted its potential to improve sociocultural responsibility and to foster compassion in doctors. Adopting a critical pedagogy approach in medical education can help uphold its social accountability through an intrinsic orientation to action, but any enterprise working toward embedding critical pedagogy within curricula must acknowledge and challenge the current structure and culture of medical education itself.
Perioperative Acute Kidney Injury
Authors: Gumbert Sam D. , Kork Felix , Jackson Maisie L. , Vanga Naveen , Ghebremichael Semhar J. , Wang Christy Y. , Eltzschig Holger K. 
Published: November 2019

Abstract
Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.
Opioid-Limiting Legislation Associated With Reduced Postoperative Prescribing After Surgery for Traumatic Orthopaedic Injuries
Authors: Reid Daniel B. C. , Shah Kalpit N. , Shapiro Benjamin H. , Ruddell Jack H. , Evans Andrew R. , Hayda Roman A. , Akelman Edward , Daniels Alan H. 
Published: November 2019

Objectives:
To evaluate opioid-prescribing patterns after surgery for orthopaedic trauma before and after implementation of opioid-limiting mandates in one state.

Design:
Retrospective review.

Setting:
Level-1 trauma center.

Patients/Participants:
Seven hundred fifty-three patients (297 pre-law and 456 post-law) undergoing isolated fixation for 6 common fracture patterns during specified pre-law (January 1, 2016–June 28, 2016) and post-law (June 01, 2017–December 31, 2017) study periods. Polytrauma patients were excluded.

Intervention:
Implementation of statewide legislation establishing strict limits on initial opioid prescriptions [150 total morphine milligram equivalents (MMEs), 30 MMEs per day, or 20 total doses].

Main Outcome Measurements:
Initial opioid prescription dose, cumulative MMEs filled by 30 and 90 days postoperatively.

Results:

Pre-law and post-law patient groups did not differ in terms of age, sex, opioid tolerance, recent benzodiazepine use, or open versus closed fracture pattern (P > 0.05). The post-law cohort received significantly less opioids (363.4 vs. 173.6 MMEs, P < 0.001) in the first postoperative prescription. Furthermore, the post-law group received significantly less cumulative MMEs in the first 30 postoperative days (677.4 vs. 481.7 MMEs, P < 0.001); This included both opioid-naïve (633.7 vs. 478.1 MMEs, P < 0.001) and opioid-tolerant patients (1659.2 vs. 880.0 MMEs, P = 0.048). No significant difference in opioid utilization between pre- and post-law groups was noted after postoperative day 30. Independent risk factors for prolonged (>30 days) postoperative opioid use included male gender (odds ratio 2.0, 95% confidence interval 1.4–2.9, P < 0.001) and preoperative opioid use (odds ratio 5.1, 95% confidence interval 2.4–10.5, P < 0.001).

Conclusions:
Opioid-limiting legislation is associated with a statistically and clinically significant reduction in initial and 30-day opioid prescriptions after surgery for orthopaedic trauma. Preoperative opioid use and male gender are independently associated with prolonged postoperative opioid use in this population.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
What’s New in the Orthopaedic Treatment of Ambulatory Children With Cerebral Palsy Using Gait Analysis
Authors: Sees Julieanne P. , Truong Walter H. , Novacheck Tom F. , Miller Freeman , Georgiadis Andrew G. 
Published: November 2019

Background:
Limb deformities in ambulatory children with cerebral palsy (CP) are common. The natural history of lower extremity deformities is variable and the impact on gait is managed with many treatment modalities. Effective interventions must consider the underlying pathophysiology, patient-specific goals, and incorporate objective outcome assessment. Evaluation and treatment include observation, tone management multilevel orthopaedic surgery to address muscle contractures and bony deformities, and the use of gait analysis for preoperative and postoperative assessment.

Methods:
A PubMed search of the orthopaedic literature for studies published between January 2016 and February 2019 was performed. Eligible abstracts included the use of 3-dimensional instrumented gait analysis in the evaluation and treatment of the lower extremities in ambulatory children with CP. Seven hundred twenty abstracts were reviewed, with 84 papers identified as eligible, of which 45 full manuscripts were included for detailed review.

Results:
The review summarized recent advances regarding the treatment of torsional alignment, knee deformities and clinical gait evaluation with visual assessment tools compared with instrumented gait analysis.

