bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensor-Based Discovery of Search and Palpation Modes in the Clinical Breast Examination
Authors: Laufer Shlomi , Klatzky Roberta L. , Pugh Carla M. 
Published: December 2024

Abstract

Purpose
Successful implementation of precision education systems requires widespread adoption and seamless integration of new technologies with unique data streams that facilitate real-time performance feedback. This paper explores the use of sensor technology to quantify hands-on clinical skills. The goal is to shorten the learning curve through objective and actionable feedback.

Method
A sensor-enabled clinical breast examination (CBE) simulator was used to capture force and video data from practicing clinicians (N = 152). Force-by-time markers from the sensor data and a machine learning algorithm were used to parse physicians’ CBE performance into periods of search and palpation and then these were used to investigate distinguishing characteristics of successful versus unsuccessful attempts to identify masses in CBEs.

Results
Mastery performance from successful physicians showed stable levels of speed and force across the entire CBE and a 15% increase in force when in palpation mode compared with search mode. Unsuccessful physicians failed to search with sufficient force to detect deep masses (F[5,146] = 4.24, P = .001). While similar proportions of male and female physicians reached the highest performance level, males used more force as noted by higher palpation to search force ratios (t[63] = 2.52, P = .014).

Conclusions
Sensor technology can serve as a useful pathway to assess hands-on clinical skills and provide data-driven feedback. When using a sensor-enabled simulator, the authors found specific haptic approaches that were associated with successful CBE outcomes. Given this study’s findings, continued exploration of sensor technology in support of precision education for hands-on clinical skills is warranted.
Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Traumatic Rib Fracture: A Randomized, Active-controlled, Participant- and Observer-masked Study
Authors: Finneran John J. , Kobayashi Leslie , Costantini Todd W. , Weaver Jessica L. , Berndtson Allison E. , Haines Laura , Doucet Jay J. , Adams Laura , Santorelli Jarrett E. , Lee Jeanne , Trescot Andrea M. , Donohue Michael C. , Schaar Adam , Ilfeld Brian M. 
Published: December 2024

Background:
Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. The authors hypothesized that cryoneurolysis would improve analgesia and inspired volume after rib fracture.

Methods:
Adults with one to six traumatic rib fractures were randomized to either active cryoneurolysis and sham peripheral nerve block or sham cryoneurolysis and active peripheral nerve block in a participant/observer-masked fashion. The primary endpoint was the maximum inspired volume the day after the procedure as measured with an incentive spirometer.

Results:
The day after the procedure, the unadjusted median [interquartile range] maximum inspired volume for participants who received cryoneurolysis (n = 11) was 2,250 ml [1,500, 2,500 ml] versus 1,300 ml [750, 2,500 ml] for peripheral nerve block (n = 9, mean difference, 496; 95% CI, –428 to 1,420; t test P = 0.269). When adjusted for covariates (e.g., baseline lung volume), the cryoneurolysis group had an estimated 793 ml greater mean volume than peripheral nerve block (95% CI, 273 to 1,312 ml; analysis of covariance P = 0.005). Improvement from baseline in maximum inspired volume for cryoneurolysis was 1,000 ml [1,000, 1,375 ml] versus 300 ml [0, 1,000 ml] for peripheral nerve block (t test P = 0.002). This was equivalent to an improvement over baseline of 100% [90%, 188%] for cryoneurolysis versus 30% [0%, 50%] for peripheral nerve block (t test P = 0.003). Average daily pain scores were generally lower for the cryoneurolysis group throughout the first month. Total cumulative oxycodone equivalents were 5 mg [0, 13 mg] for cryoneurolysis versus 45 mg [43, 135 mg] for peripheral nerve block (t test P = 0.013).

Conclusions:
Ultrasound-guided percutaneous cryoneurolysis improves maximum inspired lung volume while concurrently decreasing pain and opioid consumption after traumatic rib fracture. These results should be considered preliminary, requiring confirmation with a trial including a larger sample size.
Amino Acid Infusion for Kidney Protection in Cardiac Surgery Patients with Chronic Kidney Disease: A Secondary Analysis of the PROTECTION Trial
Authors: Redaelli Martina Baiardo , Monaco Fabrizio , Bradic Nikola , Scandroglio Anna Mara , Ti Lian Kah , Belletti Alessandro , Viscido Cristina , Licheri Margherita , Guarracino Fabio , Pruna Alessandro , Pisano Antonio , Pontillo Domenico , Federici Francesco , Losiggio Rosario , Serena Giovanni , Tomasi Enrico , Silvetti Simona , Ranucci Marco , Brazzi Luca , Cortegiani Andrea , Landoni Giovanni , Mastroroberto Pasquale , Paternoster Gianluca , Gaudino Mario F.L. , Zangrillo Alberto , Bellomo Rinaldo ,   for the PROTECTION Study Group Collaborators
Published: December 2024

Background:
In the PROTECTION trial, intravenous amino acids (AA) decreased the occurrence of acute kidney injury (AKI) in cardiac surgery patients with cardiopulmonary bypass (CPB). Recruitment of renal functional reserve may be responsible for such protection. However, patients with chronic kidney disease (CKD) have diminished renal functional reserve, and AA may be less protective in such patients. Thus, a separate investigation of such patients is warranted.

Methods:
We defined CKD as an estimated glomerular filtration rate (eGFR)<60 mL·min-1·1.73 m-2 and patients with eGFR≥60 mL·min-1·1.73 m-2 served as controls. The primary outcome was the occurrence of AKI. Secondary outcomes included severity of AKI, need for and duration of renal replacement therapy, and all-cause mortality.

Results:
Among CKD patients (n=812), compared with placebo, AA significantly decreased the rate of AKI (43.1% vs 50.3%; RR, 0.86; 95%CI, 0.74 to 0.99; p=0.041; number needed to treat [NNT]=14) with a median percentage increase in eGFR from baseline to postoperative day three of 12.7% vs. 6.5% (p=0.002). In eGFR-based CKD subgroups (30 to 39, 40 to 49, and 50 to 59 mL·min-1·1.73 m-2) the AA effect was similar (interaction p=0.50). Finally, AA infusion decreased the occurrence of severe (stage 3) AKI (2.7% vs. 5.6%; RR 0.48; 95%CI, 0.24 to 0.98; p=0.038).

Conclusions:
AA infusion protected CKD patients undergoing CPB from developing AKI, with an absolute risk reduction of 7% and a NNT of 14 in a cohort with a >45% rate of AKI. Moreover, it delivered a >50% relative risk reduction in severe AKI.
Maternal Morbidity and Medically Assisted Reproduction Treatment Types
Authors: Pelikh Alina , Smith Ken R. , Myrskylä Mikko , Debbink Michelle P. , Goisis Alice 
Published: December 2024

OBJECTIVE:
To compare odds of maternal morbidity by mode of becoming pregnant and type of medically assisted reproduction treatments: fertility-enhancing drugs, intrauterine insemination (IUI), and assisted reproductive technology (ART) with autologous or donor oocytes.

METHODS:
Birth certificates were used to study maternal morbidity among the birthing population in Utah between 2009 and 2017 (N=469,919 deliveries); 22,543 pregnancies occurred through medically assisted reproduction (4.8%). Maternal morbidity was identified as a binary variable, indicating the presence of any of the following: blood transfusion, unplanned operating room procedure, admission to intensive care unit, eclampsia, unplanned hysterectomy, and ruptured uterus. Using logistic regression, we assessed maternal morbidity among medically assisted reproduction pregnancies (overall and by type of treatment) compared with unassisted pregnancies in the overall sample before and after adjustment for individual sociodemographics (age at birth, family structure, level of education, Hispanic origin, parity), and pre-existing comorbidities (ie, chronic hypertension, heart disease, asthma), multifetal gestation, and obstetric comorbidities (ie, placenta previa, placental abruption, cesarean delivery).

RESULTS:
Individuals becoming pregnant through medically assisted reproduction had higher risk of maternal morbidity, with odds ratios (ORs) increasing as medically assisted reproduction treatments become more invasive. Associations were largely attenuated when accounting for multifetal gestation and further reduced after controlling for obstetric comorbidities. However, ART with autologous oocytes (OR 1.46, 95% CI, 1.20–1.78) maintained higher coefficients compared with unassisted pregnancies. In models including only singletons, after controlling for obstetric comorbidities, the OR differences in maternal morbidity between all medically assisted reproduction groups and unassisted pregnancies were no longer statistically significant.