Conclusions:
Gait analysis of ambulatory children with CP remains essential to evaluation and surgical decision-making. Promising results have been reported with the goal of maintaining or reaching a higher level of function and increased endurance.

Level of Evidence:
Level IV—literature review.
Reciprocal Changes in Cervical Alignment After Thoracolumbar Arthrodesis for Adult Spinal Deformity
Authors: Neuman Brian J. , Harris Andrew , Jain Amit , Kebaish Khaled M. , Sciubba Daniel M. , Klineberg Eric O. , Kim Han J. , Zebala Luke , Mundis Gregory M. , Lafage Virginie , Passias Peter , Lafage Renaud , Protopsaltis Themi S. , Bess Shay , Hamilton D. Kojo , Scheer Justin K. , Ames Christopher P. 
Published: November 2019

Study Design.
Multicenter database review of consecutive adult spinal deformity (ASD) patients.

Objective.
The aim of this study was to identify associations between changes in spinopelvic parameters and cervical alignment after thoracolumbar arthrodesis for ASD.

Summary of Background Data.
Reciprocal cervical changes occur after instrumented thoracic spinal arthrodesis. The timing and relationship of these changes to sagittal alignment and upper instrumented vertebra (UIV) selection are unknown.

Methods.
In 171 ASD patients treated with thoracolumbar arthrodesis from 2008 to 2012, we assessed changes from baseline to 6-week, 1-year, and 2-year follow-up in C2-C7 sagittal vertical axis (SVA), T1 slope, and C2-C7 lordosis. We used multivariate models to analyze associations between these parameters and UIV selection (T9 or distal vs. proximal to T9) and changes at each time point in thoracic kyphosis (TK), lumbar lordosis (LL), C7-S1 SVA, pelvic incidence, pelvic tilt, and sacral slope.

Results.
Two-year changes in C2-C7 SVA and T1 slope were significantly associated with baseline to 6-week changes in TK and LL and with UIV selection. Baseline to 2-year changes in C2-C7 lordosis were associated with baseline to 6-week changes in C7-S1 SVA (P = 0.004). Most changes in C2-C7 SVA occurred during the first 6 weeks postoperatively (mean 6-week change in C2-C7 SVA: 2.7 cm, 95% confidence interval [CI]: 0.7–4.7 cm; mean 2-year change in SVA: 2.3 cm, 95% CI: −0.1 to 4.6 cm). At 2 years, on average, there was decrease in C2-C7 lordosis, most of which occurred during the first 6 weeks postoperatively (mean 6-week change: −3.2°, 95% CI: −4.8° to −1.2°; mean 2-year change: –1.3°, 95% CI: − 3.2° to 0.5°).

Conclusion.
After thoracolumbar arthrodesis, reciprocal changes in cervical alignment are associated with postoperative changes in TK, LL, and C7-S1 SVA and with UIV selection. The largest changes occur during the first 6 weeks and persist during 2-year follow-up.

Level of Evidence: 3
Examining Associations Between Physician Data Utilization for Practice Improvement and Lifelong Learning
Authors: Sockalingam Sanjeev , Tavares Walter , Charow Rebecca , Youssef Alaa , Campbell Craig , Davis Dave , Giuliani Meredith , Okrainec Allan , Papadakos Janet , Silver Ivan , Wiljer David 
Published: November 2019

Introduction:
Practice data can inform the selection of educational strategies; however, it is not widely used, even when available. This study's purpose was to determine factors that influence physician engagement with practice data to advance competence and drive practice change.

Methods:
A practice-based, pan-Canadian survey was administered to three physician subspecialties: psychiatrists (Psy), radiation oncologists (RO), and general surgeons (GS). The survey was distributed through national specialty society membership lists. The survey assessed factors that influence the use of data for practice improvement and orientation to lifelong learning, using the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). Linear regression was used to model the relationship between the outcome variable frequency of data use and independent predictors of continuous learning to improving practice.

Results:
A total of 305 practicing physicians (Psy = 203, RO = 53, GS = 49) participated in this study. Most respondents used data for practice improvement (n = 177, 61.7%; Psy = 115, 40.1%; RO = 35; 12.2%; GS = 27, 9.4%) and had high orientation to lifelong learning (JeffSPLL mean scores: Psy = 47.4; RO = 43.5; GS = 45.1; Max = 56). Linear regression analysis identified significant predictors of data use in practice being: frequency of assessing learning needs, helpfulness of data to improve practice, and frequency to develop learning plans. Together, these predictors explained 42.9% of the variance in physicians' orientation toward integrating accessible data into practice (R2 = 0.426, P < .001).