CONCLUSION:
More invasive medically assisted reproduction treatments (ART and IUI) are associated with higher odds of maternal morbidity, whereas less invasive treatments are not. This relationship is partially explained by higher prevalence of multifetal gestation and obstetric comorbidities in people undergoing more invasive treatment, but the persistent association suggests subfertility itself may contribute to maternal morbidity.
Mid-term Results Following Surgical Hip Dislocation for Residual Pediatric Deformities
Authors: Muffly Brian T. , Trotzky Zachary A. , Oettl Felix C. , Sink Ernest L. 
Published: December 2024

Background:
Mid-term results following surgical hip dislocation (SHD) for healed slipped capital femoral epiphysis (SCFE) and Perthes-related deformities are limited. This study aimed to characterize patient-reported outcome measures [including rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS)], report survivorship free from conversion to arthroplasty, and identify risk factors associated with composite failure.

Methods:
Twenty-seven patients (n=13 SCFE, n=14 Perthes) with minimum 2-year follow-up (mean 5.7 y) who underwent primary SHD from 2011 to 2021 were retrospectively reviewed. Modified Harris Hip Score (mHHS) and International Hip Outcome Tool-12 (iHOT-12) were collected preoperatively and at the latest follow-up. Composite failure was defined as not meeting any MCID/PASS threshold or conversion to arthroplasty. Continuous variables were analyzed using independent-sample t tests or the Wilcoxon Mann-Whitney test, where appropriate. Categorical variables were analyzed using χ2 or Fisher exact test, as indicated. Kaplan-Meier survivorship was determined.

Results:
Mean mHHS improved from 56.2 to 77.2 (P=0.003) and from 63.0 to 86.3 (P<0.001), while iHOT-12 improved from 36.1 to 64.7 (P=0.008) and 36.8 to 77.2 (P<0.001) in SCFE and Perthes cohorts, respectively. MCID achievement for mHHS and iHOT-12 were 85.7% and 75.0% among SCFE, compared with 83.3% and 81.8% in Perthes. The proportion meeting PASS for mHHS and iHOT-12 was 30% for both in SCFE, compared with 61.5% and 83.3% in Perthes. 5- and 10-year survivorship free of conversion to arthroplasty was 100% and 80%, as well as 93% and 77% in the SCFE and Perthes cohorts, respectively.

Conclusions:
At mid-term follow-up, patients undergoing SHD for residual deformities related to chronic SCFE and Perthes demonstrated significant improvements in mHHS and iHOT-12, as well as relatively high rates of meeting MCID. SHD is an effective approach providing pain and functional benefit. Preoperative expectations, though, should be tempered in these cohorts, as some pre-existing damage limits the ability to completely normalize anatomy.

Level of Evidence:
Level III, retrospective comparative study.
Association of remimazolam with delirium and cognitive function
Authors: Arias Jaime Andres , Wegner Gustavo Roberto Minetto , Wegner Bruno Francisco Minetto , Silva Larissa Santos , Bezerra Francisco José Lucena , Filardi Rafaela Goes Machado 
Published: December 2024

BACKGROUND AND STUDY OBJECTIVE
Delirium is an organic mental syndrome significantly associated with long-term cognitive decline, increased hospital stays and higher mortality. This systematic review of randomised controlled trials (RCTs) with meta-analysis assesses the association of remimazolam with postoperative cognitive function and delirium compared with non-benzodiazepine hypnotics.

DESIGN
Systematic review of RCTs with meta-analysis.

DATA SOURCES
PubMed, Embase, Cochrane Library and Web of Science databases up to 27 April 2024.

ELIGIBILITY CRITERIA
Adult patients undergoing general anaesthesia or sedation procedures; use of remimazolam as the primary hypnotic or as an adjunct, administered via intermittent bolus or continuous infusion; comparison with other hypnotics or sedatives; evaluation of cognitive function or delirium.