Discussion:
This study demonstrates an association between practice data use and perceived data utility, reflection on learning needs and learning plan development. Implications for this work include process development for data-informed action planning for practice improvement for physicians.
Basomelanocytic Neoplasms: A Report of Two Similar Tumors With Divergent Treatments
Authors: Ryan Michael P. , Bennett Daniel D. , Goodwin Brandon P. , Kelly Brent C. 
Published: November 2019

Abstract:
Basomelanocytic neoplasms are tumors consisting of elements of both basal cell carcinoma and melanoma. These tumors are exceedingly rare and present a unique challenge as to how the melanoma component should be classified. Due to the paucity of cases, there are no clear-cut evidence-based guidelines as to how these tumors should be staged and which treatment options provide the optimal outcome. We present 2 separate patients with similar cases of colonizing basomelanocytic tumors that were treated in drastically different ways, highlighting the differing approaches to treatment. We discuss theses treatment modalities and the challenges inherent to diagnosing and treating basomelanocytic neoplasms.
Drug Prescribing and Outcomes After Pharmacogenomic Testing in a Developmental and Behavioral Health Pediatric Clinic
Authors: Patel Jai N. , Mueller Maxine K. , Guffey William J. , Stegman Joseph 
Published: November 2019

ABSTRACT:

Objective:
To describe drug prescribing and outcomes after pharmacogenomic (PGx) testing in children with developmental and/or behavioral disorders.

Methods:
This is a single-clinic retrospective analysis of patients aged 5 to 17 years with documented behavioral and/or development disorder(s) and having received PGx testing between May 2015 and May 2017. The primary endpoint was frequency of PGx-guided medication changes after testing. Secondary endpoints included frequency of medications in each category from the PGx report (use as directed, use with caution, and use with increased caution), changes in therapy within each category, frequency and type of actionable genes, symptomatic improvement, and frequency of medication changes up to 6 months after PGx-guided therapy.

Results:
Of 200 patients, 75% were male, 78% were white, 83% had attention-deficit/hyperactivity disorder, and 45% had anxiety, and their mean age was 10 years. Most common reasons for ordering PGx testing were lack of response (83%) and/or adverse events (42%). Approximately 84% had PGx-guided medication change(s) after testing. At baseline, 50% of medications were categorized in “use as directed,” 40% in “use with caution,” and 11% in “use with increased caution.” After testing, 8%, 29%, and 30% of medications in “use as directed,” “use with caution,” and “use with increased caution” categories were discontinued; 85% were added or continued from “use as directed” category. The most common actionable genes were ADRA2A (47%), COMT (22%), and CYP2D6 (20%). Sixty percent were on the same medication(s) suggested by the PGx report 6 months later, and 64% had provider-documented symptomatic improvement.

Conclusion:
Pharmacogenomic testing may affect drug prescribing and clinical outcomes in a pediatric behavioral health clinic.
Anatomy Behind the Facial Overfilled Syndrome: The Transverse Facial Septum
Authors: Cotofana Sebastian , Gotkin Robert H. , Frank Konstantin , Lachman Nirusha , Schenck Thilo L. 
Published: November 2019

BACKGROUND
The midface is an area of high demand for minimally invasive cosmetic procedures, that is, soft-tissue filler injections.

OBJECTIVE
To investigate the functional anatomy behind the facial overfilled syndrome observed after soft-tissue filler injections.

MATERIALS AND METHODS
The clinical part of the study enrolled 25 volunteers (12 men and 13 women, Caucasians); the anatomical part included 72 fresh frozen cephalic specimens obtained from 32 male and 40 female body donors. 3D surface scanning procedures were applied to calculate the maximal anterior projection of the midface.

RESULTS
Upon smiling, the point of maximal anterior projection shifted cranially in men by 12.43 ± 8.8 mm (difference between resting and smiling; p < .001) and by 8.75 ± 4.1 mm in women (p < .001). Cadaveric dissections identified a septum originated from the underside of the zygomaticus major muscle forming a transversely running boundary between the buccal space and the deep midfacial fat compartments.