MAIN RESULTS
Twenty-three RCTs with 3598 patients were included. The incidence of delirium was not significantly different between remimazolam and other sedatives in general anaesthesia and sedation procedures [n = 3261; odds ratio (OR) = 1.2, 95% confidence interval (CI), 0.76 to 1.91; P = 0.378843; I
2 = 17%]. Regarding cognitive function evaluation, remimazolam showed no difference compared with the control group in Mini-Mental State Examination (MMSE) scores on the first postoperative day (n = 263; mean difference = 0.60, 95% CI, −1.46 to 2.66; P = 0.5684; I
2 = 90%) or on the third postoperative day (n = 163; mean difference  = 1.33, 95% CI, −0.72 to 3.38; P = 0.2028; I
2 = 93%). Remimazolam exhibited superiority over the control group in MMSE scores on the seventh postoperative day (n = 247; mean difference = 0.53, 95% CI, 0.30 to 0.75; P < 0.0001; I
2 = 28%).

CONCLUSION
Remimazolam does not increase the incidence of delirium or cognitive impairments compared with non-benzodiazepine hypnotics. However, the analysis showed that the type of surgery significantly influenced the incidence of delirium. Additionally, remimazolam was associated with better short-term postoperative cognitive function.

SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42024532751.
Successful arm replantation using traditional surgical techniques: a case report from a low-resource country
Authors: Abubakir Malaka , Sabbagh Lana , Khalil Ghaiyath , Al Ali Shahama , Tfankji Salim , Alkanj Hussein 
Published: December 2024

Introduction:
Upper limb replantation requires rapid intervention by a multidisciplinary team and appropriate equipment to rescue the limb. Note that the success of the operation and the decision to perform it depend on several factors. This case report presents an upper limb replantation performed using traditional surgical techniques.

Case presentation:
A 12-year-old boy presented to our hospital with a crushing injury to the right upper arm, which was amputated at the lower third of the humerus, with the biceps brachii tendon remaining intact. The first aid included resuscitation and intravenous fluid administration to maintain hemodynamic stability. The surgeons replanted the arm by immobilizing the fracture with Kirschner wires, performing several arterial and venous anastomoses, and suturing the damaged nerve and muscle aponeurosis in a 3-h operation. The patient was discharged after 5 days without any complications but was recommended to undergo physical therapy to regain his arm movement and is currently undergoing monthly follow-ups to ensure the required improvement.

Discussion:
Upper limb replantation is a complicated process that enables the conservation of arm function and appearance. This requires rapid intervention by a multidisciplinary team. Additionally, advanced equipment, such as microsurgical tools, provides greater success and ease of revascularization.

Conclusion:
To successfully re-implant an amputated limb, several factors must be considered: surgeon experience, availability of necessary equipment, and provision of post-operative care. Despite lacking advanced tools, surgeons can rely on their surgical skills to overcome this challenge.
Acute ischemic stroke revealing an internal carotid artery dissection in a 12-year-old child: case report and literature review
Authors: Chahboun Bouchra , Mekkaoui Ikram , Kaba Ousmane , Zoubaa Yassmine , Laaribi Ilias , Bkiyar Houssam , Housni Brahim 
Published: December 2024

Introduction and importance:
Internal carotid artery (ICA) dissection is a known cause of stroke but is often underdiagnosed in pediatric patients. Pediatric ischemic stroke significantly contributes to juvenile brain injury. Currently, there are no universally accepted guidelines for managing stroke in children.

Case Presentation:
We report the case of a 12-year-old girl who was admitted with sudden left hemiplegia and aphasia. Imaging revealed right carotid artery dissection and ischemic stroke in the right middle cerebral artery territory. She was managed with aspirin (75 mg/day) and enoxaparin (3000 IU/12 h) and remains under observation with persistent symptoms.

Clinical discussion:
This case highlights the difficulty in diagnosing ICA dissections in pediatric patients and the lack of clear guidelines for their management. The use of aspirin and enoxaparin represents an empirically-based therapeutic approach, underscoring the urgent need for further research to better understand the risk factors and pathogenic mechanisms of this condition. The persistence of symptoms in our patient also emphasizes the importance of close monitoring and individualized management.

Conclusion:
ICA dissection in pediatric stroke is hard to diagnose and treat. Research, empirically-based treatments, and personalized monitoring are crucial for better management and outcomes.
Febrile neutropenia in an immunocompetent patient with brucellosis: a case report and literature review
Authors: Khan Fasih Mand , Khan Ariba , Raja Sandesh , Raja Adarsh , Qammar Asfia , Chaulagain Aayush 
Published: December 2024

Introduction and importance:
Brucellosis is a zoonotic disease that can affect various organs, with symptoms like fever, lymphadenopathy, and arthritis. Hematologic complications, including febrile neutropenia, are rare. This report highlights the diagnostic and therapeutic challenges of brucellosis with febrile neutropenia.

Case presentation:
A 36-year-old man presented with a 3-week history of fever, polyarthralgia, and night sweats. Examination showed febrile symptoms, joint swelling, and cervical lymphadenopathy. Laboratory tests revealed neutropenia and elevated inflammatory markers. Imaging was unremarkable, and blood cultures were negative, but brucellosis was confirmed by serology. Treatment with doxycycline and rifampicin led to clinical improvement.

Clinical discussion:
Brucellosis diagnosis can be challenging due to nonspecific symptoms and requires high suspicion, especially in non-endemic areas. In this case, early identification and targeted therapy led to symptom resolution. This case underlines the importance of considering zoonotic diseases in febrile neutropenia with inconclusive initial findings.

Conclusion:
Brucellosis with febrile neutropenia is rare but manageable with timely diagnosis and treatment, leading to favorable outcomes.
Transient olfactory hallucinations after insular glioma surgery: a case report
Authors: Mamadaliev Dilshod , Kariev Gayrat , Asadullaev Ulugbek , Yakubov Jakhongir , Khodjimetov D.N. , Chaurasia Bipin 
Published: December 2024

Introduction and importance:
There are various types of hallucinations reported in the literature (auditory, visual, tactile, gustatory, or olfactory), and most of them are related to psychiatric (schizophrenia) disorders. Olfactory hallucinations related to neurosurgical disorders are uncommon. The authors present a case of a patient with a left insular glioma who developed transient olfactory hallucinations after microsurgical resection of the tumor.

Our Objective is to share a rare case of postoperative complication—olfactory hallucination following insular glioma surgery—which can potentially raise awareness among practicing neurosurgeons.

Case presentation:
A 32-year-old male patient underwent left insular glioma resection at our institution in 2024. He developed transient olfactory hallucinations after microsurgical resection of the tumor, which resolved within a month postoperatively.

Clinical discussion:
Insular gliomas often grow to a considerable size before becoming symptomatic in many patients. The insular region is regarded as one of the brain’s most sophisticated areas, with lesions manifesting in a wide range of symptoms and syndromes including olfactory hallucinations.

Conclusion:
Olfactory hallucinations following left insular glioma resection can potentially raise awareness among practicing neurosurgeons regarding this rare postoperative complication. These types of postoperative complications may resolve in a short period if no serious vascular injury has been encountered.
Mycetoma in Somalia: an updated literature review
Authors: Mohamed Ahmed Farah , Saeed Ali Awadallah , Mohamoud Mohamed Ali , Jama Abdisamad Ahmed , Fahal Ahmed Hassan 
Published: December 2024

Introduction:
Mycetoma is a chronic disabling inflammatory disease characterized by the formation of granulomatous masses in subcutaneous tissue extending to the skin, deep tissues, and bones.

Findings:
An exhaustive and detailed exploration of medical literature unveiled only 11 published articles addressing mycetoma in Somalia since 1927. Among these, six were case reports involving 12 patients, and three were case series encompassing 163 patients, resulting in a total of 175 reported cases. Notably, two articles in French lacking abstracts were excluded from the review. Considering Somalia shares geographical and environmental traits with other mycetoma-endemic regions, a heightened prevalence of the disease is anticipated in the country. It is essential to recognize, however, that mycetoma is not a notifiable disease, and the accuracy of disease reporting in Somalia is compromised due to various factors and consequently, the actual number of mycetoma cases in Somalia is likely to surpass the figures presented in this report.

Conclusion:
Ongoing research, international collaboration, and efforts to improve healthcare accessibility and awareness are essential. Encourage country to make mycetoma a notifiable disease with the integration of data collection in the national health information system. Addressing the environmental determinants, describe true burden, disability, impact of quality life, and implementing preventive measures can contribute to mitigating the impact of mycetoma in Somalia.