CONCLUSION
Facial overfilled syndrome can potentially be explained by the presence of the transverse facial septum. Dynamic filling—injecting small amounts of filler and asking the patient to smile repeatedly during the procedure—seems to be a viable way to avoid this adverse event during soft-tissue filler injection.
Chitosan Hydrogel Enhances the Therapeutic Efficacy of Bone Marrow–Derived Mesenchymal Stem Cells for Myocardial Infarction by Alleviating Vascular Endothelial Cell Pyroptosis
Authors: Liu Yang , Li Panyang , Qiao Chenhui , Wu Tiejun , Sun Xiaoke , Wen Meng , Zhang Weihua 
Published: November 2019

Abstract:
Myocardial infarction (MI) is one of the higher mortality rates, and current treatment can only delay the progression of the disease. Experiments have shown that cell therapy could improve cardiac function and mesenchymal stem cells (MSCs)-based therapies provide a great promising approach in the treatment of MI. However, low cell survival and engraftment restricts the successful application of MSCs for treating MI. Here, we explored whether co-transplantation of a chitosan (CS) thermosensitive hydrogel with bone marrow-derived MSCs (BMSCs) could optimize and maximize the therapeutic of BMSCs in a mouse model of MI. The fate of transplanted BMSCs was monitored by bioluminescence imaging, and the recovery of cardiac function was detected by echocardiogram. Our results proved that CS hydrogel enhanced the BMSCs' survival and the recovery of cardiac function by protecting the vascular endothelial cells. Further studies revealed that the increased number of vascular endothelial cells was due to the fact that transplanted BMSCs inhibited the inflammatory response and alleviated the pyroptosis of vascular endothelial cells. In conclusions, CS hydrogel improved the engraftment of transplanted BMSCs, ameliorated inflammatory responses, and further promoted functional recovery of heart by alleviating vascular endothelial cell pyroptosis.
Peroneal Artery–based Propeller Flap to Cover the Medial Distal Tibia in the Absence of the Posterior Tibial Artery
Authors: Kish Alexander J. , Pensy Raymond A. 
Published: November 2019

Summary:
A healthy 28-year-old woman restrained driver presented to the trauma unit post-MVC with significant vehicular intrusion. Examination demonstrated a 15-cm transverse wound over the medial malleolus and anterior ankle with exposed muscle, tendon, and bone without gross contamination. Her physical examination was otherwise unremarkable. Distal to the wound, there was no Doppler signal in either dorsalis pedis or posterior tibial arteries and the foot appeared cold with delayed cap refill. She was taken to the operating room urgently for debridement and irrigation, open reduction internal fixation of both distal tibia and fibular fractures, and supplemental external fixation application. The foot regained a normal color and capillary refill upon reduction, and biphasic Doppler signals returned.
Oncoplastic Volume Replacement for Breast Cancer: Latissimus Dorsi Flap versus Thoracodorsal Artery Perforator Flap
Authors: Abdelrahman Emad M. , Nawar Ahmed M. , Balbaa M. Ashraf , Shoulah Ahmed A. , Shora Ahmed A. , Kharoub Mohamed S. 
Published: November 2019

Background:
Volume replacement oncoplastic breast techniques have become one of the standard lines in the treatment of early breast cancer. They have better cosmetic outcome and patient satisfaction. Latissimus dorsi (LD) flap is one of the most commonly used flaps for these techniques. Although it shows satisfactory surgical outcomes, postoperative shoulder dysfunction is an obvious drawback. The aim of this study was to compare LD flap with thoracodorsal artery perforator (TDAP) flap after breast-conserving surgery regarding surgical outcomes, patient satisfaction, and impact on shoulder function.

Methods:
The study included 42 adult female patients with early breast cancer who were eligible for conservative breast surgery and immediate breast reconstruction. Patients were divided into 2 equal groups: group A where patients underwent immediate reconstruction using LD flap and group B where patients underwent reconstruction using TDAP flap. Follow-up was designed for 12 months for early outcome, patient satisfaction, and shoulder functions.

Results:
The mean age of the included patients in group A and group B was 40.95 ± 5.06 and 40.33± 5.25 years, respectively. There was no significant difference in flap dimensions, postoperative complications, or cosmetic outcome in both groups. However, significantly less shoulder dysfunction was documented in cases of TDAP compared to LD flap at 3, 6, and 12 months postoperatively.

Conclusions:
TDAP flap is as reliable a technique as LD flap regarding the feasibility, postoperative complications, and the cosmetic outcome with significantly better functional outcome of the shoulder.